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Background Glass ionomer cements (GIC) have been considered the top option to restore primary teeth by dentists. The most common supply forms are hand mixed and encapsulated GIC. There is a lack of information about the impact of different GIC supply forms on restoration survival. Methods This randomized clinical trial compared the survival rate of occlusal and occlusoproximal restorations in primary molars using two glass ionomer cements versions: hand-mixed (H/M) and encapsulated (ENC) after 24 months. Children aged 3–10 years who presented dentin caries lesions in primary molars were selected at School of Dentistry, University of São Paulo, Brazil. They were randomly assigned to groups: H /M (Fuji IX®, GC Europe) or ENC (Equia Fill®, GC Europe). The occurrence of restoration failure was evaluated by two blinded and calibrated examiners. The analyses were performed in Stata 13 (StataCorp, USA). To evaluate the primary outcome (restoration survival), we performed a survival analysis. Additionally an intention to treat (ITT) analysis were done at 24 months of follow-up. Cox Regression with shared frailty was performed to assess association between restoration failure and independent variables (α = 5%). Results A total of 324 restorations were performed in 145 children. The survival for H/M group was 58.2% and 60.1% for ENC, with no difference (p = 0.738). Occlusoproximal restorations had lower survival rate when compared to occlusal ones (HR = 3.83; p Conclusions The survival rate in primary molars is not influenced by the different supply forms of GIC. Also, occlusoproximal restorations present reduced performances when compared to occlusal cavities. Trial Registration This randomized clinical trial was registered on ClinicalTrials.Gov on 10/15/2014 under protocol (NCT 02274142).

Objective To identify the best available approach to avoid initial caries lesions progression in primary teeth. Materials and methods Search was performed in MEDLINE/Pubmed, Web of Science, Embase and CENTRAL databases until March 2021. Studies compared treatment options to avoid the initial caries lesion progression with at least 12 months of follow-up were included. Network meta-analyses were conducted considering the non-progression of caries lesions as an outcome. Results Potentially eligible studies were screened (n = 2820) and eleven were included. Six studies evaluated the use of fluoride varnish, resin infiltration, sealing, and toothbrushing/flossing on proximal initial caries lesions. When considering occlusal surfaces, only two studies evaluating the ozone gas, fluoride varnish, resin infiltration, and sealants were included. For buccal/lingual surfaces, three studies evaluating toothbrushing, CPP-ACP paste, fluoride varnish, and resin infiltration were included. For all types of surfaces, the resin infiltration showed the best probability to avoid the progression of initial caries lesions. Conclusion The limited number of included studies, most with a high risk of bias and lack of hard outcomes, such as frank cavitation, makes it not feasible to recommend a specific management approach for initial caries lesion control in primary teeth with a high certainty of evidence. PROSPERO: #CRD42016037781.

Randomised clinical trial (RCT) is the best study design to evaluate the effect of the treatment and preventive healthcare procedures. The effects of the tested treatments on patient's health are compared in terms of outcomes, which are used to evaluate the participants' health changes. However, these outcomes should be relevant for the target population. In that way, RCTs represent the type of primary study design that provides the most reliable evidence to implement therapies into the clinical practice. In this review, an outline of some aspects related to the choice of RCTs' outcomes was presented, focusing on the conduction of relevant trials in Paediatric Dentistry. The importance and necessity of defining a primary outcome were addressed, preferentially a clinically relevant endpoint. The patients should perceive this outcome, and changes in this variable should reflect directly patient's health improvement or impairment. Moreover, considerations about the objective or subjective variables, use of surrogate outcomes, and the increasing tendency to develop core outcome sets were also presented in this review. The main idea of this manuscript is the RCTs must evaluate outcomes relevant to the children's oral health in order to contribute to the implementation of treatments in the evidence-based health practice.

Background There are several systematic reviews of multiple implant loading techniques, but results are conflicting. Aim To perform an umbrella review on methodological quality of systematic reviews about techniques for loading multiple dental implants. Material and methods MEDLINE (PubMed) and Scopus were searched up to December 31, 2019. Unpublished literature was searched through OpenGray and references of included articles were manually verified. Eligibility criteria were: articles had to (1) be about multiple dental implants; (2) mention the moment of loading; (3) be a systematic review. Two independent reviewers participated in the entire process. Qualitative description of included studies as well as methodological quality measurement and risk of bias through AMSTAR and ROBIS were performed. Results 21 reviews were included. Thirteen stated that there was a similarity between loading techniques, two did not affirm which one was more appropriate and six mentioned that conventional technique was better. Eight papers were classified as high risk of bias, twelve as low and one as uncertain risk. Conclusion When evaluating only studies with a low risk of bias, there are no significant differences in implant loading time.

Aim: The aim of this study is to verify the type of scaffold effect on tissue engineering for dentine regeneration in animal models. Materials & methods: Strategic searches were conducted through MEDLINE/PubMed, Web of Science and Scopus databases. The studies were included with the following eligibility criteria: studies evaluating dentine regeneration, and being an in vivo study. Results: From 1392 identified potentially relevant studies, 15 fulfilled the eligibility criteria. All studies described characteristics of neoformed dentine, being that the most reported reparative dentine formation. Most of included studies presented moderate risk of bias. Conclusion: Up to date scientific evidence shows a positive trend to dentine regeneration when considering tissue engineering in animal models, regardless the type of scaffolds used.

Background To evaluate the clinical course and interventions required during two years of follow-up of dental surfaces of deciduous molars diagnosed, and consequently treated, by two different strategies: diagnosis made by clinical examination alone or associated with radiographs. Methods This is a secondary analysis of a two-arm randomized clinical trial with parallel groups related to the diagnostic strategy for caries detection in preschool children. 216 children (3–6 years old) were followed-up for two years. All dental surfaces were diagnosed by visual inspection and later, through radiographic assessment. Baseline treatment was made in accordance with the results obtained by visual inspection performed alone or combined with radiographic method, considering the allocated group. Dental surfaces with no restoration needs, or those restored at the beginning of the study were followed-up for two years. The treatment decision was made according to the allocated group. The outcome was the occurrence of failure (a new caries lesion or a restoration replacement) during the follow-up. Results 4383 proximal and occlusal surfaces of deciduous molars in 216 preschool children were diagnosed and treated according to the abovementioned diagnostic strategies and followed-up for 24 months. The assessment of radiographs made change the initial decision reached by visual inspection in about 30% of the surfaces when all types of interventions were considered. However, most disagreements occurred for initial lesions, where radiographs tended to underestimate them. Discordances between methods occurred in less than 5% of all surfaces when considered lesions requiring operative treatment. For discrepancy cases, the placed interventions guided by following the radiographic results did not present less failures against those made following only visual inspection. As a matter of fact, the use of radiographs in the diagnostic strategy for caries detection in children brought more harms than benefits due to the occurrence of false-positives, overdiagnosis and lead-time bias. Conclusions Simultaneous association of visual inspection and radiographic assessment for caries detection in preschool children causes more harms than benefits, and therefore, visual inspection should be conducted alone in the regular clinical practice. Trial registration Clinicaltrials.gov platform: NCT02078453, registered on 5th March 2014.

Background Studies have questioned the necessity of restoring cavitated carious lesion on primary teeth, once the control of biofilm is the most important factor to arrest these lesions. This randomized clinical trial aimed to compare the survival of teeth treated with a non-restorative cavity control (NRCC) compared to resin composite restorations (RCR) on proximal carious lesion in anterior primary teeth, as well as the impact of these treatments on patient-centered outcomes. Methods A randomized clinical trial with two parallels arms (1:1) will be conducted. Children between 3 and 6 years old will be selected from the Center of Clinic Research of Pediatric Dentistry of Ibirapuera University (UNIB), a dental trailer (FOUSP) located on Educational Complex Professor Carlos Osmarinho de Lima, the Pediatric Dentistry Clinic of Santa Cecília University and from the Pediatric Dentistry Clinic of University Center UNINOVAFAPI. One hundred and forty-eight teeth will be randomly distributed in two experimental groups: (1) Selective removal of carious tissue and RCR; or (2) NRCC through cavity enlargement using a metallic sandpaper. The primary outcome will be tooth survival after 6, 12, 18 and 24 months. The duration and the cost of dental treatments will be considered for the estimation of the cost-effectiveness of the evaluated treatments. The discomfort reported by the participants will be measured after each treatment using the FIS scale. The participants’ satisfaction and perception of the parents/legal guardians will be evaluated through questionnaires. For the primary outcome, Kaplan–Meier’s survival and Long-Rank test will be used for comparison between the two groups. All the variables will be modeled by Cox regression with shared fragility. Significance will be considered at 5%. Discussion The NRCC could be an option to manage carious lesions on proximal surfaces of primary teeth, and the approach could be well accepted by the children and parents/legal guardians. Trial registration Clinicaltrials.gov registration: NCT03785730, Registered on December 18th 2018, first participant recruited 30/04/2019, https://clinicaltrials.gov/ct2/show/NCT03785730. Ethics Reference No: 91569118.8.0000.5597. Trial Sponsor: Universidade Ibirapuera. The Trial was prospectively registered.

Objective To perform a systematic review and meta-analysis of the performance of different methods for detecting carious lesions in permanent and primary teeth, considering all types of tooth surface. Methods Two reviewers searched PubMed, Embase, Scopus and other sources up to November 2020 to identify published and nonpublished studies in English. We focused on three caries detection methods: visual inspection (VI), radiographic (RX) and fluorescence-based (LF). We included studies investigating at least one of these methods which (a) assessed the accuracy of the method in detecting caries lesions; (b) considered occlusal, proximal or free smooth surfaces in primary or permanent teeth; (c) used a reference standard other than one of the three methods; and (d) reported data on sample size and accuracy. Multilevel analyses, meta-regressions and comparisons of bivariate summary receiver operating characteristics curves were undertaken. Results Two hundred and forty manuscripts from 14 129 articles initially identified met the inclusion criteria. VI was better than RX on occlusal surfaces at all caries lesion thresholds and proximal surfaces of permanent teeth only at all lesion thresholds in laboratory setting. LF was slightly better than VI for advanced lesions on occlusal surfaces of permanent teeth in the clinical setting and for all lesions on proximal surfaces of permanent teeth in the laboratory setting. Still, LF was worse than VI for advanced occlusal lesions in permanent teeth in the laboratory setting. Although LF showed slightly better performance than VI with advanced lesions, the latter had significantly higher specificity than other methods in all settings. Conclusion Visual caries detection alone is adequate for most patients in daily clinical practice regardless of tooth type or surface.

Objective This study aimed to conduct a systematic review of the use of a cell sheet formed by mesenchymal stem cells derived from dental tissues (ddMSCs) for periodontal tissue regeneration in animal models in comparison with any other type of regenerative treatment. Design PubMed and Scopus databases were searched for relevant studies up to December 2020. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Results Of the 1542 potentially relevant articles initially identified, 33 fulfilled the eligibility criteria and were considered for this review. Even with a wide variety of selected study methods, the periodontal tissue was always regenerated; this indicates the potential for the use of these cell sheets in the future of periodontics. However, this regeneration process is not always complete. Conclusion Despite the implantation, ddMSCs sheets have a great potential to be used in the regeneration of periodontal tissue. More in vivo studies should be conducted using standardized techniques for cell sheet implantation to obtain more robust evidence of the relevance of using this modality of cell therapy for periodontal tissue regeneration.

There is a lack of evidence about the best approach for cavitated caries lesions with the possibility of pulpal involvement in primary teeth. Thus, the present authors aimed to verify the best treatment for deep caries lesions with or without pulp involvement in primary teeth. The search was conducted in MEDLINE/Pubmed and Web of Science databases until May 2020. Studies that compared techniques to manage deep caries lesions with at least 12 months of follow-up were included. The risk of bias was evaluated using the RoB tool. Network meta-analysis and pairwise meta-analyses were conducted considering the treatment clinical success as an outcome, according to the pulp health condition. From 491 potentially eligible studies, 9 were included. For deep caries lesions with pulp vitality, the Hall Technique presented the highest probability of success (78%). In the event of accidental pulp exposure, pulpectomy presented a 76% chance of providing the best clinical results. For pulp necrosis, no difference was observed between a pulpectomy and non-instrumented endodontic treatment (RR = 0.69; 95%CI: 0.21–2.33) Thus, it was concluded that the Hall Technique may be a better option for deep caries lesions with pulp vitality. In cases of accidental pulp exposure of vital teeth during caries removal, a pulpectomy may be considered the best option. However, there are insufficient studies to build up evidence about the best treatment option when irreversible pulpitis or pulp necrosis is present.

BACKGROUND The aim of this study was to correlate the self-report oral health, oral hygiene and dental assistance with clinic intercurrences with hospitalization in adults in End-Stage Kidney Disease patients. METHODS Seventy-seven patients were interviewed during dialysis therapy concerning their self-report oral health, oral hygiene habits and available dental assistance. Clinical intercurrences were assessed in clinical records. Pearson correlations and linear regression tests were applied for statistical analysis. RESULTS There was a strong negative correlation between the number of brushing times/day and patient hospitalization; there was a negative correlation between oral health and patient hospitalization, there was a positive correlation between the number of teeth in the mouth and oral diseases. CONCLUSIONS The study shows an important correlation between oral health, oral hygiene habits, dental assistance and clinical intercurrences with hospitalization in dialysis patients. The results are weighty to establish protocols that can, directly improve, critical health outcomes of end-stage kidney disease patients under dialysis treatment.

We aimed to evaluate whether children’s caries experience exerts an influence on the performance of visual and radiographic methods in detecting nonevident proximal caries lesions in primary molars. Eighty children (3–6 years old) were selected and classified as having a lower (≤3 decayed, missing, or filled surfaces; dmf-s) or higher (> 3 dmf-s) caries experience. Two calibrated examiners then assessed 526 proximal surfaces for caries lesions using visual and radiographic methods. As a reference standard, 2 other examiners checked the surfaces after temporary separation. Noncavitated and cavitated lesion thresholds were considered and Poisson multilevel regression analyses were conducted to evaluate the influence of caries experience on the performance of diagnostic strategies. Accuracy parameters stratified by caries experience were also derived. A statistically significant influence of caries experience was observed only for visual inspection, with more false-positive results in children with a higher caries experience at the noncavitated lesion threshold, and more false results at the cavitated threshold. The detection of noncavitated caries lesions in children with a higher caries experience was overestimated (specificity = 0.696), compared to children with a lower caries experience (specificity = 0.918), probably due to confirmation bias. However, the examiners underestimated the detection of cavitated lesions in children with a higher caries experience (sensitivity = 0.143) compared to lower-caries-experience children (sensitivity = 0.222), possibly because of representativeness bias. The radiographic method was not influenced by children’s caries experience. In conclusion, children’s caries experience influences the performance of visual inspection in detecting proximal caries lesions in primary teeth, evidencing the occurrence of cognitive biases.

Dental caries is the most prevalent non-communicative disease worldwide. Although the etiological factors are well known for years, reducing the number of decayed and missing teeth in children still remains as a barrier. Preventive and curative options are numerous but little is known about their economical advantages. Selecting the intervention that offers the best balance of effectiveness and financial resources becomes crucial in the current situation of budget restrictions worldwide.This expert review summarizes available evidence on cost-effectiveness analyses of preventive and curative measures to manage dental caries in children.Preventive measures have been more extensively studied than dental caries treatment. Only water fluoridation and tooth brushing are well-established as cost-effective preventive approaches. Despite the increasing number of cost analysis treatment studies in the literature, most of them focus on the cost description, with no correlation to the intervention effectiveness. There is a current need of well-designed and well-reported cost-effectiveness regarding dental caries management.

The purpose of this study is to perform a systematic review on the use of lasers in oral surgery for bone healing. Selection of articles was carried out by two evaluators in Pubmed and Web of Science databases for published articles and OpenGray for gray literature. Search strategy was developed based on the PICO Question "Does the use of lasers after oral surgery improve bone healing?". Eligibility criteria were: being on laser; evaluate bone healing; involve oral surgery; do not be about implant, periodontics, orthodontics, osteonecrosis or radiotherapy, nor revisions, clinical cases, etc. Data were collected from each article in a structured spreadsheet and a descriptive analysis was performed. Risk assessment of bias of the articles was carried out through the tool elaborated by the Cochrane collaboration. A total of 827 potentially relevant references were identified. No articles were found in OpenGray. Eleven articles met the eligibility criteria and were included in the systematic review. Most of studies were in vivo and in jaw, being conducted with low-power lasers which were applied immediately after the surgical procedure of extraction. Neoformation and bone density were the outcomes of choice and there was a tendency of increase in bone density, neoformation, regeneration, mineralization, or bone condensation when laser was applied. Regarding the bias risk assessment, studies were not clear in reporting most of the parameters. Low-power laser therapy seems to reduce time of bone healing in oral surgery, although there are no defined protocols and the level of evidence is still considered weak.

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.

Objectives To evaluate the survival rate of ceramic and indirect composite inlays, onlays, and overlays manufactured according to different methods (CAD/CAM, pressable, and stratified). MEDLINE, EMBASE, and Cochrane Library databases were searched for published articles. Risk of bias, data extraction, subgroup analysis, meta‐analysis, and GRADE was performed. Materials and methods Prospective, retrospective, or RCT studies, without restriction of language, from 1983 to 2019, with follow‐up ≥5 years, reporting survival rates were screened independently by two reviewers in accordance with eligibility criteria. Results A total of 13 articles (12 for ceramic, one for indirect composite) met the inclusion criteria. No articles were included regarding crystalline ceramic. The estimated cumulative survival rate for CAD/CAM was 97% after 5 years and 89% after 10 years; for pressable was 95% after 5 years, and for stratified was 88% after 5 years and 93% after 10 years. Conclusions Regardless of the manufacturing method, vitreous ceramic inlays, onlays, and overlays showed high survival, providing evidence that these restorations are a safe treatment. Clinical relevance Vitreous ceramic inlays, onlays, and overlays showed high survival, regardless of the manufacturing method, providing evidence that these restorations are a safe treatment.

SummaryBackground Individuals with special needs are often affected by oral disorders such as dental caries and periodontal disease. Current data regarding prevalence of these conditions in individuals with autism spectrum disorders (ASD) are controversial. Aim To conduct a systematic review and meta-analysis to verify the prevalence of dental caries and periodontal disease in individuals with ASD, especially children and young adults. Design Searches were conducted through MEDLINE/PubMed, Web of Science, and Scopus databases in December 2015. Studies were included if fulfilled the following eligibility criteria: to evaluate the oral health status of individuals with ASD; to be an observational study; and to assess the prevalence of dental caries and/or periodontal disease. Meta-analyses were conducted considering prevalence of dental caries and periodontal disease in individuals as outcome. Results Search strategy identified 928 potentially relevant articles and seven of them were included in this review. All included studies reported dental caries prevalence, and the pooled prevalence was 60.6% (95% CI: 44.0–75.1). Moreover, only three studies showed prevalence of periodontal disease, resulting in pooled prevalence of 69.4% (95% CI: 47.6–85.0). Conclusion Prevalence of dental caries and periodontal disease in children and young adults with ASD can be considered as high, pointing to the need for oral health policies focused on these individuals.

Objective To evaluate the influence of previous conditioning with different materials on the bond strength in dentin, or clinical performance of restorations with glass-ionomer cements (GICs). Methodology: Articles published until February 04, 2020 were searched for in the PubMed and Scopus databases. Gray literature was fetched through the OpenGray platform. The references of the included articles were checked manually. Eligibility criteria (1) be about GICs; (2) test surface conditioning for GICs; (3) be about dentin; and (4) be an intervention study (clinical or laboratorial). Two reviewers participated in the entire process, independently, using structured tables in Excel spreadsheets. Direct and network meta-analyses were performed through mixed treatment comparisons (MTCs) to verify the best conditioning treatment, besides the evaluation of methodological quality and risk of bias. Results 2791 articles were pre-nominated and after the eligibility criteria were applied, 30 articles were selected to perform this study. One clinical study and all in vitro studies presented a high risk of bias. Regarding direct comparisons, in restorations with self-cure GIC, the only possible comparison was between polyacrylic acid and non-previous dentin conditioning, and there was no difference between them. Regarding the use of resin-modified GIC, in the direct comparison between non-previous conditioning and use of polyacrylic acid, a favorable difference toward the use of polyacrylic acid was found. In the subgroup of comparison between non-previous treatment and primer, a favorable difference toward the use of primer was found. In the comparison subgroups between phosphoric acid and non-treatment, cavities conditioners and non-treatment, and phosphoric acid and polyacrylic acid, no statistically significant differences were verified. In the network analysis, considering direct and indirect meta-analyses for resin-modified GICs, it was found that the best conditioning for dentin prior to resin-modified GIC fillings is with phosphoric acid, followed by the cavity conditioners; and the worst is not to perform any type of conditioning. Conclusion Prior conditioning does not interfere with the bond strength of self-cure GICs to the sound dentin of permanent teeth, while conditioning dentin with phosphoric acid improves the bond strength of resin-modified GICs to the sound dentin after 24 h, used in permanent teeth. However, the risk of bias is high, the level of evidence is moderate, and the degree of recommendation is weak.

Background Visual inspection (VIS) with radiographic examination (RAD) is the recommended diagnostic strategy for detecting caries in children; however, this recommendation is based on accuracy studies. The authors conducted a clinical trial to compare the detection and subsequent treatment of carious lesions in primary molars performed with VIS alone and with RAD. Methods Children (3-6 years old) were randomly assigned to 2 groups according to the diagnostic strategy used for caries detection on primary molars: VIS or RAD. Participants were diagnosed and treated according to the management plan related to the allocated group. The primary outcome was the number of new operative interventions during the 2-year follow-up period. Other secondary outcomes were also compared. Comparisons were performed with Mann-Whitney test using an intention-to-treat approach. Results Of the 252 children included and randomized, 216 were followed-up after 2 years (14.3% attrition rate). There was no difference between the groups for the primary outcome (P = .476). For the secondary outcomes, the RAD group had more restoration replacements (P = .038) and more restorations performed since the beginning of the study (P = .038) compared with the VIS group. In addition, the RAD group had a higher number of false-positive results than the VIS group (P Conclusions Simultaneous use of VIS and RAD for caries diagnosis in primary molars of children who seek dental treatment does not provide additional benefits compared with VIS alone. Practical Implications Dentists should perform VIS only, not RAD, for detecting carious lesions in preschool-aged children. ClinicalTrials.gov: NCT02078453 .

A Odontodisplasia Regional é uma anomalia dental rara, que envolve os tecidos dentários de origem ectodérmica (esmalte) e mesodérmica (dentina, polpa e cemento). O objetivo deste trabalho foi relatar um caso clínico de odontodisplasia regional em uma criança. Paciente de nove anos, sexo masculino, tendo como queixa principal a ausência de alguns dentes decíduos e a não irrupção dos dentes permanentes em determinada região da maxila. O dente 16, que havia irrompido, apresentava-se clinicamente, com um esmalte hipoplásico e hipomineralizado e uma imagem radiográfica bastante tênue, por isso sendo conhecido como “dente fantasma”. Foram apresentados nesse relato, aspectos clínicos e radiográficos e destacadas as questões envolvidas na elaboração de um plano de tratamento. Há poucos estudos disponíveis sobre a odontodisplasia regional. A anamnese detalhada e o conhecimento das características clínicas e radiográficas são imprescindíveis para um correto diagnóstico.

Background Due to the lack of evidence to determine the best treatment for deep cavitated caries lesions in primary molars, the search for an effective restorative technique, which results in a minimal discomfort to patients, and reduce the time needed for the treatment, becomes relevant. The objective of this randomized clinical trial was to evaluate if high-viscosity glass ionomer cement (HVGIC) restorations is noninferior to restoration with calcium hydroxide cement associated with HVGIC for treatment of deep lesions in primary molars, as well as the impact of the treatments on cost and discomfort of the patient. Methods A non-inferiority randomized clinical trial with two parallels arms (1:1) will be conducted. Children with 4 to 8 years will be selected at Clinic of Pediatric Dentistry at Ibirapuera University. 108 teeth will be randomized into two groups: (1) Calcium hydroxide cement associated with HVGIC and (2) HVGIC restoration. Primary outcome will be considered the pulp vitality and to be evaluated after 6, 12, 18 and 24 months by two calibrated examiners. Survival of restorations will also be evaluated in the equal intervals. The duration of dentals treatment and the cost of all materials used will be considered for estimating of cost-efficacy of each treatment. Individual discomfort will be measured after each dental procedure using the Wong-Baker’s Facial Scale. For the primary outcome, Kaplan-Meier survival and the long-rank test will be used to comparison between the groups. Cox regression will be performed to assess the influence of variables on the outcome. For all analyzes, the significance level is set at 5%. Discussion Based on the philosophy of ART, our hypothesis is that the HVGIC restoration is a possible approach to restore the deep caries lesion with pulp vitality without the use of rubber dam and anesthesia. Trial registration Clinicaltrials.gov registration NCT02903979. Registered on June 9th 2016. Electronic supplementary material The online version of this article (10.1186/s12903-018-0703-3) contains supplementary material, which is available to authorized users.

To evaluate the impact of radiographic examination on changes of treatment decision related to dental caries compared to decisions guided by visual inspection alone in primary molars. A total of 126 children aged 3–6 years who had sought dental assistance were randomly selected and examined by two calibrated examiners using visual inspection. A treatment plan regarding dental caries was generated based on this assessment. The same examiners then evaluated two bitewing radiographs, creating an additional treatment plan guided by concurrent assessment of both visual and radiographic methods. Occlusal and proximal surfaces of primary molars received a treatment decision as follows: (i) no treatment, (ii) non-operative treatment, and (iii) operative treatment. The frequency of changes in the treatment decision after radiographic examination was calculated, with subsequent Poisson multilevel regression analysis to evaluate variables influencing such changes. Changes from “no treatment” decided with visual inspection to “non-operative treatment” after radiographic evaluation occurred in 52 surfaces (3.2%), and changes to “operative treatment” were observed in 46 dental surfaces (2.8%). Furthermore, 50 surfaces (6.2%) had their treatment decision changed from non-operative to operative treatment after radiographic assessment. In addition, changes were significantly more frequent in children with higher caries experience, on proximal surfaces and in 1st primary molars. The impact of radiographic examination on changes in the treatment decision of primary molars made with visual inspection is modest. Changes are more frequent in children with higher caries experience and in proximal surfaces. The benefits of the radiographic method for detecting caries in children, as a protocol in the diagnostic process, seem to be overestimated; the impact of this method on changes in treatment decision made by visual examination alone is low. Radiographs could be, however, useful in particular conditions, such as in children with high caries experience.

BACKGROUND Scientific evidence on the benefits of fluoride was responsible for an important change in dental practice. Individual and collective actions have been planned to impact the epidemiology of oral health. However, questions around this topic persist, making discussions and researches still necessary. In this regard, the aim of this study was to verify the fluoride-related knowledge of pediatricians (PP) and dentists (DS) working in primary care, comparing related aspects such as its multiple sources of intake and dental fluorosis. METHODS A group of PP and DS answered as self-administered questionnaire related to fluoride knowledge. PP group presented a lower level of adherence (34%) in comparison to the DS group (70%). RESULTS Fluoride-related topics were learnt at undergraduate courses by 95,95% of dentists and 38.46% of pediatricians. Ninety-two per cent of DS and 78.57% of PP claimed to know the clinical aspects of dental fluorosis. Pediatricians tend to indicate the use of fluoridated dentifrices at any age but advise less about the right amount to be placed on the toothbrush in comparison to DS. CONCLUSIONS Dentists and pediatricians presented limited fluoride-related knowledge. Continued education/training is encouraged and necessary at this level in order to deliver the benefits of fluoride use to populations.

Background Diagnostic meta-analyses on caries detection methods should assist practitioners in their daily practice. However, conventional meta-analysis estimates may be inapplicable due to differences in test conduct, applied thresholds and assessed population between settings. Our aim was to demonstrate the impact of tailored meta-analysis of visual and radiographic caries detection to different settings using setting-specific routine data. Methods Published systematic reviews and meta-analyses on the accuracy of visual and radiographic caries detection were used. In two settings (a private practice in Germany and a public health clinic in Egypt), routine data of a total of 100 (n = 50/practice) consecutive 12–14 year-olds were collected. Test-positive rates of visual and radiographic detection for initial and advanced carious lesions on occlusal or proximal surfaces of molars were used to tailor meta-analyses. If prevalence data were available, these were also used for tailoring. Results From the original reviews, 210 and 100 heterogeneous studies on visual and radiographic caries detection were included in our meta-analyses. For radiographic detection, sensitivity and specificity estimates derived from conventional and tailored meta-analysis were similar. For visual detection of advanced occlusal carious lesions, the conventional meta-analysis yielded a sensitivity and specificity (95% CI) of 64.6% (57–71) and 90.9% (88–93), whereas the tailored estimates for Egypt were 75.1% (70–81) and 84.9% (82–89), respectively, and 43.7% (37–51) and 96.5% (95–97) for Germany, respectively. Conclusion Conventional test accuracy meta-analyses may yield aggregate estimates which are inapplicable to specific settings. Routine data may be used to produce a meta-analysis estimate which is tailored to the setting and thereby improving its applicability. Electronic supplementary material The online version of this article (10.1186/s12903-018-0561-z) contains supplementary material, which is available to authorized users.

BackgroundDespite the increasing number of studies evaluating patient reported outcome measures (PROs), there is no clearness regarding which restorative treatment offers major benefits based on the pediatric patient perspective.AimTo compare different restorative techniques in pediatric dentistry regarding patient-reported outcomes.DesignLiterature searching was carried out on prospective studies indexed in PubMed, Scopus and OpenGrey. A Mixed Treatment Comparisons (MTC) meta-analysis was undertaken considering the results from reviewed studies. Anxiety, pain and quality of life were extracted as mean with standard deviation, percentage of pain, and mean difference of scores with standard deviation, respectively. For direct comparisons, data were combined using a random-effect model. Heterogeneity was assessed with the I2 statistic. For indirect comparisons, fixed and random effects were chosen through comparison of competing models based on the Deviance Information Criteria (DIC). The expected efficacy ranking based on the posterior probabilities of all treatment rankings was also calculated.ResultsAn initial search resulted in 4,322 articles, of which 17 were finally selected. Due to unavailability of data, only pain, anxiety and oral health related quality of life (OHRQoL) were statistically analyzed. The difference in means (95% CI) of anxiety between treatments using only hand instruments with or without chemomechanical agents were -5.35 (-6.42 to -4.20) and -5.79 (-7.77 to -3.79) respectively when compared to conventional treatment using rotary instruments and/or local anesthesia. Regarding pain, there was a trend for treatments without rotary instruments and local anesthesia to be less frequently reported as painful. No statistical difference was found intragroup nor among treatments for OHRQoL.ConclusionsAnxiety and pain are directly related with more invasive restorative treatments. On the other hand, quality of life is not improved regardless of the restorative technique used. Further well-designed prospective studies regarding PROs in children are still necessary.

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.

Contains fulltext : 196198.pdf (Publisher’s version ) (Closed access) OBJECTIVE: Accuracy studies should associate the diagnostic criteria and outcomes collected to the treatment decision for patients to be considered clinically relevant. This systematic review performed a critical evaluation of the clinical relevance of accuracy studies on the visual and radiographic methods for secondary caries detection, and other aspects. SOURCE: The search was conducted in PubMed, SCOPUS and ISI Web of knowledge databases. STUDY SELECTION: Accuracy studies assessing clinical and/or radiographic method for evaluation of secondary caries were included. The systematization of the diagnostic criteria, lesion activity assessment and differential diagnosis of secondary caries from factors that can lead to misinterpretations were assessed. Clinical relevance was evaluated by the report of aspects related to: link to treatment decision, evaluation of patient-centered outcomes, establishment of thresholds for non-operative and operative treatment, lesion activity assessment, and reference method. Risk of bias was also assessed. A descriptive analysis was performed. DATA: Following eligibility criteria, 19 articles of the 3089 searched were reviewed. Different diagnostic criteria were reported, mainly for the visual inspection. The use of a standardized diagnostic system, lesion activity assessment and differential diagnosis were described by a limited number of studies. Approximately half of the studies reported association of diagnosis and treatment. Enamel lesions were evaluated radiographically in 28.6% of studies, and visually in 69.2%. Visual diagnosis was more relevant in relation to the operative treatment decision. Patient-centered outcomes were not investigated. CONCLUSION: The majority of studies fails to present clinical relevance and report of patient-centered outcomes. 01 augustus 2018

Background The responsiveness of the Early Childhood Oral Health Impact Scale (ECOHIS) has varied greatly across studies; hence, we hypothesized that this discrepancy could be related to the complexity of dental treatment received. Thus, we aimed to evaluate the responsiveness of the ECOHIS to changes in oral health-related quality of life (OHRQoL) following dental treatments of varying complexity in preschool children. Methods Preschool children aged 3 to 6 years were selected; their parents responded to the ECOHIS at baseline. The parents responded to the ECOHIS again and a global transition question 30 days after the children were treated. The type of treatment received by the children was categorized according to complexity, as follows: 1) non-operative treatment only, 2) restorative treatment, and 3) endodontic treatment and/or tooth extraction. Change scores and effect sizes (ES) were calculated for total scores, as well as considering the different treatment types and global transition question responses. Results Of the 152 children who completed the study, the ECOHIS yielded large ES for total scores (0.89). The children showed increasing ES values associated with better perception of improvement, assessed by the global transition question. The magnitude of ES after treatment was related to treatment complexity (0.53, 0.92 and 1.43, for children who received non-operative treatment only, restorative treatment, and endodontic treatment and/or tooth extraction, respectively). Conclusions Parents whose children required more complex dental treatment are more likely to perceive treatment-related changes to OHRQoL assessed with the ECOHIS. Electronic supplementary material The online version of this article (doi: 10.1186/s12955-017-0756-z) contains supplementary material, which is available to authorized users.

The aims of this study were: (1) to evaluate the overall reproducibility and accuracy of the International Caries Detection and Assessment System (ICDAS) for assessing coronal caries lesions, and (2) to investigate the use of systems associated with the ICDAS for activity assessment of coronal caries lesions. Specific search strategies were adopted to identify studies published up to 2016. For the first objective, we selected studies that assessed primary coronal caries lesions using the ICDAS as a reference standard. A total of 54 studies were included. Meta-analyses summarized the results concerning reproducibility and accuracy (correlation with histology, summary ROC curves [SROC], and diagnostic odds ratio [DOR]). The latter 2 were expressed at D1/D3 levels. The heterogeneity of the studies was also assessed. Reproducibility values (pooled) were > 0.65. The ICDAS mostly presented a good overall performance as most areas under SROC were > 0.75 at D1 and > 0.90 at D3; DOR ≥6. For the second objective, we selected studies investigating activity assessment associated with the ICDAS. The meta-analyses pooled results based on the same methodology and parameters as above. Longitudinal findings regarding caries progression were described to estimate the validity of these systems. On average, the systems for activity assessment of caries lesions showed moderate values concerning reproducibility and overall performance. Active caries lesions were more prone to progress than inactive ones after 2 years. In conclusion, the ICDAS presented a substantial level of reproducibility and accuracy for assessing primary coronal caries lesions. Additional systems associated with the ICDAS that classify caries lesion activity can be useful as they are moderately reproducible and accurate.

Background A systematic quantitative evaluation of the available evidence of the treatment for caries lesions in primary teeth that considers how different caries progressions lead to the need for distinct interventions might provide additional useful information for clinical evidence-based decision making. The aim of this systematic review and network meta-analysis was to verify the effect of the treatments on caries lesion arrestment (CLA) or the success rate (SR) of dentin caries lesion treatments in the primary teeth. Methods A search was conducted using the MEDLINE/PubMed, Web of Science and Scopus databases through December 2017. The primary search terms used in combination were primary teeth, caries lesion and restoration. The grey literature was also screened, as were the reference lists of eligible studies. A search of prospective studies with at least 12 months of follow up that compared different techniques was performed. The exclusion criteria were the absence of a comparison group; no evaluation of different restorative techniques; the evaluation of other outcomes unrelated to this review; and the recruitment of specific patient. The risk of bias was evaluated by the tools: the Cochrane Handbook for Systematic Reviews of Interventions and ROBINS-I. A network meta-analyses and meta-analyses were conducted considering CLA or SR as outcomes according to the surface involved and the depth of progression. Results Of the 1671 potentially eligible studies, 15 were included. For occlusal surfaces, only two studies presented data regarding the outer half of the dentin, with conventional restorative treatment (CRT) using composite resin showing superior results; five studies presented data regarding the depth of caries lesions, and CRT with compomer resulted in the best results. Seven studies considered occlusoproximal surfaces, and the Hall technique showed the best SR among the evaluated treatments. Finally, two annual applications of silver diamine fluoride showed the best nonrestorative approach to arrest caries lesions on occlusal and smooth surfaces. Discussion/conclusions The treatments for dentin caries lesions in primary teeth depend on the depth of progression and the surface involved. However, few of the included studies provided evidence to strongly recommend the best treatment option. Other Funding: FAPESP; Systematic review registration number-PROSPERO CRD42016037784.

Aim To systematically review the literature for in vitro studies that evaluated the immediate or after ageing bond strength of etch-and-rinse and self-etch adhesive systems to enamel and dentin of primary teeth. Design The search was conducted in PubMed/MEDLINE, Cochrane, SciELO, Lilacs, and Scopus databases with no publication year or language limits, following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. From 459 potentially eligible studies, 39 were selected for full-text analysis, and 5 were identified in reference lists, with 36 considered in the meta-analysis. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Pooling bond strength data was calculated using random effects analysis method, comparing two categories of adhesives (etch-and-rinse versus self-etch systems) when applied in different types and conditions of substrate (α = 0.05). Results No statistical significant difference in bond strength between both categories was observed in caries-affected dentin at immediate evaluation and in sound dentin after ageing. Etch-and-rinse adhesives, however, performed better in sound enamel and dentin substrates considering immediate bond strength. None study assessed the long-term adhesive effectiveness to sound or demineralized enamel. Conclusion Although the articles included in this meta-analysis showed high heterogeneity and high risk of bias, the in vitro literature suggests superior performance of etch-and-rinse adhesives in primary teeth in comparison with self-etch systems.

Data sourcesElectronic Databases searched in PubMed, Embase and Scopus. Unpublished literature was traced through OpenSIGLE, annals of IADR/AADR (International and American Associations for Dental Research) and ORCA (European Organisation for Caries Research) from 2003-2014. Studies were limited to English.Study selectionStudies involving visual inspection for detection of primary coronal caries lesions in primary or permanent human teeth were considered. All papers needed to include a clearly defined reference standard and the reporting of absolute numbers of true positives, false positives, true negatives and false negatives or a presentation of sufficient data to calculate these figures. Reference methods considered appropriate were histologic evaluation, operative intervention, direct visual inspection after temporary tooth separation and radiography. For studies with the same data set only the most complete study was included. Articles that reported caries detection using artificial caries, root caries or recurrent decay adjacent to restorations were excluded.Data extraction and synthesisStudy selection for inclusion was performed independently by two reviewers and disagreements were resolved by discussion with a third reviewer. Data were collected by two reviewers on structured tables. Discrepancies were resolved by consensus. A meta-analysis was performed. The following information was extracted; reference standard method, setting (clinical or laboratory), type of teeth (primary or permanent), surface evaluated (smooth, proximal or occlusal), sample size, examiner's experience. Also recorded were visual scoring systems. Studies that did not report any criteria were classified as 'with no criteria'. If authors used criteria with no reference to previously published studies they were classified as 'own criteria'. The PRISMA guideline was followed to report the review and the QUADAS-2 checklist (Quality assessment of studies of diagnostic performance included in systematic reviews) was used to assess the risk of bias of the included studies.ResultsData were used to calculate the pooled sensitivity, specificity, diagnostic odds ratio and summary receiver operating characteristics curve. Heterogeneity of the studies was also assessed. A total of 102 manuscripts and one abstract were included. The analysis demonstrated that the visual method had good accuracy for detecting carious lesions. Clinically obtained specificity was higher. Also observed was moderate to high heterogeneity and evidence of publication bias. Studies employing well known visual scoring systems were significantly more accurate than those that used their own criteria. The results were grouped and differentiate the type of dentition (permanent or primary), type of lesion (initial or advanced), proximal or occlusal surface and clinical settings from laboratory settings.The pooled specificity calculated was high in most of the groups and ranged from 0.573 to 0.992 mostly > 0.90; the lowest was in the occlusal initial caries lesions in primary teeth.The sensitivity ranged from 0.274 to 0.77; the lowest from clinical studies in proximal surfaces in permanent teeth, the highest from three studies evaluating the occlusal initial caries lesions in permanent teeth. Most of the pooled sensitivities were around a low level.ConclusionsVisual caries detection method has good overall performance. Although the studies together had high heterogeneity and risk of bias, the use of detailed and validated indices seems to improve the accuracy of the method.

Objective To carry out a systematic review with meta-analysis of prevalence of caries in Latin America and Caribbean children considering studies performed in this new century. Methods Two reviewers searched PubMed, Embase, LILACS and governmental databases through May 2016 to identify papers published in English, Portuguese or Spanish. Studies in those countries performed with 5–6 or 11–13 year-old children and that presented separate prevalence figures from primary and permanent teeth were selected. We performed a descriptive analysis of studies and meta-analysis to calculate the overall prevalence and 95% confidence intervals (95% CI) in both primary and permanent teeth. We also analyzed the trends of prevalence of caries through the years and influence of other variables on caries prevalence using multilevel analysis. Results Seventy-five studies were included from the 1,306 articles initially retrieved. The meta-analysis of caries prevalence grouped for Latin American and the Caribbean countries were highly different from Brazil and other investigated countries for primary teeth (5–6 years-old—Brazil: 0.52, other countries:0.70) and permanent teeth (11–12 years-old—Brazil: 0.56, other countries: 0.63). For studies conducted only in Brazil the prevalence was significant lower for primary but not for permanent teeth. In Brazil, a downward trend of caries prevalence was observed in 11-13-year-old children. Conclusion Despite the decline of caries prevalence in permanent teeth, mainly in Brazil, the disease still affects more than half of the children population in Latin American and Caribbean countries in the 21st Century.