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1.
Acta Odontol Scand ; 78(1): 6-12, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31267814

RESUMO

Aim: To describe the distribution of enamel-, dentin-, root- and secondary caries within an elderly population in Northern-Norway.Material and methods: A study population (n = 1 173) was divided into age groups: 65-69 (seniors), 70-74 (young elderly), 75-79 (elderly) and 80-94 (old elderly). Seven examiners registered presence, location and severity of caries lesions on x-rays and intra-oral photos. Severity of approximal, occlusal, secondary and root caries was graded (D1-2: into enamel; D3-5: into dentin, root caries), and decayed missing filled surfaces/teeth (DMFS/DMFT) were calculated. T-test, ANOVA and a Bonferroni correction were used.Results: The seniors had more primary caries (DS1-5) compared to the oldest age groups, while the old elderly had significantly more secondary caries than the other groups (p < .05). Of those ≥65 years 13.8% were affected with root caries, 21% among the oldest. About 48% of the old elderly had one or more surfaces with untreated caries lesions into dentin, while for the other groups the number was 35% (p < 0.05).Conclusion: Individuals seem to maintain good oral health up to at least 80 years of age. Those older than 80 years have more root caries needing more intensified caries-controlling measures and a higher prevalence of untreated dentin lesions often in need of operative treatment.


Assuntos
Esmalte Dentário , Idoso , Idoso de 80 Anos ou mais , Índice CPO , Cárie Dentária/epidemiologia , Esmalte Dentário/patologia , Dentina/patologia , Feminino , Humanos , Masculino , Noruega/epidemiologia , Prevalência
2.
Niger J Clin Pract ; 22(11): 1576-1582, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31719280

RESUMO

Aims: To evaluate the diagnostic abilities of near-infrared light transillumination (using the DIAGNOcam) and bitewing radiographs in detecting cavitated proximal carious lesions in primary molars. Subjects and Methods: The study was a cross-sectional analytical, clinical study. The proximal surfaces of primary molars of healthy 5- to 8-year-old children were radiographically screened for the presence of carious lesions in the enamel or outer third of dentin (D1). Two trained and calibrated examiners evaluated the depth of caries in bitewing radiographs and DIAGNOcam images and then verified the presence of cavitation by direct visual examination using the "International Caries Detection and Assessment System" after temporary tooth separation. Results: A total of 236 proximal lesions were included in the study. Most of the clinically cavitated lesions (51.9%) were D1 radiographically and in outer dentin lesions (scores 3 and 4) by the DIAGNOcam (37% and 48.1%, respectively). Although DIAGNOcam showed higher sensitivity (0.852) compared to the radiographs (0.519), it showed slightly less specificity (0.569) compared to the radiographs (0.579). However, DIAGNOcam showed higher value of the area under the curve (AUC = 0.722; P < 0.001) compared to the radiographic method (AUC = 0.561; P = 0.308). Conclusions: The DIAGNOcam showed higher sensitivity and better accuracy than bitewing radiographs in diagnosing cavitated proximal lesions in primary molars and can be generally considered as an alternative to radiographs to detect cavitation without the hazards of ionizing radiation in children.


Assuntos
Cárie Dentária/diagnóstico , Microrradiografia/instrumentação , Microrradiografia/métodos , Radiografia Interproximal/métodos , Radiografia Dentária/métodos , Dente Decíduo/diagnóstico por imagem , Transiluminação , Criança , Pré-Escolar , Estudos Transversais , Cárie Dentária/patologia , Esmalte Dentário/diagnóstico por imagem , Esmalte Dentário/patologia , Dentina/diagnóstico por imagem , Dentina/patologia , Feminino , Humanos , Masculino , Dente Molar/patologia , Radiografia Dentária Digital , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
3.
Acta Odontol Latinoam ; 32(2): 75-78, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31664297

RESUMO

The aim of the present study was to identify the characteristics and severity of tooth wear in children aged 2 to 5 years attending a kindergarten in the city of Medellin. The study population comprised 92 children aged 2 to 5 years attending a kindergarten in Medellin; the final sample included 86 children selected using a non-probabilistic sampling method. All assessments were performed using the index devised by Hansson and Nilner (1989). Prevalence of tooth wear in the studied population was 100%. The observed results confirm previous findings showing that the severity of tooth wear is proportionally related with increase in age, and is mainly due to the physiological wear of teeth. No significant differences in tooth wear facets were observed among the different types of teeth (incisors, canines, molars). It is necessary to develop validated, precise, and comparable indices that allow establishing the etiology and orienting treatment of non-physiological tooth wear.


Assuntos
Dentição Permanente , Erosão Dentária/epidemiologia , Desgaste dos Dentes/epidemiologia , Dente Decíduo , Pré-Escolar , Estudos Transversais , Dentina/patologia , Feminino , Humanos , Incisivo , Masculino , Dente Molar , Prevalência , Inquéritos e Questionários , Erosão Dentária/etiologia
4.
Clin Oral Investig ; 23(10): 3691-3703, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31444695

RESUMO

OBJECTIVES: To define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions. METHODS: Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference. RESULTS: Carious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds. CONCLUSIONS: Comprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions. CLINICAL RELEVANCE: Carious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.


Assuntos
Cárie Dentária/terapia , Esmalte Dentário/patologia , Dentina/patologia , Consenso , Técnica Delfos , Estética Dentária , Humanos
5.
J Endod ; 45(4): 442-446, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30827768

RESUMO

INTRODUCTION: The aim of this study was to investigate the influence of various apical preparation designs for surgical endodontics on stress concentrations in the mesial root of the mandibular molar under different experimental conditions using finite element analysis. METHODS: We designed 2 apical preparation groups according to whether an isthmus was present or not. Each group contained 4 subgroups according to the size of the apical preparation. We constrained the displacement of all nodes at the base of the supporting bone and applied a force of 150 N to the vertical axis. We analyzed stress generation and concentrations numerically for the groups and subgroups. RESULTS: In the subgroups, the von Mises and maximum principal stresses reduced gradually according to the enlargement of the prepared cavity. However, when the preparation extended excessively in the isthmus preparation groups, the situation reversed (ie, both von Mises and maximum principal stresses increased). CONCLUSIONS: Within the limitations of this study, the apical preparation design influenced the distribution of stress concentration. Unlike the overall pattern in which stress decreased as the amount of apical preparation increased, stress increased when the amount of residual dentin was extremely thin.


Assuntos
Preparo da Cavidade Dentária/métodos , Análise do Estresse Dentário , Endodontia , Análise de Elementos Finitos , Mandíbula , Dente Molar , Estresse Mecânico , Raiz Dentária , Modelos Dentários , Dentina/anatomia & histologia , Dentina/patologia , Dentina/cirurgia , Humanos , Raiz Dentária/anatomia & histologia , Raiz Dentária/patologia , Raiz Dentária/cirurgia
6.
Microsc Res Tech ; 82(7): 1114-1126, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30907056

RESUMO

Microenergy dispersive X-ray fluorescence (µ-EDXRF) spectroscopy and scanning electron microscopy (SEM) were used to test the hypothesis that zirconia modified glass ionomer cement (GIC) could improve resistance to erosion-abrasion to a greater extent than conventional cement. Bovine enamel (n = 40) and dentin (n = 40) samples were prepared with cavities, filled with one of the two restorative materials (GIC: glass-ionomer cement or ZrGIC: zirconia-modified GIC). Furthermore, the samples were treated with abrasion-saliva (AS) or abrasion-erosion cycles (AE). Erosive cycles (immersion in orange juice, three times/day for a duration of 1 min over a 5 day period) and/or abrasive challenges (electric toothbrush, three times/day for a duration of 1 min over a 5 day period) were performed. Positive mineral variation (MV%) on the enamel after erosion-abrasion was observed for both materials (p < 0.05), whereas a negative MV% on the dentin was observed for both materials and treatments (p < 0.05). The SEM images showed clear enamel loss after erosion-abrasion treatment and material degradation was greater in GIC_AE compared to those of the other groups. Toothbrush abrasion showed a synergistic effect with erosion on substance loss of bovine enamel, dentin, GIC, and ZrGIC restorations. Zirconia addition to the GIC powder improved the resistance to abrasive-erosive processes. The ZrGIC materials may find application as a restorative material due to improved resistance as well as in temporary restorations and fissure sealants.


Assuntos
Esmalte Dentário/efeitos dos fármacos , Dentina/efeitos dos fármacos , Cimentos de Ionômeros de Vidro/química , Teste de Materiais , Zircônio/química , Animais , Bovinos , Cárie Dentária , Dentina/patologia , Microscopia Eletrônica de Varredura , Saliva , Espectrometria por Raios X , Erosão Dentária , Escovação Dentária
7.
J Oral Sci ; 61(1): 19-24, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30726799

RESUMO

Minimally invasive treatment protocols may leave a residual layer of carious dentin, which requires treatment for the inhibition of bacterial growth beneath restorations. We aimed to examine the in vivo effect of silver diammine fluoride (SDF) and SDF + potassium iodide (KI) application on bacteria present in deep carious lesions. We studied the in vivo efficacy in five patients, each of which had five carious lesions. Dentin samples taken before and after treatment were subjected to microbial analyses. Following treatment with SDF, the median colony-forming unit (CFU) counts per mg of dentin reduced from 9 × 105 to 1.6 × 102 (P < 0.05), and following that with SDF + KI, the counts decreased from 2.9 × 105 to 9.2 × 10 (P < 0.05). The use of chlorhexidine gluconate (CHX) reduced CFU counts from 1.1 × 105 to 4.8 × 102 (P < 0.05). In four of the five patients, no CFUs were found on mitis salivarius-bacitracin agar with respect to SDF or SDF + KI application. For CHX, the median CFU count before treatment was 1.6 × 103 and that after treatment was 1.1 × 102. SDF completely inhibited mutans streptococci growth in four of the five patients, while the growth of anaerobes was not completely inhibited.


Assuntos
Amônia/uso terapêutico , Antibacterianos/uso terapêutico , Cárie Dentária/tratamento farmacológico , Cárie Dentária/microbiologia , Dentina/patologia , Fluoretos/uso terapêutico , Compostos de Prata/uso terapêutico , Amônia/química , Contagem de Colônia Microbiana , Fluoretos/química , Humanos , Compostos de Prata/química , Streptococcus mutans/efeitos dos fármacos
8.
Sensors (Basel) ; 19(4)2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30791530

RESUMO

The mineral content of dental hard tissues has traditionally been measured by destructive tests such as transverse microradiography. Microfocus X-ray computed tomography (micro CT) has enabled non-destructive 3D assessment of tooth demineralization. This study compared the preventive effects of silver diammine fluoride (SDF) and potassium iodide (KI) in comparison with fluoride varnish. SDF has been known to arrest caries but darkens the tooth. KI creates a precipitate with SDF that reduces the discoloration, but its effects on SDF efficacy in terms of preventing demineralization of at-risk root dentin surfaces is unknown. Bovine root dentin blocks were randomly distributed into four groups and subjected to a pretreatment in each group (n = 8); Control: deionized water (DIW); F-Varnish: 5% sodium fluoride varnish: 38% Saforide; SDF+KI: SDF followed by saturated solution of KI in DIW. The treated dentin was subjected to 8 cycles of demineralization (pH 5) for 14 h and remineralization in artificial saliva (pH 7) for 10 h. Specimens were then scanned for 12 min using micro CT at 73 KV and 1012 µA with 8.3 µm resolution. The 3D images were analyzed in Amira software to calculate lesion depth (LD), surface layer mineral density (SL) and mineral loss (ΔZ) for each specimen. One-way ANOVA with Bonferroni posthoc showed that there was a statistically significant difference between Control and all three other groups for all parameters (P < 0.001), however, there was no statistical difference among F-Varnish, SDF and SDF+KI (P > 0.05). Single application of F-Varnish, SDF and SDF+KI showed comparable preventive effects against root dentin demineralization. Application of KI did not affect anti-demineralization properties of SDF in this study. Micro CT is a quick and effective method for objective and high-resolution characterization of dentin caries lesions.


Assuntos
Cárie Dentária/prevenção & controle , Fluoretos Tópicos/administração & dosagem , Iodeto de Potássio/administração & dosagem , Cárie Radicular/prevenção & controle , Animais , Bovinos , Cárie Dentária/diagnóstico por imagem , Cárie Dentária/patologia , Dentina/diagnóstico por imagem , Dentina/efeitos dos fármacos , Dentina/patologia , Humanos , Cárie Radicular/diagnóstico por imagem , Cárie Radicular/patologia , Desmineralização do Dente/diagnóstico por imagem , Desmineralização do Dente/tratamento farmacológico , Raiz Dentária/diagnóstico por imagem , Raiz Dentária/efeitos dos fármacos , Raiz Dentária/patologia , Microtomografia por Raio-X
9.
Am J Phys Anthropol ; 168(4): 764-788, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30771253

RESUMO

OBJECTIVES: To compare relative response of enamel, dentin and bone to developmental stressors between attritional and catastrophic mortality assemblages of pigs. MATERIALS AND METHODS: Heads from 70 Sus scrofa of known sex, weight and age comprising an attritional sample of 50 sick pen (SP) pigs that died prematurely versus 20 control pigs slaughtered at 6 months (Catastrophic assemblage). Hard tissue changes (alveolar bone thinning), abnormal bone formation (Harris lines) and re-modeling (auditory bullae) were recorded. Areas and volumes of coronal enamel and dentin were recorded from microCT scans with Avizo 6.3 and Geomagic Wrap. RESULTS: Attritional and catastrophic assemblages are metrically indistinguishable. Ages at death and tissue measures in the SP pigs are differentially distributed, necessitating partition into developmental outcome cohorts. SP "late death" pigs are of lesser physiological maturity than expected, free of disease, with large dental tissue dimensions, comparable to "Controls". SP "early death" pigs have 5% less dentin and enamel and chronic bone infection. Older cohorts of the SP "early deaths" mortality assemblage show progressively reduced enamel. SP pigs show dental evidence of reduced bone mass in the maxilla. DISCUSSION: Bone, dentin and enamel tissues, each, respond distinctively to developmental stressors. Bone mass evinces malnutrition not disease. Both dental tissue reduction and abnormal bone formation link to chronic infection. Paradoxically, reduced dentin mass signals lower survivorship while reduced enamel signals enhanced survivorship. Meaningful comparison of Attritional and Catastrophic assemblages necessitates recognition of developmental outcome cohorts, stratified by age at death and physiological maturity, to reveal heterogeneity of survivorship, tissue measures and lesions.


Assuntos
Esmalte Dentário , Dentina , Estresse Fisiológico/fisiologia , Odontopatias , Animais , Esmalte Dentário/crescimento & desenvolvimento , Esmalte Dentário/patologia , Dentina/crescimento & desenvolvimento , Dentina/patologia , Feminino , Masculino , Sus scrofa , Suínos , Dente/crescimento & desenvolvimento , Dente/patologia , Odontopatias/patologia , Odontopatias/veterinária
10.
Clin Oral Investig ; 23(10): 3879-3883, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30693398

RESUMO

OBJECTIVE: To assess the radiographic pattern of underlying dentine shadows (UDS) in the occlusal surfaces of permanent teeth. METHODS: A total of 282 permanent posterior teeth pertaining to 91 individuals, 142 UDS and 140 non-cavitated enamel lesions (NCEL), were included for comparison. UDS was defined as shadows of discolored dentin visible through the enamel surface which may or may not show signs of localized enamel breakdown, classified as code 4 by the International Caries Detection and Assessment System group. Data collection included the application of a questionnaire, clinical examination, and bilateral bitewing radiographs. The risk for presenting radiolucency was estimated using logistic regression model with generalized estimating equations. RESULTS: Approximately 79% of UDS exhibited no radiolucency. The proportion of teeth exhibiting a radiolucency restricted to the enamel-dentin junction was 20.4% for UDS and 3.6% for NCEL (p < 0.001, chi-square test). UDS had a sixfold increased risk for exhibiting radiolucency compared with NCEL (OR = 5.78, 95% CI = 2.73-12.22, p < 0.001). Despite this finding, it is important to highlight that virtually all cases were located at the enamel-dentin junction, and only one tooth in each category of clinical status exhibited radiolucency at the outer one half of dentin. No tooth exhibited radiolucency reaching the deep dentin. CONCLUSION: The present study showed that UDS presented radiolucency in very few cases. The vast majority of lesions showed no radiolucency. CLINICAL RELEVANCE: Our findings suggest that only a small proportion of UDS would demand restorative treatment.


Assuntos
Esmalte Dentário/patologia , Dentina/patologia , Esmalte Dentário/diagnóstico por imagem , Dentina/diagnóstico por imagem , Dentição Permanente , Humanos , Radiografia Interproximal
11.
Niger J Clin Pract ; 22(1): 117-124, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30666030

RESUMO

Objective: The aim of this in-vivo study was to evaluate the long-term clinical survival of different deep dentin caries treatment options. Materials and Methods: : In total, 391 patients with at least one permanent tooth with clinically diagnosed deep dentin caries were inspected. Two hundred and fourteen patients were examined at recall visits. Inclusion criteria were teeth with deep caries lesions with pulp vitality but absence of spontaneous pain and periapical alterations. The subjects received either stepwise removal (SWR), complete caries removal (CCR), or direct pulp capping (DPC). The radiological and clinical exams were performed after a mean observation time of 62 months. Success was defined as pulp sensitivity to vitality test and absence of periapical lesions as well as a clinical symptom. Data were statistically analyzed using Kaplan-Meier and log-rank (Mantel-Cox) tests (α = 0.05). Results: Of the total 214 patients evaluated, 126 received SWR, 88 received CCR, and 67 received DPC treatment. One hundred and twenty-seven restorations were amalgam and 141 were composite. The mean observation period was 62 months. Survival rates were 85.7%, 90.9%, and 59.7% for SWR, CCR, and DPC, respectively (P = 0.001). Success rates of amalgam restorations (86.6%) were similar to composite restorations (83%), and both were found to be successful (P = 0.401). Conclusion: SWR treatment should be considered to preserve pulp vitality of deep dentin lesions instead of CCR or DPC. Clinical Relevance: SWR method for deep dentin caries management had acceptable results over 5 years.


Assuntos
Cárie Dentária/terapia , Preparo da Cavidade Dentária/métodos , Capeamento da Polpa Dentária/métodos , Restauração Dentária Permanente/métodos , Dentina/patologia , Adulto , Cárie Dentária/diagnóstico por imagem , Cárie Dentária/patologia , Materiais Dentários , Polpa Dentária/diagnóstico por imagem , Polpa Dentária/patologia , Polpa Dentária/fisiologia , Exposição da Polpa Dentária/patologia , Exposição da Polpa Dentária/prevenção & controle , Dentina/diagnóstico por imagem , Dentição Permanente , Feminino , Humanos , Masculino , Tratamento do Canal Radicular , Resultado do Tratamento
12.
Photodiagnosis Photodyn Ther ; 25: 265-270, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30611863

RESUMO

BACKGROUND: The difference in autofluorescence between enamel and dentine layer has prompted recommendations to use the quantitative light-induced fluorescence (QLF) method for quantifying tooth wear (TW). This study investigated the potential of QLF for distinguishing the severity of occlusal TW based on differences in the autofluorescence intensity. METHODS: In total, 106 extracted permanent molars and premolars having suspected wear without pulp exposure were used. The severity of wear was determined by visually examining all teeth using the tooth wear index (TWI) of Smith and Knight. QLF images were captured and converted into 8-bit grayscale images. The difference in the fluorescence intensity (ΔG) was calculated by comparing mean grayscale levels between sound and worn areas. Finally, histological examination was conducted by stereomicroscope to confirm the presence of dentine exposure. RESULTS: 100 teeth were included in the final analysis without six teeth having enamel cracks around worn area. The ΔG values increased with the severity of TW as quantified using conventional TWI codes, and differed significantly between the sound and enamel- and dentine-wear teeth (P < 0.001). The histology indicated that enamel remained on 57 teeth, while 43 teeth had dentine-exposed wear and showed significant differences in ΔG compared with enamel-remained teeth. CONCLUSIONS: The fluorescence intensity differed significantly depending on the presence of dentine exposure. ΔG could be used to distinguish between sound and enamel- and dentine-wear teeth with a significant correlation. These findings indicate that QLF could be useful for determining the severity of TW of occlusal surfaces noninvasively.


Assuntos
Esmalte Dentário/patologia , Dentina/patologia , Fluorescência Quantitativa Induzida por Luz/métodos , Desgaste dos Dentes/diagnóstico , Dente Pré-Molar , Humanos , Dente Molar/patologia
13.
Int Endod J ; 52(1): 86-93, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29858500

RESUMO

AIM: To evaluate and compare the canal shaping ability of BioRace, ProTaper NEXT and Genius engine-driven nickel-titanium (NiTi) file systems in extracted mandibular first molars using micro-computed tomography (MCT). METHODOLOGY: Sixty mesial root canals of mandibular first molars were randomly divided into three equal groups, according to the instrument system used for root canal preparation (n = 20): BioRace (BR), ProTaper NEXT (PTN) or Genius (GN). Root canals were prepared to the full WL using a crown-down technique up to size 35, .04 taper instruments for BR and GN groups and size 30, .07 taper instruments for the PTN group. MCT was used to scan the specimens before and after canal instrumentation. Changes in dentine volume, the percentage of uninstrumented canal surface and degree of canal transportation were evaluated in the coronal, middle and apical thirds of canals. Data were analysed statistically using one-way analysis of variance and Tuckey's post hoc tests with the significance level set at 5%. RESULTS: There were no significant differences between the three groups in the terms of dentine removed after preparation and determination of the root canal volume, or percentage of uninstrumented canal surface (P > 0.05). No significant differences were found between the systems for canal transportation in any canal third (P > 0.05). CONCLUSIONS: The shaping ability of the BR, PTN and GN NiTi file systems was equally effective. All instrumentation systems prepared curved root canal systems with no evidence of undesirable changes in 3D parameters or significant shaping errors.


Assuntos
Ligas Dentárias/química , Níquel/química , Preparo de Canal Radicular/instrumentação , Titânio/química , Microtomografia por Raio-X/métodos , Análise de Variância , Instrumentos Odontológicos , Cavidade Pulpar/anatomia & histologia , Cavidade Pulpar/diagnóstico por imagem , Dentina/anatomia & histologia , Dentina/patologia , Desenho de Equipamento , Humanos , Processamento de Imagem Assistida por Computador/métodos , Técnicas In Vitro , Mandíbula/anatomia & histologia , Mandíbula/diagnóstico por imagem , Dente Molar/anatomia & histologia , Dente Molar/diagnóstico por imagem , Dente Molar/cirurgia , Preparo de Canal Radicular/métodos , Propriedades de Superfície
14.
Caries Res ; 53(1): 65-75, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29940580

RESUMO

BACKGROUND: Over the last years, conventional restorations for the treatment of active carious lesions (CL) in primary teeth have been challenged and a more biological approach has been suggested. This approach involves less invasive techniques that alter the environment of the CL isolating it from the cariogenic biofilm and substrate. AIM: To investigate the cost-effectiveness and patient acceptance of 2 treatment approaches for the treatment of deep CLs in primary teeth in children. METHODS: This was a retrospective/prospective cohort study carried out in 2 UK specialist hospital settings. Data on cost-effectiveness was extracted retrospectively from clinical dental records of 246 patients aged 4-9 years. A prospective study design was used to explore patient acceptance of the 2 treatment approaches. One hundred and ten patients aged 4-9 years and their carers completed 2 questionnaires on treatment acceptance. RESULTS: In total, 836 primary teeth that had received treatment with either approach were included. More than 2 thirds (75.7%) of the restorations in the conventional approach were of non-selective removal to hard dentine followed by pulpotomy (24.3%). In the biological approach, most of the restorations were stainless steel crowns placed with the Hall Technique (95%) followed by selective removal to firm dentine (5%). The majority of the primary teeth remained asymptomatic after a follow-up period of up to 77 months; 95.3% in the conventional and 95.8% in the biological arm. When the treatment costs were analysed, a statistically significant difference was found between the mean costs of the 2 approaches with a mean difference of GBP 45.20 (Pound Sterling; p < 0.001), in favour of the biological approach. The majority of the children and carers were happy with the conventional or biological restorations. CONCLUSION: Although both approaches had similar successful outcomes, the biological approach consisting mainly of Hall Technique was associated with reduced treatment costs. Both approaches were accepted favourably by the children and carers.


Assuntos
Coroas/economia , Coroas/psicologia , Cárie Dentária/terapia , Restauração Dentária Permanente/métodos , Pulpotomia/economia , Pulpotomia/psicologia , Dente Decíduo/patologia , Criança , Pré-Escolar , Análise Custo-Benefício , Dentina/patologia , Inglaterra , Feminino , Seguimentos , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Satisfação do Paciente , Estudos Prospectivos , Estudos Retrospectivos
15.
Int Endod J ; 52(2): 237-243, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30030844

RESUMO

AIM: To compare solutions of di- and tetrasodium ethylenediaminetetraacetic acid (EDTA) and 1-hydroxyethane-1,1-diphosphonic acid (HEDP) regarding their ability to solubilize calcium from dentine and remove smear layer. METHODOLOGY: Solutions with a molarity corresponding to that of 17% Na2 EDTA (pH adjusted to 8.5) were prepared by dissolving Na2 and Na4 salts of HEDP (etidronate), or Na4 EDTA in deionized water. Standardized root dentine discs covered by a smear layer were prepared from human third molars. These discs (n = 10 per group) were immersed in test solutions or phosphate-buffered saline for 1 min. The dissolved Ca2+ was determined by atomic absorption spectroscopy, apparently opened dentinal tubules by laser scanning microscopy and automated image analysis. Ca2+ values were compared between groups by parametric, tubular areas by nonparametric methods, α = 0.05. RESULTS: Solutions prepared from the tetrasodium salts were alkaline (pH 11.3-11.4), whilst counterparts made from the disodium salts were acidic. The EDTA solutions dissolved more calcium than the HEDP counterparts (P < 0.05); solutions prepared with the disodium salts dissolved more calcium than those made from the tetrasodium salts (P < 0.05). There was a high correlation between dissolved calcium and the apparently opened tubular areas (Spearman's ρ = 0.81). Differences between groups regarding opened tubules were similar to those observed regarding the Ca2+ values, with a slightly reduced discerning power due to high variance. CONCLUSION: Calcium chelation and thus smear layer removal by EDTA and HEDP are influenced by pH.


Assuntos
Dentina/efeitos dos fármacos , Ácido Edético/uso terapêutico , Ácido Etidrônico/uso terapêutico , Camada de Esfregaço/terapia , Cálcio/análise , Quelantes , Dentina/patologia , Humanos , Concentração de Íons de Hidrogênio , Microscopia Confocal , Dente Serotino , Irrigantes do Canal Radicular/uso terapêutico , Raiz Dentária/efeitos dos fármacos
16.
Caries Res ; 53(1): 107-117, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30021200

RESUMO

This study investigated the role of a matrix metalloproteinase (MMP) inhibitor (CHX 2%) in the development of secondary caries wall lesions in different interface conditions with small (run 1) and wider gaps (run 2). Dentin discs were restored and pretreated with or without CHX 2%. In run 1, interfaces were made with gaps of 30, 60, or 90 µm. Interfaces with composite placed directly onto the dentin were either bonded (Adper Single Bond 2) or not bonded. In run 2, interfaces were made with gaps of 100 µm, with or without adhesive on the composite side (CLEARFIL SE Bond). Interfaces were either bonded or not bonded, as in run 1. Microcosm biofilms were grown on dentin-composite samples for 14 days. Caries lesion outcomes were analyzed by transversal wavelength-independent microradiography at 3 locations: the outer surface, and the interface wall at a distance of 200 and 500 µm from the gap entrance. Linear regression analyses showed that pretreatment with MMP inhibitor did not influence progression of the wall lesion at any location (p ≥ 0.218). Interfaces with intentional gaps showed positive and significant effect on the wall lesion progression at 200 µm from the gap entrance (p ≤ 0.005). A small trend of increase in wall lesion development was observed at the 200-µm location when bonding was present on the composite side. In conclusion, the dentin pretreatment with CHX 2% was not able to slow down the development of secondary caries wall lesions in small and wide gaps in this biofilm model.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Biofilmes/efeitos dos fármacos , Clorexidina/uso terapêutico , Cárie Dentária/tratamento farmacológico , Dentina/efeitos dos fármacos , Inibidores de Metaloproteinases de Matriz/uso terapêutico , Análise de Variância , Carga Bacteriana/efeitos dos fármacos , Resinas Compostas/química , Cárie Dentária/diagnóstico por imagem , Dentina/patologia , Adesivos Dentinários/química , Humanos , Modelos Lineares , Masculino , Microrradiografia , Cimentos de Resina , Saliva , Adulto Jovem
17.
Int Endod J ; 52(1): 77-85, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29985531

RESUMO

AIM: To evaluate the bacterial reduction achieved by WaveOne Gold (Dentsply Sirona Endodontics, Ballaigues, Switzerland), Hyflex EDM (Coltene-Whaledent, Altstätten, Switzerland), and XP-endo Shaper (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) in canals infected with Enterococcus faecalis. The null hypothesis (H0 ) was that there would be no difference amongst the NiTi systems in reducing the root canal bacterial load. METHODOLOGY: Seventy-four mandibular premolar teeth with straight and round root canals were selected. Sixty-two root canals were contaminated with E. faecalis for 4 weeks and subjected to mechanical preparation with one of three single-file NiTi rotary systems (WaveOne Gold, Hyflex EDM, and XP Endo Shaper). Twelve non-contaminated root canals were used as negative controls. Bacterial samples were collected with sterile paper points (Dentsply Sirona Endodontics) before and after rotary instrumentation to quantify the bacterial load. Five roots from each instrumentation group were evaluated topographically from the coronal, middle and apical thirds by SEM. The bacterial reduction was calculated and analysed statistically by the Kruskal-Wallis and Dunn post hoc tests, all at 5% significance. RESULTS: The samples taken before instrumentation showed approximately 9.64 log CFU bacterial load. Instrumentation with the Hyflex EDM and XP-endo Shaper resulted in significantly greater bacterial reduction than those with WaveOne Gold (P = 0.00). All specimens had bacterial growth. SEM images supported the CFU/mL data. Thick and dense debris was observed in WaveOne Gold samples. Instrumentation resulted in the disruption of the biofilm-like structure, and both areas of clean and open dentinal tubules and areas with thick debris were observed in Hyflex EDM and XP-endo Shaper samples. CONCLUSIONS: Instrumentation in straight and round canals of premolar teeth with the Hyflex EDM and XP-endo Shaper resulted in significantly greater bacterial reduction than WaveOne Gold. No instrumentation system rendered root canals completely free from bacteria.


Assuntos
Carga Bacteriana , Instrumentos Odontológicos , Cavidade Pulpar/microbiologia , Enterococcus faecalis , Preparo de Canal Radicular/instrumentação , Dente Pré-Molar , Biofilmes , Dentina/diagnóstico por imagem , Dentina/patologia , Enterococcus faecalis/crescimento & desenvolvimento , Desenho de Equipamento , Humanos , Níquel , Preparo de Canal Radicular/métodos , Propriedades de Superfície , Titânio
18.
Int Endod J ; 52(1): 68-76, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29985533

RESUMO

AIM: To examine the contribution of perivascular cells expressing αSMA to reactionary dentinogenesis. METHODOLOGY: An inducible, Cre-loxP in vivo fate-mapping approach was used to examine the contribution of the descendants of cells expressing the αSMA-CreERT2 transgene to reactionary dentinogenesis in mice molars. Reactionary dentinogenesis was induced by experimental mild injury to dentine without pulp exposure. The Student's t test was used to determine statistical significance at *P ≤ 0.05. RESULTS: The lineage tracing experiments revealed that mild injury to dentine first led to activation of αSMA-tdTomato+ cells in the entire pulp chamber. The percentage of areas occupied by αSMA-tdTomato+ in injured (7.5 ± 0.7%) teeth were significantly higher than in teeth without injury (2 ± 0.5%). After their activation, αSMA-tdTomato+ cells migrated towards the site of injury, gave rise to pulp cells and a few odontoblasts that became integrated into the existing odontoblast layer expressing Col2.3-GFP and Dspp. CONCLUSION: Mild insult to dentine activated perivascular αSMA-tdTomato+ cells giving rise to pulp cells as well as a few odontoblasts that were integrated into the pre-existing odontoblast layer.


Assuntos
Actinas/metabolismo , Dentinogênese/fisiologia , Animais , Remodelação Óssea , Movimento Celular , Polpa Dentária/metabolismo , Dentina/crescimento & desenvolvimento , Dentina/lesões , Dentina/patologia , Proteínas da Matriz Extracelular/metabolismo , Imuno-Histoquímica , Camundongos , Camundongos Transgênicos , Modelos Animais , Dente Molar , Odontoblastos , Fosfoproteínas/metabolismo , Sialoglicoproteínas/metabolismo
19.
J Endod ; 45(1): 62-67, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30446405

RESUMO

INTRODUCTION: The aim of this study was to evaluate the root canal shaping effect of instruments manufactured from nickel titanium, M-Wire, and Gold wire with different glide path preparation techniques. METHODS: One hundred thirty-five mesiobuccal canals of extracted human maxillary molars were randomly divided into 3 equal groups (N = 45) for glide path preparation with K-files (KF) (Dentsply Sirona, Ballaigues, Switzerland), One G (OG) files (Micro-Mega, Besançon, France), and ProGlider (PG) files (Dentsply Sirona). Specimens of each glide path group were further divided equally into 3 groups for instrumentation with ProTaper Next (PTN, Dentsply Sirona), One Shape (OS, Micro-Mega), and WaveOne Gold (WOG, Dentsply Sirona) systems (n = 15). Micro-computed tomographic imaging was used to scan teeth before instrumentation and after shaping to compare centering ratio and canal transportation values at the apical, midroot, and coronal levels and the overall changes in canal volume. Data sets were statistically analyzed (analysis of variance and Kruskal-Wallis H tests). RESULTS: The centering ratios for all groups were statistically similar at all levels. Apical canal transportation was significantly high for K/OS and K/PTN (P = .003). Midroot canal transportation was significantly high for K/PTN, K/OS, and OG/OS (P = .0003). Coronal canal transportation was significantly high for K/PTN and K/OS (P = .011). The highest change in canal volume was observed with all PTN groups and the lowest with PG/WOG (P = .06). CONCLUSIONS: WOG manufactured from Gold wire combined with PG showed better root canal shaping ability and removed less dentin from the canal walls. The nickel-titanium (OS) and M-Wire (PTN) instruments used in combination with KF significantly transported more canals. PTN removed the most dentin from the canal walls regardless of the GPP technique.


Assuntos
Maxila , Dente Molar , Preparo de Canal Radicular/instrumentação , Ligas , Cavidade Pulpar/diagnóstico por imagem , Cavidade Pulpar/patologia , Dentina/diagnóstico por imagem , Dentina/patologia , Ouro , Humanos , Dente Molar/diagnóstico por imagem , Preparo de Canal Radicular/métodos , Microtomografia por Raio-X/métodos
20.
J Investig Clin Dent ; 10(1): e12382, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30556962

RESUMO

AIM: Silver diammine fluoride (SDF) is an anticaries agent that binds to tooth tissue. The aim of the present study was investigate the dose-response effect of SDF on demineralized dentine in basal medium mucin (BMM) saliva substitute and human saliva. METHODS: Dentine discs stored in saliva substitute, BMM, and human unstimulated whole saliva (UWS) were chemically demineralized, and 10 µL of 10 wt%, 24 wt%, or 38 wt% SDF was applied and then stored in its respective saliva (BMM or UWS) for 5 days. Dentine disc samples were digested in 70% HNO3 , and silver was quantitatively detected by inductively coupled plasma mass spectroscopy. RESULTS: For both the BMM and UWS groups, the presence of silver increased proportionally with increasing concentrations of SDF (P < 0.05). For the 38 wt% SDF application, the mean absorption percentage of silver in dentine was 3.90% for the UWS group and 6.61% for the BMM group. The BMM group was found to yield a significantly higher amount of silver compared to UWS at 10 wt% and 38 wt% SDF application (α = 0.05); 38 wt% SDF interacts more with BMM with higher silver deposition than UWS. CONCLUSION: The amount of silver found in dentine was in proportion to the concentration of SDF. Extrapolation of in vitro investigations using artificial saliva for SDF tooth interactions should be interpreted with caution.


Assuntos
Compostos de Amônio Quaternário/administração & dosagem , Compostos de Amônio Quaternário/uso terapêutico , Saliva/química , Compostos de Prata/administração & dosagem , Compostos de Prata/uso terapêutico , Prata/administração & dosagem , Desmineralização do Dente/tratamento farmacológico , Desmineralização do Dente/prevenção & controle , Administração Tópica , Amônia , Cariostáticos/administração & dosagem , Cariostáticos/uso terapêutico , Cárie Dentária/tratamento farmacológico , Cárie Dentária/prevenção & controle , Dentina/efeitos dos fármacos , Dentina/patologia , Relação Dose-Resposta a Droga , Fluoretos , Fluoretos Tópicos/administração & dosagem , Fluoretos Tópicos/uso terapêutico , Humanos , Técnicas In Vitro , Propriedades de Superfície , Desmineralização do Dente/patologia
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