Incomplete caries removal: a systematic review and meta-analysis.

Increasing numbers of clinical trials have demonstrated the benefits of incomplete caries removal, in particular in the treatment of deep caries. This study systematically reviewed randomized controlled trials investigating one- or two-step incomplete compared with complete caries removal. Studies treating primary and permanent teeth with primary caries lesions requiring a restoration were analyzed. The following primary and secondary outcomes were investigated: risk of pulpal exposure, post-operative pulpal symptoms, overall failure, and caries progression. Electronic databases were screened for studies from 1967 to 2012. Cross-referencing was used to identify further articles. Odds ratios (OR) as effect estimates were calculated in a random-effects model. From 364 screened articles, 10 studies representing 1,257 patients were included. Meta-analysis showed risk reduction for both pulpal exposure (OR [95% CI] 0.31 [0.19-0.49]) and pulpal symptoms (OR 0.58 [0.31-1.10]) for teeth treated with one- or two-step incomplete excavation. Risk of failure seemed to be similar for both complete and incomplete excavation, but data for this outcome were of limited quality and inconclusive (OR 0.97 [0.64-1.46]). Based on reviewed studies, incomplete caries removal seems advantageous compared with complete excavation, especially in proximity to the pulp. However, evidence levels are currently insufficient for definitive conclusions because of high risk of bias within studies.

What is different in operative dentistry?

There have been both large and small changes in operative dentistry in the last 30 years. Extension for prevention is no longer the mantra. The design features of amalgam preparations have moved into the smallest preparations possible to gain full access to the carious dentin. The default Class 2 amalgam or resin composite is a slot preparation with no preparation of the occlusal fissures. Class 1 fissure caries once implied the entire fissure system was to be cut out. Now only the known carious portions of the fissure are cut away, the tooth is restored, and the remaining fissures in that tooth are sealed. Resin composite preparations have no depth requirements and saucer shaped boxes are more favorable for lowering shrinkage strains on the bonded walls. Re-mineralization of proximal lesions that can be seen on a radiograph is now a proven successful service for many lesions that are at or just into the dentin by radiographic interpretation. The largest paradigm shift has been in the decision that in vital teeth with normal pulps soft dentin can be left over a vital asymptomatic pulp with every expectation that the direct restoration will be successful long term.

[Cavity preparation and restorative therapy in articles, published by the Fogorvosi Szemle in the last hundred years]. / Az üregalakítás és a tömésterápia 100 éve a Fogorvosi Szemle publikációinak tükrében.

The aim of this review is to overview the development achieved in restorative therapy based on the publications in Fogorvosi Szemle during the past hundred years. The top quality of the restorative therapy was, and still has been the inlay, but nowadays the esthetic inlay -- fixed with adhesive material -- has priority over the gold inlay. The quality of amalgam fillings has been recently improved by using high-copper containing amalgam alloys. The development on the field of adhesive material and methods made it possible to give up the routine use of any conventional base material. The place of gingival wall of the cavity moved from subgingival position into supragingival position. The macro retention has been replaced by micro retention, and nowadays the cavity preparation prefers minimal-invasive techniques.

Avaliação da qualidade de margem de preparos cavitários realizados com diferentes técnicas e instrumentos / Margin quality of cavity preparations with different techniques and instruments

Há mais de 50 anos, a Odontologia usa a mesma tecnologia para a preparação de cavidades, que é a alta velocidade com ponta diamantada e brocas carbides. Novos estudos e novas técnicas têm sido proporcionada para que haja uma opção a mais para esse procedimento no tratamento para os pacientes. Surgiram, então, novas tecnologias no mercado odontológico para eliminação mecânica da cárie e preparação de cavidades, como alta pressão de ar associado a jato de areia, aparelho de Laser, contra- ângulo multiplicador e ultrassom associado a pontas diamantadas. Mas por serem tecnologias novas, há ainda necessidade de pesquisas para a constatação de que realmente poderão vir a ser técnicas alternativas ou até substituir a tecnologia clássica que vem sendo utilizada com bons resultados. Assim, o propósito desta pesquisa foi avaliar, através de microscopia eletrônica de varredura (MEV), as margens cavitárias com e sem acabamento, realizadas com pontas diamantadas e CVDentus, associadas a diferentes tipos de dispositivos e mecanismo de ação. Os resultados encontrados mostraram não haver diferenças estatisticamente significantes (p < 0.05) entre as condições testadas, nas comparações individuais, com exceção dos grupos G4 x G7 (Alta velocidade+ Ponta Diamantada Preparo + Baixa Rotação + Ponta Diamantada para acabamento x Ultrassom + CVDentus Preparo 50% + Contra-ângulo). Concluiu-se que todas as formas de acabamento das margens cavitárias, testadas nesta pesquisa, são confiáveis e podem ser utilizadas. O uso do aparelho de ultrassom deve ser recomendado nas potências variando entre 50% a 75% para preparos cavitários.

For more than 40 years, dentistry has used the same technology for cavity preparation, high-speed rotation systems with diamond burs. New studies and techniques have been performed to develop a new treatment option for patients. Thus, new technologies have been possible such as high pressure sandblasting systems, laser devices, multiplying low-speed rotation, and finally, the ultra-sound with diamond burs. However, whether these new technologies can be an alternative or substitute for old practices with standard results is not known. The aim of this study was to evaluate by SEM cavity preparation margins with and without finishing, made by diamond burs and the CVDentus system associated to different devices and action forms. The results showed no statistically significant differences (p < .05) among the tested conditions on individual comparisons, except for GIV x GVII (highspeed rotation plus diamond bur + low-speed rotation plus diamond finishing bur x ultra-sound plus CVDentus 50% power plus low-speed rotation). It was concluded that all finishing modes on margin cavities are reliable and can be used in clinical practice. The use of the ultra-sound device can be recommended within 50-75% power for cavity preparations.

Ablation of composite resins using Er:YAG laser--comparison with enamel and dentin.

OBJECTIVES: The purpose of this work is to investigate comparative ablation rate between composite resins and dental hard tissues (enamel and dentin) after Er:YAG laser irradiation to verify possible development of an ultra-conservative dentistry to with minimum effect for the teeth tissue. METHODS: We have used 11 extracted or exfoliated primary anterior and posterior teeth and six extracted permanent molar teeth. Three different types of composite resin were chosen (microfiller, hybrid, and condensable) in terms of chemical and structural composition. Composite tablets and the teeth were irradiated with a Er:YAG laser at different laser beam energy level per pulse (100, 200, 300, and 400 mJ). Diameter and depth of each resulted microcavity were measured and the material removed volumes were calculated. The resulted values were plotted and fitted to allow a comparative observation of the material removed as a function of energy level per pulse. RESULTS: While the idea of ultra-conservative dentistry seems to apply well for enamel of primary and permanent teeth, at the present stage it does not apply well for primary or permanent dentin. For dentin, the composition and content of water makes the Er:YAG laser ablation equal or superior in rate compared with the three used resins. SIGNIFICANCE: This work presents of a comparative study of Er:YAG laser ablation, allowing to analyze the possible selective ablation between composite resin placed and cured and dental hard tissues, with the goal to propose a new clinical technique: differential ablation for composite resin restorations using Er:YAG laser.

Dois anos de avaliaçäo clínica de retauraçöes em resinas compostas condensáveis em molares / Two years of studying clinical evaluation of the performance of packable composite resins in molars

Este estudo teve por objetivo avaliar, pelo período de 2 anos, o comportamento clínico de restauraçöes com as resinas condensáveis Solitaire© (HERAEUS/KULZER) e ALERTtm (JENERIC©/PENTRON©), e com a resina híbrida multi-uso Z100(3Mmr)). Foram executadas 120 restauraçöes em dentes molares dos pacientes, sendo 89 do tipo Classe I e 31 do tipo Classe II. Quarenta cavidades foram restauradas com Z100, 41 com Solitaire© e 39 com ALERTtm. Os pacientes foram indagados em relaçäo à sensibilidade pós-operatória nos dentes restaurados, e em caso afirmativo, o tempo aproximado de sua duraçäo. As restauraçöes foram avaliadas no início e após 12 e 24 meses, de acordo com o critério U.S.P.H.S modificado (van DIJKEN, J. Dent. Res., 78(7):1319-25, 1999), sendo analisados os seguintes aspectos: forma anatômica da cárie, adaptaçäo marginal, alteraçäo de cor, descolaraçäo marginal e rugosidade superficial. Os resultados das avaliaçöes foram submetidos aos testes estatísticos de Kruskal-Wallis e Mann-Whitney (ANOVA - näo paramétricos) p<-0,05, que mostraram, após 24 meses, näo haver diferença estatisticamente significativa entre os três materiais estudados, em relaçäo aos itens: forma anatômica, cárie, adaptaçäo marginal e descoloraçäo marginal. Em relaçäo à alteraçäo de cor, o Z100 apresentou maior estabilidade de que os demais, que tiveram desempenho semelhante. Quanto à descoloraçäo marginal e à rugosidade superficial, o Z100 e o Solitaire© mostraram comportamento estatisticamente semelhante e superior ao do ALERTtm. O tipo de preparo cavitário näo teve influência sobre nenhum dos aspectos estudados, exceto para o item forma anatômica, nos permitir concluir que, independentemente do material utilizado, as restauraçöes de Classe I apresentaram desempenho superior ao das restauraçöes de Classe II. Em relaçäo à sensibilidade pós-operatória, sua incidência foi menor nos dentes restaurados com Z100, ocorrendo diferença estatisticamente significativa em relaçäo ao Solitaire© e ao ALERTtm, que foram semelhantes entre si. Näo houve diferença estatisticamente significativa entre os tipos de cavidades quanto à sensibilidade pós-operatótia e sua duraçäo

¿Es actualmente la extensión por prevención un concepto válido? / Is currently the extension for prevention a valid concept?

Se analizan y discuten los diferentes conceptos de extensión por prevención de la preparación que se han desarrollado desde 1881 hasta 1999. La introducción de nuevos conocimientos en diversas áreas de la odontología hicieron que los postulados de Black en ese particular se cuestinaran tanto en la enseñanza como en la práctica clínica

Painting the future for ART.

The objective of this paper is to review recent research and developments with respect to the atraumatic restorative treatment (ART) approach and to outline future areas of research and development. Areas identified as requiring further investigation include the evaluation of: ART restorations for longer than 3 years duration using recognised evaluation criteria, multi-surface ART restorations, ART restorations in primary teeth and ART sealants. In addition, the possibility and potential dangers of caries remaining after cavity cleaning with hand instruments must be investigated and the findings balanced against the known damage to sound tooth tissue caused by more routine cavity preparation techniques. New bioactive restorative materials which offer the possibility of healing dentinal caries lesions should be developed and evaluated. Finally, behavioural and educational aspects of the ART approach should be investigated.

Avaliaçäo da influência do treinamento e diferentes níveis de formaçöes acadêmicas na efetividade da remoçäo de cárie em preparos cavitários tipo túnel / Evaluation of the influence of training and academic formation in effectiveness in the removal of caries in the tunel preparation

Em funçäo da importância do preaparo cavitário tipo túnel na preservaçäo da estrutura dentária e da provável influência do treinamento e dos diferentes níveis de formaçöes acadêmicas na técnica, pudemos planejar este trabalho para avaliar a efetividade da remoçäo da cárie in vitro. Estabeleceram-se dois grupos de estudo: um sem treinamento prévio nesta técnica operatória, outro após a realizaçäo do treinamento. A técnica foi realizada por quatro operadores, sendo três cirurgiöes-dentistas (clínico geral, especialista e mestre em Dentística Restauradora) e um, acadêmico em Odontologia. Os operadores confeccionaram os preparos na superfície proximal de 120 dentes pré-molares superiores, sendo que cada um deles realizou 30 preparos cavitários (dez antes, dez durante e dez após o treinamento). Os dados obtidos neste trabalho permitiram-nos as seguintes conclusöes: 1) o preparo cavitário tipo túnel in vitro, sem o treinamento prévio realizado por todos os operadores em conjunto, possibilitou a remoçäo total das lesöes cariosas, artificialmente produzidas, em 67,5 por cento dos preparos; 2) o preparo cavitário tipo túnel in vitro, após o treinamento realizado por todos os operadores em conjunto, possibilitou a remoçäo total das lesöes cariosas, artificialmente produzidas, em 92,5 por cento dos preparos; 3) a técnica operatória realizada sem o treinamento prévio, näo foi eficiente apenas no grupo 3 (operador cirurgiäo-dentista especialista em Dentística Restauradora); 4) todos os operadores em conjunto, apresentaram uma melhora da remoçäo da cárie, estatisticamente significante, após serem submetidos ao treinamento