Mast cells in oral lichen planus and oral lichenoid lesions related to dental amalgam contact.

The aim of this study was to analyze the expression of mast cell markers toluidine blue, c-kit, and tryptase and presence of mononuclear inflammatory cells in oral lichen planus (OLP) and oral lichenoid lesions related to dental amalgam. Nineteen specimens of OLP, OLLC, and healthy oral mucosa were selected. Mononuclear inflammatory cells were analyzed. Histochemical and immunohistochemical analyses were performed using toluidine blue, anti-c-kit and anti-tryptase reagents, and the results were quantified in areas A and B of connective tissue. Mast cells of all OLP and OLLC samples were positive for toluidine blue, c-kit, and tryptase. The density of toluidine blue+, c-kit+ and tryptase+ mast cells was higher in tissue with OLP and OLLC compared with healthy controls (p < 0.05). No difference was noted in mast cells density between OLP and OLLC (p > 0.05). The density of tryptase+ mast cells was higher in the subepithelial region (area A) than the region below it (Area B) in OLLC (p = 0.047). The mononuclear inflammatory cell density was higher in OLLC compared to OLP, but without statistical significance (p > 0.05). A positive statistical correlation was found between mononuclear immune cells and density of c-kit+ and tryptase+ mast cells in OLP (r = 0.943 and r = 0.886, respectively). Our data demonstrate that the etiopathogenesis process of OLP and OLLC modulates the expansion and degranulation of mast cells; mast cells density, however, was similar between OLP and OLLC. The distribution of mast cells appears to vary along the lamina propria.

The "Phase Down" of Dental Amalgam Restorations - What are the Criteria for Replacement and Indication?

ABSTRACT Objective: To guide professionals about the criteria for replacing amalgam restorations and inform them about the new guidelines regarding the use/indication of this (amalgam) material after the Minamata Convention - COP-4. Material and Methods: The articles were selected from the databases (PubMed, Scielo, Bireme), and relevant articles on the subject between the years 2003-2021 were selected. Recently, social media have been flooded with dental treatments that aim to perform restorations only with composite resins or other types of esthetic material and completely replace all dental amalgam restorations, irrespective of their time in place, size, and functionality. Results: Although improperly, it has been noted that this information reaches patients, and they are led to believe in the inaccurate data that is passed on, such as, for example, (that amalgam leads to) permanent contamination by mercury, causing systemic problems and the loss of the tooth. Conclusion: The "phase down" of amalgam in research and teaching has previously been observed in several countries worldwide; however, its use is still necessary given particular circumstances, which, theoretically, make it a material with exact indication.

O ensino do amálgama na formação odontológica ainda é necessário? Percepção de cirurgiões-dentistas / ¿Sigue siendo necesaria la enseñanza de la amalgama en la carrera odontológica? Percepción de los dentistas / Is the teaching of amalgam in dental training still necessary? Perceptions of dentists

A Odontologia tem vivenciado, nos últimos tempos, um declínio acentuado do uso do amálgama, em consequência da evolução dos materiais e técnicas adesivas e das discussões acerca dos riscos de contaminação pelo mercúrio. Assim, buscou-se identificar a percepção dos cirurgiões-dentistas sobre a necessidade da continuidade do ensino do amálgama nos cursos de Odontologia. Trata-se de um estudo transversal, usando um questionário semiestruturado com aspectos relativos às condições sociodemográficas, capacitação para executar os procedimentos, conhecimento acerca do manejo do material e gerenciamento dos resíduos. As respostas objetivas foram analisadas pela estatística descritiva e as subjetivas processadas no software IRaMuTeQ. Dos 257 respondentes, 60,7%afirmam utilizar esse material, 91,8% usam amálgama encapsulado e 95,7% descartam os resíduos em lixo hospitalar. Sobre a permanência do material, 63,4% acreditam ser necessária e 88% concordam que o ensino deva continuar sobretudo considerando o perfil do egresso sugerido pelas Diretrizes Curriculares Nacionais. Dos dados subjetivos emergiram cinco classes/categorias que retratam a percepção dos profissionais sobre relação custo-benefício, acesso ao serviço, condições de trabalho e longevidade das restaurações. Conclui-se que, mesmo com a evolução dos materiais adesivos, o amálgama ainda é necessário, principalmente no serviço público, onde a demanda por restaurações de baixo custo e grande longevidade é alta. Assim, para essa amostra, enquanto não houver um material restaurador livre de mercúrio, barato, de fácil manuseio e durável, o ensino desse conteúdo deve permanecer nos cursos de graduação em Odontologia (AU).

La odontología ha experimentado recientemente una fuerte disminución en el uso de amalgamas como resultado de las discusiones sobre los riesgos de contaminación por mercurio, así como la evolución de los materiales y las técnicas adhesivas. Así, buscamos identificar la percepción de los odontólogos sobre la necesidad de continuar enseñando amalgama en los cursos de odontología. Se trata de un estudio transversal utilizando un cuestionario semiestructurado con aspectos relacionados con las condiciones sociodemográficas, capacitación para realizar los procedimientos, conocimientos sobre manejo de materiales y gestión de residuos. Las respuestas objetivas se analizaron mediante estadística descriptiva y las respuestas subjetivas se procesaron mediante el software IRaMuTeQ. De los 257 encuestados, el 60,7% afirma utilizar este material, el 91,8% utiliza amalgama encapsulada y el 95,7% desecha los residuos en la basura de hospital. En cuanto a la permanencia del material, el 63,4% cree que es necesario y el 88% está de acuerdo en que la enseñanza debe continuar, sobre todo para la graduación de profesionales que van al servicio público. A partir de los datos subjetivos, surgieron cinco clases/categorías que retratan la percepción de los profesionales sobre la rentabilidad, el acceso al servicio, las condiciones de trabajo y la longevidad de las restauraciones. Se concluye que, aún con la evolución de los materiales adhesivos, la amalgama sigue siendo necesaria, especialmente en el servicio público, donde la demanda de restauraciones de bajo costo y gran longevidad es alta. Así, mientras no exista un material restaurador libre de mercurio, económico, fácil de manejar y duradero, la enseñanza de este contenido O ensino do amálgama na formação odontológica ainda é necessário? Percepção de cirurgiões-dentistas debe permanecer en los cursos de graduación en odontología (AU).

Dentistry has recently experienced a sharp decline in the use of amalgam, as a result of the evolution of adhesive materials and techniques and discussions about the risks of mercury contamination. Thus, we sought to identify the perception of dentists about the need to continue teaching amalgam in dentistry courses. This is a cross-sectional study, using a semi-structured questionnaire with aspects related to sociodemographic conditions, training to perform the procedures, knowledge about material management and waste management. The objective responses were analyzed by descriptive statistics and the subjective ones processed in the IRaMuTeQ software. Of the 257 respondents, 60.7% claim to use this material, 91.8% use encapsulated amalgam and 95.7% dispose of waste in hospital waste. Regarding the permanence of the material, 63.4% believe it is necessary and 88% agree that teaching should continue, especially considering the profile of the graduate suggested by the National Curriculum Guidelines. From the subjective data emerged five classes/categories that portray the perception of professionals about cost-benefit ratio, access to service, working conditions and longevity of restorations. It is concluded that, even with the evolution of adhesive materials, amalgam is still necessary, especially in the public service, where the demand for low cost and high longevity restorations is high. Thus, for this sample, as long as there is no mercury-free, inexpensive, easy to handle and durable restorative material, the teaching of this content should remain in undergraduate courses in Dentistry (AU).

Assessment of Bite Forces in Restored Teeth with Different Commonly Used Restorative Materials: A Comparative Study

ABSTRACT Objective: To evaluate and compare bite force (BF) in permanent first molars restored with glass ionomer cement (GIC), composite and amalgam, and normal contralateral permanent first molars. Material and Methods: BF was recorded in decayed permanent first molars, which were filled with GIC (n=30), composite (n=30), and amalgam (n=30), and in healthy contralateral first molars (n=90) with Force Transducer Occlusal Force Meter and compared. Results: BF was significantly higher in normal teeth on the contralateral side compared to teeth restored with GIC and composite. However, in patients with amalgam restoration, though it was less compared to that on the contralateral side, it was not statistically significant (p>0.05). Conclusion: Restoring teeth with various filling materials may improve bite force. In the present study, it was found that the teeth restored with amalgam had higher bite forces in comparison to the other restorative materials used. However, it was not comparable to that observed in the normal tooth (control) on the contralateral side.

Evidence-practice gap in treatment decisions about defective composite and amalgam restorations among Brazilian dentists

Better understanding of dentists' decision-making about defective restorations is needed to close the evidence-practice gap (EPG). This study aimed to quantify the EPG about defective restorations and identify dentist factors associated with this EPG. Methods: 216 dentists from São Paulo State, Brazil, completed a questionnaire about three clinical case scenarios involving defective composite restorations with cementum-dentin margins (case 1) and enamel margins (case 2), and an amalgam (case 3) restoration. Dentists were asked what treatment, if any, they would recommend, including preventive treatment, polishing, re-surfacing, or repairing the restoration, or replacing the entire restoration. Replacing the entire restoration in any of these three scenarios was classified as inconsistent with the evidence, comprising an EPG. Bivariate analyses using Chi-square, ANOVA, or multiple comparison tests were performed (p<.05). Results: for defective composite restorations, 49% and 55% of dentists chose to replace the entire restoration for cases 1 and 2, respectively. Twenty-nine percent of dentists chose to replace the entire amalgam restoration. Dentists were significantly more likely to choose to replace the defective amalgam restoration than the composite restoration with a defect at the cementum-dentin margins or the enamel margins (both at p < .001). Female dentists were more likely to choose a conservative treatment than male dentists for cases 1 (p=.034) and 2 (p=.009). Dentists with a higher percentage of patients interested in individualized caries prevention were also more conservative in case 1 (p=.045). Conclusion: a substantial EPG regarding treatment decisions for defective restorations exists, especially for composite restorations. This study adds to the international evidence that an EPG exists in this clinical area and that global strategies need to be developed to close the gap

Materiais restauradores em odontopediatria: preferência de pais e crianças e análise bibliométrica-altimétrica / Restorative materials in pediatric dentistry: children's and adults' preference and bibliometric-altmetric analysis

Atualmente, diversos materiais restauradores encontram-se disponíveis para aplicabilidade em Odontopediatria. Os avanços dos materiais restauradores conduzem à necessidade de novos estudos nessa temática. O presente estudo apresenta duas propostas de investigação: 1) Estudo transversal com objetivo de avaliar a preferência de pais/responsáveis e crianças quanto ao emprego do compômero colorido (Twinky Star®, Voco, Alemanha); 2) Estudo bibliométrico altimétrico com objetivo de analisar 50 artigos mais citados referente aos materiais restauradores utilizados em Odontopediatria e o alcance dessa informação científica nas mídias on-line. O estudo transversal envolveu 260 pares de pais/responsáveis e crianças de 5 a 11 anos de idade de dois serviços de saúde da região metropolitana de Belo Horizonte-MG. Exame quanto à cárie dentária foi realizado por examinadora calibrada para o critério da Organização Mundial da Saúde. Um manequim odontológico contendo restaurações com compômeros coloridos e materiais convencionais (resina composta, ionômero de vidro e amálgama) foi apresentado aos participantes do estudo e realizou-se inquérito sobre a preferência dos materiais dentários. O Questionário de Estilo e Dimensões dos Pais (PSDQ) e o Eysenck Personality Questionnaire Junior (EPQ-J) foram aplicados, este último apenas para pais/responsáveis de crianças de 5 e 6 anos de idade. Análises descritivas, bivariadas e regressão multivariada de Poisson foram realizadas. A maioria dos pais/responsáveis (74,2%) preferiu materiais convencionais. A idade da criança (p=0,006), a renda familiar (p= 0,001) e o nível de escolaridade (p< 0,001) associaram se a essa escolha. A análise multivariada demonstrou que crianças menores de 7 anos apresentaram 1,20 vezes maior probabilidade de escolher compômeros coloridos do que seus pares mais velhos (p< 0,001), assim como pais/responsáveis com menos de 11 anos de escolaridade e cujos filhos eram menores de 7 anos apresentaram 2,17 e 1,74 maior probabilidade para escolher compômeros coloridos, respectivamente. Concluiu-se que responsáveis com maior escolaridade apresentaram maior resistência às restaurações coloridas e crianças menores de 7 anos aceitaram melhor este material. O estudo bibliométrico-altimétrico adotou estratégia de busca em três bases (Web of Science, Scopus e Google Scholar), independente da data de publicação. Após seleção dos artigos por um grupo de cinco pesquisadores, em março de 2023, foram incluídos estudos que avaliassem qualquer material restaurador empregado em dentes decíduos e analisados dados referentes ao título, número de citações, país/continente, autoria, periódico, instituição, desenho do estudo, tipo de material restaurador, e escore altimétrico. Os artigos, publicados entre 1991 a 2002, apresentaram variação de citações de 19 a 113. Os autores com maior número de citações foram Qvist V e Teglers PT. O estudo experimental foi o principal delineamento de estudo observado e o cimento de ionomero de vidro foi o material mais reportado. A Europa foi o continente, e o Brasil, o país com maior número de citações. O escore altimétrico esteve presente em 23 artigos, com ênfase para dois artigos (43/6º e 73/7º). Concluiu-se que o cimento de ionômero de vidro foi o material mais estudado. Ficou evidente o distanciamento entre a posição dos trabalhos nas análises bibliométrica e altimétrica, apontando necessidade de disseminação da informação além dos círculos acadêmicos.

Currently, an arsenal of restorative materials is available for applicability in pediatric dentistry. The advances in restorative materials conducted to need for further studies in this thematic. The present study presents two investigation proposals: 1) Cross-sectional study aiming to evaluate the preference of parents and children regarding the use of colored compomer (Twinky Star®, Voco, Germany); 2) Bibliometric-altmetric study aiming to analyze the 50-most cited papers regarding to restorative materials used in pediatric dentistry and the dissemination of scientific information in online media. The cross-sectional study included 260 pairs of caregivers/children aged 5 to 11, in two public health services, in the metropolitan region of Belo Horizonte-MG. Examination for dental caries was performed by an examiner calibrated to the criteria of the World Health Organization. A dental mannequin containing colored compomers restorations and conventional materials (composite resin, glass ionomer cement and dental amalgam) was presented to the population and a survey was conducted about the preference of dental materials. Parents' Style and Dimensions Questionnaire (PSDQ) and Eysenck Personality Questionnaire Junior (EPQ-J) were applied, the last one only for parents/caregivers of children aged 5 to 6. Descriptive, bivariate and Poisson regression analyzes were performed. Most adults (74.2%) preferred conventional materials. Family income (p= 0.001) and education level (p< 0.001) were associated with its choice. Age up to 7 (p< 0.001) associated with children's choice for colored restorations (72.3%). Children younger than 7 had 1.20 higher probability to choose colored compomers than their older pairs, while adults with children younger than 7 and less than 11 years of schooling had 1.74 and 2.17 higher probability to choose colored compomers, respectively. It was concluded that caregivers with higher educational level showed greater resistance to use of colored restorations and children younger than 7 had better acceptance of colored material. The bibliometrics-altmetrics study adopted a search strategy in three databases (Web of Science, Scopus and Google Scholar), independent of the year of publication. After selection of papers by a panel of five researchers, in March 2023, any restorative material used in deciduous teeth was included and data about the title, number of citations, country/continent, authorship, journal, design of the study, type of restorative material, university and altmetrics score were analyzed. The papers, published between 1991 and 2002, ranged from 19 to 113 citations. The authors with the highest number of citations were Qvist V and Teglers PT. The experimental study was the main study design observed. Analyzing the continent and country with the highest number of citations, Europe highlighted and Brazil was predominant. The altmetric score was present in 23 papers, emphasizing two articles (43/6th and 73/7th). It was concluded that glass ionomer cement was the most studied material. A gap between the position of the papers correlating the bibliometrics and altmetrics analyzes was evident, demonstrating the need to disseminate the information beyond academic circles.

Norma técnica de salud para el uso del odontograma: NTS N° 188-MINSA/DGIESP-2022 / Technical health norm for the use of the odontogram: NTS N° 188-MINSA/DGIESP-2022

La publicación describe los criterios para el registro de datos de las características, anomalías patológicas de las piezas dentarias, así como el registro de procedimientos estomatológicos realizados para el uso y manejo del odontograma en las diferentes UPS, pudiendo ser utilizados en aspectos clínicos, legales, forenses, estadísticos, de investigación o docencia. Asimismo las pautas para estandarizar el gráfico y la nomenclatura básica para el registro de hallazgos clínicos en el odontograma, permitiendo a la comunidad de cirujanos dentistas manejar la misma información

Risk of failure of repaired versus replaced defective direct restorations in permanent teeth: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to systematically review the literature to compare the risk of failure of repaired and replaced defective direct resin composite and amalgam restorations performed in permanent teeth. MATERIALS AND METHODS: The PubMed/MEDLINE, Scopus, Lilacs, BBO, Web of Science, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL) databases, and gray literature were searched to identify longitudinal clinical studies related to the research question. No publication year or language restriction was considered. Two authors independently selected the studies, extracted the data, and assessed the risk of bias and certainty of evidence. A meta-analysis was performed using a fixed effects model at a 5% significance level. RESULTS: From 1224 potentially eligible studies, thirteen were selected for full-text analysis, and three were included in the systematic review and meta-analysis. There was no difference in the risk of failure of repaired and replaced defective direct restorations (RR: 1.21, 95% CI: 0.51-2.83), either for resin composite (p = 0.97) or amalgam (p = 0.51) restorations. The risk of bias was high and the certainty of evidence was very low. CONCLUSION: Based on the very low certainty of evidence, the repair of direct restorations does not present a significant difference in the risk of failure when compared to replacements in permanent teeth. CLINICAL RELEVANCE: Restoration repair is a procedure that is included in the minimal intervention principle for improvement of tooth longevity in that the risk of failure of repaired partially defective restorations in permanent teeth seems similar to that of replacement. Further studies are required before definitive conclusions can be drawn.

Restorative Techniques for Permanent First Molars Affected by Hypomineralization: A Systematic Review.

Purpose: There are several restorative modalities for molar hypomineralization, but there is no consensus on the best approach. The purpose of this review was to describe restorative approaches applied to permanent first molars (PFM) with molar hypomineralization (MH). Methods: This review was registered (PROSPERO database CRD42017078336). Searches were conducted in the PubMed, Scopus, Web of Science, LILACS, BBO, and Cochrane Library databases and grey literature. From a total of 1,751 studies, 12 that compared restorative treatments for PFM with MH were included. The risk of bias of the studies was assessed using the Cochrane Collaboration and the Newcastle-Ottawa Scale. The success rate was the primary outcome. Results: The restorative treatment options were direct restorations with amalgam, glass ionomer cement, and resin-based composite as well as indirect restorations with stainless steel, porcelain, ceromer, and gold crowns. The restorative techniques, considering the type of isolation and the removal of caries and hypomineralization, vary between the study. There was also a lack of standard clinical criteria for restorative evaluation. The follow-up period ranged from six to 216 months. The success of direct restorations ranged from 86.3 to 100 percent. For indirect restorations, success ranged from 91.3 to 100 percent. Conclusions: There were multiple clinical protocols for MH. The studies presented heterogeneity in the restoration technique, time, and clinical criteria for restorative follow-up. Direct restorations with glass ionomer cement and resin-based composite could be the first choices for restoration. Further randomized clinical trials on a restorative treatment for MH are needed.

Tatuaje por amalgama: Caso Clínico / Amalgam Tattoo: Clinical Case

El tatuaje de amalgama o argirosis focal, es una lesión iatrogénica que sigue a la implantación traumática de partículas de amalgama en tejido blando o a la transferencia pasiva por fricción crónica de la mucosa contra una restauración de amalgama se caracteriza por el depósito de restos de material restaurativo compuesto por una mezcla de plata, mercurio, zinc, estaño y cobre en el tejido conectivo. Objetivo presentar el caso clínico de un paciente con tatuaje por amalgama y el tratamiento que fue realizado previo a su rehabilitación dental. Métodos Se realizó diagnóstico y la biopsia excisional de la lesión pigmentada Resultado como resultado de la biopsia encontramos tatuaje por amalgama con reacción granulomatosa a cuerpo extraño. Conclusión: Por medio de una Biopsia excisional se comprobó el diagnósticode la lesión que se observóen la paciente, resultando así un tatuaje por amalgama con reacción granulomatosa a cuerpo extraño

Experience, prevalence, need for treatment and cost of care for caries: A multicenter study in a developing country.

OBJECTIVE: To assess the experience, prevalence, need for treatment and economic impact of caries among students 6-12 years old in four cities in Mexico. BASIC RESEARCH DESIGN: Cross-sectional clinical study. SETTING: Elementary public schools. PARTICIPANTS: 500 schoolchildren aged 6 to 12 years. METHOD: Oral clinical examinations using WHO criteria for caries in the primary (dmft) and permanent (DMFT) dentitions. MAIN OUTCOME MEASURES: Indicators of caries in the primary and permanent dentitions: experience, prevalence, severity and the Significant Caries Index. In addition, we calculated the treatment needs, dental care rate and cost of care. RESULTS: dmft in the primary dentition was 2.59±2.83, and DMFT was 0.82±1.44 in the permanent dentition. Caries prevalence reached 67.7% in the primary and 34.1% in permanent dentition. The treatment needs index was 85.9% and 91.3% in the primary and permanent dentitions, respectively; the dental care index was 13.9% and 8.5%, respectively. The cost of care for caries in the primary dentition was estimated at $22.087 millions of international dollars (PPP US$) when amalgam was the restorative material used, and PPP US$19.107 millions for glass ionomer. For the permanent dentition, the cost was PPP US$7.431 millions when amalgam was used and PPP US$7.985 millions when resin/composite was used as restorative material. CONCLUSIONS: The prevalence and experience of caries in the primary dentition were 50% greater than those of other studies carried out in Mexico. In the permanent dentition they were less. There is considerable need for the treatment of caries and minimal experience with restorative care. The cost of care for caries may be assumed to be high for a health system such as Mexico's.

Comparison of the expression of the volumetric alteration artifact in cylindrical and triangular fields of view in two cone-beam computed tomography devices.

OBJECTIVE: To compare the expression of the volumetric alteration (VA) artifact between cylindrical and convex triangular fields of view (FOVs) using high-density materials in different positions in two cone-beam computed tomography (CBCT) devices. MATERIALS AND METHODS: Cylinders of five high-density materials (amalgam, chromium-cobalt, gutta-percha, titanium, and zirconium) with known physical volume were individually submitted to CBCT acquisition in four positions inside a polymethylmethacrylate phantom using two different FOV shapes (convex triangular and cylindrical) on the Veraviewepocs® R100 (R100) and Veraview® X800 (X800) devices. Two oral radiologists obtained the tomographic volumes by segmenting each cylinder. The difference between the tomographic and physical volumes corresponded to the VA. These values were analyzed by intraclass correlation coefficient and analysis of variance for repeated measures with Tukey post hoc test (α = 5%). RESULTS: The FOV influenced the VA only in the X800 device (p = 0.014): the VA in the triangular FOV was greater than in the cylindrical FOV. The VA in the triangular FOV of the X800 device was greater than the R100 device (p < 0.0001). The material influenced the expression of the VA only in the R100 device (p < 0.0001); gutta-percha presented the highest VA, being underestimated, and differing from the other materials (p < 0.01). CONCLUSION: The triangular FOV increased the VA of high-density materials in the X800 device. CLINICAL RELEVANCE: It is important to know if there is an influence on the volumetric alteration artifact of dental materials due to the different image formation geometry in the convex triangular FOV.

Glass ionomer heated or not to identify bone defect created in rat calvaria / Ionômero de vidro aquecido ou não para identificação de defeitos ósseos criados em calvárias de ratos

Introduction: Some experimental models have been used to evaluate the use of biomaterials in bone regeneration. Among them are the critical size defects (CSD) created in rat calvaria. An experimental model has been described in the literature, in which "L" markings are performed on the margins of the bone defects in order to assist in the precise identification of these defects during laboratory processing and analysis of the results. In the proposed model, the "L" markings are filled with amalgam. Objective: The purpose of the present study was to evaluate the amalgam replacement of an experimental bony defect model in rat calvaria by heated or unheated glass ionomer. Material and method: 24 rats were used. A 5 mm CSD was created at each animal calvaria. Two "L" shaped markings were made 2 mm from the margins of the bone defect, filled with amalgam (Group AM), heated glass ionomer cement (Group GIh) or not (Group GI). The animals were euthanized 15 days postoperatively. The areas of the surgical defect and the L-shaped marking were histomorphometrically analyzed and the data were analyzed statistically (p <0.05). Result: There were no significant clinical, histological or methodological differences among the experimental groups. Conclusion: It can be concluded that GI can replace AM in the proposed experimental model and GI heating did not promote additional benefits.

Introdução: Alguns modelos experimentais têm sido usados para avaliar o uso de biomateriais na regeneração óssea. Entre eles estão os defeitos de tamanho crítico (DTC) criados em calvárias de ratos. Um modelo experimental foi descrito na literatura onde marcações em L são realizadas nas margens do defeito ósseo para auxiliar na identificação precisa desses defeitos durante o processamento laboratorial e análise dos resultados. No modelo experimental proposto, as marcações em "L" são preenchidas com amálgama. Objetivo: Avaliar a substituição do amálgama por ionômero de vidro aquecido ou não em um modelo experimental para identificação de defeito ósseo criado em calvária de ratos. Material e método: Foram utilizados 24 ratos. Um DTC de 5 mm de diâmetro foi criado na calvária de cada animal. Duas marcações em "L" foram realizadas a 2 mm das margens do defeito ósseo, preenchidas com amálgama (Grupo AM), ionômero de vidro aquecido (Grupo CIVaq) ou não (Grupo CIV). Os animais foram eutanasiados aos 15 dias pós-operatórios. A área do defeito cirúrgico e das marcações em "L" foram histomorfometricamente avaliadas e os dados estatisticamente analisados (p<0,05). Resultado: Não houve diferença estatisticamente significativa entre os grupos experimentais para as análises metodológicas, clínicas ou histomorfométrica realizadas. Conclusão: Dentro dos limites deste estudo, pode-se concluir que CIV pode substituir o AM no modelo experimental proposto e o aquecimento do CIV não promoveu benefícios adicionais.

Uma revisão de escopo de revisões sistemáticas sobre exposição humana ao mercúrio / A scoping review of systematic reviews on human exposure to mercury

Resumo: Introdução: a promulgação da Convenção de Minamata no Brasil em 2018 incentivou o cumprimento dos seus objetivos em reduzir o uso e a poluição por mercúrio. Objetivo: caracterizar a produção científica sobre exposição humana ao mercúrio e identificar lacunas de conhecimento a fim de subsidiar a tomada de decisão em saúde. Métodos: revisão de escopo de revisões sistemáticas e metanálises, sem restrição de idioma ou data de publicação, utilizando as bases PubMed, BVS e Cochrane Library. Resultados: 71 estudos atenderam aos critérios de elegibilidade, com 40 revisões sistemáticas, 30 metanálises e 1 overview. Amálgama dentário e contaminação alimentar e ambiental por atividades que utilizam mercúrio foram as fontes de exposição mais mencionadas. Os temas mais estudados contaram com transtornos mentais e comportamentais, assim como uso de biomarcadores e testes neurocomportamentais relacionados à exposição ao mercúrio. Discussão: lacunas como a exposição ocupacional ao mercúrio, uso em práticas tradicionais e em cosméticos apontam para a necessidade de mais estudos. As revisões identificadas podem oferecer subsídios para sínteses de evidências e protocolos de atenção à saúde de populações expostas, assim como para a elaboração de políticas públicas que visem o controle do uso e da exposição ao mercúrio.

Abstract: Introduction: in 2018, the promulgation of the Minamata Convention in Brazil encouraged compliance with its goals of reducing mercury use and pollution. Objective: to characterize the scientific production and identify the knowledge gaps to subsidize decision-making in healthcare on human exposure to mercury. Methods: a scoping review was carried out of systematic reviews and metanalysis, without language and publication date restriction, retrieved from the PubMed, BVS, and Cochrane Library databases. Results: a total of 71 studies met the eligibility criteria, of which 40 were systematic reviews, 30 meta-analyses, and one overview. Dental amalgam as well as food and environmental contamination by mercury-based activities were the most cited sources of exposure. Most studies focused on mental and behavioral disorders, as well as the use of biomarkers and neurobehavioral tests related to mercury exposure. Discussion: knowledge gaps on occupational exposure to mercury, mercury use in both traditional practices and cosmetics point to the need for further studies. The reviews identified could provide data for evidence synthesis and healthcare protocols for affected populations, as well as for elaborating public policies aimed at controlling mercury use and exposure.

Recomendaciones sobre la reparación de restauraciones de amalgama / Recommendations about the repair of dental amalgam restorations

Introducción: La reparación de restauraciones de amalgama, los materiales, las caras de los dientes de preferencia para realizarlas y su controversia con la contraparte de realizar reemplazos, es algo que amerita atención por los investigadores para lograr definiciones y protocolos precisos. Objetivo: Sistematizar sobre las recomendaciones de la literatura con respecto a la reparación de restauraciones de amalgama. Métodos: Se realizó una revisión cualitativa. Se plantearon criterios de inclusión y exclusión para la selección de los artículos. La búsqueda se realizó en Scopus y Pubmed. De las investigaciones resultantes de la búsqueda fueron decantados los artículos que no coincidían con el problema de investigación en cuestión, luego los que no cumplían los criterios de inclusión y exclusión. Se realizó una evaluación de la calidad y validez de los artículos seleccionados para ser incluidos en esta investigación y, finalmente, se le dio lectura a los textos completos y resúmenes para extraer los datos necesarios para completar la base de datos de la investigación. Quedaron un total de 27 artículos que fueron tamizados en una base de datos Excel, la que luego se exportó al software SPSS para su procesamiento estadístico. Resultados: El 44,4 por ciento y 55,6 por ciento de los artículos recomiendan reparar las restauraciones con amalgama y resina compuesta, respectivamente. Casi la mitad de los artículos (48,1 por ciento) no precisaron una cara del diente susceptible o no para realizar reparaciones. El 44,4 por ciento concluyen con que es un tratamiento recomendable. Conclusiones: Es recomendable realizar reparaciones de restauraciones de amalgama con amalgama dental y con resina compuesta. No está claramente definido cuál cara del diente es susceptible o no a recibir reparaciones y es un tratamiento que puede formar parte del arsenal terapéutico de los odontólogos(AU)

Introduction: The repair of amalgam restorations, the materials used, the tooth sides preferred to perform them, and the controversy with the replacement option, are all topics deserving the attention of researchers with a view to achieving accurate definitions and protocols. Objective: Systematize the recommendations available in the literature about the repair of amalgam restorations. Methods: A qualitative review was carried out. Inclusion and exclusion criteria were established for the selection of papers. The search was conducted in Scopus and Pubmed. Papers not related to the research problem at hand were the first to be discarded. Then those not meeting the inclusion and exclusion criteria. An evaluation was performed of the quality and validity of the remaining papers, and finally their full texts and abstracts were read to retrieve the data required to complete the database of the study. The 27 papers thus obtained were sifted in an Excel database, which was then exported to the SPSS software for statistical processing. Results: 44.4 percent and 55.6 percent of the papers recommend to repair restorations with amalgam and composite resin, respectively. Almost half (48.1 percent) do not state any preference for a specific tooth side to perform the repair. 44.4 percent recommend the treatment. Conclusions: It is advisable to perform repairs of amalgam restorations with dental amalgam and with composite resin. It is not clearly defined which tooth side is preferred to undergo the repair. This treatment may be part of the therapeutic arsenal of dentists(AU)

The protective role of selenium against dental amalgam-induced intracellular oxidative toxicity through the TRPV1 channel in DBTRG glioblastoma cells.

OBJECTIVE: The exposure to mercury (Hg) from dental amalgams is a suspected causative factor in neurological diseases. This study investigated the toxic effects of two different amalgam compositions related to Hg and the protective effects of selenium against the toxic effects of Hg through the TRPV1 channel in the human DBTRG glioblastoma cell line. METHODOLOGY: Six groups of the cells were organized. Analyses of cell viability, apoptosis, caspase 3 and caspase 9 activities, mitochondrial membrane depolarization, reactive oxygen species (ROS) production, and Western Blotting for protein expression levels were performed. RESULTS: Cell viability values were lower in amalgam with high copper (HCu) and low copper (LCu) groups independently of time but were increased by selenium and capsazepine (p<0.001 and p<0.05). Conversely, apoptosis rates, caspase 3 and caspase 9 expression, ROS formation, mitochondrial membrane depolarization, and protein expression levels were higher in the HCu and LCu groups but were decreased by selenium (p<0.001 and p<0.05). CONCLUSIONS: Selenium combined with an amalgam of either HCu or LCu decreases the toxic effects created by Hg in human DBTRG glioblastoma cells.

The protective role of selenium against dental amalgam-induced intracellular oxidative toxicity through the TRPV1 channel in DBTRG glioblastoma cells

Abstract Objective The exposure to mercury (Hg) from dental amalgams is a suspected causative factor in neurological diseases. This study investigated the toxic effects of two different amalgam compositions related to Hg and the protective effects of selenium against the toxic effects of Hg through the TRPV1 channel in the human DBTRG glioblastoma cell line. Methodology Six groups of the cells were organized. Analyses of cell viability, apoptosis, caspase 3 and caspase 9 activities, mitochondrial membrane depolarization, reactive oxygen species (ROS) production, and Western Blotting for protein expression levels were performed. Results Cell viability values were lower in amalgam with high copper (HCu) and low copper (LCu) groups independently of time but were increased by selenium and capsazepine (p<0.001 and p<0.05). Conversely, apoptosis rates, caspase 3 and caspase 9 expression, ROS formation, mitochondrial membrane depolarization, and protein expression levels were higher in the HCu and LCu groups but were decreased by selenium (p<0.001 and p<0.05). Conclusions Selenium combined with an amalgam of either HCu or LCu decreases the toxic effects created by Hg in human DBTRG glioblastoma cells.

Cuerpo extraño (fragmento de amalgama intraóseo) de la mandíbula: informe de caso / Foreign body (intraosseous bone fragment) of the mandible: report of a case

Un cuerpo extraño es un objeto o una estructura que se incluye accidental o intencionalmente en la intimidad de los tejidos orgánicos de un individuo. Puede desencadenar importantes procesos inflamatorios/ infecciosos, dependiendo de su naturaleza, requiriendo en la mayoría de los casos su extracción quirúrgica, con el fin de evitar daños al paciente. Este trabajo tiene como objetivo informar un caso de cuerpo extraño (fragmento de amalgama) incluido iatrogénicamente en la exodoncia de un molar inferior derecho en un paciente que, después de 8 años, optó por hacerse un implante en el área y descubrió la inclusión de este material, siendo necesaria su extracción quirúrgica para la posterior colocación del implante dental en la región. Los autores destacan la necesidad de realizar una minuciosa inspección y toilette de la caja alveolar en el acto de la exodoncia, para evitar incluir cuerpos extraños en el sitio quirúrgico y evitar así, una nueva intervención en el área (AU)

Foreign body is an object or structure included accidentally or intentionally in the intimacy of the organic tissues of individuals. They can trigger important inflammatory / infectious processes, depending on its nature, requiring its surgical removal in most cases, to prevent damage to the patient. This study aimed to report a case of a foreign body (fragment of amalgam) iatrogenically included in extraction of a right lower molar in a patient who, after 8 years, opted to have an implant in the area and discovered the inclusion of this material, requiring its surgical removal for subsequent placement of a dental implant in the region. The authors highlight the need to perform a thorough inspection and toilet of the alveolar box in the act of extraction, to avoid including foreign bodies in the surgical site, avoiding further intervention in the area (AU)

Amalgam allergy and Burning Mouth Syndrom: treatment and 25 years recall / Alergia ao amálgama e Síndrome da ardência bucal: tratamento e 25 anos de proservação

Background: Burning mouth syndrome (BMS) is a non-neuropathic chronic orofacial pain condition, characterized by the presence of burning/warm sensation without specific mucosal lesions. Objective: The aim of the present clinical case report is to describe the positive outcome of dental treatment of a patient with BMS and followed up for 25 years. Data Treatment: This report describes the case of a 50-year-old black woman sought treatment for burning, and persistent swelling of tong (24h/day) occurring over years. Clinical evaluation of the oral environment revealed the tongue with cracking, darkened points areas, surrounded by whitish areas. Twelve teeth presented extensive amalgam restorations. Patch testing revealed a very strong hypersensitivity to Amalgam. All amalgam restorations were substituted by composite resin restorations. Results and Conclusion: Burning sensation disappeared completely after these restorations had been changed. After 25-year follow-up period, it was observed that burning sensation has never been felt anymore. Clinical Significance: Burning mouth syndrome is a chronic orofacial pain, usually without specific mucosal lesions. The etiology is complex and multifactorial and the treatment should be made specifically for each pacient. (AU)

Introdução: A síndrome de ardência bucal (SAB) é uma condição de dor orofacial crônica não neuropática, caracterizada pela presença de sensação de queimação/calor sem lesões específicas da mucosa. Objetivo: Oobjetivo do presente relato de caso clínico é descrever a evolução positiva do tratamento odontológico de uma paciente com SAB e o retorno após 25 anos. Tratamento dos Dados: Este relato descreve o caso de uma mulher negra de 50 anos que buscou tratamento por queimadura e edema persistente da língua (24h/dia) ocorrendo ao longo dos anos. A avaliação clínica da cavidade bucal revelou a língua com áreas fissuradas e áreas com pontos escurecidos circundadas por áreas esbranquiçadas. Doze dentes apresentavam restaurações extensas de amálgama de prata. O teste de contato revelou hipersensibilidade muito forte ao amálgama de prata. Todas as restaurações de amálgama de prata foram substituidas por restaurações de resina composta. Resultados e Conclusão: A sensação de queimação desapareceu completamente após a substituição das restaurações. Após um periodo de 25 anos, observou-se que a sensação de queimação nunca foi mais relatada. Significado Clínico: a síndrome da ardência bucal é uma dor orofacial crônica, geralmente sem lesões específicas da mucosa. A etiologia é complexa e multifatorial e o tratamento deve ser feito especificamente para cada paciente.(AU)

Evaluation of Effectiveness of Self-Adhesive Composites for Amalgam Repair with or Without Alloy Primer, in Terms of Shear Bond Strength / Evaluación de la efectividad de los compuestos autoadhesivos para la reparación de amalgamas con o sin imprimación de aleación, en términos de resistencia al cizallamiento

Abstract Purpose: The purpose of the present research was to evaluate the effectiveness of self-adhesive composites in amalgam repair as time-saving alternatives to universal bonding-universal composite materials, with or without the usage of Alloy Primer in terms of shear bond strength. Materials and Methods: Forty- two disc-shaped amalgam samples were prepared by condensing into 6×2 mm holes in acrylic resin blocks, sandblasted with 50 μm Al2O3 and randomly divided into 6 groups according to repair material [Constic (Group C), Fusio Liquid Dentin (Group FLD), Universal bonding+Universal composite (Group Control), Alloy Primer+Constic (Group APC), Alloy Primer+Fusio Liquid Dentin (Group APFLD), Alloy Primer+Universal bonding+Universal composite (Group APControl)]. After shear bond strength test, the fracture modes were determined under a digital microscope. Statistical analysis was performed using one-way analysis of variance and Tukey's post hoc test. Results: The highest shear bond strength values were obtained for Fusio Liquid Dentin, among the three repair materials when Alloy Primer was not applied (p<0.05). Usage of Alloy Primer increased shear bond strength values of the investigated repair materials to amalgam, except Fusio Liquid Dentin. Conclusion: Within the limitations of the present research, it can be concluded that; the investigated self-adhesive composite materials could be time-saving alternatives to the Universal bonding+Universal composite for the purpose of amalgam repair, in terms of shear bond strength. The clinicians could prefer Fusio Liquid Dentin self-adhesive composite material without Alloy Primer application for the purpose of amalgam repair in non-cooperative patients.

Resumen Propósito: El propósito de la presente investigación fue evaluar la efectividad de las resinas compuestas autoadhesivas en la reparación de amalgamas como alternativas que ahorran tiempo con respecto a las resinas compuestas universales de adhesión universal, con o sin el uso de Alloy Primer en términos de resistencia al cizallamiento. Materiales y métodos: Se prepararon 42 muestras de amalgama en forma de disco condensándolas en orificios de 6×2 mm en bloques de resina acrílica, arenadas con 50 μm de Al2O3 y divididas al azar en 6 grupos según el material de reparación [Constic (Grupo C), Fusio Liquid Dentin (Grupo FLD), Adhesivo universal+Resina universal (Grupo Control), Imprimación de aleación+Constic (Grupo APC), Imprimación de aleación+Fusio Liquid Dentin (Grupo APFLD), Imprimación de aleación+Adhesivo universal+Resina universal (Grupo APControl)]. Después de la prueba de resistencia al cizallamiento, los modos de fractura se determinaron bajo un microscopio digital. El análisis estadístico se realizó mediante análisis de varianza unidireccional y la prueba post hoc de Tukey. Resultados: Se obtuvieron los valores de resistencia al cizallamiento más altos para Fusio Liquid Dentin, entre los tres materiales de reparación cuando no se aplicó Alloy Primer (p<0.05). El uso de Alloy Primer aumentó los valores de resistencia al cizallamiento de los materiales de reparación investigados para la amalgama, excepto Fusio Liquid Dentin. Conclusión: Dentro de las limitaciones de la presente investigación, se puede concluir que; los materiales compuestos autoadhesivos investigados podrían ser alternativas que ahorran tiempo con respecto al adhesivo universal+resina universal con el fin de reparar las amalgamas, en términos de resistencia a la cizalladura. Los clínicos podrían preferir el material compuesto autoadhesivo Fusio Liquid Dentin sin la aplicación Alloy Primer con el fin de reparar amalgamas en pacientes poco cooperadores.