Dificuldades no atendimento odontológico das crianças, devido à necessidade de controle do comportamento e de suporte familiar adequado, além de peculiaridades relativas à anatomia dos dentes decíduos, suscitam o uso de técnicas de mínima intervenção para o controle da cárie dentária. Logo, o objetivo do presente trabalho foi realizar uma revisão bibliográfica sobre o tratamento minimamente invasivo de lesões de cárie em dentes decíduos, abordando as características, indicações e limitações de diferentes técnicas dentro desse conceito. O controle de biofilme sem selamento dentário é uma abordagem na qual nenhum tipo de material restaurador é colocado para selar as cavidades, sendo instituída a higiene bucal de modo eficiente como estratégia para paralisar as lesões de cárie. O selamento da lesão sem remoção de tecido cariado prevê a utilização de selantes resinosos ou coroas metálicas diretamente sobre as cavidades, sem remoção prévia de tecido cariado. Já a remoção seletiva de cárie seguida de restauração é a técnica mais aceita e utilizada em odontopediatria, sendo atualmente considerado o padrão ouro, em detrimento da remoção total de tecido cariado. Apesar de a mínima intervenção ser bem aceita pelas crianças, sua aceitabilidade pelos responsáveis e odontopediatras ainda é questionável. Verificou-se que todas essas técnicas se apresentam como alternativas eficazes para o tratamento minimamente invasivo em odontopediatria. Entretanto, é fundamental o entendimento, participação e comprometimento dos familiares, tendo em vista que o controle do biofilme e da dieta possuem papel fundamental para garantir o sucesso desses tratamentos.
Objective To investigate the influence of the selective etching in the survival rates of indirect restorations cemented with self‐adhesive resin luting. Materials and Methods The eligibility criteria were formulated based on PICOS strategy. The search without restrictions was performed in PubMed/Medline, the Cochrane Library, Web of Science, Scopus, LILACS databases and gray literature until May 2018. Cochrane Collaboration's tool was performed for assessing the risk of bias. According to the bias risk analysis, the studies were classified as low risk of bias and high quality of evidence. The systematic review was conducted according to PRISMA and registered in PROSPERO (CRD42018091202). The meta‐analysis was performed using RevMan 5.3 software (RevMan, Copenhagen, Denmark) and the risk ration and confidence interval was obtained (p < 0.05). Results After database screening, removal of duplicates and eligibility criteria application, two studies were selected for this systematic review, with 65 participants (34 in one and 31 in the other). The pooled meta‐analysis demonstrated no statistically significant difference in clinical longevity for selective etching in indirect restorations (P > .05; I2 = 0%) and risk ratio of 0.46 [0.19‐1.09]. Conclusions Based on the findings, the results of this systematic review suggest that the selective enamel etching prior to application of self‐adhesive luting cements systems for indirect restoration do not influence the clinical longevity of indirect restorations. Clinical significance: The knowledge of the clinical steps of adhesive procedures is fundamental to the success of adhesive restorations and their longevity. Self‐adhesive resin cements simplify the luting procedure of indirect restorations. However, adding a step that could significantly improve long‐term survival would be of great value. Thus, the results of this systematic review will provide data so that the decision making regarding materials used for adhesive cementation is conducted based on scientific evidence.
The aim of the present study was to verify if a protocol for cleaning the oral cavity of infants in the pre-dental period can reduce extrinsic salivary metabolites observed through Nuclear Magnetic Resonance (NMR). A cross-sectional clinical study with a convenience sample was conducted, and infants were recruited at the UFRJ Pediatric Dentistry Clinic. Participants who had used antibiotics and/or antifungals up to 3 months before and whose legal guardians did not consent or sign the Informed Consent Form were excluded. An anamnesis was performed with the guardians and the participants' intraoral clinical examination. Initial collection of unstimulated total saliva was performed using an automatic pipette with sterile plastic tips in the buccal floor region, at least 1 h after the last feeding. Subsequently, the infants' oral mucosa was cleaned with gauze moistened with filtered water, and after 5 min, a new collection was performed, using the same methodology. The obtained samples were immediately transferred on ice to the laboratory, centrifuged (10,000 g), and stored at −80°C. The NMR analyses were performed using a 500-MHz spectrometer Bruker, Germany); evaluations were done via the 1H and 1H-1H TOCSY spectra for metabolite signaling. Eleven pre-dental infants were evaluated, with a mean age of 3.8 months, including six girls (55%). Of these, nine participants (82%) were exclusively breastfed. The higher presence of components such as lactose, glucose, sugars, acetate, alanine, and lactate were observed in the samples before oral mucosa cleaning. Regarding the type of diet, more lactose was observed in the saliva of patients who were exclusively breastfed than those that received mixed feeding. We conclude that the oral mucosa cleaning of infants in the pre-dental period tends to reduce the concentration of extrinsic components from the diet, such as lactose, in the salivary metabolomic profile analyzed by NMR.
The aim of this study was to check the in vitro accuracy of ICDAS criteria on digital images compared to visual examination for the diagnosis of occlusal caries against a micro-CT gold standard. ICDAS was scored in 40 extracted permanent molars by means of visual inspection and stereomicroscopic images. Visual examinations were performed in duplicate and at a one-week interval by three different calibrated examiners. The analysis of digital images by ICDAS criteria was also performed in duplicate, 1 month after visual examinations. The detection methods were compared by means of sensitivity, specificity, area under the curve, predictive positive and negative values, and accuracy for two different thresholds (1- sound vs. carious teeth; 2- tooth requiring operative vs. non-operative treatment). Sensitivity and accuracy values for threshold 1 in the visual ICDAS and image-based ICDAS methods were high for sensitivity (0.93 and 0.97) and for accuracy (0.83 and 0.85), but low for specificity (0.55 for both methods). Specificity values for threshold 2 were 0.77 and 0.82, while sensitivity was 0.33 and 0.28 for each method. Spearman's rank correlation coefficient was 0.53 and 0.43 (p<0.05) for visual and image-based ICDAS compared to the gold standard scores. Both visual and image-based ICDAS scores were similar to each other in terms of diagnostic accuracy when compared to the micro-CT gold standard. Low specificity for the presence of caries and sensitivity for the detection of caries requiring operative treatment were found.
Palavras-chave: Anquiloglossia. Pessoas com Deficiência. Freio Lingual. RESUMOIntrodução: A frenectomia é o tratamento mais indicado para os casos de anquiloglossia em crianças e jovens, sendo a recorrência extremamente rara. Objetivo: O objetivo é relatar o caso incomum de um menino de 8 anos, com paralisia cerebral, apresentando recidiva de anquiloglossia dois anos após a realização de frenectomia lingual. Relato de caso: Ao exame físico, em consulta de revisão, 2 anos após uma frenectomia lingual observou-se freio lingual levemente elástico, curto e aderido, presença de formato de coração na língua, restrição severa dos movimentos laterais e superiores, além de dificuldades na fala e deglutição. Uma nova frenectomia foi realizada após dois anos da primeira frenectomia , sob anestesia local, restaurando a mobilidade lingual. O paciente foi acompanhado periodicamente junto com a fonoaudiologia e após 2 anos da segunda cirurgia, a inserção firme do freio e a continuidade do aspecto bífido da língua foram novamente verificadas, porém, os movimentos da língua e as funções orais mantiveram-se satisfatórios. O paciente continuará a ser acompanhado periodicamente e, se houver alterações nas funções orais, uma nova intervenção será realizada. Conclusão: É fundamental o diagnóstico e tratamento multidisciplinar da anquiloglossia, além da necessidade de acompanhamento clínico periódico para identificar possíveis casos de recidiva, que, embora raros, podem ocorrer.
The aim of the present study was to evaluate the microtensile bond strength and the microleakage of a bulk-fill composite resin compared with a conventional incremental composite resin, in permanent molars and under cariogenic challenge using a Streptococcus mutans model. Permanent human third molars (n = 60) with an occlusal cavity of 5x3x2 mm were randomly allocated into four subgroups of restorative treatments: conventional composite resin with (n = 15) and without (n = 15) cariogenic challenge (Z350-E and Z350-C experimental and control groups, respectively), and bulk-fill composite resin with (n = 15) and without (n = 15) cariogenic challenge (Bulk Fill-E and Bulk Fill-C, respectively). Ten specimens from each subgroup were submitted to microtensile strength, and 5, to microleakage. The cariogenic challenge was conducted using the Streptococcus mutans strain (ATCC) for 7 days. The stickers obtained (1 x 1 x 2 mm) were submitted to a microtensile strength test, followed by classification of the fracture mode. Microleakage was performed using a scoring system. The data were analyzed by Kruskal-Wallis and Mann-Whitney tests (p < 0.05). Filtek Z350 XT resin presented higher microtensile bond strength than Bulk Fill resin without (19.02 ± 4.90 and 8.76 ± 3.94MPa, respectively; p < 0.001) and with cariogenic challenge (22.69 ± 7.86 and 13.31 ± 3.38MPa, respectively; p < 0.02). Z350-C and Bulk Fill-C resins presented a higher prevalence of mixed fractures (23 and 14%, respectively) in the specimens submitted to cariogenic challenge than those of the control groups, whereas microleakage was similar (p = 0.85). The conventional composite resin had higher microtensile bond strength than the bulk-fill resin, but both resin types had similar adhesion quality and microfiltration scores.
A cárie dentária é a doença crônica mais comum na infância, sendo responsável por causar impactos funcionais, estéticos e até mesmo na qualidade de vida dos pacientes afetados. Diante do exposto, o objetivo desse trabalho foi explorar uma visão atual da cárie precoce da infância, através de revisão de literatura. A American Academy of Pediatric Dentistry classifica a cárie precoce da infância como a presença de um ou mais dentes decíduos cariados (lesões cavitadas ou não), perdidos por cárie ou restaurados antes dos 71 meses de idade. No Brasil, a prevalência da cárie precoce da infância é de 60% entre as crianças com cinco anos de idade. Seu aparecimento na cavidade bucal ocorre pela interação de microrganismos hospedeiros e uma dieta cariogenica. Além disso, a cárie está relacionada ao contexto social, no qual, verifica-se que indivíduos com baixo nível socioeconômico apresentam maior prevalência da doença. Sendo assim, a prevenção tem um papel fundamental para o não desenvolvimento da doença e deve ter seu início desde a gestação, através de orientações dadas aos pais sobre hábitos alimentares e de higiene bucal a serem adotados a partir do nascimento da criança. Uma vez que a doença já esteja instalada, o tratamento proposto vai variar de acordo com o estágio no qual se encontra o processo carioso, diferenciando-se em abordagens preventivas, interceptativas e reabilitadoras.
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