Adhesive restoration of molars affected by molar incisor hypomineralization: a randomized clinical trial.

OBJECTIVE: This randomized clinical trial evaluated the survival of direct restorations on first permanent molars (FPMs) with molar incisor hypomineralization (MIH) and its impact on self-reported dental pain and dental anxiety. MATERIAL AND METHOD: FPMs with MIH of 35 patients aged 7 to 16 years were included. The FPMs were randomized into the following two groups: total-etch (TE-37% phosphoric acid etching) and self-etch (SE-no prior etching). The FPMs were restored with universal adhesive and bulk-fill resin composites. The restoration survival was evaluated according to USPHS criteria modified by a blinded examiner. Dental anxiety (Venham picture test) and dental pain (Faces pain scale-revised) were evaluated before treatment and at 1, 6, and 12 months post-treatment. Survival rates were analyzed by the Kaplan-Meier method and the log-rank test. Nonparametric tests compared pain and anxiety in the follow-up periods. RESULTS: A total of 64 FPMs were restored (TE = 33; SE = 31). Survival rates were 96.9% (TE) and 96.7% (SE) after 1 month, 90.5% (TE) and 80.6% (SE) after 6 months, and 80.8% (TE) and 62.3% (SE) after 12 months (p > 0.05). Self-reported dental pain and anxiety level decreased after treatment in both groups (p < 0.05). Self-reported pain decreased after 1 month in SE, but it occurred at 6 months in TE. CONCLUSION: Both restorative protocols presented similar longevity, decreasing self-reported pain and anxiety levels. CLINICAL RELEVANCE: A universal adhesive could be appropriate for restoration of MIH-affected teeth, and the survival of restorations could be higher in the total-etch technique, reducing dental pain and anxiety.

Silver Diamine Fluoride Has Efficacy in Controlling Caries Progression in Primary Teeth: A Systematic Review and Meta-Analysis.

A systematic review was performed to evaluate the efficacy of silver diamine fluoride (SDF) in controlling caries progression in children when compared with active treatments or placebos. A search for randomized clinical trials that evaluate the effectiveness of SDF for caries control in children compared to active treatments or placebos with follow-ups longer than 6 months was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and grey literature. The risk of bias tool from the Cochrane Collaboration was used for quality assessment of the studies. The quality of the evidence was evaluated using the GRADE approach. Meta-analysis was performed on studies considered at low risk of bias. A total of 5,980 articles were identified. Eleven remained in the qualitative synthesis. Five studies were at "low," 2 at "unclear," and 4 studies at "high" risk of bias in the key domains. The studies from which the information could be extracted were included for meta-analysis. The arrestment of caries at 12 months promoted by SDF was 66% higher (95% CI 41-91%; p < 0.00001) than by other active material, but it was 154% higher (95% CI 67-85%; p < 0.00001) than by placebos. Overall, the caries arrestment was 89% higher (95% CI 49-138%; p < 0.00001) than using active materials/placebo. No heterogeneity was detected. The evidence was graded as high quality. The use of SDF is 89% more effective in controlling/arresting caries than other treatments or placebos. The quality of the evidence was graded as high.

Effect of sealing infected dentin with glass ionomer cement on the abundance and localization of MMP-2, MMP-8, and MMP-9 in young permanent molars in vivo.

BACKGROUND: The study of MMPs' behavior in carious lesions contributes to the understanding of the mechanisms involved in dentin reorganization after restoration. AIM: To compare the abundance and localization of MMPs 2, 8, and 9 in infected dentin before and after restoration. DESIGN: The sample consisted of 23 young permanent molars with active deep carious lesions. Infected carious dentin samples were collected from the same tooth at baseline and 60 days after cavity lining with GIC and composite resin restoration and processed for immunohistochemistry assays. After digital images were obtained, two calibrated operators analyzed the samples according to the immunostaining intensity and the MMPs' localization. Chi-square test was used for statistical analysis. RESULTS: The intensity of immunostaining for MMP-8 was reduced after 60 days (P = 0.02), and no difference was observed for MMP-2 (P = 0.32) and MMP-9 (P = 0.14). The MMPs' distribution was generalized in the intertubular dentin and absent or located in the intratubular dentin, regardless of the period. CONCLUSION: The sealing of infected carious dentin in young permanent molars reduced the expression of MMP-8, which is consistent with the initial remodeling process of the dentin matrix.

Effects of prolonged light exposure times on water sorption, solubility and cross-linking density of simplified etch-and-rinse adhesives.

PURPOSE: This study evaluated the effects of light exposure times on water sorption, solubility, and polymer cross-linking density of simplified etch-and-rinse adhesives. MATERIALS AND METHODS: Four commercial adhesives (XP Bond, Adper Single Bond 2, Tetric N-Bond, and Ambar) were selected, and resin disks 5 mm in diameter and 1.0 mm thick were prepared and light cured for 20, 40, or 80 s using an LED light-curing unit at 1200 mW/cm2. Water sorption and solubility were evaluated over a 28-day period. For polymer cross-linking density, additional specimens were prepared and their Knoop hardness measured before and after immersion in 100% ethanol. The data from each test were evaluated using a two-way ANOVA and Tukey's test (α = 0.05). RESULTS: The XP Bond adhesive showed higher water sorption (similar to Adper Single Bond 2) and solubility (p < 0.05) than did the other materials. Prolonged exposure times did not reduce the water sorption but did reduce the solubility of all tested materials (p < 0.05). For Ambar, the increase in the exposure time resulted in a significantly lower percent reduction in hardness. CONCLUSION: Water sorption, solubility, and cross-linking density of the materials selected in this study seem to be mainly influenced by the adhesive composition. Prolonged light exposure times reduced the solubility of the materials.

Adherence to the CONSORT statement of randomized clinical trials on ART restorations in children: current status and reporting characteristics.

Appropriate research reports are important to facilitate the evaluation of studies and the decision-making by dentists and policymakers. This meta-research study assessed the conformity of randomized clinical trials (RCTs) on atraumatic restorative treatment (ART) restorations with the CONSORT recommendations and their risk of bias (RoB). Cochrane Library, MEDLINE, BBO, LILACS, Scopus, and Web of Science databases were searched from April 2019 to June 2021 for RCTs that assessed the longevity of ART restorations in children. A specific tool was used to assess adherence to the CONSORT recommendations; RoB was evaluated with the Cochrane risk-of-bias tool. Descriptive analyses included the number of studies by journal, follow-up period, country, and quality assessments. A total of 2,181 papers were retrieved and 36 of them were analyzed qualitatively. The overall CONSORT mean score (CONms) was 22.52 ± 6.17 out of 32 points. The best described items were intervention and outcomes, whereas allocation concealment was described in only 22% of the papers. Significant differences in CONms were detected in the analysis by country and publication dates. High CONms were observed in recently published papers (26.7 ± 3.1) when compared to first ART studies (18.1 ± 4.6; p < 0.001). RoB was low in four studies, unclear in 11, and high in 21. Adherence of the papers to the CONSORT recommendations was not fully achieved and most of the papers had unclear and high RoB (PROSPERO registration #CRD42020201460).

Orthodontic bracket bonding techniques and adhesion failures: A systematic review and meta-analysis.

Background: This systematic review compared the bonding failures of orthodontic brackets bonded by indirect or direct techniques. Data sources: The searched databases were Cochrane Library, LILACS, BBO, PubMed, Scopus, Web of Science. Material and Methods: A search for randomized clinical trials comparing the two techniques was carried out to answer the research question: When considering orthodontic bracket bonding on permanent teeth, does the indirect technique reduce the number of bonding failures compared to the direct one over time? The quality of the included papers was assessed with Cochrane risk of bias tool and the quality of evidence with GRADE. Results: From 3096 articles identified, seven were included in the systematic review (five at unclear; two at low risk of bias). Meta-analysis was carried out according to the follow-up periods (0-6 months and 12-15 months). Results: In the first period, bonding techniques were similar with regard to adhesion failures (RR = 0.59; 95% CI 0.10-3.62; p = 0.00001; I2 = 92%); in the 12-to-15-month period, the direct bonding technique proved to be superior (RR = 1.44; 95% CI 1.05 - 1.99; p = 0.41; I2 = 0%). The quality of evidence was classified as low for the 0-6 months follow-up and high for the 12 months. Conclusions: Based on the absence of heterogeneity and the high quality of evidence, it is concluded that the direct bracket bonding technique has a lower failure rate than the indirect technique in the long term (12-15 months). Key words:Orthodontic brackets, fixed orthodontics, systematic review.

New Dual-cure Resin-based Material in Occlusal and Occluso-proximal Restorations of Primary Teeth: Results of a Randomized Clinical Trial.

Background: The clinical performance of new restorative materials must be evaluated before recommending its use in primary teeth. Aim: This randomized clinical trial evaluated the survival rates of restorations in single and occluso-proximal cavities of primary teeth performed with a new dual-cure resin-based material in comparison with a resin-modified glass ionomer cement after 12 months of follow-up. Materials and methods: A total of 107 restorations were placed in 27 children by one experienced pediatric dentist. Two materials were tested: Vitremer and a dual-cure resin-based material with (CentionN+Adh) and without (Cention N-Adh) adhesive system application. Two calibrated and blinded examiners evaluated the restorations at 3, 6, and 12-month. The longevity of the restorations was analyzed using Kaplan-Meier survival curves and Log-rank test (α = 5%). Results: The overall survival rates after 12-month were 81.9% for Vitremer, 70.4% for Cention N+Adh, and 66.7% for Cention N-Adh, which had the poorer performance (HR = 0.54; 95% CI= 0.31-0.95; p = 0.031). When considering the type of the cavities, the difference was significant only for occluso-proximal cavities when Cention N-Adh was used (HR = 0.46; CI = 0.26-0.81; p = 0.008). Conclusion: All evaluated materials are suitable for restoring occlusal cavities after selective caries removal. However, Cention N needs to be used with adhesive in occluso-proximal cavities. Clinical significance: Cention-N can be used for deciduous teeth restorations, with similar longevity rates as resin modified glass ionomer cements.Trial registration number RBR-9nqszr. How to cite this article: da Cunha CM, Wambier LM, Paris Matos TD, et al. New Dual-cure Resin-based Material in Occlusal and Occluso-proximal Restorations of Primary Teeth: Results of a Randomized Clinical Trial. Int J Clin Pediatr Dent 2022;15(1):38-46.

Clinical versus laboratory adhesive performance to wet and dry demineralized primary dentin.

PURPOSE: To evaluate the influence of dentin moisture on bond strengths of an etch-and-rinse bonding agent to primary dentin clinically and in the laboratory. METHODS: The sample consisted of two groups of 20 caries-free primary second molars: molars in exfoliation period (clinical group) and extracted molars (laboratory group). Class I cavities were prepared in all specimens leaving a flat dentin surface on the pulpal floor. A two-step etch-and-rinse adhesive was vigorously rubbed on either dry (n = 5) or wet demineralized dentin (n = 5) under clinical or laboratory conditions. After restorative procedures, the teeth from the clinical group were extracted after 20 minutes. All samples were processed and underwent microtensile bond strength test and silver nitrate uptake evaluation under scanning electron microscopy. RESULTS: Statistically higher bond strength values were observed when the bonding was performed under laboratory conditions and on a wet demineralized dentin. Most of the failures were adhesive and mixed irrespective of the experimental condition. Silver nitrate uptake occurred in all groups irrespective of the experimental condition. Resin-dentin bond strengths produced in the laboratory in primary teeth may overestimate those produced under clinical circumstances.

The influence of toothbrush age on plaque control and gingivitis.

PURPOSE: The purpose of this single-blind randomised controlled clinical trial was to verify the impact of progressive toothbrush age on clinical variables of dental plaque and gingival conditions. MATERIALS AND METHODS: A total of 110 undergraduates were randomly assigned to one of four groups according to toothbrush age, as measured at 4, 8, 12, and 16 weeks. Clinical parameters (plaque and gingival indices) were assessed at 1 week (initial) and final periods. The wear of toothbrushes was evaluated by the wear index. RESULTS: Despite progressive toothbrush age, plaque and gingival indices were similar after the toothbrushing periods (p > 0.05, ANOVA). Significantly more plaque and gingivitis were present on lingual/palatal surfaces as compared with facial surfaces for all weeks, including the baseline (P < 0.001, paired t test.). The wear index increased from 4 weeks to 16 weeks. Plaque and gingival indices did not show statistical differences among 'lowest wear', 'moderate wear' and 'highest wear' (P > 0.05, ANOVA). CONCLUSION: Under the experimental conditions of this study, progressive toothbrush age did not lead to a decrease in plaque control. It was concluded that toothbrush age may not be critical in ensuring optimal plaque control.

Use of Sealants in Permanent Molars by Brazilian Dentist: A Comparative Study of Public versus Private

Abstract Objective: To compare the use of sealants in permanent molars between public and private dentists in Brazil. Material and Methods: This was a cross-sectional and analytical web survey study. The convenience sample consisted of dentists in Brazil who answered a pre-tested online form released via social media between July and October 2021. Descriptive analysis was performed using absolute and relative frequencies (%) and associations using the Chi-square test (p<0.05). Results: Brazilian professionals participated in the study (n=2,244). Comparing the professionals from the public service with those from the private service, the former had a higher positive perception of the use of sealants as a preventive (92.4% vs. 81.1%, p<0.00l) and therapeutic procedure (90.7% vs. 82.4%, p=0.00l), higher percentage of non-invasive (91.7% vs. 83.8%, p<0.00l) and invasive (22.8% vs. 12.0%, p< 0.001) techniques. Professionals from the private service reported more frequently that they did not use sealants than those from the public service (14.0% vs. 4.8%, p<0.00l). Resin sealant (97.7% vs. 94.9%, p=0.0l5) and Flow resin (62.0% vs. 54.3%, p=0.013) were the most used by professionals in the private service. The use of glass ionomer cement was not associated with the type of service (75.1% vs. 77.2%, p=0.172), nor was the use of adhesives (0.6% vs. 1.4%, p=0.195) or resin with Giomer technology (1.9% vs. 2.2%, p=0.856) (p>0.05). Conclusion: The percentage of use of sealants among dentists in Brazil is high, especially among professionals in the public service, and the most used materials were resinous sealants and glass ionomer cement.

Randomized Clinical Trial of ART Class II Restorations Using Two Glass Ionomer Cements: One-Year Follow-Up.

PURPOSE: The purpose of this study was to compare the survival rate of ART (atraumatic restorative treatment) Class II restorations in primary teeth, performed with glass carbomer cement and a high-viscosity glass ionomer cement, after 12 months. METHODS: One pediatric dentist placed 59 Class II ART restorations in 33 children (eight plus/minus two years old) of both genders. Two calibrated examiners, blinded to the type of material and not involved in the placement, evaluated the restorations at baseline, six, and 12 months. RESULTS: The overall success rate (95 percent confidence interval) at the six-month follow-up for the GP Glass Fill and Equia Fil was 69 percent (51 to 83) and 83 percent (66 to 93), respectively. No significant difference was detected between the study groups (Fisher's exact test, P=0.20). However, at 12 months, the overall success rates of both materials were 56 percent (37 to 73) and 86 percent (69 to 94), and this difference was statistically significant (Fisher's exact test, P=0.03). CONCLUSION: Class II ART restorations with glass carbomer showed lower survival rates after 12 months compared to those with high-viscosity glass ionomer cement.

A Randomized Clinical Trial Evaluating Rubber Dam Clamp Pain Reduction from a New Topical Liposomal Anesthetic Gel.

PURPOSE: Discomfort during rubber dam clamp often occurs in pediatric dentistry. The purpose of this randomized, triple-blind, clinical trial was to evaluate the effect of pain reduction using a new topical liposomal thermo-sensitive gel (TLTG) or a placebo gel during rubber dam clamp isolation for sealants in children. METHODS: Eighty-one children (eight to 12 years old) had LTSG or the placebo gel with random assignment placed around the gingival tissue of their permanent mandibular first molars. A clamp was placed after two minutes on the teeth, and intensity of pain was registered using a Wong-Baker FACES scale and an 11-point numerical scale. The data were evaluated using McNemar's test and Wilcoxon signed rank test. RESULTS: The odds ratio for pain (OR equals 0.7; 95 percent confidence interval equals 0.3 to 1.8) was not statistically significant (P=0.52). However, there was a small difference in the pain intensity between liposomal and placebo groups for both scales (P<0.05). CONCLUSION: The liposomal thermo-sensitive anesthetic gel may reduce, to a small extent, the pain intensity in children submitted to rubber dam isolation before resin sealant placement.

Ultrastructural and microbiological analysis of the dentin layers affected by caries lesions in primary molars treated by minimal intervention.

PURPOSE: The purpose of this in vivo study of primary teeth was to analyze the ultrastructure and microbiology of dentin layers affected by caries lesions before and after restorations with resin-modified glass ionomer. METHODS: Samples of carious dentin from primary teeth removed prior to restoration placement (baseline-0 day) were compared with samples taken after 30 and 60 days. Dentin from 8 primary molars was analyzed by scanning electron microscopy (SEM) and dentin from 22 primary molars was examined microbiologically to compare bacteria (total of viable counts, Streptococcus spp, Streptococcus mutans, Lactobacillus spp, and Actinomyces spp) before and after treatment (30 and 60 days). RESULTS: Baseline caries samples had enlarged dentinal tubules with bacteriol invasion. SEM samples after treatment suggest better tissue organization, with more compact collagen fibers arrangement and narrower dentinal tubules. The number of bacteria decreased in all samples at both 30 (98%) and 60 (96%) days, with all bacteria species showing similar trends. CONCLUSIONS: The minimal intervention approach is very effective to promote beneficial changes in the lesion environment and favorable conditions for the healing process in primary teeth.

Adherence to the CONSORT statement of randomized clinical trials on ART restorations in children: current status and reporting characteristics

Abstract: Appropriate research reports are important to facilitate the evaluation of studies and the decision-making by dentists and policymakers. This meta-research study assessed the conformity of randomized clinical trials (RCTs) on atraumatic restorative treatment (ART) restorations with the CONSORT recommendations and their risk of bias (RoB). Cochrane Library, MEDLINE, BBO, LILACS, Scopus, and Web of Science databases were searched from April 2019 to June 2021 for RCTs that assessed the longevity of ART restorations in children. A specific tool was used to assess adherence to the CONSORT recommendations; RoB was evaluated with the Cochrane risk-of-bias tool. Descriptive analyses included the number of studies by journal, follow-up period, country, and quality assessments. A total of 2,181 papers were retrieved and 36 of them were analyzed qualitatively. The overall CONSORT mean score (CONms) was 22.52 ± 6.17 out of 32 points. The best described items were intervention and outcomes, whereas allocation concealment was described in only 22% of the papers. Significant differences in CONms were detected in the analysis by country and publication dates. High CONms were observed in recently published papers (26.7 ± 3.1) when compared to first ART studies (18.1 ± 4.6; p < 0.001). RoB was low in four studies, unclear in 11, and high in 21. Adherence of the papers to the CONSORT recommendations was not fully achieved and most of the papers had unclear and high RoB (PROSPERO registration #CRD42020201460).

Avaliação da sorção e solubilidade de água em cimentos de ionômero de vidro com e sem agente de proteção / Evaluation of water sorption and solubility in glass ionomer cements with and without protective agent

Objetivo: Avaliar o efeito de um protetor de superfície na sorção e solubilidade de cimentos de ionômero de vidro. Materiais e Métodos: Quatro materiais foram selecionados: ionômero modificado por resina encapsulado (Riva Light Cure); modificado por resina pó/líquido (Vitremer); convencional encapsulado (Equia Forte) e convencional pó/líquido (Fuji IX). Foram confeccionados 20 espécimes de cada, sendo metade com proteção superficial do Equia Forte Coat. As amostras foram mantidas em estufa a 37°C em repouso por 5 dias. Em seguida, esses foram pesados em intervalos de 24 horas. A espessura e o diâmetro foram medidos com um paquímetro digital para o cálculo do volume. Novas pesagens foram realizadas para a obtenção da massa intermediária. Em seguida, as amostras foram mantidas em repouso por 5 dias a 37°C e realizada nova pesagem. Resultados: Os dados obtidos de sorção e solubilidade foram submetidos à análise de variância (ANOVA dois fatores, material e protetor de superfície) e teste Tukey ( =0,05). Para sorção, houve diferença significativa apenas para o fator material (p<0,05), Vitremer > Equia Forte > Riva Light Cure > Fuji IX. O ionômero Fuji IX apresentou os menores valores de sorção, diferindo significativamente dos demais materiais, independentemente do uso do protetor superficial. Não houve diferença significativa para o fator proteção de superfície (p>0,05). Para solubilidade não houve diferença significativa no fator material, protetor de superfície ou interação material*protetor. Conclusão: O uso do protetor superficial não influenciou nos valores de sorção e solubilidade dos ionômeros avaliados e o ionômero convencional Fuji IX apresentou menores taxas de sorção.

Objective: evaluate the effect of a surface coating agents on the sorption and glass ionomer cements solubility. Materials and Methods: Four materials were selected: Encapsulated resin-modified ionomer (Riva Light Cure); Powder/liquid Encapsulated resin-modified (Vitremer); Encapsulated conventional (Equia Forte) and powder/ liquid conventional (Fuji IX). Twenty samples of each were made, half with surface protection of Equia Forte Coat. The samples were kept in an oven for 5 days. These were then weighed at 24-hour intervals. The thickness and diameter were measured using a digital caliper to calculate their volume. New weightings were performed to obtain the intermediate mass. Then, the samples were kept at rest for 5 days and weighed again. Results: The sorption and solubility data obtained were subjected to analysis of variance (two-way ANOVA, material and surface coating agents) and Tukey test ( =0.05). For sorption, there was a significant difference only for the material factor (p<0.05), Vitremer > Equia Forte > Riva Light Cure > Fuji IX. The Fuji IX ionomer showed the lowest sorption values, differing significantly from the other materials, regardless of the use of surface coating agents. There was no significant difference for the surface protection factor (p>0.05). For solubility there was no significant difference for the material factor, surface coating agents or material*surface coating agent interaction. Conclusion: The use of surface coating agents did not influence the sorption and solubility values of the evaluated ionomers and the conventional Fuji IX ionomer showed lower sorption rates.

The influence of the lining material on the repair of the infected dentin in young permanent molars after restoration: A randomized clinical trial.

AIM: This study evaluated the impact of liner material on the fluorescence, morphological and mineral characteristics of permanent carious dentin after cavity sealing. METHODS: Thirty children (11.0 ± 2.7 years old) presenting at least one active deep carious lesion in permanent molars were selected. Fragments of carious dentin were removed from teeth before lining the cavity (baseline samples) with high-viscosity glass ionomer cement (G1) or an inert material (wax - G2). Cavities were restored with composite resin and reopened 60 days later, and other fragments were removed (60-day sample). The laser fluorescence (LF) readings and morphological and mineral changes of both groups were compared. RESULTS: After 60 days, forty teeth were available for evaluation. Lower LF means were obtained (Wilcoxon signed-rank test; P < 0.05), and enhanced calcium and phosphorus levels were detected for both groups (t-test, P < 0.05). An uptake of fluorine was observed only in G1 (t-test; P < 0.05). Regardless of the group, baseline samples exhibited clear signs of bacterial invasion, and the collagen fibers were exposed; the 60-day samples showed a better-organized tissue with a more compact intertubular dentin. CONCLUSION: Caries arrestment with dentin reorganization occurs regardless of the lining material placed in contact with the infected dentin.

Clinical, mineral and ultrastructural changes in carious dentin of primary molars after restoration.

INTRODUCTION: Partial caries removal has been shown to be an effective method to treat deep carious lesions in deciduous teeth. Nevertheless, the possibility of keeping infected dentin in the cavity still requires additional investigation. The objective of this research was to describe changes in primary infected dentin after restoration with glass ionomer cement. METHODS: Dentin from 45 primary molars with deep and active carious lesions was evaluated using clinical and laboratory criteria, before and 60 days after restoration. The clinical analysis evaluated dentin colour (CO), dentin consistency (COS) and laser fluorescence (LF). The laboratory procedures assessed bacterial contamination and mineral content (MC), and evaluated the dentin ultrastructure and collagen content. Data on CO, COS, LF and colony forming units were analysed using the Wilcoxon signed-rank test; MC, bacterial counts and collagen evaluations were evaluated using the Student's t-test. RESULTS: After 60 days, lower values of LF were observed, together with a lower bacterial count, and a higher COS was found, with an increase in calcium, phosphorus and collagen contents. Differences were not detected for CO or for fluorine content. Baseline samples showed enlarged tubules with bacterial invasion; 60-day samples showed better organised tissue, with a more compact intertubular dentin and narrower tubules. CONCLUSION: It is concluded that appropriate cavity sealing can promote beneficial changes in deep carious lesions of primary teeth, even in the presence of infected dentin.

Clinical performance of a micro invasive treatment based on demineralization-remineralization for dental fluorosis: case report

Introduction: Dental fluorosis manifests clinically as white to brown spots on the enamel teeth that were exposed to excessive fluoride during the formation process. Esthetic treatments were described in the literature to reduce or eliminate the fluorotic stains on the enamel surface. Objective: The aim of this study is to present an alternative treatment for fluorosis-stained teeth. Case report: This case report describes the clinical performance of a treatment of a 12-year-old male patient whose teeth presented moderate fluorosis. This treatment is based on tooth demineralization and remineralization. The material has an acid phase made by hydrochloric acid with tricarboxylic acid, and an alkaline phase made by Calcium Hydroxide. Results: This pain less and fast treatment presented good results. The treatment eliminated the spots during the follow-up and preserved most of the dental structure, improving the appearance of the patient's teeth. Conclusion: The appearance of the treated enamel showed a surface almost completely free of fluorotic stains, demonstrating the satisfactory results of this treatment.

Introdução: A fluorose dentária manifesta-se clinicamente como manchas brancas a marrons no esmalte de dentes expostos ao excesso de flúor durante o processo de formação. Tratamentos estéticos foram descritos na literatura para reduzir ou eliminar as manchas fluoróticas na superfície do esmalte. Objetivo: Apresentar uma alternativa de tratamento para dentes manchados por fluorose dentária. Relato do caso: Este relato de caso descreve o desempenho clínico do tratamento para dentes com fluorose moderada em um paciente de 12 anos. Esse tratamento foi baseado numa técnica de desmineralização e remineralização do dente. O material possui uma fase ácida composta por ácido clorídrico com ácido tricarboxílico, e uma fase alcalina composta por Hidróxido de Cálcio. Resultados: Observou-se que esse tratamento, sem dor e rápido, apresentou resultados satisfatórios, pois eliminou as manchas durante o acompanhamento. Além disso, preservou ao máximo a estrutura dentária, beneficiando o paciente com uma melhor aparência dos seus dentes. Conclusão: O aspecto do esmalte tratado mostrou uma superfície quase sem manchas fluoróticas, demonstrando resultados satisfatórios deste tratamento.

Are glass carbomer sealants more efficient in preventing carious lesions in children's permanent molars when compared to other sealant materials? A systematic review and meta-analysis

Objective: This systematic review was performed to evaluate the efficacy of glass carbomer when compared with other sealant materials in preventing carious lesions in children and retention in pit and fissures. Sources of data: The paper included only randomized clinical trials that compared pit and fissure sealants with glass carbomer and other sealant materials in children's permanent molars with at least six-monthfollow-up. A systematic search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library and Grey literature (December 2020/January 2021). The risk of bias tool from the Cochrane Collaboration was used for quality assessment of the studies and GRADE approach for the quality of the evidence. Meta-analysis was performed on studies from which data could be achieved. Synthesis of data: A total of 1685 papers were identified, 54 were selected for review. From these, 40 articles were excluded after the reading of the abstract and 14 articles were put aside for assessment. Eight papers were included in qualitative and quantitative synthesis. The prevalence of caries-free pit and fissures did not show differences after six (p=0.77; I2= 0%) or 12 months (p=0.60; I2= 0%) and the quality of the evidence was judged as low; after 24 months, other sealant materials performed better (p=0.30; I2=7%) and the quality as moderate. There were no differences in the retention rates of the different materials after six-month (p<0.0001; I2= 96%), 12-month follow-up (p<0.0001; I2= 99%) and 24 months (p<0.00001; I2= 100%); the quality of the evidence was considered very low. Conclusion: Glass carbomer sealants have a similar performance to other sealant materials when retention is considered. For the development of new carious lesions, other sealant materials performed better over time. However, new clinical trials are needed to corroborate these findings since it still lacks quality to the evidence raised.

Objetivo: Esta revisão sistemática foi realizada para avaliar a eficácia de selantes de fóssulas e fissuras em carbômero de vidro comparados a outros materiais seladores na prevenção de lesões cariosas em crianças e retenção em fóssulas e fissuras. Fontes dos dados: Este estudo incluiu apenas estudos clínicos randomizados que compararam selantes em carbômero de vidro com selantes em outros materiais em molares permanentes em crianças com um acompanhamento mínimo de 6 meses. Uma busca sistemática foi realizada nas bases de dados PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library e literatura cinzenta. Resumos de IADR, registros de triagens clínicas não publicadas, bases de dissertações e teses também foram pesquisados. O risco de viés dos estudos foi avaliado por meio da ferramenta Cochrane e a qualidade da evidência com o GRADE. Metanálises foram realizadas com os estudos que permitiram a coleta de dados. Síntese dos dados: Um total de 1685 artigos foram identificados e 54 selecionados para revisão. Destes, 40 artigos foram excluídos depois da leitura do resumo e 8 foram incluídos na análise qualitativa e quantitativa. A prevalência de fóssulas e fissuras livres de cárie foi similar após 6 (p=0,77; I2= 0%) e 12 meses (p=0,60; I2= 0%) e qualidade da evidência foi considerada baixa; após 24 meses, os outros materiais tiveram melhor desempenho (p=0,30; I2=7%) com evidência moderada. Não houve diferença nas taxas de retenção dos diferentes materiais após 6 (p<0,0001; I2= 96%), 12 meses (p<0,0001; I2= 99%), ou 24 meses (p<0,0001; I2= 100%) de acompanhamento; a qualidade foi considerada muito baixa. Conclusão: Selantes de carbômero de vidro tem retenção similar aos outros materiais seladores utilizados. Em relação ao desenvolvimento de novas lesões de cárie, os outros materiais apresentaram melhor desempenho ao longo do tempo. Todavia, novos estudos clínicos devem ser desenvolvidos para corroborar estes achados, uma vez que há falta de qualidade na evidência obtida.

The role of glass ionomer cement on the remineralization of infected dentin: an in vivo study.

PURPOSE: This study's purpose was to investigate the effect of a glass ionomer cement as a liner over infected unexcavated dentin after 60 days and at 10 to 15 months. METHODS: Forty-five permanent molars with deep carious lesions were selected. Fragments of carious dentin were removed prior to lining the cavity (baseline sample) with glass ionomer cement (G1) or an inert wax material (G2). Cavities were restored with composite resin and reopened 60 days later, when other fragments were removed (60-day sample). The dentin morphology (scanning electron microscopy) and mineral content of calcium, phosphorus, and fluorine were assessed. During the follow-up periods (60 days and 10 to 15 months), restorations were evaluated and standardized radiographs were taken. A postprocessing routine was used to identify changes in the radiographic density between periods. RESULTS: After 60 days, the dentin exhibited a better organization, fewer bacteria, and signs of remineralization. The weight percents of calcium and phosphorus were higher 60 days after the cavity sealing, regardless of the group. Higher gray levels of carious and sound dentin were seen on the 10- to 15-month radiographs, irrespective of the group. The success rates of G1 and G2 were 89 percent and 88 percent, respectively. CONCLUSIONS: The lining material isn't fundamental for caries arrestment. Early (60-day) and late (10 to 15 months) dentin changes occurred, indicating the remineralization of dentin carious tissue.