Camila de Almeida Brandão Guglielmi

Is Atraumatic restorative treatment an option for restoring occlusoproximal caries lesions in primary teeth? A systematic review and meta-analysis.

BACKGROUND Atraumatic restorative treatment (ART) has demonstrated good longevity when used for single-surface restorations, but lower success rates are reported for occlusoproximal surfaces. AIM This systematic review and meta-analysis aimed to verify the pooled success rate of occlusoproximal ART restorations in primary teeth considering the outcomes: longevity, pulp damage, or caries lesion progression. DESIGN Literature searching was carried out on the studies reporting clinical trials indexed in PubMed and in English language, comprising the outcomes. A meta-analysis was undertaken considering the results from reviewed studies. RESULTS An initial search resulted in 126 articles, and three of them were finally selected. The main reasons for excluding articles were the absence of control group, as amalgam, composite resin, or compomer restorations to be compared with ART (hand excavation + high-viscous GIC). The pooled estimate (odds ratio; 95% confidence interval) for ART approach success was 1.04 (0.65-1.66). CONCLUSION Atraumatic restorative treatment restorations performed with high-viscous GIC present similar survival/success rates to conventional approach using composite resin or amalgam for occlusoproximal restorations in primary teeth and can be suggested as a good option for occlusoproximal cavities in primary molars. In addition, further randomized controlled clinical investigations concerning occlusoproximal restorations in primary teeth are still necessary.

Clinical use of photodynamic antimicrobial chemotherapy for the treatment of deep carious lesions

The purpose of this study was to assess photodynamic antimicrobial chemotherapy (PACT) via irradiation, using a low power laser associated with a photosensitization dye, as an alternative to remove cariogenic microorganisms by drilling. Remaining dentinal samples in deep carious lesions on permanent molars (n = 26) were treated with 0.01% methylene blue dye and irradiated with a low power laser (InGaAIP - indium gallium aluminum phosphide; λ = 660 nm; 100 mW; 320 Jcm(-2); 90 s; 9J). Samples of dentin from the pulpal wall region were collected with a micropunch before and immediately after PACT and kept in a transport medium for microbiological analysis. Samples were cultured in plates of Brucella blood agar, Mitis Salivarius Bacitracin agar and Rogosa SL agar to determine the total viable bacteria, mutans streptococci and Lactobacillus spp. counts, respectively. After incubation, colony-forming units were counted and microbial reduction was calculated for each group of bacteria. PACT led to statistically significant reductions in mutans streptococci (1.38 log), Lactobacillus spp. (0.93 log), and total viable bacteria (0.91 log). This therapy may be an appropriate approach for the treatment of deep carious lesions using minimally invasive procedures.

Tubule density and diameter in coronal dentin from primary and permanent human teeth.

This study compared dentinal tubule density and diameter of human primary and permanent teeth at different depths of the coronal dentin. Crowns of eight primary second molars and eight permanent third molars were serially sectioned into three disks of ~0.5 mm thickness (superficial, middle, and deep layers), perpendicular to the long axis. Tubule density and diameter were evaluated in 2,000× and 3,000× magnifications by scanning electron microscopy. Data obtained were subjected to two-way repeated measures ANOVA and Tukeys post hoc test (α = 0.05). Tubule density was greater in primary teeth compared with permanent ones, regardless of depth (primary: 124,329 ± 43,594 mm2; permanent: 45,972 ± 21,098 mm2). In general, the tubule density increased as the dentin depth increased, except to the superficial and middle layers from permanent teeth. Tubule diameter was larger in the dentin layer close to the pulp chamber (superficial: 2.4 ± 0.07 μm; middle: 3.70 ± 0.06 μm; deep: 4.28 ± 0.04 μm). No difference was observed between primary (3.48 ± 0.81 μm) and permanent teeth (3.47 ± 0.73 μm). The tubule diameter increases as the dentin depth increases for primary and permanent teeth; however, the tubule density is higher in primary teeth.

Eroded dentin does not jeopardize the bond strength of adhesive restorative materials

This in vitro study evaluated the bond strength of adhesive restorative materials to sound and eroded dentin. Thirty-six bovine incisors were embedded in acrylic resin and ground to obtain flat buccal dentin surfaces. Specimens were randomly allocated in 2 groups: sound dentin (immersion in artificial saliva) and eroded dentin (pH cycling model - 3× / cola drink for 7 days). Specimens were then reassigned according to restorative material: glass ionomer cement (KetacTM Molar Easy Mix), resin-modified glass ionomer cement (VitremerTM) or adhesive system with resin composite (Adper Single Bond 2 + Filtek Z250). Polyethylene tubes with an internal diameter of 0.76 mm were placed over the dentin and filled with the material. The microshear bond test was performed after 24 h of water storage at 37ºC. The failure mode was evaluated using a stereomicroscope (400×). Bond strength data were analyzed with two-way ANOVA and Tukeys post hoc tests (α = 0.05). Eroded dentin showed bond strength values similar to those for sound dentin for all materials. The adhesive system showed the highest bond strength values, regardless of the substrate (p < 0.0001). For all groups, the adhesive/mixed failure prevailed. In conclusion, adhesive materials may be used in eroded dentin without jeopardizing the bonding quality. It is preferable to use an etch-and-rinse adhesive system because it shows the highest bond strength values compared with the glass ionomer cements tested.

Nd:YAG Laser Irradiation Effect on Apical Intracanal Dentin - A Microleakage and SEM Evaluation

The purpose of this in vitro study was to evaluate the effect of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser irradiation on intracanal dentin surface by SEM analysis and its interference in the apical seal of filled canals. After endodontic treatment procedures, 34 maxillary human incisors were randomly assigned to 2 groups. In the negative control group (n=17), no additional treatment was performed and teeth were filled with vertically condensed gutta-percha; in the laser-treated group (n=17), the root canals were irradiated with Nd:YAG laser (1.5 W, 100 mJ, 15 Hz) before filling as described for the control group. Two specimens of each group were prepared for SEM analysis to evaluate the presence and extent of morphological changes and removal of debris; the other specimens were immersed in 0.5% methylene blue dye (pH 7.2) for 24 h for evaluation of the linear dye leakage at the apical third. SEM analysis of the laser-treated group showed dentin fusion and resolidification without smear layer or debris. The Students t-test showed that the laser-treated group had significantly less leakage in apical third than the control group. Within the limitations of this study, it may be concluded that the morphological changes on the apical intraradicular dentin surface caused by Nd:YAG laser resulted in less linear dye apical leakage.

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.

Influence of ultrasound or halogen light on microleakage and hardness of enamel adjacent to glass ionomer cement

BACKGROUND The use of external sources of energy may accelerate the setting rate of glass ionomer cements (GICs) allowing better initial mechanical properties. AIM To investigate the influence of ultrasound and halogen light on the microleakage and hardness of enamel adjacent to GIC restorations, after artificial caries challenge. DESIGN Cavities were prepared in 60 primary canines, restored with GIC, and randomly distributed into three groups: control group (CG), light group (LG) - irradiation with a halogen light-curing unit for 60s, and ultrasonic group (UG) - application of ultrasonic scaler device for 15s. All specimens were then submitted to a cariogenic challenge in a pH cycling model. Half of sample in each group were immersed in methylene blue for 4h and sectioned for dye penetration analysis. The remaining specimens were submitted to Knoop cross-sectional microhardness assessments, and mineral changes were calculated for adjacent enamel. RESULTS Data were compared using Kruskal-Wallis test and two-way ANOVA with 5% significance. Higher dye penetration was observed for the UG (P<0.01). No significant mineral changes were observed between groups (P=0.844). CONCLUSION The use of halogen light-curing unit does not seem to interfere with the properties of GICs, whereas the use of ultrasound can affect its marginal sealing.

Erosive potential of different types of grape juices

The purpose of the present study was to evaluate the erosive potential of different types (concentrated and powdered) and commercial brands of industrialised grape juices. The pH of all five fruit drinks was measured at two time points: immediately after preparation and 24 hours later. Sixty specimens of bovine enamel were randomly allocated and immersed in different types of grape juice (n = 10) for 10 minutes four times a day for fifteen days. The enamel alteration was analysed using surface Knoop microhardness (KHN) and surface roughness (Ra) tests at baseline and on the 5(th), 10(th) and 15(th) days of the experiment. Two way ANOVA, Tukeys post hoc and Pearsons correlation tests were used for statistical analysis (α = 5%). The grape juices presented pH values ranging from 2.9 to 3.5. All of the tested juices promoted significant enamel mineral loss (p < 0.05) on the first evaluation (5(th) day of immersion) and produced a significant increase in the mean roughness from the 10(th) day on when compared to the control group (p < 0.05). By the 15(th) day, all of the beverages had produced surface roughnesses that were significantly higher than that of the control group. The results suggest that all grape juices, regardless of their commercial presentation, present erosive potential.

Mineral loss on adjacent enamel glass ionomer cements restorations after cariogenic and erosive challenges.

OBJECTIVES the purpose of this study was to determine the mineral loss on surrounding enamel restored with glass ionomer cements (GIC) after erosive and cariogenic challenges. METHODS Bovine enamel specimens were randomly assigned into six groups according to the restorative material: G1 - composite resin; G2 - high viscous GIC; G3 - resin-modified glass ionomer with nanoparticles; G4 - encapsulated resin-modified GIC; G5 - encapsulated high viscous GIC; G6 - resin-modified GIC. After restorative procedures, half of specimens in each group were submitted to caries challenge using a pH cycling model for 5 days, and the other half were submitted to erosive challenge in citric acid for 10 min. Before and after the challenges, surface Knoop microhardness assessments were performed and mineral changes were calculated for adjacent enamel at different distances from restorative margin. RESULTS Data were compared for significant differences using two-way ANOVA and Student-Newman-Keuls tests (p<0.05). Erosive challenge significantly reduced enamel surface hardness, but no significant difference was observed irrespectively restorative materials (p>0.05). The cariogenic challenge promoted a higher surface hardness loss for the resin-modified GIC (G4) and only for the High viscous GIC (G2) an increase in surface hardness was observed. For enamel analyses, significant differences were observed with respect to the different materials (p<0.001) and distances (p=0.023). Specimens restored with the composite resin presented higher mineral loss and specimens restored with the conventional high viscous GIC and the encapsulated resin-modified GIC presented the lowest values for mineral loss. CONCLUSION The GICs exerts protective effect only for cariogenic challenge.

Bilayer technique and nano-filled coating increase success of approximal ART restorations: a randomized clinical trial.

BACKGROUND The high-viscosity consistency of glass ionomer cement (GIC) may lead to its incorrect adaptation into the cavity and therefore to restoration failure. AIM To compare two different insertion techniques for GIC in approximal atraumatic restorative treatment (ART) restorations and two different surface protection materials. DESIGN Approximal caries lesion in primary molars from 208 schoolchildren was randomly assigned into four groups: G1, conventional GIC insertion protected with petroleum jelly (PJ); G2, bilayer technique protected with PJ; G3 conventional GIC insertion protected with nano-filled particles coating for GIC (NPC); G4, bilayer technique protected with NPC. Restorations were evaluated after 1, 6, 12, 18, 24, and 36 months. Kaplan-Meier survival analysis and log-rank test were performed. Cox regression analysis (α = 5%) was used to verify the influence of clinical factors. RESULTS Restoration survival was 52.8%. Log-rank test indicated a better survival of the bilayer technique restorations, compared to conventional restorations (P = 0.005), whereas the coated conventional restorations presented higher survival than the uncoated ones (P = 0.035). Cox regression analysis showed no influence of any clinical tested variables. CONCLUSION The survival rate of the approximal ART restorations is positively influenced by the bilayer technique, and the application of nano-filled coating increases the longevity of the conventional approximal ART restorations.