Oral healthcare management practices in Brazil: systematic review and metasummary

Universal health coverage is a global target included in the United Nations Sustainable Development Goals agenda for 2030. Healthcare in Brazil has universal coverage through the Unified Health System (SUS), which guarantees health as basic right to the Brazilian population. Considering the principles of SUS, public oral healthcare management is a huge challenge. Aim: To identify good management practices for quality care adopted by local public oral healthcare managers and teams around Brazil. Methods: This study was registered with PROSPERO (CRD42017051639). Five databases (PubMed, Embase, Web of Science, Scopus and Lilacs) as well as the reference lists and citations of the included publications were searched according to PRISMA guidelines. Results:A total of 30,895 references were initially found, which were evaluated according to the defined eligibility criteria. Twenty qualitative studies, eight surveys and two mixed-model studies were selected. The practices (codes) were organized into three main groups (families), and the Frequency of the Effect Size (FES) of each code was calculated. Among the 20 codes identified, the most relevant ones were: Diagnosis and Health Planning (FES=80%) and Family Health Strategy(FES=66,7). The Intensity of the Effect Size of each study was also calculated to demonstrate the individual contribution of each study to the conclusions. Conclusion: The evidence emerging from this review showed that healthcare diagnosis, planning, and performance based on the family health strategy principles were the most relevant practices adopted by public oral healthcare managers in Brazil. The widespread adoption of these practices could lead to improved oral healthcare provision and management in Brazil

LED photobiomodulation effect on the bleaching-induced sensitivity with hydrogen peroxide 35%-a controlled randomized clinical trial.

OBJECTIVES: The aim of this study was to evaluate the effect of a protocol of photobiomodulation (PBM) with light-emitting diodes (LED) on the clinical risk of bleaching-induced sensitivity. MATERIALS AND METHODS: Sixty-four volunteers were selected and randomly divided in two groups, placebo (PG) and LED (LG). The LG received PBM irradiation and tooth bleaching, while the PG received tooth bleaching and simulation of the irradiation. The occurrence of painful sensitivity was recorded during the dental bleaching; immediately after bleaching; and 24, 48, and 72 h after tooth bleaching. At the same measurement times, data were collected on the intensity of sensitivity (VAS and NRS scale) and teeth affected by bleaching-induced sensitivity. A questionnaire sought to measure how the painful sensitivity influenced basic daily activities. Tooth color measures were performed using subjective and objective methods. RESULTS: LED irradiation decreased the occurrence of sensitivity at all studied evaluation times as well as its intensity, with the exception of the 72-h data when both groups presented no difference. Teeth affected by bleaching-induced sensitivity were significantly greater in the PG. Color measurements presented no differences between the groups in the recently after and later measures. CONCLUSIONS: PBM with LED decreases sensitivity risk and sensibility intensity during and after office bleaching and causes no influence on the shade degree of whitening achieved. The decrease in tooth sensitivity provided more comfort and less suffering while drinking. CLINICAL RELEVANCE: LED irradiation is a promising intervention in the control of bleaching-induced sensitivity. TRIAL REGISTRATION: RBR-7hpfwj. Sensitivity intensity measured by the VAS scale (0-10) in the first whitening session (Graphic A) and second whitening session (Graphic B). Significance level set at ≤ 5%. *Mann-Whiteney U test. Columns followed by the same letter are significant different (ap < 0.001; bp < 0.001; cp < 0.001; dp =0.013; ep < 0.001; fp < 0.001; gp < 0.001; hp = 0.002).

Opalescence and color stability of composite resins: an in vitro longitudinal study.

OBJECTIVES: This study aims to evaluate the opalescence (OP) and color stability of composite resins over a period of 180 days and to compare composite resins' OP with enamel's OP. MATERIALS AND METHODS: Twenty human enamel specimens (5.0 × 0.3 mm) and 9 specimens (10.0 × 1.0 mm) of 10 colors of 4 different composite resins (3 M ESPE, FGM, Ivoclar-Vivadent, Miscerium) and one brand of adhesive (3 M ESPE) were made. The results were obtained by measuring the reflectance and transmittance spectra in the visible region. After baseline measurement, composites and adhesive were analyzed after 2, 7, 30, 60, 120, and 180 days. The Lab color coordinates were used in the calculations of the OP parameter and color differences in the CIELab and CIEDE2000 methods. The data were analyzed statistically. RESULTS: The materials tested showed variation and an increase in OP over time. The OP found for enamel was 18.06 ± 2.99, and some resins showed higher results. There was a strong correlation between the coordinate b*T and the OP over time. Enamel Plus was the only one material that presented no color changes during all periods in both color analyses. Filtek Z350 XT, AT, and BT did not show differences in any time when analyzed by CIELAB. CONCLUSIONS: The OP of most composite resins changed during the period of 180 days and was different from the OP of tooth enamel. In general, composites demonstrated small color changes over the period tested, being this characteristic material dependent. CLINICAL RELEVANCE: Natural teeth present different optical properties. Composite resins restorations should present properties similar to natural teeth and it is important that characteristics like color and opalescence remain stable over time.

Association of Oral Health Teams implantation with collective actions and extractions in Paraná State, Brazil. / Associação da implantação de Equipes de Saúde Bucal com ações coletivas e exodontia no Estado do Paraná, Brasil.

This article aims to monitor the indicators of outpatient production of Dentistry and to evaluate the association of collective action and extraction indicators with the number of Oral Health Teams (OHT) between 2006 and 2015 in Paraná. In this longitudinal ecological study, consolidated secondary data were analyzed (collective actions of supervised brushing-SB, topical application of fluoride-TAF, fluoride mouthwash-FM, oral examination for epidemiological purposes-OE and extractions of permanent teeth-EX) from the Ambulatory Information System (SIA-SUS) and OHT numbers from the National Registry System of Health Establishments. Descriptive analyzes and Pearson's correlation were performed, with significance level of p<0.05. It was verified the increase of the OHT implantation over time and a strong positive correlation with collective procedures of SB (r=0.78; p=0.007) and FM (r=0.76; p=0.011) and moderate negative correlation with EX (r=-0.53). It was concluded that the evaluated indicators showed that the implementation of Oral Health Teams may have contributed to changes to the healthcare model, with an increase in preventive collective procedures and reduction of tooth loss in Paraná.

O artigo tem por objetivo monitorar a produção ambulatorial em Odontologia e avaliar a associação de indicadores de ação coletiva e exodontia com o número de Equipes de Saúde Bucal (ESB) entre 2006 e 2015, no Paraná. Neste estudo ecológico longitudinal foram analisados dados secundários consolidados (ações coletivas de escovação supervisionada-ES, aplicação tópica de flúor-ATF, bochecho fluorado-BF, exame bucal com finalidade epidemiológica-EB e exodontia de dente permanente-EXO) do Sistema de Informação Ambulatorial e números de ESB no Sistema de Cadastro Nacional de Estabelecimentos de Saúde. Foram realizadas análises descritivas e correlação de Pearson, com nível de significância de p<0,05. Verificou-se um aumento de ESB implantadas ao longo do tempo e correlação forte positiva com procedimentos coletivos de ES (r=0,78; p=0,007) e BF (r=0,76; p=0,011) e correlação moderada negativa com EXO (r=-0,53). Conclui-se que os indicadores avaliados demonstraram que a implantação de Equipes de Saúde Bucal pode ter contribuído para mudanças no modelo de atenção, com aumento dos procedimentos coletivos preventivos e redução de perdas dentárias no Paraná.

Evaluation of the influence of light-curing units on the degree of conversion in depth of a bulk-fill resin.

BACKGROUND: It is known that bulk-fill have been widely studied and used by dentists in the clinic. However, the use of light-curing units that do not have the ability to adequately light-cure these materials at the appropriate depth can affect their clinical performance. The aim of this study was evaluating the influence of 5 different light curing units (LCUs) on the degree of conversion (DC) of a bulk-fill resin at depths of 0 to 4 mm and determined the effect of using 20s exposure and 40s. MATERIAL AND METHODS: Cylinders of composite were made in a stainless steel matrix (n=10). The specimens were exposed from the top surface using 5 LCUs: Valo® Cordless (VA); Radii Plus (RA); Emitter.D (EM), Biolux Plus (BI), Woodpecker® (WO). The emission wavelength and the power density was determined. After the photoactivation, the Raman vibrational modes were calculated taking as reference the peaks at 1,601 (aromatic bonds C=C) and 1,640 cm-1 (aliphatic bonds C=C). RESULTS: The largest difference in DC in 20s, comparing the values obtained in the first and last layer is for BI, with a variation from 61.24% to 53.86%. Comparing the LCUs, the last layer in 40s DC values are 57.40% (BI), 58.21% (WO), 58.97% (VA), 60.90% (RA) and 62.42% (EM). The higher the dose (J/cm²) and the close the λmax is to the maximum CQ absorption length (λmax ~ 470 nm) the better the DC value. CONCLUSIONS: There was a significant difference in the DC values between the LCUs with increasing depth of the bulk-fill increments. Results indicate significant differences in DC among the different LCUs as well as enhanced DC when using 40s exposure compared to 20s. It is suggested that for DC improvement using lower power photoactivator increase the exposure time the exposure time should be 20s to 40s. Key words:Polymerization, Composite Resins, Raman spectroscopy.

Heating and preheating of dental restorative materials-a systematic review.

OBJECTIVES: To perform a review on the influence of preheating and/or heating of resinous and ionomeric materials on their physical and mechanical properties and to discuss the benefits and methods of preheating/heating that have been used. MATERIAL AND METHODS: A search was performed in the Pubmed, Scopus, Scielo, and gray literature databases. In vitro studies published from 1980 until now were searched using the descriptors "composite resins OR glass ionomer cements OR resin cements OR adhesives AND heating OR preheating." Data extraction and quality of work evaluation were performed by two independent evaluators. RESULTS: At the end of reading the search titles and abstracts, 74 articles were selected. Preheating of composite resins reduces viscosity, facilitates adaptation to cavity preparation walls, increases the degree of conversion, and decreases the polymerization shrinkage. Preheating of resin cements improves strength, adhesion, and degree of conversion. Dental adhesives showed good results such as higher bond strength to dentin. However, unlike resinous materials, ionomeric materials have an increase in viscosity upon heating. CONCLUSIONS: Preheating improves the mechanical and physical properties. However, there is a lack of clinical studies to confirm the advantages of preheating technique. CLINICAL RELEVANCE: Preheating of dental restorative materials is a simple, safe, and successful technique. In order to achieve good results, agility and training are necessary so the material would not lose heat until the restorative procedure. Also, care is necessary to avoid bubbles and formation of gaps, which compromises the best restoration performance.

In vitro evaluation of composite resin fluorescence after natural aging.

BACKGROUND: Some composite resins contain luminophorous agents in order to reproduce tooth fluorescence. The objective of this study was to compare the fluorescence spectra emitted by composite resins with those of human enamel and dentin, and their emission behaviour after a 90-day natural aging period. MATERIAL AND METHODS: Nine shades of the composite resins Z350XT/3M (XT), Opallis/FGM (OP) and Empress Direct/Ivoclar-Vivadent (ED) were analyzed. Five specimens (10.0 mm x 2.0mm) were fabricated for each shade. Enamel (5.0 mm x 0.30 mm) and dentin (5.0 mm x 1.0 mm) specimens were obtained from sound human third molars. Fluorescence spectra of human dentin and enamel as well as the composite specimens immediately after fabrication were measured at the excitation peaks of 375, 395 and 410 nm. To assess composite resin fluorescence intensity changes over time, measurements were conducted after 30, 60 and 90 days, at 395 nm. Differences in fluorescence intensity over time were analyzed with ANOVA and Tukey's test (p<0.05). RESULTS: Fluorescence spectra baseline values of composites demonstrated no differences in intensity among the excitation peaks tested, with maximum emission found at the peak of 450 nm. Enamel and dentin spectra varied with different excitations, and the greater the excitation, the longer the wavelength in comparison to composite resins. After 90 days, XT presented an increase in fluorescence intensity, while OP and ED showed a reduction when compared with baseline values. CONCLUSIONS: Fluorescence intensity of composite resins changed during the period analyzed, with an emission behavior different from that of human enamel and dentin. The main changes occurred in the first 30 days. Key words:Composite resins, dental materials, fluorescence, fluorescence spectrometry.

System dynamics modeling for tooth decay treatment in Brazilian children.

Prevention and health promotion are considered important strategies to control oral diseases. Dental caries is preventable disease and remains the most common chronic disease that affects mainly low income children and still considered the main cause of tooth loss in adulthood in Brazil. The aim of this study is to present a System Dynamics model (SDM) specifically developed with the Stella Architect software to estimate the cost and clinical hours required to control the evolution of dental caries in preschool children in Maringá, Brazil. Two main strategies to control caries were considered in the model: the application of fluoride varnish on teeth presenting white spots, and the use of Atraumatic Restorative Treatment (ART) in cavitated carious lesions without pulp involvement. The parameters used in the model were: number of people covered by a local oral health team = 4,000; number of children up to 5 years = 7% of the population; children's decayed, missing, filled teeth (dmft) index = 2.4; time/cost of 4 applications of fluoride varnish = 5 minutes/US$ 0.716; and time/cost of each ART restoration = 15 minutes/US$ 1.475. The SDM generated an estimated total cost of US$698.00, and a total of 112 clinical hours to treat the population in question. The use of the SDM presented here has the potential to assist decision making by measuring the material and human resources required to prevent and control dental caries at an early age.

System dynamics modeling for tooth decay treatment in Brazilian children

Abstract Prevention and health promotion are considered important strategies to control oral diseases. Dental caries is preventable disease and remains the most common chronic disease that affects mainly low income children and still considered the main cause of tooth loss in adulthood in Brazil. The aim of this study is to present a System Dynamics model (SDM) specifically developed with the Stella Architect software to estimate the cost and clinical hours required to control the evolution of dental caries in preschool children in Maringá, Brazil. Two main strategies to control caries were considered in the model: the application of fluoride varnish on teeth presenting white spots, and the use of Atraumatic Restorative Treatment (ART) in cavitated carious lesions without pulp involvement. The parameters used in the model were: number of people covered by a local oral health team = 4,000; number of children up to 5 years = 7% of the population; children's decayed, missing, filled teeth (dmft) index = 2.4; time/cost of 4 applications of fluoride varnish = 5 minutes/US$ 0.716; and time/cost of each ART restoration = 15 minutes/US$ 1.475. The SDM generated an estimated total cost of US$698.00, and a total of 112 clinical hours to treat the population in question. The use of the SDM presented here has the potential to assist decision making by measuring the material and human resources required to prevent and control dental caries at an early age.

Diacetylcurcumin: a new photosensitizer for antimicrobial photodynamic therapy in Streptococcus mutans biofilms.

This study evaluated the effect of antimicrobial photodynamic therapy (aPDT) on S. mutans using diacetylcurcumin (DAC) and verified DAC toxicity. In vitro, S. mutans biofilms were exposed to curcumin (CUR) and DAC and were light-irradiated. Biofilms were collected, plated and incubated for colony counts. DAC and CUR toxicity assays were conducted with Human Gingival Fibroblast cells (HGF). In vivo, G. mellonella larvae were injected with S. mutans and treated with DAC, CUR and aPDT. The hemolymph was plated and incubated for colony counts. Significant reductions were observed when DAC and CUR alone were used and when aPDT was applied. HGF assays demonstrated no differences in cell viability for most groups. DAC and CUR reduced the S. mutans load in G. mellonella larvae both alone and with aPDT. Systematic toxicity assays on G. mellonella demonstrated no effect of DAC and CUR or aPDT on the survival curve.

Avaliação da solubilidade e sorção em água de alguns materiais restauradores diretos / Evaluation of solubility and sorption in water of some direct restorative materials

Resumo Introdução A solubilidade e sorção dos materiais restauradores são considerados fatores críticos, pois podem interferir na qualidade e durabilidade das restaurações. Objetivo Avaliar a solubilidade e sorção de água de alguns materiais restauradores. Material e método Foram confeccionados quatorze espécimes de cada um dos seguintes materiais: Equia® Forte, Z100, Fuji IX/ e Vidrion R, os quais foram levados a uma dessecadora e pesados diariamente até estabilização. Em seguida, foram inseridos em recipientes individuais contendo 40 mL de água destilada cada e divididos em dois grupos de acordo com o tempo de armazenagem: 7 ou 30 dias. Ao final de cada período, os espécimes foram retirados da água, pesados, levados à dessecadora e pesados novamente até estabilização. Os resultados foram analisados estatisticamente utilizando os testes ANOVA 2 critérios e Tukey. Resultado Com exceção do Equia® Forte e Z100, os demais materiais, apresentaram uma variação significativa da solubilidade ao longo do tempo. Quanto à sorção, observa-se que apenas o material Z100 não apresentou diferença significativa em relação ao tempo de armazenagem, mas, na comparação entre os materiais, todos apresentaram diferenças significativas em ambos os períodos. Conclusão Após os períodos de armazenagem de 7 e 30 dias em água, os materiais restauradores Equia® Forte e Z100 não apresentam variação significativa da solubilidade, sendo mais estáveis que os materiais Fuji IX e Vidrion R. Os materiais à base de ionômero de vidro, Equia® Forte, Fuji IX e Vidrion R, sofrem mais sorção em água quando comparados ao material Z100 em ambos os períodos.

Abstract Introduction The solubility and sorption parameters of restorative materials are considered critical factors since they may interfere with the quality and durability of restorations. Objective The aim of this study was to evaluate the solubility and water sorption of some restorative materials. Material and method Fourteen specimens were made (10.0 mm x 2.0 mm) of each of the following material: Equia® Forte, Z100, Fuji IX/ e Vidrion R, then taken to a desiccator and weighed daily until stabilized. They were then placed in individual containers with 40mL of distilled water each and divided into two groups according to the storage time: 7 or 30 days. At the end of each period, the specimens were removed from the water, weighed, taken to the desiccator and weighed again until stabilized. The results were analyzed statistically with two-way ANOVA and Tukey. Result Except for Equia® Forte and Z100, the other materials presented a significant variation of solubility over time. As for sorption, it was noticed that only Z100 presented no significant difference in relation to the storage time, but in comparison of the materials, all had significant differences in both 7 and 30 days periods. Conclusion After storage periods of 7 and 30 days in water, the restorative materials Equia® Forte and Z100 do not present significant variation of solubility, being more stable than the materials Fuji IX and Vidrion R. The glass ionomer-based materials, Equia® Forte, Fuji IX and Vidrion R, suffer more sorption in water when compared to Z100 material in both periods.

Heterocontrole da fluoretação da água de abastecimento público da 15ª Regional de Saúde do Paraná / Heterocontrol of fluoridation of public water supply 15 th Health Region (state of Paraná, Brazil)

Objetivou-se conhecer o processo de fluoretação das águas de abastecimento público e realizar o heterocontrole do fluoreto nas águas dos 30 municípios que compõem a 15ª Regional de Saúde do Paraná. Um questionário contendo dados relativos a fluoretação dos municípios foi aplicado e cinco coletas de água em Unidades Básicas de Saúde ou poços artesianos foi realizado em todos esses municípios, no período de 12 meses. Dos 30 municípios que compõem esta regional, em 77% dos municípios a água utilizada é proveniente de poços, 77% relatam ter água fluoretada e 40% dos municípios realizaram levantamento epidemiológico para fluorose dental. Das 335 amostras de água, 79,5% foram classificadas como máximo benefício contra cárie e mínimo risco para fluorose dentária. Conclui-se que apesar da maioria dos municípios pesquisados realizarem a fluoretação das águas de abastecimento, o heterocontrole não é prática comum nos mesmos. (AU)

The objective of this study was to know the process of fluoridation of the public water supply, and to perform the heterocontrol of fluoride in the waters of 30 municipalities of the 15th Regional Department of Health of Paraná. A questionnaire containing data on fluoridation in the municipalities was applied, and five water collections in Basic Health Units, or in artesian wells, were carried out in all these municipalities, in a period of 12 months. Of the 30 municipalities composing this regional department, 77% use water from wells, 77% reported having fluoridated water, and 40% carried out an epidemiological survey for dental fluorosis. Of the 335 water samples, 79.5% were classified as the maximum benefit against dental decays, and minimal risk for dental fluorosis. It is concluded that most of the cities surveyed perform fluoridation of water supply, but heterocontrol is not a common practice. (AU)

Práticas de educação em saúde para a prevenção da cárie dentária: um estudo qualitativo com cirurgiões-dentistas / Health education practices for the prevention of dental caries: a qualitative study

O objetivo do trabalho foi identificar a percepção de cirurgiões-dentistas de serviços públicos da Atenção Básica de uma regional de saúde do Paraná, quanto às práticas de educação em saúde para a prevenção da cárie dentária, por meio de uma pesquisa qualitativa. Foram realizadas entrevistas, baseadas em um roteiro semiestruturado. A transcrição das gravações foi realizada de forma manual e o conteúdo categorizado segundo o método da análise de conteúdo proposta por Bardin. Os resultados apontaram que, nesse contexto, os cirurgiões-dentistas realizam práticas de educação em saúde por meio de ações de transmissão de informação, demonstração, motivação, monitoramento e comunicação. Conclui-se que os profissionais pesquisados demonstraram entendimento da importância da motivação e da persistência para um resultado eficaz do processo educativo, porém foi possível perceber diferentes graus de entendimento do processo educativo (AU).

The objective of this study was to identify the perception of dental surgeons on public services of Primary Care at Regional Health Service, in Paraná, regarding health education practices for dental caries prevention, through a qualitative research. Interviews were conducted, based on semi-structured script. Recordings transcription was manually performed. The content was categorized according to the Method of Content Analysis proposed by Bardin. The results pointed out that, in this context, dentists perform health education practices through information transmission, demonstration, motivation, monitoring and communication. It is concluded that the studied professionals demonstrated to understand the importance of motivation and persistence for an educational process effective result, however it was possible to perceive different education to process of understanding (AU).

Exploring factors influencing dental caries preventive measures by general dental practitioners in the public oral health care service in Paraná State, Brazil / Explorando fatores que influenciam na prevenção da cárie dentária no atendimento odontológico do serviço público do Estado do Paraná, Brasil

This study aimed to explore the views of dentists working for the Brazilian health system, in regards to the prevention of dental caries. Semi-structured face to face interviews were held with 18 dentists working in the state of Paraná, Brazil. Data was recorded, manually transcribed and analyzed with a software, based content analysis. Results revealed 13 factors favoring prevention, of which 4 were considered new emerging factors, not previously described in the literature. Among the main factors to influence caries prevention were: the preventive conscientiousness of dentists, professional training received and the organization of the service. The results found indicated that the implementation of prevention depends on several factors such as the training received by dental students, changes in the public dental care provided by expanding the Family Health Strategy and changes in clinicians' attitudes towards prevention through more effective public policies involving the community (AU).

A cárie é a doença crônica mais comum na infância e leva a perdas dentárias ao longo da vida. Entretanto, a percepção dos cirurgiõesdentistas (CDs) quanto sua prevenção, ainda é pouco explorada. O objetivo do estudo foi explorar as percepções dos CDs que trabalham no Sistema Único de Saúde, no que diz respeito à prevenção da cárie dentária, contribuindo para políticas públicas efetivas, a partir da identificação dos fatores que levam os CDs a uma maior conscientização preventiva. Foram realizadas entrevistas semiestruturadas com 18 CDs atuantes nos municípios do Paraná. As entrevistas foram realizadas face a face, conduzidas por um roteiro e gravadas. A transcrição foi realizada de forma manual e analisada segundo o método de análise de conteúdo. Os resultados apontaram treze fatores facilitadores à prevenção, sendo quatro deles fatores emergentes, não descritos anteriormente pela literatura. Dentre os principais fatores que influenciam a prevenção da cárie: consciência preventiva dos CDs, formação acadêmica do profissional e organização do serviço. Assim, a implementação da prevenção depende de vários fatores, como a formação recebida por estudantes de Odontologia, mudanças no atendimento público odontológico e nas condutas adotadas pelos CDs e políticas públicas efetivas que envolvam a comunidade (AU).

Survival analysis of ART restorations in primary molars of preschool children: 1 year follow-up / Análise de sobrevivência de restaurações ART em molares decíduos de crianças com idade pré-escolar: acompanhamento de 1 ano

Among the minimally invasive approaches available today, the atraumatic restorative treatment (ART) has demonstrated promising results both in the primary and permanent dentition. Objective: To evaluate the survival of Class I ART restorations in preschoolers with two Brazilian brands of glass ionomer cements (GIC) in comparison with a reference GIC. Material and method: The cavities of 49 preschool children (three to five years) with carious lesions in the posterior teeth (N=81) were filled by two experienced pediatric dentists according to the ART technique. The Brazilian GICs Maxxion-R (MR) and Vitro-Fil LC (VF), and the reference GIC Ketac-Molar (KM) were placed in a randomly pre-established sequence. Restorations were evaluated after 6 and 12 months by another investigator. Scores 0 and 1 were considered successful, while scores 3-9 were classified as failures. Kaplan-Meier survival analysis and the log-rank test were performed (p<0.05). Result: No statistically significant differences in survival rates of the tested GIC were observed after 12 months. Conclusion: The clinical performance the low-cost Brazilian GICs MR and VF observed after 12 months suggests that they may be an alternative for Class I ART restorations to safeguard the natural exfoliation of primary teeth. However, until further studies involving a larger number of restorations and longer follow-up periods are conducted, reference GIC such as KM should continue to be the material of choice for ART restorations.

Dentre as abordagens minimamente invasivas atualmente disponíveis, o tratamento restaurador atraumático (ART) demonstra resultados promissores tanto na dentadura decídua quanto permanente. Objetivo: Avaliar a sobrevivência de restaurações ART Classe I, em pré-escolares, com duas marcas brasileiras de cimentos de ionômeros de vidro (CIV) em comparação com um CIV de referência. Material e método: Cavidades de 49 crianças pré-escolares (três a cinco anos de idade) com lesões cariosas nos dentes posteriores (N = 81) foram preenchidas por dois odontopediatras experientes, de acordo com a técnica ART. Os CIV brasileiros Maxxion-R (MR) e Vitro-Fil LC (VF) e o CIV de referência, Ketac-Molar (KM), foram inseridos em uma sequência pré-estabelecida aleatoriamente. As restaurações foram avaliadas após 6 e 12 meses por outro pesquisador. As pontuações 0 e 1 foram consideradas bem-sucedidas, enquanto as pontuações 3-9 foram classificadas como falhas. Foram aplicadas a análise de sobrevivência de Kaplan-Meier e o teste log-rank (p <0,05). Resultado: Não foram observadas diferenças estatisticamente significativas nas taxas de sobrevivência dos CIV testados após 12 meses. Conclusão: O desempenho clínico dos CIV brasileiros MR e VF, observado após 12 meses, sugere que estes podem ser uma alternativa para restaurações ART Classe I para proteger a esfoliação natural dos dentes decíduos. No entanto, até que sejam realizados estudos adicionais envolvendo um maior número de restaurações e períodos de acompanhamento mais longos, os CIV de referência, como o KM, devem continuar sendo o material de escolha para as restaurações ART.

Meta-analysis of the clinical behavior of posterior direct resin restorations: Low polymerization shrinkage resin in comparison to methacrylate composite resin.

Polymerization shrinkage of resin composite can compromise the longevity of restorations. To minimize this problem, the monomeric composition of composites have been modified. The objective of this study was to conduct a meta-analysis to assess the clinical behavior of restorations performed with low polymerization shrinkage resin composite in comparison with traditional methacrylates-based resin composite. This systematic review was registered at Prospero data system (CRD42015023940). Studies were searched in the electronic databases PubMed, Web of Science, Scopus, Lilacs and EMBASE according to a predefined search strategy. The inclusion criteria were as follow: (1) randomized controlled clinical trials with at least six months of follow-up; (2) studies investigating composites with monomers designed to reduce polymerization shrinkage; (3) studies conducted with class I or II restorations in the permanent dentition; and (4) studies that assessed at least one of the following criteria: marginal integrity/adaptation, marginal discoloration, recurent caries, retention of composite restorations, and postoperative sensitivity. Two independent reviewers analyzed the articles to determine inclusion and risk of bias. The search conducted in the databases resulted in a total of 14,217 studies. After reviewing the references and citations, 21 articles remained. The longest clinical follow-up time was 60 months. The meta-analysis of the data in the included studies demonstrated that only one variable (marginal adaptation after 12 months) showed statistically significant outcomes, in which methacrylates-based composites presented significantly better results than resin composites containing modified monomers. The good level of the scientific evidence as well as the overall low risk of bias of the included studies indicate that composites with silorane, ormocer or bulk-fill type modified monomers have a clinical performance similar to conventional resin composites.

In vitro effect of energy drinks on human enamel surface / Análise in vitro da ação de bebidas energéticas no esmalte dental humano

Introduction: Energy drinks (ED) possess low pH and citric acid in their composition, making them potentially erosive beverages that can contribute to the high dental erosion rates found currently in the general population and also in young people. Objective: To evaluate the mean pH and titratable acidity of commercial ED and the influence of a brand of ED on the superficial microhardness of human enamel. Material and method: Ten commercial ED were selected and the pH of two lots of each ED with and without gas was obtained. Acid titration was conducted with the addition of NaOH aliquots until the pH 7 was reached. Eighteen human enamel specimens were allocated in three groups (N=6), Red Bull (RB), Red Bull Light (RBL) and distilled water (C), submitted to an acid challenge with the ED, six consecutive times, with 12 hours intervals, during three days. Knoop microhardness was measured before and after the acid challenge. Result: All ED brands tested presented low pH levels ranging from 2.1 to 3.2. Regarding titratable acidity, it was found that the amount of base required promoting the neutralization of the solutions ranged from 1200μL to 3750μL. Samples of human enamel in the RB and RBL groups submitted to the acid challenge presented significantly decreased Knoop microhardness when compared with the group C. Conclusion: All ED examined have potential to promote mineral loss due to the low pH and high titratable acidity. The ED analyzed promoted significant mineral losses on the dental enamel surface.

Introdução: O potencial erosivo das bebidas energéticas (BE) devido ao baixo pH e à presença de ácido cítrico pode estar relacionado ao aumento dos índices de erosão dental da população em geral e especialmente, nos jovens. Objetivo: Verificar o pH e a titulação ácida de BE e a influência de uma marca de BE na microdureza superficial do esmalte. Material e método: Dez amostras de BE de diferentes marcas comerciais foram selecionadas. O pH de dois lotes de cada BE foi analisado, com e sem gás. A titulação ácida foi realizada com a adição de alíquotas de NaOH, até atingir pH 7,0. Dezoito amostras de esmalte dental humano foram distribuídas aleatoriamente em três grupos (n = 6), Red Bull (RB), Red Light Bull (RBL) e água destilada (C), submetidas a um desafio ácido com a BE, seis vezes consecutivas, com intervalos de 12 horas, durante três dias. A microdureza Knoop foi medida antes e depois do desafio ácido. Resultado: Todas as marcas de BE testadas apresentaram baixos níveis de pH, variando de 2,1 a 3,2. Em relação à titulação ácida, verificou-se que a quantidade de base necessária para promover a neutralização das soluções variou de 1200 μL a 3750 μL. Amostras de esmalte humano nos grupos RB e RBL submetidos ao desafio ácido apresentaram diminuição significativa da microdureza Knoop. Conclusão: Todas as BE examinadas apresentaram baixo pH e alta titulação ácida e, portanto, potencial para promover perda mineral. As BE analisadas promoveram perdas minerais significativas na superfície do esmalte dental.

Evaluation of photosensitizer penetration into sound and decayed dentin: A photoacoustic spectroscopy study.

BACKGROUND: Photodynamic therapy (PDT) may have topical indications. In those cases it is important for a topical photosensitizer to penetrate into the tissue to which it has been applied. This study aimed to compare the penetration of two different concentrations of erythrosine into intact and in vitro decayed dentin samples. METHODS: This in vitro study evaluated erythrosine (0.3 and 5%) penetration into sound (intact) and decayed dentin. A total of 11 dentin discs were prepared and divided into two equal halves, in order to keep one half sound while the other half was submitted to sterilization and an in vitro demineralization model for 5 days. Before erythrosine application, the organic and inorganic composition of all samples was evaluated by Fourier Transform Raman spectroscopy, and after erythrosine application for 30 min, the penetration depth was determined by Photoacoustic spectroscopy technique. RESULTS: The results indicated that 0.3% erythrosine showed a higher penetration depth into sound dentin (p = 0.002); and 5% erythrosine higher penetration into decayed dentin (p < 0.001). However considering clinical parameters, no statistically significant difference was found between any of the conditions tested. CONCLUSIONS: Erythrosine demonstrated ability to penetrate into dentin, irrespective of sound or decayed condition. Photoacoustic spectroscopy can be considered a method for estimating the penetration into hard tissues, and in conjunction with Raman spectroscopy, these are effective methods for evaluating the spectral response of dentin. Considering that erythrosine is capable of penetrating into decayed dentin, clinical trials are needed to test the effectiveness of this photosensitizer in Photodynamic therapy and Antimicrobial Photodynamic therapy.

Histological and morphological evaluation of condylar cartilage of young rats in response to stimulation of mandibular protrusion / Avaliação histológica e morfológica da cartilagem condilar de ratos frente a estímulos de protrusão mandibular

The aim of this study was to evaluate the histogical and morphological aspects of the condyle in response to mandibular protrusion induced by composite resin occlusal planes. Thirty five-week-old male Wistar rats were selected and randomly divided in two groups. One group received a composite resin type of oclusal plane that induced mandibular protrusion, and the other was the control group, without treatment. Animals were euthanized after experimental time intervals of 7, 21 and 30 days. For histological analysis, thickness of the proliferative, serial and hypertrophic layers was measured, as well as each layer separately. The highest difference in cartilage thickness was observed at day 21, showing a significant increase of the proliferative layer. There were also other histomorphological changes related to occlusal plane interference. Condylar forward repositioning induced by composite occlusal planes influenced the endochondral ossification, increasing the proliferative layer.

Este estudo teve como objetivo avaliar os aspectos histológicos e morfológicos do côndilo mandibular diante da protrusão induzida por um plano inclinado fixo de resina. Para tanto, trinta ratos Wistar machos com cinco semanas de vida foram divididos aleatoriamente em dois grupos. Um grupo experimental (E) recebeu o plano inclinado fixo de resina, que induziu a mandíbula à protrusão, e o outro consistiu no grupo controle (C), sem tratamento. Os animais foram eutanasiados após 7, 21 e 30 dias de experimento. Para análise histológica, foi realizada a mensuração da espessura condilar total, incluindo as camadas proliferativa, seriada e hipertrófica, assim como cada camada separadamente. A maior espessura da cartilagem foi observada em 21 dias no grupo E, com significante aumento da camada proliferativa. Também foram verificados níveis de histodiferenciação nos demais períodos, caracterizando interferência do plano inclinado. Concluiu-se que a indução do posicionamento condilar em avanço por meio do plano inclinado fixo interferiu no processo de ossificação endocondral, aumentando a atividade da camada proliferativa.

Processo de construção coletiva da Clínica Ampliada na Odontologia por meio de uma gestão colegiada / Process of collective construction of the Expanded Clinic in Dentistry

O objetivo deste estudo foi relatar o processo de construção coletiva da Clínica Ampliada (CA) no Departamento de Odontologia da Universidade Estadual de Maringá (UEM). Este é um estudo do tipo descritivo, de caráter documental, baseado na análise dos temas registrados nas atas das reuniões semanais da Comissão Permanente de Avaliação da Clínica Ampliada (COPACA), desde o primeiro semestre de 2010 até o primeiro semestre de 2017. Os dados foram interpretados pelo método da análise de conteúdo preconizado por Bardin. Os documentos apontaram que os impactos da gestão colegiada sobre o funcionamento da clínica odontológica da UEM foram: maior resolutividade dos problemas, menor dificuldade nos enfrentamentos dos desafios encontrados, maior comprometimento dos envolvidos, planejamento integral dos casos e satisfação dos docentes, discentes, agentes universitários e usuários. Como produtos das discussões realizadas pela COPACA, podemos citar: Prontuário único; Manual da Clínica Ampliada e Instrutivo da Clínica Ampliada. Este estudo permitiu concluir que a construção e o aprimoramento da CA no Departamento de Odontologia da Universidade Estadual de Maringá (UEM) têm ocorrido de forma contínua no período de 2010 a 2017, resultado de um esforço e sinergia da equipe. As reuniões semanais da COPACA são o espaço onde a gestão colegiada se consolida e a escuta e as potencialidades são legitimadas. Diversas temáticas emergiram a partir de problemas detectados no dia a dia. Houve discussão e reflexão e propostas foram elaboradas objetivando a melhoria do serviço e do ensino, conforme preconiza a Política Nacional de Humanização (AU).

The objective of this study was to report the collective construction process of the Expanded Clinic (EC) in Dentistry, through permanent health education. This descriptive study is a documentary based in the analysis of the topics in the records of the weekly meetings of the Permanent Commission for the Evaluation of the Expanded Clinic (CEEC), Department of Dentistry, State University of Maringá (UEM), from the first half of 2010 to the first half of 2017. The data were interpreted using the content analysis method recommended by Bardin. The documents pointed out that the impacts of collegial management on the UEM dental clinic's operation were: greater problem solving, less difficulty in confrontations and greater commitment, more efficient case planning and satisfaction of all in this collective construction process. As products of the collective discussions and constructions carried out by CEEC, we can cite three basic documents: Single record; Expanded Clinic's Instructional and Manual. This study allowed us to conclude that the construction and improvement of the EC have occurred continuously over seven years, resulting from an effort and synergy of the team. The weekly meetings of CEEC are the space where collegial management is consolidated and listening, and potentialities are legitimized. Several issues emerged from problems detected daily. There were discussion and reflection, and proposals were elaborated aiming at the improvement of service and teaching, as recommended by the National Humanization Policy (AU).