Ana Flávia Bissoto Calvo

ART is an alternative for restoring occlusoproximal cavities in primary teeth - evidence from an updated systematic review and meta-analysis.

BACKGROUND A previous systematic review showed that atraumatic restorative treatment (ART) can be an option to restore the occlusoproximal cavities in primary teeth; however, few studies fulfilled the criteria of inclusion to generate a high level of evidence. AIM To update the existing systematic review and address questions regarding survival rate of ART restorations compared to the conventional approach in occlusoproximal cavities in primary molars. DESIGN The search was extended beyond the original search through the PubMed/MEDLINE database up to February 2016. Furthermore, Web of Science and EMBASE were searched. The inclusion criteria were subjects related to the scope of the systematic review. After selection by title and abstract, potentially eligible articles were read in full and included in accordance with exclusion criteria. Meta-analysis was carried out with the outcome being the survival rate of restorations. RESULTS The search strategy identified 560 potentially relevant studies, in addition to 127 from the original systematic review. A total of four articles were included in the qualitative and quantitative analyses. Meta-analysis showed no statistically significant difference between ART and conventional approaches in survival rate of occlusoproximal cavities (OR = 0.887, 95% CI: 0.574-1.371). CONCLUSION ART restorations have similar survival rate compared to conventional treatment and can be considered an option to restore occlusoproximal cavities in primary molars.

Is the red fluorescence of dental plaque related to its cariogenicity

Abstract. It has been speculated that the red fluorescence emitted by dental plaque could be related to its cariogenicity. To test this hypothesis, we designed this crossover in situ study, with two experimental phases of 14 days each. Seventeen volunteers, wearing a palatal appliance with bovine enamel blocks, were instructed to drip a 20% sucrose solution (experimental group) or purified water (control group) onto the enamel blocks eight times daily. The specimens were removed after 4, 7, 10, and 14 days, and the red fluorescence of dental plaque formed on the enamel blocks was assessed using a quantitative light-induced fluorescence device. After the plaque removal, surface and cross-sectional microhardness tests were performed to assess the mineral loss. The comparisons were made by a multilevel linear regression analysis. We observed a significant increase in the red fluorescence of the dental plaque after longer periods of formation, but this trend was verified in both groups. The mineral loss assessed by the microhardness techniques, contrariwise, showed a significant increase only in the experimental group. In conclusion, the red fluorescence emitted by the dental plaque indicates a mature biofilm, but this fact is not necessarily associated with its cariogenicity.

Does the method of caries induction influence the bond strength to dentin of primary teeth

PURPOSE To evaluate the effect of chemical and microbiological methods of caries induction on microtensile bond strength (μTBS) of current adhesive systems to primary dentin. MATERIALS AND METHODS Flat dentin surfaces from 36 primary molars were assigned to 3 groups according to the method of inducing caries-affected dentin: (1) control (sound dentin); (2) pH cycling; and (3) microbiological. In both methods, teeth were submitted to caries induction for 14 days, and the sound dentin was stored in distilled water for the same period. Specimens were then randomly reassigned according to adhesive system: a two-step etch-and-rinse adhesive (Adper Single Bond 2) or a two-step self-etching system (Clearfil SE Bond). Composite buildups were constructed and the teeth were sectioned to obtain bonded sticks (0.8 mm2) to be tested for microtensile bond strength. The μTBS means were analyzed by two-way ANOVA and Tukeys tests (α = 0.05). Failure mode was evaluated using a stereomicroscope (400X). RESULTS Both methods of caries induction resulted in lower μTBS values (with no significant difference between them) than those obtained for sound dentin. Adhesive systems showed similar bond strength values. The percentage of premature failure was higher in the microbiological group, regardless of adhesive system. CONCLUSION Microbiological and pH-cycling methods are both suitable for simulating caries-affected dentin for bonding evaluations in primary teeth.

Do glass ionomer cements prevent caries lesions in margins of restorations in primary teeth?: A systematic review and meta-analysis

BACKGROUND Fluoride released from glass ionomer cements (GICs) is capable of preventing caries lesions. However, the preventive effect in margins of occlusal and occlusoproximal restorations have not been proved. The aim of this study was to evaluate the ability of GIC to prevent caries lesions in margins of occlusal and occlusoproximal restorations in primary teeth compared with that of other restorative materials. TYPES OF STUDIES REVIEWED The authors conducted a literature search in PubMed and MEDLINE to verify the clinical trials available on the outcome of caries lesions. The inclusion criteria were that the subject related to the scope of this systematic review, the study had a follow-up, and the study was not performed in specific groups. The authors performed all meta-analyses by considering the secondary caries rates for the restorations in clinical trials. RESULTS The search strategy identified 450 potentially relevant studies, and the authors included 8 of them in the review. The main reasons for exclusion were that the studies were not related to the scope of this review or were not longitudinal trials. The secondary caries rate of the occlusal restorations was not different among the restorative materials (odds ratio, 1.2; 95% confidence interval, 0.5-3.1). For occlusoproximal analysis, GIC was associated significantly with better ability to prevent caries lesions (odds ratio, 1.7; 95% confidence interval, 1.2-2.5). CONCLUSIONS AND PRACTICAL IMPLICATIONS Because new caries lesions in the margins of restorations are the main reason for failure and replacement of restorations in primary teeth, it is important to know whether there is a benefit in using GICs in both occlusal and occlusoproximal cavities.

Mechanical properties of high-viscosity glass ionomer cement and nanoparticle glass carbomer

Introduction. The lack of evidence regarding the best available material for restoring occlusal-proximal cavities in primary teeth leads to the development of new restorative material, with nanoparticles, in order to enhance mechanical properties, resulting in increased restoration longevity. Aim. To evaluate the Knoop hardness and bond strength of nanoparticles material glass carbomer cement (CAR) and high-viscosity glass ionomer cement (GIC) in sound and caries-affected dentin. Methods. Forty bovine incisors were selectedand assigned into four groups (n = 10): SGIC, sound dentin and GIC; SCAR, sound dentin and CAR; CGIC, caries-affected dentin andGIC; and CCAR, caries-affected dentin and CAR. All groups were submitted to microshear bond strength (MPa). Knoop hardness was also performed. Bond strength values were subjected to two-way ANOVA and Tukey test. Knoop hardness data were subjected to one-way ANOVA. Results. GIC presented higher Knoop hardness (p < 0.001) and bond strength (p = 0.027) than CAR. Also, both materials showed better performance in sound than in caries-affected substrates (p = 0.001). The interaction between factors was not statistically different (p = 0.494). Conclusion. Despite nanoparticles, CAR shows inferior performance as compared to GIC for the two properties tested in vitro. Moreover, sound dentin results in better bonding performance of both restorative materials evaluated.

Contact with fluoride-releasing restorative materials can arrest simulated approximal caries lesion

Previous studies have suggested that the presence of white-spot lesion is very probable when adjacent surface is affected by cavitated lesions. This study evaluated the potential of different fluoride-releasing restorative materials in arresting enamel white-spot lesions in approximal surface in contact with them, in vitro (I) and in situ (II). White-spot lesions were formed in 240 primary enamel specimens via pH-cycling. They were put in contact with cylindrical blocks of 6 materials (n = 20): composite resin, 2 high-viscous glass ionomer cements (HVGIC), resin-modified GIC, resin-modified nanoionomer, and polyacid-modified resin. In both studies I and II, these settings were designed to simulate the contact point between the restoration and simulated approximal lesion. For study I, they were subjected to a new pH-cycling cariogenic challenge for 7 or 14 days (n = 10). For study II, a randomized doubleblind in situ design was conducted in two phases (7/14 days) to promote cariogenic challenge. At the end of both studies, specimens were collected for mineral analysis by cross-sectional microhardness. Higher mineral loss was observed for lesions in contact with resin (p < 0.001). HVGICs were the most efficient in preventing mineral loss, whereas other materials presented an intermediate behavior. It is concluded that fluoride-releasing materials can moderately reduce white-spot lesions progression, and HVGIC can arrest enamel lesion in approximal surface in contact with them.

Caries lesion prevention and arrestment in approximal surfaces in contact with glass ionomer cement restorations - a systematic review and meta-analysis

BACKGROUND Studies have suggested that in the presence of approximal cavities, the approximal surface in contact with this one shows a higher risk in the development of caries lesions. AIM To evaluate the ability of dental materials to prevent and to arrest caries lesion in approximal surfaces in contact with occlusoproximal restorations. DESIGN Two independent reviewers performed a literature search in PubMed through November 2014. The inclusion criteria were: (1) subject related to the scope of this systematic review, (2) study with follow-up, (3) not performed in specific groups, (4) to have a comparison group. After selection by title and abstract, potentially eligible articles were read in full. Meta-analysis was carried out considering the outcome as caries lesion progression or arrestment. RESULTS The search strategy identified 772 potentially relevant studies, and 10 of them were included in the review (six laboratory studies and four longitudinal trials). For the longitudinal clinical trials, no difference was verified among the materials (OR = 0.680,95%CI:0.233-1.983). When a meta-analysis was performed for laboratory studies, GIC was significantly associated with better ability to arrest caries lesions (OR = 0.153,95%CI:0.060-0.391). CONCLUSIONS In laboratory studies, GIC shows better ability to arrest caries lesion in approximal adjacent surfaces, but this ability was not confirmed in longitudinal clinical trials.

Evaluation of the relationship between the cost and properties of glass ionomer cements indicated for atraumatic restorative treatment

The aim of this study was to evaluate microshear bond strength (μSBS), water sorption and solubility of glass ionomer cements (GIC) indicated for atraumatic restorative treatment (ART). Cylindrical specimens (6 x 2.4 mm) were used to test the sorption and solubility of each GIC (n = 5). The specimens were weighed before and after immersion in water and desiccation. For the μSBS test, 60 primary molars were ground to obtain flat surfaces from both enamel and dentin. The teeth were then assigned to the tested GIC (n = 10) groups, namely Fuji IX - FIX, Ketac Molar - KM and Maxxion R - MX. The exposed surfaces were pre-treated with GIC liquid. Polyethylene tubes were placed on the pre-treated surface and filled with one of the GIC. After 24 h, the specimens were submitted to the μSBS test. The failure mode was assessed using a stereomicroscope (400 x magnification). The powder to liquid ratio and cost of material were also determined (n = 3). The data were analyzed by ANOVA and Tukeys post hoc test. Linear regression was used to determine the relation between cost and the other variables. Overall, MX showed lower μSBS values (enamel: 3.93 ± 0.38; dentin: 5.04 ± 0.70) than FIX (enamel: 5.95 ± 0.85; dentin: 7.01 ± 1.06) and KM (enamel: 5.91 ± 0.78; dentin: 6.88 ± 1.35), as well as higher sorption and solubility. The regression analyses showed a significant and positive correlation between cost and μSBS in enamel (R2 = 0.62; p < 0.001) and dentin (R2 = 0.43; p < 0.001); and a negative correlation between cost and water sorption (R2 = 0.93; p < 0.001) and solubility (R2 = 0.79; p < 0.001). In conclusion, the materials indicated for ART exhibit distinct physical and mechanical properties; in addition, low-priced materials may interfere with GIC properties.

Bond Strength of High-Viscosity Glass Ionomer Cements is Affected by Tubular Density and Location in Dentin?

This study evaluated the influence of tubular density of different dentin depths and location on the bond strength of high-viscosity glass ionomer cements (GIC). A total of 20 molars were selected and assigned into six experimental groups, considering two different high-viscosity GICs-Fuji IX (FIX) or Ketac Molar (KM), and dentin location-proximal, occlusal superficial, or occlusal deep dentin (n=10). Teeth were cut and a topographical analysis of four sections per group was performed to obtain data about the tubular density of each different dentin location and depths by laser scanning confocal microscopy (100×). Polyethylene tubes were placed over the pretreated surfaces and filled with one of the GICs. Microshear bond strength (µSBS) test was performed after storage in distilled water (24 h at 37°C). Failure modes were evaluated using a stereomicroscope (400×). Multilevel regression analysis was performed to compare the results at a significance level set at 5%. The tubule density was inversely proportional to the bond strength for both GICs (p<0.05). Adhesive/mixed failure prevailed in all experimental groups. Proximal (30036.5±3433.3) and occlusal superficial 29665.3±1434.04 dentin shows lower tubule density, resulting in a better GIC bonding performance (proximal: FIX-3.61±1.05; KM-3.40±1.62; occlusal superficial: FIX-4.70±1.85; KM-4.97±1.25). Thus, we can concluded that the lowest tubule density in proximal and occlusal superficial dentin results in a better GIC bond strength performance.

Treatment of Riga-Fede disease using laser therapy: clinical case report

ABSTRACT Neonatal teeth arise in the oral cavity in up to 30 days of life. Early eruption of teeth associated with dental trauma on the ventral surface of the tongue during breastfeeding may lead to a set of signs and symptoms called the Riga-Fede lesion, which manifests as a chronic ulceration on the ventral surface of the tongue. Establishing the treatment plan is a challenging task. The pediatric dentist and pediatrician, should act in promoting health and recovery of the baby with the disease, taking care not to neglect the weight loss in newborns. The aim of this study was to demonstrate the clinical implications of a Riga-Fede lesion and treatment approach using laser therapy. A 43-day-old child was referred to pediatric dentistry, presenting weight loss and a congenital lingual injury caused by a neonatal tooth. The treatment, after radiographic examination was extraction of tooth 71, topical application of Triacinolone acetonide and laser therapy. Laser therapy has been shown to be a possible treatment option for Riga-Fede lesions, reducing the healing time to four days, allowing the return to feeding and improvement in the pain symptoms from the first day of application.Indexing terms: Low-level light therapy. Oral Ulcer. Tooth deciduous.