Lesions In Primary Molars Research Articles

Prevalence and Factors of Peri-apical Lesions in Primary Molars

Prevalence and Factors of Peri-apical Lesions in Primary Molars

Comparative Clinical and Radiographic Success Rate of Bioceramic Premix vs Biosilicate-based Medicament as Indirect Pulp Treatment Materials in Primary Molars: A Double-blind Randomized Trial with a Follow-up of 12 Months.

To evaluate and compare the clinical and radiographic success of NeoPUTTY® and Biodentine™ as indirect pulp treatment (IPT) materials in primary molars. This clinical trial was conducted on children aged 5-9 years. Class I carious lesions in primary molars indicated for IPT were divided into two groups-group I, NeoPUTTY®, and group II, Biodentine™. IPC was performed as per the standard protocols. The treated teeth were evaluated for clinical and radiographic success, along with the presence of a dentinal bridge at 6 and 12 months, by three blind examiners independently. All the data were tabulated, and statistical analysis was performed using the Mann-Whitney U test. Interexaminer reliability was analyzed using Fleiss κ statistics, and it showed "good" agreement. Clinical success was 100% in both groups at 6- and 12-month follow-up, while radiographic success was also 100% at 6-month follow-up for both groups. However, at 12-month follow-up, it was 93.33% for group I and 100% for group II. The difference was statistically nonsignificant. The presence of a dentinal bridge at 12-month follow-up was seen in 86.66% of cases in group I and 100% of cases in group II, but there was no statistical difference observed between them with a p-value of 0.555. Within the limitations of the study, we conclude that NeoPUTTY® and Biodentine™ are equally effective as IPT agents in primary teeth. Kothari P, Mathur A, Tirupathi S, et al. Comparative Clinical and Radiographic Success Rate of Bioceramic Premix vs Biosilicate-based Medicament as Indirect Pulp Treatment Materials in Primary Molars: A Double-blind Randomized Trial with a Follow-up of 12 Months. Int J Clin Pediatr Dent 2024;17(7):748-753.

2-year survival and cost analysis of occlusoproximal ART restorations using encapsulated glass ionomer cement in primary molars: a randomized controlled trial

BackgroundThe survival of ART restorations can be influenced by the choice of the restorative material. The aim of this randomized non-inferiority controlled trial was to compare the 2-year survival rate and cost analysis of two encapsulated glass ionomer cements (GIC) as occlusoproximal restorative materials in primary molars.MethodsChildren from public schools in Tietê (Brazil), aged 4–8 years with occlusoproximal dentine carious lesions in primary molars were selected and randomly assigned to receive either Equia Forte (EF) or Riva Self Cure (RSC) as restorative materials. Treatment was carried out by two trained final-year dental students in schools following ART premises. Restorations were assessed by a trained and calibrated examiner after 2, 6, 12, 18, and 24 months. The primary outcome was restoration survival after 2 years, analyzed using Kaplan-Meier survival and Cox regression analysis (α = 5%). Professional and materials costs for each group were collected in Brazilian Reais (R$) and converted into US dollars (US$) and analyzed using Monte-Carlo simulation.ResultsA total of 152 children (76 per group) were included in the study, and 121 (79%) were evaluated after 2 years. The overall 2-year restoration survival rate was 39% (EF = 45%; RSC = 32%) with no difference between the groups. The baseline and 2-year total cost of restorations using RSC was lower when compared to EF (incremental cost: US$ 6.18).ConclusionAfter two years of follow-up, Riva Self Cure shows comparable restoration survival rates to Equia Forte, being more cost-effective in the Brazilian perspective.Trial RegistrationThis randomized clinical trial was registered on ClinicalTrials.Gov - NCT02730000.

Partial pulpotomy success in primary molars followed up for 24 months: A randomized controlled clinical trial using mineral trioxide aggregate, biodentine, and acemannan.

Finding the best treatment approach and suitable capping materials in primary molars with deep carious lesions remains unresolved. To compare the success rates of partial pulpotomy in deep caries lesions in primary molars treated with mineral trioxide aggregate (MTA), biodentine, or acemannan for 6-24 months. A parallel-design, non-inferiority randomized controlled clinical trial was performed. Ninety mandibular primary molars from 65 children meeting the criteria, aged 3-8 years, were included. After inflamed pulp tissue removal and hemostasis, each tooth was randomly allocated into the MTA control group, or the biodentine or acemannan experimental group (N = 30 per group). All teeth were restored with a stainless steel crown. The outcomes were evaluated for 6-24 months. A generalized estimating equation model was used to compare the overall success rate in each group. After 24 months, 58 children (83 teeth) were available for evaluation. The results indicated that the success rate in the MTA, biodentine, and acemannan groups was 83.3%, 76.9%, and 74.1%, respectively. No significant difference in success rates among groups, however, was observed at the 6- to 24-month follow-ups (at 24th month, p = .30). There was no statistically significant difference between MTA, biodentine, or acemannan in the partial pulpotomy success after 24 months.

In vitro remineralization of adjacent interproximal enamel carious lesions in primary molars using a bioactive bulk-fill composite

BackgroundSurface remineralization is recommended for the management of active non-cavitated interproximal carious lesions in primary teeth. According to the American Academy of Pediatric Dentistry, a recently recognized category of materials called bioactive restorative materials can be used for remineralization. This study aimed to evaluate the release of fluoride (F), calcium (Ca) and phosphate (P) ions from Predicta® Bioactive Bulk-fill composite compared with EQUIA Forte® and Filtek™ Z350 and to determine the remineralization effect of these 3 restorative materials on adjacent initial interproximal enamel carious lesions.MethodsThe release of F, Ca and P ions from 3 groups ((n = 10/group) (Group 1- Predicta®, Group 2- EQUIA Forte® and Group 3- Filtek™ Z350)) was determined at 1st, 4th, 7th and 14th days. After creating artificial carious lesions, human enamel samples were randomly assigned into 3 groups (n = 13/group) which were placed in contact with occluso-proximal restorative materials and exposed to a 14-day pH cycling period. Surface microhardness was determined using a Knoop microhardness assay at baseline, after artificial carious lesions formation and after pH cycling. The difference in the percentage of surface microhardness recovery (%SMHR) among groups was compared. Mineral deposition was analyzed with energy-dispersive x-ray spectroscopy (EDS) and the enamel surface morphology was evaluated with scanning electron microscopy (SEM). Kruskal-Wallis’s test with Dunn’s post hoc test and one-way ANOVA with Tukey’s post hoc test were used for data analysis.ResultsEQUIA Forte® released the highest cumulative amount of F and P ions, followed by Predicta® and Filtek™ Z350. Predicta® released higher amount of Ca ions than EQUIA Forte® and Filtek™ Z350. Predicta® demonstrated the highest %SMHR, followed by EQUIA Forte® and Filtek™ Z350. There was a significant difference in the %SMHR between Predicta® and Filtek™ Z350 (p < 0.05). However, EQUIA Forte® demonstrated the highest fluoride content, followed by Predicta® and Filtek™ Z350. The SEM images of EQUIA Forte® and Predicta® revealed the greater mineral deposition.ConclusionPredicta® demonstrated a marked increase in surface microhardness and fluoride content of adjacent initial interproximal enamel carious lesions in primary molars compared with Filtek™ Z350. Predicta® is an alternative restorative material to remineralize adjacent initial interproximal enamel carious lesions in primary molars, especially in high-risk caries patients.

Iatrogenic Incidents in Primary Molar Pulpectomy: A Case Series Report and Literature Review

Pulpectomy is a common treatment for severe carious lesions in primary molars. Care should be taken during pulpectomy of the primary teeth for successive permanent teeth. This case series report aimed to describe the cases of three patients who experienced excessive extrusion of canal filling materials and file separation during primary molar pulpectomy. The presence of separated files or excessive overfilling materials observed around successive permanent tooth germs leads to underdevelopment and may trigger cystic changes owing to abscess formation. The most important aspect is to preserve the unerupted successive developing permanent tooth. Therefore, clinicians should consider the anatomy of the primary molars prior to endodontic treatment, be careful when manipulating instruments during pulpectomy, provide appropriate treatment if iatrogenic incidents occur during endodontic treatment, and perform close follow-up to ensure the successful development and eruption of subsequent permanent teeth.

Silver diamine fluoride modified atraumatic restorative treatment compared to conventional restorative technique on carious primary molars–A randomized controlled trial

ObjectiveTo compare the success of silver diamine fluoride-modified atraumatic restorative technique (SMART) with that of the conventional drill and fill method in restoring carious lesions in primary molars. MethodChildren (4–8years old) reporting to a tertiary care hospital setting with asymptomatic cavitated dentinal carious lesions in primary molars were randomly allocated to two groups; SMART and Conventional; and subsequently restored with Glass Ionomer Cement (GIC). Follow-up evaluations were carried out by blinded independent evaluator at 6-months intervals to assess the status of restorations. Primary outcome was the success of restorations at 24 months and the secondary outcome was the child's behaviour and acceptance of the treatment at the time of interventions. Two sample Z-test of proportion, logistic regression analysis and Chi-square test were used to compare the outcomes in two groups. ResultsA total of 226 children (SMART group, 112 and conventional, 114) were included with 280 and 282 GIC restorations placed by the SMART and the conventional method respectively. At 24-months, 459 (81.6 %) primary molars were available for evaluation. Success rates of restorations was 38.4 % and 45.8 % % in SMART and conventional groups respectively (p = 0.105). The rate of acceptability of treatment in the SMART and conventional group was 79 % and 56 % (p<0.001) respectively. ConclusionThere was no significant difference in the success rates of GIC restorations by SMART and conventional technique in carious primary molars at 24 months. SMART was better accepted by children as compared to the conventional restorative technique. Clinical significanceSMART can be an alternative option to treat the asymptomatic carious lesions in primary molars and is well accepted by children than the conventional drill and fill technique thus implying that it has a useful role in un-cooperative children.

Microbiota of Dental Caries in Primary Teeth of a Costa Rican Child Population

The objective of this research was to identify bacteria present in the microbiota of dentinal carious lesions in primary molars of some Costa Rican pediatric patients. Data were collected from 15 children aged between 4 and 8 years old who attended the Pediatric Dentistry Clinic at the Faculty of Dentistry from the University of Costa Rica (UCR). The inclusion criteria were: infants between 4 and 8 years old who presented cavitated carious lesions in primary teeth, who were actively attended by students at the Faculty of Dentistry from the UCR, and whose parents or legal guardians signed the informed consent to participate in this research. Samples were taken using a sterile spoon, placed in storage vials, and subjected to various conventional and molecular microbial identification techniques, such as Gram stain identification, catalase tests, oxidase, TSI, API 20E, API STAPH, and VITEK 2. Of the 60 bacterial strains subjected to Gram staining, the following was obtained: 28 Gram-positive bacteria and 32 Gram-negative bacteria. The main isolated organisms were species of Staphylococcus epidermidis, Pasteurella pneumotropica/Mannheimia haemolytica, Pantoea spp, and Streptococcus mutans.

Treatment success of carious primary molars with marginal breakdown: comparison of three treatment approaches in a real-world clinical setting (using decision tree analysis).

treatment of carious primary molars is always indicated especially on young children, however there is no clear guidelines precisely explain the best treatment approach treating class II carious molars with marginal breakdown (ICDAS 5). This prospective observational clinical study is aimed to assess the efficacy of three restorative techniques in treating ICDAS 5 class II lesions in primary molars: Compomer fillings [CF], preformed metal crowns performed [PMC], Pulpotomy and conventional preformed metal crowns. The secondary goal is to evaluate the impact of some cofactors on the course of treatment. Overall, 92 children (female n= 50, 54.3%; male n= 42, 25.3%, 2-9 years old; mean age= 5.9±1.9) with 166 treated teeth were included. The d3mft of the whole sample was 8.0± 3.4. The distribution of the sample according to type of treatment was CF= 53 (31.9%), PMC= 64 (38.6%) and PMC+P= 49 (29.5%). Paired t-test, non-parametric Friedman's Anova test, and decision tree analysis were used as the basis for the statistics. After 12 months, data from 75.8% (72/95) treated patients, corresponding to 63.5% (103/166) of the treated teeth (CF=42/53, 79.2 %; PMC= 38/64, 59.3%; PMC+P= 23/49, 46.9%) were available for analysis. The mean patients age was 6.8± 1.8; 32 (47%) were boys and 36 (52.9%) girls. The mean d3mft of the remaining sample was 7.8±3.35. PMC and PMC+P arms showed the highest success rates (>91%) as compared to the CF arm, which showed the lowest success rates (61.9 %), with 9/42 teeth of the CF group (21.4%) presenting with minor failures, and 7/42 teeth (16.7%) with major failures (p<0.0001). According to decision tree analysis, PMC and PMC+P had a success rate of 99 %, whereas CF had a success rate of only 69 %. some cofactors like treatment decision, plaque index (API), and tooth number, had higher impact on the tree anlysis than others like age, dmfs, and dmft values especially when treatment selection was CF. It is necessary to examine the impact of other cofactors on the outcomes of conventional fillings using a bigger sample size.

Effect of Light-Curable Resin-Modified Glass Ionomer Varnish on Non-Cavitated Proximal Caries Lesions in Primary Molars: A Randomized Controlled Trial.

The purpose of this study was to radiographically and clinically assess, after six and twelve months, the additive effect of light-curable resin-modified glass ionomer (LCRMGI) varnish on preventive standard-of-care measures (sodium fluoride varnish, oral hygiene instructions, and dietary counseling) for the treatment of non-cavitated proximal carious lesions in primary molars. This prospective, split-mouth, randomized clinical trial recruited 5-8-year-old children with at least one pair of bilateral non-cavitated proximal carious lesions in the enamel or outer third of the dentin. The lesions were randomized into one of two groups: experimental (which received LCRMGI varnish with the preventive standard-of-care measures) or control (which received the preventive standard-of-care measure). A total of 47 out of 53 participants, with 70 out of 80 pairs, completed the study. Radiographically, lesions in the experimental groups were more likely to regress after six (OR = 3.25) and twelve months (OR = 2.67), but it was not statistically significant (p = 0.052 and p = 0.055, respectively). Clinically, the experimental group showed significantly higher regression rates than the control group after six and twelve months (p = 0.041 and p = 0.003, respectively). The LCRMGI varnish demonstrated promising potential as an adjuvant to preventive standard-of-care measures in promoting regression and inhibiting the progression of non-cavitated proximal carious lesions.

Is silver diammine fluoride effective in arresting dental caries in cavitated primary molars?

To evaluate the efficacy of silver diamine fluoride (SDF) in arresting dental caries in cavitated caries lesions in primary molars. A systematic search was carried out in PubMed, Scopus, and Embase. Furthermore, cross-referencing was performed using the references lists of full-text articles and grey literature was also retrieved for eligible studies. Two independent reviewers were responsible for study selection and data extraction. Randomized and non-randomized clinical studies that evaluated the caries arrest rate of SDF compared to no treatment or any other type of non-invasive or minimally-invasive treatment were included. Only publications in the English, Italian and French language and with a minimum follow-up of 6 months were considered for study eligibility. The characteristics of the included studies-age, sex, type of study, sample size, caries at baseline, setting, operator, blinding, intervention, outcomes and assessment of any confounders-were extracted from the included papers. The quality assessment was carried out using the Cochrane risk of bias tool. The success rate and odds ratios were chosen to calculate the effect size for the meta-analysis. A total of nine publications were included for qualitative review and five of them were included in the meta-analysis. Around half of lesions that received annual or biannual application SDF ≥ 38% were arrested. SDF 38% application was found to be effective in arresting dental caries progression in cavitated primary molars.

The clinical success of ART restorations and Hall technique in primary molars: a randomized 18-month follow-up study.

The aim of the study was to evaluate the clinical and radiographic success of the Hall technique (HT) and atraumatic restorative treatment (ART) restorations using high-viscosity glass-ionomer cement for the management of occlusal carious lesions in primary molars. This randomized clinical study observed 40 children (aged 5-6 years). For each child, one tooth was treated with HT and one with ART. The primary outcome measures for HT restorations were successful, minor, and major failure rates. Clinical evaluations of ART restorations were performed according to the modified United States Public Health Service criteria during 18-month follow-up. McNemar test was used for statistical analysis. Thirty of 40 (75%) participants returned for 18 months of follow-up. In the clinical evaluations of teeth that were treated with HT, the patients did not have complaints of pain or other symptoms, all crowns remained in the oral cavity, the gums were healthy, and the teeth were functional in all evaluations. At the end of the 18-month follow-up, the surface texture and marginal integrity criteria of ART restorations were recorded as 26.7% and 33.3%, respectively. In the radiographic evaluation of 30 patients treated with ART and HT, all restorations were considered successful. The 18-month clinical and radiographic results after treatments applied to single-surface cavities in anxious children showed that both treatment methods were successful.

Silver Diamine Fluoride as Indirect Pulp Capping Agent in Primary Molars: A Case Series

According to the current recommendations of the American Academy of Pediatric Dentistry (AAPD), Indirect Pulp Capping or Indirect Pulp Treatment (IPT) is defined as a procedure that preserves the deepest cavities adjacent to the pulp to prevent pulp exposure. Preserving and protecting the vital pulp through remineralisation of hypomineralised carious dentin poses a significant challenge in restorative dentistry. Traditionally, managing deep caries often led to pulp exposure and subsequent root canal treatment. Selective or stepwise caries removal is based on the concept of halting the progression of carious destruction, allowing for biological repair of the pulp-dentin complex by promoting the formation of tertiary dentin between temporary and definitive restorations. Silver Diamine Fluoride (SDF) has gained popularity due to its unique combination of silver and fluoride, which provides antimicrobial and remineralising properties. In this case series of three cases, three-year-old preschool boy, five year old girl and five year old girl, in whom, deep carious lesions in primary molars were treated using selective caries removal techniques with SDF as an IPT agent, resulting in successful minimally invasive restorative procedures. This case series underscores the importance of employing selective caries removal techniques and the potential use of SDF as an IPT agent in such scenarios to preserve tooth vitality in a less invasive therapeutic approach suitable for the pediatric population.

Survival rate of the Hall technique compared with resin composite restoration in multi-surface cavities in primary teeth: a 1-year randomized clinical trial.

Hall technique (HT) has been indicated for teeth with dentinal caries lesion; however, extensive cavities, with more than two surfaces still seem challenging for restorative treatment in pediatric dentistry, resulting in a higher failure rate and an increased need for retreatment. To compare the survival rate of the Hall technique preformed metal crown (HT) with resin composite restoration (RC) for multi-surface cavitated caries lesions in primary molars. In this multicenter two-arm randomized clinical trial, children between 4 and 9 years of age with at least one primary molar with cavitated caries lesion involving more than two surfaces, including one buccal or palatal/lingual surface, were selected from 17 Brazilian cities. A total of 364 teeth were allocated into two groups: (1) teeth treated with selective caries removal and RC and (2) treated with the HT. The survival rate was assessed at 6 and 12 months after the interventions. Survival analysis was performed with the Kaplan‒Meier method. Cox regression was used to determine the influence of explanatory variables on the survival rate (α=5%). After 12 months, 292 teeth were re-evaluated. A total of 358 teeth were re-evaluated at least once during the study and included in the survival analysis. The HT (87.8%) resulted in a higher survival rate than RC restoration (75.7%) (p=0.004). HT has a higher survival rate than RC as a treatment for multi-surface cavitated caries lesions in primary teeth. ClinicalTrials.gov: NCT02782390.

Silver Diamine Fluoride (SDF) Efficacy in Arresting Cavitated Caries Lesions in Primary Molars: A Systematic Review and Metanalysis.

A systematic review and meta-analysis were carried out to evaluate the efficacy of silver diamine fluoride (SDF) in controlling caries progression in cavitated primary molars. A search for randomized and non-randomized trials with follow-up > 6 months was performed using PubMed, Scopus and Embase. The Cochrane risk of bias tools were used for the quality assessment. The success rate and odds ratios were chosen to calculate the effect size for the meta-analysis. A total of 792 papers were identified and 9 were selected. A high variability regarding SDF application protocol was found; otherwise, caries arrest was always recorded using visual/tactile methods. Two studies were judged at low risk of bias, six at moderate risk and one at high risk. Data from five studies were aggregated for meta-analysis. Heterogeneity was found moderate (I2 = 35.69%, p = 0.18). SDF application was found to be overall effective (fixed effect model) in arresting caries progression (ES = 0.35, p < 0.01). In a total of 622 arrested lesions, out of 1205 considered, the caries arrest rate was 51.62% ± 27.40% (Confidence = 1.55) using SDF ≥ 38% applied annually or biannually. In conclusion, when applied to active cavitated caries lesions in primary molars, SDF appears to be effective in arresting dental caries progression, especially if applied biannually.

RADIOGRAPHIC EVALUATION OF CARIES DEPTH, ROOT RESORPTION, AND FURCATION LESION IN PRIMARY MOLARS

Objectives To determine the relationship of caries depth, root resorption, and furcation injury in primary molars. Study Design A cross-sectional study of patients aged 3 to 12 years. A health questionnaire was applied; the teeth were submitted to physical examination using the International Caries Detection and Assessment System and periapical radiography. Criteria for radiographic interpretation were established and assessments performed by 3 different specialists. The kappa coefficient measured interexaminer agreement at a level of significance of 5% for all tests. Results The sample consisted of 26 patients and 50 primary molars. The interexaminer agreement was almost perfect between the radiologist and pediatric dentist for caries depth on the mesial surface (K = 0.97), occlusal surface (K = 0.97), resorption of the mesial (K = 0.89), and distal roots (K = 0.93). The detection of furcation lesions was present in 42.3%; 50% of the teeth had at least one third of the mesial root resorbed and 75% of the distal root. Conclusions The depth of caries in primary teeth leads to the presence of a furcation lesion that influences root resorption. This information should be used by radiologists and dentistry to guide the use of criteria in radiographic evaluation and treatment decisions. To determine the relationship of caries depth, root resorption, and furcation injury in primary molars. A cross-sectional study of patients aged 3 to 12 years. A health questionnaire was applied; the teeth were submitted to physical examination using the International Caries Detection and Assessment System and periapical radiography. Criteria for radiographic interpretation were established and assessments performed by 3 different specialists. The kappa coefficient measured interexaminer agreement at a level of significance of 5% for all tests. The sample consisted of 26 patients and 50 primary molars. The interexaminer agreement was almost perfect between the radiologist and pediatric dentist for caries depth on the mesial surface (K = 0.97), occlusal surface (K = 0.97), resorption of the mesial (K = 0.89), and distal roots (K = 0.93). The detection of furcation lesions was present in 42.3%; 50% of the teeth had at least one third of the mesial root resorbed and 75% of the distal root. The depth of caries in primary teeth leads to the presence of a furcation lesion that influences root resorption. This information should be used by radiologists and dentistry to guide the use of criteria in radiographic evaluation and treatment decisions.

Assessment of dental caries lesion activity status using quantitative parameters obtained from the quantitative light-induced fluorescence method and difference of microbial distribution in primary molars

BackgroundThis study aimed to assess differences in quantitative measures obtained from the quantitative light-induced fluorescence method and microbial composition of carious dentin and saliva according to the activity status of caries lesions in primary molars. MethodsA total of 34 teeth from 34 children were evaluated in this study. The activity status of carious lesions was classified using the International Caries Classification and Management System criteria (active or inactive). Images of the carious lesions were captured using a quantitative light-induced fluorescence device for quantitative analyses. Carious dentin and saliva were collected to detect and quantify selected bacterial species (S. mutans, S. sobrinus, Lactobacillus species, F. nucleatum, P. nigrescence, P. intermedia) and C. albicans by quantitative polymerase chain reaction. Mann–Whitney U tests were performed to evaluate differences in quantitative measures from quantitative light-induced fluorescence, the microbial composition of carious dentin, and saliva according to the activity status of carious lesions. ResultsRed fluorescence values (∆R, ∆Rmax) from the quantitative light-induced fluorescence method were significantly higher in active lesions (∆R, p = 0.009; ∆Rmax, p = 0.014). The quantitative mean levels of Lactobacillus species (p = 0.010) in carious dentin and S. sobrinus (p = 0.017) in saliva were significantly higher in the active-lesion group. ConclusionsQuantitative measures related to red fluorescence from the quantitative light-induced fluorescence method, levels of Lactobacillus species from carious dentin, and levels of S. sobrinus from saliva were associated with caries lesion activity.

Selective stepwise caries removal in primary teeth: a microbiological assessment on surviving microbiota

Partial caries removal performed by the stepwise treatment has a high rate of clinical success and promotes a reduction of microorganisms in carious dentin. However, the adaptive behavior of these cloistered bacteria is not entirely clear. Aim: This study aimed to evaluate the carious dentin and quantify the microorganisms Streptococcus mutans and Lactobacillus acidophilus at the first intervention and after 90 days, assessing the acidogenicity and aciduricity of these bacteria isolated from the lesions. Methods: Twenty patients presenting deep caries lesion in primary molars eligible to receive the stepwise treatment were selected, dentin samples were collected in two different moments: in the first intervention, just after partial caries removal; and in the second intervention, during the reopening of the cavity (90 days after the temporary sealing of the lesion). The samples were processed for microbiological analyses via culture, identification and quantification. The bacteria isolates were subjected to phenotypic tests of acidogenicity and aciduricity. Dentin consistency and color was also recorded by a calibrated examiner. Data were statistically analyzed. Results: There was a reduction in the number of viable microorganisms while dentin rehardening and browning was noted (p&lt;.05), but no change occurred in the acidogenicity and aciduricity properties of Streptococcus mutans and Lactobacillus acidophilus over time. Conclusion: Thus, the stepwise treatment promoted clinical changes as darkening and hardening of carious dentine and promoted a reduction in the number of viable microorganisms, but no influence was found on the phenotypic characteristics of acidogenicity and aciduricity of the species analyzed after 90 days.

ART restorations for occluso-proximal cavities in primary molars: a two-year survival and cost analysis of an RCT comparing two GIC brands

There are many glass ionomer cements available on the Brazilian market for Atraumatic Restorative Treatment (ART), however, there is still a gap in the literature regarding their cost-effectiveness. Objectives To evaluate the influence of restorative materials (Ketac Molar, 3M ESPE; and Vitro Molar, Nova DFL) in the two-year survival rate and cost-effectiveness of occluso-proximal ART restorations in primary molars. Methodology A total of 117 children (aged four to eight years) with at least one occluso-proximal carious lesion in primary molars were selected and randomly divided in treatment groups (KM or VM) in this parallel randomized controlled trial. Treatments followed ART premises and were conducted in public schools by trained operators in Barueri, Brazil. A trained, calibrated, and blinded examiner performed the evaluations after two, six, 12, and 24 months (k=0.92). Kaplan-Meier survival analysis was used to estimate restoration survival and Cox regression was used to test the association with clinical factors (α=5%). For cost analysis, material and professional costs were considered. Monte Carlo analysis was used to generate a cost-effectiveness plane and bootstrapping was used to compare material costs over the years. Results The overall survival rate was 36.9% after two years (48.6% for KM and 25.4% for VM). Restorations with VM failed more than those with KM (HR=1.70; 95% CI=1.06–2.73; p=0.027). VM presented lower initial cost, but no difference was observed between groups considering the two-year incremental cost. Conclusion After a two-year evaluation, KM proved to be a better option than VM for occluso-proximal ART restorations in primary molars. ClinicalTrials.gov: NCT02267720

Children’s self-reported discomfort of restorative treatments for deep caries lesions in primary teeth: Results from a randomized clinical trial

The aim of this study was to evaluate the impact of different restorative techniques to treat deep caries lesions of primary molars on children’s self-reported discomfort. A randomized clinical trial with two parallel arms (1:1) was conducted in São Paulo, Brazil. 4-8 years-old children with at least one occlusal or occlusoproximal deep caries lesion in primary molars were selected. Molars were randomly allocated into two groups: (1) restoration performed with calcium hydroxide cement followed by high-viscosity Glass Ionomer Cement (CHC+HVGIC), and (2) HVGIC restoration. Immediately after the intervention, children reported the experienced discomfort during restoration to an external examiner using a Wong-Baker face-scale. Children’s self-reported discomfort was analyzed using Poisson regression comparing both groups and assessing other variables’ influence (α=5%). One hundred and eight children fulfilled the eligibility criteria and were randomized in the two groups (n=54). Most of the children who received CHC+HVGIC restorations reported none or minimal discomfort (83.3%). Similar scores (92.6%) were reported for those treated with HVGIC (p=0.758). The mean reported discomfort in children with CHC+HVGIC restorations was 0.37(1.01), and 0.41(1.01) for those with HVGIC restorations. Children’s self-reported discomfort was associated with age, sex, children’s cooperation, and intervention duration. We can conclude that CHC+HVGIC or HVGIC restorations result in none or minimal discomfort in the management of deep caries lesions, being considered a reliable option.