Silver diamine fluoride modified atraumatic restorative treatment compared to conventional restorative technique on carious primary molars-A randomized controlled trial.

OBJECTIVE: To compare the success of silver diamine fluoride-modified atraumatic restorative technique (SMART) with that of the conventional drill and fill method in restoring carious lesions in primary molars. METHOD: Children (4-8years old) reporting to a tertiary care hospital setting with asymptomatic cavitated dentinal carious lesions in primary molars were randomly allocated to two groups; SMART and Conventional; and subsequently restored with Glass Ionomer Cement (GIC). Follow-up evaluations were carried out by blinded independent evaluator at 6-months intervals to assess the status of restorations. Primary outcome was the success of restorations at 24 months and the secondary outcome was the child's behaviour and acceptance of the treatment at the time of interventions. Two sample Z-test of proportion, logistic regression analysis and Chi-square test were used to compare the outcomes in two groups. RESULTS: A total of 226 children (SMART group, 112 and conventional, 114) were included with 280 and 282 GIC restorations placed by the SMART and the conventional method respectively. At 24-months, 459 (81.6 %) primary molars were available for evaluation. Success rates of restorations was 38.4 % and 45.8 % % in SMART and conventional groups respectively (p = 0.105). The rate of acceptability of treatment in the SMART and conventional group was 79 % and 56 % (p<0.001) respectively. CONCLUSION: There was no significant difference in the success rates of GIC restorations by SMART and conventional technique in carious primary molars at 24 months. SMART was better accepted by children as compared to the conventional restorative technique. CLINICAL SIGNIFICANCE: SMART can be an alternative option to treat the asymptomatic carious lesions in primary molars and is well accepted by children than the conventional drill and fill technique thus implying that it has a useful role in un-cooperative children.

Survival Analysis and Cost Effectiveness of Silver Modified Atraumatic Restorative Treatment (SMART) and ART Occlusal Restorations in Primary Molars: a randomized controlled trial.

OBJECTIVE: To evaluate and compare the clinical performance and cost effectiveness of Silver Modified Atraumatic Restorative Treatment (SMART) and Atraumatic Restorative Treatment (ART) restorations in primary molars over 12 months follow up period. MATERIALS AND METHODS: Sixty-seven children, aged 5-9 years old having at least one asymptomatic primary molar with active caries, were randomly assigned to either the test arm (SMART) or the control arm (ART). Clinical performance was assessed after 6 and 12-months using the modified United States Public Health Services criteria. The trial was registered at Clinical Trial.gov with a registration number (NCT03881020). Treatment time for each restoration was recorded, Kaplan-Meier survival analysis and the log-rank test were performed (p<0.05) and cost effectiveness was measured at the end of the study. RESULTS: Both techniques showed comparable clinical performance and the mean survival time was 11.8 and 11.6 months for SMART and ART restorations respectively with no detected significant differences (p=0.416). Mean treatment time for SMART restorations (7.8 min.), however, was significantly lower than ART (15 min.) (p < 0.001). SMART technique, also, showed statistically significant lower mean total cost per restoration (p <0.001). CONCLUSIONS: Though SMART and ART have comparable clinical performance and survival in single-surface occlusal restorations in primary molars, SMART is less time consuming and more cost effective. CLINICAL SIGNIFICANCE: Using SMART technique could change paradigms in caries management. Being a patient friendly and cost-effective approach, it could be adopted as a superior treatment option when dealing with young children, those with behavioral and medical challenges and for promoting access to oral care among the underprivileged.

A systematic review of randomized controlled trials on survival rate of atraumatic restorative treatment compared with conventional treatment on primary dentition.

Background: In this COVID era, it's critical to promote nonaerosol procedures. Atraumatic restorative treatment (ART) is one of them, and it's particularly effective in children for lowering anxiety, enhancing dental health, and giving restorative care. Aim: The aim of this study was to assess the survival rate of ART compared with conventional treatment procedures in primary dentition. Materials and Methods: The review was done in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analysis statement and is been registered in PROSPERO (CRD42021213729). The studies included comprised clinical investigations with randomized controlled trials (RCTs) which compared the survival rate of ART and conventional restorative treatments using the same or different restorative materials to treat carious lesion. RCTs in which ART was compared with conventional treatment on patients in the age group of 6-10 years with minimum follow-up of 6 months. Studies available as open access and free full text in PubMed, DOAJ, and Google Scholar databases, and published in English Language only were included in the study. Cochrane's collaboration tool for RCTs was used for the assessment of risk of bias. Results: The survival rate of single surface and multiple surface in primary dentition treated according to the ART compared with conventional treatment was found to be similar. Conclusion: The ART approach is equally helpful in managing dental caries in children and this method may be considered a useful intervention in clinical practice to enhance the dental health of children.

Comparison of Clinical Outcomes of Silver-modified Atraumatic Restorative Technique vs Atraumatic Restorative Technique in Primary Teeth: A Randomized Controlled Trial.

AIM: To compare the clinical outcomes of silver-modified atraumatic restorative technique (SMART) vs atraumatic restorative technique (ART) in primary teeth. MATERIALS AND METHODS: This study was a randomized clinical trial conducted on 30 children. The study was split-mouth design, so each group was consisted of 30 children. Children aged 3-6 years old of both genders. Communication with the children was established. Gross debris from cavitation was removed. Carious dentin on walls was excavated using spoon excavator and low-speed contra with round or fissure bur. The areas to be treated were isolated with cotton rolls. For ART, glass ionomer cement (GIC) was applied according to the manufacturer's instructions. For silver-modified atraumatic restorative technique (SMART), a protective coating was applied to the lips and skin to prevent a temporary tattoo. Silver diamine fluoride (SDF) was applied carefully using bended microsponge brush. It was applied directly to only the affected tooth surface. The lesion was dried for 15 seconds with gentle flow of compressed air. After 1 week, GIC was applied according to the manufacturer's instructions. Clinical evaluation was done for all teeth at 6 and 12 months. The data were collected and then statistically analyzed using the Chi-square test to show the difference between groups. RESULTS: The restoration of the first primary molar with ART restoration alone showed a lower success rate when compared with the restoration with a combination of SDF and ART (SMART technique), with percentages of 70% and 76.67% and 53.33% and 60% after 6 months and 12 months of follow-up, respectively. CONCLUSION: Silver diamine fluoride is successful in arresting dentin caries and can be used to increase the efficacy of the ART technique in primary teeth. CLINICAL SIGNIFICANCE: It is recommended to use SDF as a noninvasive approach to control dentin caries with the ART technique.

Atraumatic restorative treatments and oral health-related quality of life and dental anxiety in Australian Aboriginal children: A cluster-randomized trial.

OBJECTIVES: The management of early childhood caries is challenging and the impacts of its treatment on child oral health-related quality of life (COHRQoL) and dental anxiety among Australian Aboriginal children is relatively unknown. The aim of the study was to compare the impact on COHRQoL and dental anxiety after approximately 12 months among Aboriginal children treated for early childhood caries (ECC) using the Atraumatic Restorative Treatment and the Hall Technique (ART/HT: test) or standard care (control). METHODS: Consenting Aboriginal communities in the North-West of Western Australia were randomized into early (test) or delayed (control) intervention for the management of ECC. Children and parents/carers completed a questionnaire at baseline and at follow-up. The questionnaire sought information on COHRQoL using the proxy-reported Early Childhood Oral Health Impact Scale (ECOHIS) and the self-reported Caries Impacts and Experiences Questionnaire for Children (CARIES-QC). The test group was provided with the ART/HT care at baseline while the control group was advised to seek care through the usual care options available within the community. At follow-up, both groups were offered care using the ART/HT approach. Changes in the mean scores from baseline to follow-up within groups were evaluated using appropriate paired (t-test, Wilcoxon paired test), and between groups with unpaired tests (t-test). Multivariate regression analysis after multiple imputations of missing data used generalized estimating equation (GEE) controlling for clustering within communities. RESULTS: Twenty-five communities and 338 children (mean age = 3.6 years, sd 1.7) participated in the study (test = 177). One child was excluded from the analysis because of a missing questionnaire and clinical data at baseline and follow-up. At baseline, test group children were older (test = 3.8 years, 95% CI 3.6-4.1;control = 3.3 years, 95% CI 3.1-3.6) and had higher caries experience (test dmft = 4.4, 95% CI 3.8-5.0;control dmft = 3.1, 95% CI 2.5-3.7), but there was no significant difference in COHRQoL or anxiety levels between the groups. At follow-up, parents in the delayed intervention reported worsening of COHRQoL (70% worsening of the family impact section of the ECOHIS and 37% worsening of the total ECOHIS scale), and there was an 8% reduction in child dental anxiety among the early treatment group. CONCLUSIONS: The application of the ART/HT approaches was feasible, effective, and impacted positively on child oral health-related quality of life and child dental anxiety among Aboriginal children in remote communities. The model of care as tested in this study should be further developed for inclusion in main-stream service delivery programmes.

Treatment time, pain experience and acceptability of the technique for caries removal in primary teeth using the ART approach with or without Brix3000™ papain gel: a preliminary randomised controlled clinical trial.

PURPOSE: To compare the Atraumatic Restorative Treatment (ART) associated with Brix3000™ to ART considering treatment time, pain experienced, and acceptability to children. METHODS: This study was accepted in Research Ethics Committee in July 2019 (number 3469402). Healthy patients (n = 20) aged 3-9 years, with at least one primary molar with occlusal dentine caries without cusp involvement were randomly allocated to either the ART + Brix3000™ group or the ART-only group. The sample was characterised by sex, age, tooth location and caries experience. Time spent and pain experience scores were recorded at prophylaxis, caries removal and restoration. The pain experience (intense, moderate, or mild) was evaluated by the Face, Legs, Activity, Cry, Consolability-revised scale (FLACC-r). Acceptability was assessed by a five-point hedonic facial scale (dichotomised into 'like' and 'indifferent/dislike' bins) and by an open-question interview. Mann-Whitney, Chi-square, and Fisher's exact tests were applied to discern differences in time, pain/sample characterisation and acceptability, respectively. RESULTS: The ART + Brix3000™ group required 8.6 ± 3.1 min to remove caries tissue, whereas the ART group required only 4.8 ± 2.0 min (p = 0.03). The total time spent with treatments was 13.1 ± 4.0 min for ART + Brix3000™, and 9.8 ± 2.7 min for ART (p = 0.03). There was no difference in pain experience and acceptability found among the groups (p > 0.05). CONCLUSION: Although the ART + Brix3000™ technique demanded more treatment time than the ART alone, there were no differences in either pain experience or acceptability.

Interventions for treating cavitated or dentine carious lesions.

BACKGROUND: Traditionally, cavitated carious lesions and those extending into dentine have been treated by 'complete' removal of carious tissue, i.e. non-selective removal and conventional restoration (CR). Alternative strategies for managing cavitated or dentine carious lesions remove less or none of the carious tissue and include selective carious tissue removal (or selective excavation (SE)), stepwise carious tissue removal (SW), sealing carious lesions using sealant materials, sealing using preformed metal crowns (Hall Technique, HT), and non-restorative cavity control (NRCC). OBJECTIVES: To determine the comparative effectiveness of interventions (CR, SE, SW, sealing of carious lesions using sealant materials or preformed metal crowns (HT), or NRCC) to treat carious lesions conventionally considered to require restorations (cavitated or micro-cavitated lesions, or occlusal lesions that are clinically non-cavitated but clinically/radiographically extend into dentine) in primary or permanent teeth with vital (sensitive) pulps. SEARCH METHODS: An information specialist searched four bibliographic databases to 21 July 2020 and used additional search methods to identify published, unpublished and ongoing studies.  SELECTION CRITERIA: We included randomised clinical trials comparing different levels of carious tissue removal, as listed above, against each other, placebo, or no treatment. Participants had permanent or primary teeth (or both), and vital pulps (i.e. no irreversible pulpitis/pulp necrosis), and carious lesions conventionally considered to need a restoration (i.e. cavitated lesions, or non- or micro-cavitated lesions radiographically extending into dentine). The primary outcome was failure, a composite measure of pulp exposure, endodontic therapy, tooth extraction, and restorative complications (including resealing of sealed lesions). DATA COLLECTION AND ANALYSIS: Pairs of review authors independently screened search results, extracted data, and assessed the risk of bias in the studies and the overall certainty of the evidence using GRADE criteria. We measured treatment effects through analysing dichotomous outcomes (presence/absence of complications) and expressing them as odds ratios (OR) with 95% confidence intervals (CI). For failure in the subgroup of deep lesions, we used network meta-analysis to assess and rank the relative effectiveness of different interventions. MAIN RESULTS: We included 27 studies with 3350 participants and 4195 teeth/lesions, which were conducted in 11 countries and published between 1977 and 2020. Twenty-four studies used a parallel-group design and three were split-mouth. Two studies included adults only, 20 included children/adolescents only and five included both. Ten studies evaluated permanent teeth, 16 evaluated primary teeth and one evaluated both. Three studies treated non-cavitated lesions; 12 treated cavitated, deep lesions, and 12 treated cavitated but not deep lesions or lesions of varying depth.  Seventeen studies compared conventional treatment (CR) with a less invasive treatment: SE (8), SW (4), two HT (2), sealing with sealant materials (4) and NRCC (1). Other comparisons were: SE versus HT (2); SE versus SW (4); SE versus sealing  with sealant materials (2); sealant materials versus no sealing (2).  Follow-up times varied from no follow-up (pulp exposure during treatment) to 120 months, the most common being 12 to 24 months. All studies were at overall high risk of bias. Effect of interventions Sealing using sealants versus other interventions for non-cavitated or cavitated but not deep lesions There was insufficient evidence of a difference between sealing with sealants and CR (OR 5.00, 95% CI 0.51 to 49.27; 1 study, 41 teeth, permanent teeth, cavitated), sealing versus SE (OR 3.11, 95% CI 0.11 to 85.52; 2 studies, 82 primary teeth, cavitated) or sealing versus no treatment (OR 0.05, 95% CI 0.00 to 2.71; 2 studies, 103 permanent teeth, non-cavitated), but we assessed all as very low-certainty evidence. HT, CR, SE, NRCC for cavitated, but not deep lesions in primary teeth The odds of failure may be higher for CR than HT (OR 8.35, 95% CI 3.73 to 18.68; 2 studies, 249 teeth; low-certainty evidence) and lower for HT than NRCC (OR 0.19, 95% CI 0.05 to 0.74; 1 study, 84 teeth, very low-certainty evidence). There was insufficient evidence of a difference between SE versus HT (OR 8.94, 95% CI 0.57 to 139.67; 2 studies, 586 teeth) or CR versus NRCC (OR 1.16, 95% CI 0.50 to 2.71; 1 study, 102 teeth), both very low-certainty evidence. CR, SE, SW for deep lesions The odds of failure were higher for CR than SW in permanent teeth (OR 2.06, 95% CI 1.34 to 3.17; 3 studies, 398 teeth; moderate-certainty evidence), but not primary teeth (OR 2.43, 95% CI 0.65 to 9.12; 1 study, 63 teeth; very low-certainty evidence). The odds of failure may be higher for CR than SE in permanent teeth (OR 11.32, 95% CI 1.97 to 65.02; 2 studies, 179 teeth) and primary teeth (OR 4.43, 95% CI 1.04 to 18.77; 4 studies, 265 teeth), both very low-certainty evidence. Notably, two studies compared CR versus SE in cavitated, but not deep lesions, with insufficient evidence of a difference in outcome (OR 0.62, 95% CI 0.21 to 1.88; 204 teeth; very low-certainty evidence). The odds of failure were higher for SW than SE in permanent teeth (OR 2.25, 95% CI 1.33 to 3.82; 3 studies, 371 teeth; moderate-certainty evidence), but not primary teeth (OR 2.05, 95% CI 0.49 to 8.62; 2 studies, 126 teeth; very low-certainty evidence). For deep lesions, a network meta-analysis showed the probability of failure to be greatest for CR compared with SE, SW and HT. AUTHORS' CONCLUSIONS: Compared with CR, there were lower numbers of failures with HT and SE in the primary dentition, and with SE and SW in the permanent dentition. Most studies showed high risk of bias and limited precision of estimates due to small sample size and typically limited numbers of failures, resulting in assessments of low or very low certainty of evidence for most comparisons.

TRA associado ou não ao Brix3000, tendências mundiais e o conhecimento sobre técnicas de mínima intervenção para o controle da cárie dentária / ART associated or not with Brix3000, world trends and knowledge of minimal interventional dentistry for the control of dental caries

A presente dissertação foi dividida em três estudos: o primeiro avaliou o Tratamento Restaurador Atraumático (TRA) associado ou não ao Brix3000™ quanto ao tempo de tratamento, experiência de dor e aceitabilidade de crianças (n=20) de 3-9 anos em um ensaio clínico controlado e randomizado. O tempo foi cronometrado do início ao fim do tratamento. A experiência de dor foi avaliada pela versão revisada da escala "Face, Legs, Activity, Cry, Consolability" (FLACC-r) e a aceitabilidade por uma escala facial hedônica. O grupo TRA + Brix3000™ gastou 4 minutos a mais (13,14±4,0 min) que o grupo TRA (9,8±2,7 min) (p=0,03). Não houve diferença quanto à aceitabilidade e à dor (p>0,05). O segundo estudo caracterizou a literatura científica mundial sobre produtos de remoção químico-mecânica de tecido cariado (RQMTC), por meio de mineração de dados bibliométricos, metodológicos e dos resultados de 397 artigos. Houve maior número de publicações entre 2011-2020, no Journal of Dental Research, desenvolvidos no Brasil e Índia. Estudos in vitro foram mais prevalentes, seguidos dos estudos clínicos. Nestes últimos, Carisolv™e Papacarie™ foram os produtos mais utilizados, prescritos para uso isolado e comparados ao uso de brocas. Os produtos para RQMTC foram mais estudados em crianças, cujos dentes foram restaurados com o cimento de ionômero de vidro, nos quais o tempo gasto e dor foram os principais desfechos. Observou-se que a RQMTC demanda maior tempo, entretanto, promove redução de ansiedade, dor e necessidade de anestesia local. O estudo 3 avaliou o conhecimento de dentistas brasileiros sobre odontologia de mínima intervenção (OMI) pelo desenvolvimento, validação e aplicação de uma escala de conhecimento (Minimal Interventional Dentistry for Dental Caries Knewlodge Scale - MIDDeC-KS), de 12 itens (0-12 pontos). Quanto maior a pontuação, maior o conhecimento do dentista. Dados sociodemográficos e de formação acadêmica foram coletados. A escala (α=0,72; ICC=0,85) foi aplicada por meio da plataforma Survey Monkey™ a 637 dentistas que demostraram ter conhecimento médio de 7,4±2,5 sobre OMI. As maiores pontuações foram alcançadas por mulheres (7,8±2,4; p=0,00); profissionais com mais de 10 anos de formados (7,6±2,6; p=0,02); emfaculdades públicas (7,8±2,4; p=0,00), atuando no setor público (7,9±2,3; p=0,00) ou acadêmico (8,8±2,3; p=0,04). Pontuações maiores foram alcançadas por especialistas em Odontopediatria (9,2±1,6) e menores por Cirurgiões buco-maxilo-faciais (3,1±2,1). Houve maior conhecimento sobre controle de dieta, biofilme e aplicação tópica de flúor. Técnica de Hall, infiltrante resinoso e RQMTC foram as técnicas menos conhecidas. Com a presente dissertação, concluiu-se que o TRA associado ao Brix3000™ demandou mais tempo de tratamento, sem diferença quanto à aceitabilidade e à dor. Os estudos com produtos para RQMTC aumentaram ao longo dos anos, principalmente em países em desenvolvimento. Os estudos clínicos com crianças tendem a avaliar o tempo gasto e a dor em comparação ao uso de brocas e, a RQMTC reduz ansiedade, dor e necessidade de anestesia, embora aumente o tempo de tratamento. Foi constatada suficiente evidência psicométrica da escala MIDDeC-KS. As maiores pontuações foram alcançadas por profissionais do gênero feminino e especialistas em Odontopediatria, com maior conhecimento sobre controle de dieta, biofilme e aplicação tópica de flúor. (AU)

This dissertation was divided into three studies: the first evaluated the Atraumatic Restorative Treatment (ART) associated or not with Brix3000 ™ in terms of treatment time, pain experience and acceptability of children (n=20) aged 3-9 years through a randomized controlled clinical trial. The time was calculated from the beginning to the end of the treatment. Pain experience was assessed by the revised version of the "Face, Legs, Activity, Chy, Consolability" (FLACC-r) scale and acceptability by a hedonic facial scale. The ART + Brix3000 ™ group spent 4 minutes longer (13.14±4.0 min) than the ART group (9.8±2.7 min) (p=0.03). There was no difference regarding acceptability and pain (p>0.05). The second study characterized the world scientific literature on chemical-mechanical carious tissue removal (CMCTR) products, through bibliometric, methodological and results data mining of the 397 articles. There was a greater number of publications between 2011-2020, in the Journal of Dental Research, which were developed in Brazil and India. In vitro studies were more prevalent, followed by clinical studies. In the latter, Carisolv ™ and Papacarie ™ were the most used products prescribed for isolated use and compared to the use of drills. CMCTR products have been most studied in children whose teeth were restored with glass ionomer cement, in which time spent and pain were the main outcomes. Clinical application of CMCTR takes more treatment time but can also reduce patient anxiety, pain and need for anesthesia Study 3 assessed the knowledge of Brazilian dentists about minimal intervention dentistry (MID) through the development, validation, and application of a 12-item (0-12 points) knowledge scale (Minimal Interventional Dentistry for Dental Caries Knewlodge Scale - MIDDeC-KS). The higher the score, the greater the knowledge of the dentist. Gender, educational level, specialty, academic training institutions and workplace were collected. The final scale (α=0.72; ICC=0.85) was applied through the Survey Monkey™ platform to 637 dentists who demonstrated an average knowledge of 7.4±2.5 about MID. The highest scores were achieved by women (7.8±2.4; p=0.00); professionals with more than 10 years of graduation (7.6±2.6; p=0.02); in public colleges (7.8±2.4; p=0.00), working in the public sector (7.9±2.3; p=0.00) or academic (8.8±2.3; p =0.04). Higher scores were achieved by specialists in Pediatric Dentistry (9.2±1.6) and lowest by maxillofacial surgeons (3.1±2.1). There was greater knowledge about diet and biofilm control, as well as topical application of fluoride. Hall technique, resin infiltration and CMCTR were the least known MID techniques. With the present master thesis, it was concluded that ART associated with Brix3000™ required more treatment time, with no difference in terms of acceptability and pain. Studies with products for CMCTR have increased over the years, mainly in developing countries. The clinical studies with children tend to assess the time spent and pain compared to the use of drills. CMCR clinical application reduces anxiety, pain and need for anesthesia, despite increase treatments' time Sufficient psychometric evidence of the MIDDeC-KS scale was observed. The highest scores were achieved by women, specialists in Pediatric Dentistry, with more knowledge about diet control, biofilm, and topical fluoride application. (AU)

TRA associado ou não ao Brix3000, tendências mundiais e o conhecimento sobre técnicas de mínima intervenção para o controle da cárie dentária / ART associated or not with Brix3000, world trends and knowledge of minimal interventional dentistry for the control of dental caries

A presente dissertação foi dividida em três estudos: o primeiro avaliou o Tratamento Restaurador Atraumático (TRA) associado ou não ao Brix3000™ quanto ao tempo de tratamento, experiência de dor e aceitabilidade de crianças (n=20) de 3-9 anos em um ensaio clínico controlado e randomizado. O tempo foi cronometrado do início ao fim do tratamento. A experiência de dor foi avaliada pela versão revisada da escala "Face, Legs, Activity, Cry, Consolability" (FLACC-r) e a aceitabilidade por uma escala facial hedônica. O grupo TRA + Brix3000™ gastou 4 minutos a mais (13,14±4,0 min) que o grupo TRA (9,8±2,7 min) (p=0,03). Não houve diferença quanto à aceitabilidade e à dor (p>0,05). O segundo estudo caracterizou a literatura científica mundial sobre produtos de remoção químico-mecânica de tecido cariado (RQMTC), por meio de mineração de dados bibliométricos, metodológicos e dos resultados de 397 artigos. Houve maior número de publicações entre 2011- 2020, no Journal of Dental Research, desenvolvidos no Brasil e Índia. Estudos in vitro foram mais prevalentes, seguidos dos estudos clínicos. Nestes últimos, Carisolv™ e Papacarie™ foram os produtos mais utilizados, prescritos para uso isolado e comparados ao uso de brocas. Os produtos para RQMTC foram mais estudados em crianças, cujos dentes foram restaurados com o cimento de ionômero de vidro, nos quais o tempo gasto e dor foram os principais desfechos. Observou-se que a RQMTC demanda maior tempo, entretanto, promove redução de ansiedade, dor e necessidade de anestesia local. O estudo 3 avaliou o conhecimento de dentistas brasileiros sobre odontologia de mínima intervenção (OMI) pelo desenvolvimento, validação e aplicação de uma escala de conhecimento (Minimal Interventional Dentistry for Dental Caries Knewlodge Scale - MIDDeC-KS), de 12 itens (0-12 pontos). Quanto maior a pontuação, maior o conhecimento do dentista. Dados sociodemográficos e de formação acadêmica foram coletados. A escala (α=0,72; ICC=0,85) foi aplicada por meio da plataforma Survey Monkey™ a 637 dentistas que demostraram ter conhecimento médio de 7,4±2,5 sobre OMI. As maiores pontuações foram alcançadas por mulheres (7,8±2,4; p=0,00); profissionais com mais de 10 anos de formados (7,6±2,6; p=0,02); em faculdades públicas (7,8±2,4; p=0,00), atuando no setor público (7,9±2,3; p=0,00) ou acadêmico (8,8±2,3; p=0,04). Pontuações maiores foram alcançadas por especialistas em Odontopediatria (9,2±1,6) e menores por Cirurgiões buco-maxilo-faciais (3,1±2,1). Houve maior conhecimento sobre controle de dieta, biofilme e aplicação tópica de flúor. Técnica de Hall, infiltrante resinoso e RQMTC foram as técnicas menos conhecidas. Com a presente dissertação, concluiu-se que o TRA associado ao Brix3000™ demandou mais tempo de tratamento, sem diferença quanto à aceitabilidade e à dor. Os estudos com produtos para RQMTC aumentaram ao longo dos anos, principalmente em países em desenvolvimento. Os estudos clínicos com crianças tendem a avaliar o tempo gasto e a dor em comparação ao uso de brocas e, a RQMTC reduz ansiedade, dor e necessidade de anestesia, embora aumente o tempo de tratamento. Foi constatada suficiente evidência psicométrica da escala MIDDeC-KS. As maiores pontuações foram alcançadas por profissionais do gênero feminino e especialistas em Odontopediatria, com maior conhecimento sobre controle de dieta, biofilme e aplicação tópica de flúor. (AU)

This dissertation was divided into three studies: the first evaluated the Atraumatic Restorative Treatment (ART) associated or not with Brix3000 ™ in terms of treatment time, pain experience and acceptability of children (n=20) aged 3-9 years through a randomized controlled clinical trial. The time was calculated from the beginning to the end of the treatment. Pain experience was assessed by the revised version of the "Face, Legs, Activity, Chy, Consolability" (FLACC-r) scale and acceptability by a hedonic facial scale. The ART + Brix3000 ™ group spent 4 minutes longer (13.14±4.0 min) than the ART group (9.8±2.7 min) (p=0.03). There was no difference regarding acceptability and pain (p>0.05). The second study characterized the world scientific literature on chemical-mechanical carious tissue removal (CMCTR) products, through bibliometric, methodological and results data mining of the 397 articles. There was a greater number of publications between 2011-2020, in the Journal of Dental Research, which were developed in Brazil and India. In vitro studies were more prevalent, followed by clinical studies. In the latter, Carisolv ™ and Papacarie ™ were the most used products prescribed for isolated use and compared to the use of drills. CMCTR products have been most studied in children whose teeth were restored with glass ionomer cement, in which time spent and pain were the main outcomes. Clinical application of CMCTR takes more treatment time but can also reduce patient anxiety, pain and need for anesthesia Study 3 assessed the knowledge of Brazilian dentists about minimal intervention dentistry (MID) through the development, validation, and application of a 12-item (0-12 points) knowledge scale (Minimal Interventional Dentistry for Dental Caries Knewlodge Scale - MIDDeC-KS). The higher the score, the greater the knowledge of the dentist. Gender, educational level, specialty, academic training institutions and workplace were collected. The final scale (α=0.72; ICC=0.85) was applied through the Survey Monkey™ platform to 637 dentists who demonstrated an average knowledge of 7.4±2.5 about MID. The highest scores were achieved by women (7.8±2.4; p=0.00); professionals with more than 10 years of graduation (7.6±2.6; p=0.02); in public colleges (7.8±2.4; p=0.00), working in the public sector (7.9±2.3; p=0.00) or academic (8.8±2.3; p =0.04). Higher scores were achieved by specialists in Pediatric Dentistry (9.2±1.6) and lowest by maxillofacial surgeons (3.1±2.1). There was greater knowledge about diet and biofilm control, as well as topical application of fluoride. Hall technique, resin infiltration and CMCTR were the least known MID techniques. With the present master thesis, it was concluded that ART associated with Brix3000™ required more treatment time, with no difference in terms of acceptability and pain. Studies with products for CMCTR have increased over the years, mainly in developing countries. The clinical studies with children tend to assess the time spent and pain compared to the use of drills. CMCR clinical application reduces anxiety, pain and need for anesthesia, despite increase treatments' time Sufficient psychometric evidence of the MIDDeC-KS scale was observed. The highest scores were achieved by women, specialists in Pediatric Dentistry, with more knowledge about diet control, biofilm, and topical fluoride application. (AU)

Silver diamine fluoride compared to atraumatic restorative technique for the treatment of caries in primary and mixed first phase dentition. / Fluoruro diamino de plata comparado con técnica de restauración atraumática para el tratamiento de caries cavitadas en dentición primaria y mixta primera fase.

INTRODUCTION: Cavitated carious lesions in primary and mixed dentition require prompt treatment to control caries progression. Silver diamine fluoride has emerged as an alternative to the atraumatic restorative technique due to its easy application. However, there is still uncertainty regarding its effectiveness and safety. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a metanalysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified ten systematic reviews, including two studies overall, which are randomized trials. We concluded that silver diamine fluoride compared to the atraumatic restorative technique may increase the arrest of caries in primary and mixed first phase dentition, however, the certainty of the evidence has been assessed as low. On the other hand, treatment with silver diamine fluoride compared to the atraumatic restorative technique (ART) probably increases the risk of adverse events.

INTRODUCCIÓN: Las lesiones de caries cavitadas en dentición primaria y mixta requieren un tratamiento oportuno, para evitar así la progresión de la caries. El fluoruro diamino de plata ha surgido como una alternativa a la técnica de restauración atraumática debido a su fácil aplicación. Sin embargo, aún existe incertidumbre en relación a su efectividad y seguridad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos diez revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, ambos ensayos aleatorizados. Concluimos que el fluoruro diamino de plata en comparación a la técnica de restauración atraumática podría aumentar el arresto de caries en dentición primaria y mixta primera fase, pero la certeza de la evidencia ha sido evaluada como baja. Por otra parte, el tratamiento con fluoruro diamino de plata comparado con la técnica de restauración atraumática (ART) probablemente aumenta el riesgo de eventos adversos.

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.

Does low-cost GIC have the same survival rate as high-viscosity GIC in atraumatic restorative treatments? A RCT.

Atraumatic Restorative Treatment (ART) is one of the strategies used to control dental caries; it involves hand instruments for removal of carious tissue, and restorations using high-viscosity Glass Ionomer Cement (GIC). The present controlled clinical trial aimed to evaluate the performance of low-cost GIC indicated for ART in primary teeth, compared with high-viscosity GIC, after one year of follow-up. Two-to six-year-old children with dentin caries lesions on one or two surfaces of anterior and posterior teeth were selected. The children were randomly assigned to 2 groups according to the restorative material used: G1 (control) - Ketac Molar®; G2 (experimental) - Vitro Molar®. Treatments were performed in a school setting, following the guidelines of the ART. A total of 728 restorations were performed in 243 children. Descriptive analysis and Poisson regression were applied, with a significance level of p < 0.05. After 12 months, 559 (76.8%) restorations were re-evaluated. The success rate was evaluated by the prevalence ratio (PR), associated with restorations performed in primary second molars (PR = 1.21; 95%CI = 1.03-1.42), and with small (PR = 1.35; 95%CI = 1.14-1.60) or medium cavities (PR = 1.29; 95%CI = 1.08-1.55), using Ketac Molar® material (PR= 1.07; 95%CI = 1.01-1.15), considering p < 0.05. Small or medium restorations in primary second molars performed with high-viscosity GIC (Ketac Molar®) were more successful than restorations performed with low-cost GIC indicated for ART.

Fluoruro diamino de plata comparado con técnica de restauración atraumática para el tratamiento de caries cavitadas en dentición primaria y mixta primera fase / Silver diamine fluoride compared to atraumatic restorative technique for the treatment of caries in primary and mixed first phase dentition

INTRODUCCIÓN: Las lesiones de caries cavitadas en dentición primaria y mixta requieren un tratamiento oportuno, para evitar así la progresión de la caries. El fluoruro diamino de plata ha surgido como una alternativa a la técnica de restauración atraumática debido a su fácil aplicación. Sin embargo, aún existe incertidumbre en relación a su efectividad y seguridad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos diez revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, ambos ensayos aleatorizados. Concluimos que el fluoruro diamino de plata en comparación a la técnica de restauración atraumática podría aumentar el arresto de caries en dentición primaria y mixta primera fase, pero la certeza de la evidencia ha sido evaluada como baja. Por otra parte, el tratamiento con fluoruro diamino de plata comparado con la técnica de restauración atraumática (ART) probablemente aumenta el riesgo de eventos adversos

INTRODUCTION: Cavitated carious lesions in primary and mixed dentition require prompt treatment to control caries progression. Silver diamine fluoride has emerged as an alternative to the atraumatic restorative technique due to its easy application. However, there is still uncertainty regarding its effectiveness and safety. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a metanalysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified ten systematic reviews, including two studies overall, which are randomized trials. We concluded that silver diamine fluoride compared to the atraumatic restorative technique may increase the arrest of caries in primary and mixed first phase dentition, however, the certainty of the evidence has been assessed as low. On the other hand, treatment with silver diamine fluoride compared to the atraumatic restorative technique (ART) probably increases the risk of adverse events.

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.

Eficácia do diamino fluoreto de prata em paralisar lesões de cárie em dentina: ensaios laboratorial e clínico controlado e randomizado / Efficacy of silver diamine fluoride in arresting dentin caries lesions: controlled randomized clinical tria

Este estudo objetivou: (1) investigar a eficácia in vitro do diamino fluoreto de prata (DFP) em paralisar lesões de cárie em dentina após diferentes concentrações e tempos de aplicação; (2) comparar o impacto do DFP e do tratamento restaurador atraumático (TRA) na qualidade de vida relacionada à saúde bucal (QVRSB) de préescolares; e (3) avaliar a eficácia do DFP comparado ao TRA, em paralisar lesões de cárie, por meio de um ensaio clínico controlado e randomizado após 2 anos de acompanhamento. Para o objetivo 1, blocos de dentina (n=42) foram fixados em placas de poliestireno. Um inóculo bacteriano misto (1,5x108 UFC/mL) foi adicionado ao meio de cultura com sacarose 5%, contido nas placas, que foram incubadas para a formação de biofilme. As amostras foram escaneadas em micro CT (M1) e tratadas com DFP de acordo com os grupos (n=6): DFP 30%, aplicação imediata; DFP 30%, 1'; DFP 30%, 3'; DFP 38%, aplicação imediata; DFP 38%, 1'; DFP 38%, 3'. Um grupo controle, sem tratamento, também foi preparado. Após o escaneamento (M2), os blocos foram submetidos a um desafio cariogênico (21 dias) e novamente escaneados (M3). O pH do meio de cultura e a profundidade das lesões inter e intra grupos foram comparados pelos testes de Kruskal-Wallis e Wilcoxon. Para os objetivos 2 e 3, préescolares com ao menos uma lesão de cárie ativa na oclusal de seus molares decíduos foram randomicamente alocados em dois grupos: DFP e TRA. Os índicesceo-d/CPO-DICDAS foram usados para detecção da presença e atividade de cárie. O B-ECOHIS foi usado para avaliar a QVRSB antes (M1), 15 dias (M2) e 3 meses (M3) após os tratamentos. O sucesso clínico foi avaliado após 6, 12, 18 e 24 meses. Foram ainda avaliados: tempo do procedimento, efeitos adversos/percepção estética e ansiedade. No estudo in vitro, em M1 e M2, não houve diferença na profundidade das lesões entre os grupos (p>0,05). Em M3, o DFP 38% apresentou menor pH do biofilme e os grupos que receberam aplicação por 1' e 3', em ambas as concentrações, não apresentaram aumento na profundidade da lesão em relação ao M1. DFP e TRA não diferiram quanto ao B-ECOHIS total, CIS e FIS em M2 e M3 e o B-ECOHIS total diminuiu de M1 para M2 e M3 em ambos os grupos (p<0,05). Após 2 anos, não houve diferença entre os tratamentos quanto à paralisação da cárie (p=0,072) e o tempo de tratamento para o DFP foi menor (p<0,001). Não houve diferença entre os grupos quanto aos efeitos adversos/percepção estética observados pelo operador (p=0,816) e pelos pais (p=1,000). A ansiedade não mudou após os tratamentos (p=0,583). Assim, o tempo mínimo de aplicação do DFP 30% para paralisar lesões de cárie foi de 1', enquanto o 38% paralisou com aplicação imediata, in vitro. Tanto o DFP quanto TRA melhoraram a QVRSB dos pré-escolares, sem diferença entre eles. Ainda, o DFP mostrou-se semelhante ao TRA na paralisação de cárie, ansiedade e efeitos adversos, requerendo menor tempo de cadeira. (AU)

This study aimed to: (1) investigate the in vitro efficacy of silver diamine fluoride (SDF) in arresting dentin caries lesions after different concentrations and application times; (2) compare the impact of SDF and atraumatic restorative treatment (ART) on the oral health-related quality of life (QHRQoL) in preschoolers; and (3) to evaluate the effectiveness of SDF compared to ART, in arresting caries lesions, through a controlled randomized clinical trial after 2 years of follow-up. For objective 1, dentin blocks (n=42) were fixed in polystyrene plates. A mixed bacterial inoculum (1.5x108 CFU/mL) was added to the culture medium with 5% sucrose, in the plates; that were incubated for biofilm formation. The samples were scanned on micro CT (M1) and treated with SDF according to the groups (n=6): SDF 30%, immediate application; SDF 30%, 1'; SDF 30%, 3'; SDF 38%, immediate application; SDF 38%, 1'; SDF 38%, 3'. A control group, without treatment, was also prepared. After scanning (M2), the blocks were submitted to a cariogenic challenge (21 days) and scanned again (M3). The pH of the culture medium and the depth of lesions between and within the groups were compared using the Kruskal-Wallis and Wilcoxon tests. For objectives 2 and 3, preschoolers with at least one active caries lesion on the occlusal surface of their primary molars were randomly allocated into two groups: SDF and ART. The indexes dmft/DMFT and ICDAS were used to detect the presence and activity of caries. B-ECOHIS was used to assess the QHRQoL of children before (M1), 15 days (M2) and 3 months (M3) after treatments. Clinical success was assessed after 6, 12, 18 and 24 months. Were also evaluated: time of the procedure, adverse effects/aesthetic perception and the child's anxiety. In the in vitro study, in M1 and M2, there was no difference in the depth of the lesions between the groups (p>0.05). In M3, SDF 38% had a lower pH of the biofilm and the groups that received application for 1' and 3', in both concentrations, did not present an increase in the depth of the lesion in relation to M1. SDF and ART did not differ in total B-ECOHIS, CIS and FIS in M2 and M3; and the total B-ECOHIS decreased from M1 to M2 and M3 for both groups (p<0.05). After 2 years, there was no difference between treatments regarding caries arrest (p=0.072) and the treatment time for SDF was shorter (p<0.001). There was no difference regarding the adverse effects/aesthetic perception observed by the operator (p=0.816) and reported by the parents (p=1.000), according to the groups. Anxiety did not change either before or after treatments (p=0.583). Thus, the minimum time of application of SDF 30% to arrest dentin caries was 1', while SDF 38% arrested with immediate application, in vitro. Both SDF and ART improved the QHRQoL of preschoolers, with no difference between them. Still, SDF was similar to ART in arresting caries, anxiety and adverse effects, requiring less chair time. (AU)

High-viscosity glass-ionomer vs. composite resin restorations in persons with disability: Five-year follow-up of clinical trial.

The aim of this clinical trial was to compare the 5-year cumulative survival of atraumatic restorative treatment restorations using high-viscosity glass-ionomer restorations (ART/HVGIC) and conventional resin composite restorations (CRT) placed in patients with intellectual and/or physical disability. Patients referred for restorative care to a special care service in Córdoba, Argentina, were recruited. Patients and/or caregivers were provided with written and verbal information regarding treatment options and selected the alternative they preferred. The treatment protocols were ART (hand instruments/HVGIC) in the clinic or CRT (rotary instrumentation/resin composite) in the clinic or under general anaesthesia (GA). Two independent, trained and calibrated examiners evaluated restoration survival using established ART codes after 6, 12, 24, 36 and 60 months. The proportional hazard model with frailty corrections provided survival estimates. Jackknife errors were used to test 5-year results. Sixty-six patients (13.6 ± 7.8 years) with 16 different medical conditions participated. CRT in the clinic proved feasible for five patients (13%), and 14 patients received CRT under GA (21%). ART was provided for 47 patients (71.2%). A total number of 298 dentine carious lesions were restored in primary and permanent teeth (182 ART; 116 CRT). Four patients died between the 3 and 5-year follow up. Percentage survival and jackknife standard error were calculated and were significantly higher for all ART/HVGIC restorations (90.2% ± 2.6) than for all CRT restorations (82.8% ± 5.3), 5 years after placement (p=0.044). These 5-year follow-up results confirm that ART/HVGIC is an effective treatment protocol for patients with disability, equal to that of conventional resin composite restoration. The results of this clinical trial support the use of ART as an evidence-based treatment resource contributing to the reduction of inequalities in access to oral health care among people with disability.

Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment on dentine caries arrestment in primary molars of preschool children: A 12-months parallel randomized controlled clinical trial.

OBJECTIVES: This clinical trial investigated the efficacy of silver diamine fluoride (SDF) in arresting dentine caries in primary molars of preschoolers. Time required for treatment, adverse effects, parental aesthetic perception, anxiety and oral health related to quality of life (OHRQoL) was evaluated. MATERIALS AND METHODS: Children, 2-5 years old, with active dentine caries lesions on the occlusal surface of primary molars were randomly allocated to test group (SDF) or control group (atraumatic restorative treatment/ART). The dmf-t/DMF-T and ICDAS indexes determined the presence of caries and activity. The main outcome after 3, 6 and 12-month follow-up was assessed by a blind examiner. The time required to perform the treatments was recorded and a facial image scale was applied to assess anxiety before and after treatment. Adverse events and aesthetic perception were assessed through questions addressed to caregivers; and the OHRQoL through the B-ECOHIS questionnaire. RESULTS: In 68 patients that were randomized, the mean number of treated teeth per child was 2.42(1.04) and 2.09(1.18) in the SDF and ART groups (p = 0.074), respectively. The mean difference of arrested lesions between the groups after 12 months was -0,07(0.05; - 0.17-0.30). The time required to treat with SDF was lower than the ART (p < 0.001). There was no difference in the percentage of adverse events + aesthetic perception (p = 0.709), and the change in anxiety (p = 0.155). There was a less impact in OHRQoL after ART treatment, but only when the parents' distress subscale was considered (p = 0.012). CONCLUSION: SDF requires much less chair-time and have similar results as ART in arresting caries lesion, anxiety, adverse effects, aesthetic perception and quality of life.

Does low-cost GIC have the same survival rate as high-viscosity GIC in atraumatic restorative treatments? A RCT

Abstract Atraumatic Restorative Treatment (ART) is one of the strategies used to control dental caries; it involves hand instruments for removal of carious tissue, and restorations using high-viscosity Glass Ionomer Cement (GIC). The present controlled clinical trial aimed to evaluate the performance of low-cost GIC indicated for ART in primary teeth, compared with high-viscosity GIC, after one year of follow-up. Two-to six-year-old children with dentin caries lesions on one or two surfaces of anterior and posterior teeth were selected. The children were randomly assigned to 2 groups according to the restorative material used: G1 (control) - Ketac Molar®; G2 (experimental) - Vitro Molar®. Treatments were performed in a school setting, following the guidelines of the ART. A total of 728 restorations were performed in 243 children. Descriptive analysis and Poisson regression were applied, with a significance level of p < 0.05. After 12 months, 559 (76.8%) restorations were re-evaluated. The success rate was evaluated by the prevalence ratio (PR), associated with restorations performed in primary second molars (PR = 1.21; 95%CI = 1.03-1.42), and with small (PR = 1.35; 95%CI = 1.14-1.60) or medium cavities (PR = 1.29; 95%CI = 1.08-1.55), using Ketac Molar® material (PR= 1.07; 95%CI = 1.01-1.15), considering p < 0.05. Small or medium restorations in primary second molars performed with high-viscosity GIC (Ketac Molar®) were more successful than restorations performed with low-cost GIC indicated for ART.

Selective carious tissue removal using subjective criteria or polymer bur: study protocol for a randomised controlled trial (SelecCT).

INTRODUCTION: Selective (incomplete/partial) carious tissue removal is suitable for treating deep carious lesions in teeth with vital, asymptomatic pulps. In the periphery of a cavity, removal to hard dentin is performed, while in pulpo-proximal areas, leathery or soft dentin is left to avoid pulp exposure. As the decision of what contains 'soft' or 'leathery' dentin is subjective, using self-limiting burs which help to standardise the hardness of the remaining dentin, has been suggested to increase the reliability of carious tissue removal. The trial compares subjectively measured selective carious tissue removal in deep lesions in primary teeth with objectively measured selective removal with a self-limiting bur (Polybur, Komet). METHODS AND ANALYSIS: A community-based single-blind clustered randomised controlled superiority trial nested into a larger evaluation is performed. Recruitment for this trial has been concluded. We have recruited 115 children aged 6-8 years with ≥1 vital primary molar with a deep dentin lesion. The unit of randomisation was the child, with all eligible molars per child treated identically. Treatment was performed in a mobile dental unit. Subjective and objective carious tissue removal was performed at random. Teeth were restored using glass ionomer cement (Equia Forte, GC). Our primary outcome will be the time until complications occur, evaluated via multilevel survival analysis. Secondary outcomes will be the time until extraction is needed, subjective satisfaction of the child with the treatment (measured using a Likert scale) and cost-effectiveness. Re-examination will be performed after 12, 24 and 36 months (the final examination is expected in 2020). ETHICS AND DISSEMINATION: This trial has been approved by the Ethics Committee of the Health Sciences of the University of Brasília (CAAE 51310415.0.0000.0030). Trial results will be published in peer-reviewed journals and presented on conferences. TRIAL REGISTRATION NUMBER: NCT02754466.

Clinical wear of approximal glass ionomer restorations protected with a nanofilled self-adhesive light-cured protective coating.

OBJECTIVE: High viscous glass ionomer cement (GIC) has gained popularity as a restorative material; however, high wear is pointed as one of the major drawbacks of this material. Protective surface coatings were developed to protect GIC from water contamination with the additional advantage of occluding any surface cracks or porosities commonly found in this material, possibly resulting in an increased wear resistance of the restorations. The objective of this study was to investigate the clinical wear of GIC approximal restorations in primary molars protected either with a nanofilled self-adhesive light-cured protective coating (NPC) or with petroleum jelly. MATERIAL AND METHODS: Approximal caries lesions in primary molars from 32 schoolchildren previously enrolled in another clinical trial were included in this investigation. GIC restorations were performed according to the Atraumatic Restorative Treatment approach and protected with either petroleum jelly or a NPC. Impressions of the restored hemiarch were done after 1 day and 6, 12, 24 and 36 months. The impressions were scanned in a 3-D appliance and the obtained images were superimposed using an appropriate computer software. Two-way ANOVA for repeated measures and Tukey's post-hoc test were used to analyze the wear of restorations (α=5%). RESULTS: A significant difference was found between the two groups, with a wear protection offered by the application of a NPC. Conclusion: These results suggest that the application of a NPC has a protective effect on the clinical wear of approximal GIC restorations in primary teeth.