Evaluation of composite restorations in primary molars subjected to selective caries removal associated with antimicrobial photodynamic therapy: A randomized controlled trial.

BACKGROUND: Antimicrobial photodynamic therapy (aPDT) has been used as an adjunct treatment of deep caries lesions; however, studies on the effects of aPDT on the longevity of restorations are still limited. AIM: To evaluate the clinical performance of composite restorations in primary molars subjected to selective caries removal (SCR) associated with aPDT. DESIGN: A randomized clinical trial was designed. Primary molars of patients (mean age 6.15 years) with deep caries lesions without signs and symptoms of pulpal involvement were selected. A total of 64 teeth were randomly divided into groups G1 (SCR, 32 teeth) and G2 (SCR + aPDT, 32 teeth) for treatment, restored with composite, and evaluated after a week (T0 ), 6 months (T1 ), and 12 months (T2 ) according to the criteria of FDI. Groups were compared using the Rao-Scott chi-squared test and the logistic regression analysis for complex designs to account for multiple observations per subject (alpha = 0.05). RESULTS: From all FDI criteria evaluated, the marginal adaptation for the SCR + aPDT group was significantly better in comparison with the SCR group at T0 and T2 in the logistic regression analysis (T0: OR = 0.151; 95% CI = 0.03-0.068, P = .015; and T2: OR = 0.201; 95% CI = 0.05-0.79, P = .022). CONCLUSION: The marginal adaptation of primary molar resin restorations was positively affected by aPDT after 12 months of follow-up.

Does selective caries removal in combination with antimicrobial photodynamic therapy affect the clinical performance of adhesive restorations of primary or permanent teeth? A systematic review with meta-analysis.

Antimicrobial photodynamic therapy (aPDT) is an adjunct to a selective caries removal (SCR) technique for deep caries lesion treatment. The knowledge about chemical and structural changes affecting the remaining dentin surface after the use of this therapy is still unknown. OBJECTIVE: to answer the following question: Does the SCR technique in combination with aPDT affect the clinical performance of adhesive restorations in deep carious lesions of primary or permanent teeth? STUDY DESIGN: a systematic review was conducted. Five databases, supplemented by trial registers, google scholar, manual search, personal communications, and grey literature were investigated. Randomized clinical trials were included. Two independent reviewers selected the studies, extracted qualitatively the data, and evaluated the risk of bias (using Cochrane Collaboration's tool and Robot Reviewer program). The certainty of the evidence was accessed based on The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A meta-analysis of comparable data was performed with RevMan software 5.3. RESULTS: A total of 39 articles and 3 studies were found. The final selection included 3 articles with a total of 82 participants. No studies were found on permanent teeth. The studies presented low risk of bias. Considering the treatment in the experimental (SCR + aPDT) or control groups (SCR), no difference on clinical performance of adhesive restorations in deep caries of primary teeth was observed after 6 months (p = 0.78; CI -0.01 (-0.09, 0.07)) or 12 months (p =0.75; CI -0.02 (-0.12, 0.08)). All outcomes presented moderate certainty of evidence mainly due to the small sample size that downgrade the GRADE scores. CONCLUSIONS: based on moderate certainty of the evidence, the clinical use of aPDT as an adjuvant of SCR has potential indication for treatment in deep caries of primary teeth. However, studies with more follow up and on permanent teeth are missing with the necessity for further research.

Effect of Treatment with Selective Caries Removal Associated to Antimicrobial Photodynamic Therapy on Children's Oral Health-Related Quality of Life: A Non-Randomized Clinical Study.

How patients perceive impact of diseases is an essential component when characterising different disease impacts, and effects of dental treatments should be perceived by the patients. This study aimed to assess the impact of conservative treatment of deep caries lesions using the selective caries removal (SCR) associated to a low laser therapy (antimicrobial photodynamic therapy-aPDT) on oral health-related quality of life (OHRQoL). STUDY DESIGN: A non-randomized clinical before-and-after study was conducted on children aged 4 to 8 years. The data was obtained applying the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) to the caretakers in an interview before and after treatment. The paired T-student test considering p<0.05 and the treatment responsiveness detecting the effect size by means of standardized response mean (SRM) was evaluated. RESULTS: The mean impact on OHRQoL on the total scale was 5.46 ± 4.54 for before and 2.42 ± 3.54 for after treatment (p<0.01). The ECOHIS demonstrated satisfatory longitudinal responsiveness except for psychological, self-image/social interaction and Family function domain (SRM<0.5). CONCLUSION: This study demonstrated that the association of a low laser therapy (aPDT) with SCR did not influence negatively on OHRQoL. In the practice of pediatric dentistry, this conservative dental treatment improved the OHRQoL after 3 months of follow up.

Minimally invasive treatment of an extruded deciduous tooth - Case report.

When a traumatic dental injury affects the deciduous teeth, the main management is to regularly review the patient until the successor permanent tooth erupts to avoid further consequences to the affected tooth and, especially, sequelae in the tooth germs of the successor permanent tooth. This report describes a case of a tooth extrusion in a 4-year-old male treated with a minimally invasive approach. After 4 years of follow-up, there was a mild disturbance (demarcated opacity in the vestibular surface) and a satisfactory result with normal eruption of the permanent successor tooth.