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Purpose: To evaluate the factors associated with longitudinal changes in the caries activity profile of high caries risk children.
Methods: The sample consisted of clinical records of children who had undergone dental care in a public setting during a one-year period. Patients with active carious lesions (non-cavitated and/or cavitated) at the initial examination and who completed treatment were considered for the analysis. A caries-controlled profile was set as the main outcome based on arresting active carious lesions. Poisson regression was used to evaluate the association of patient- and treatment-related factors with the outcome ( P <0.05).
Results: The analysis included 130 caries-active children (7.8±2.4 [standard deviation - SD] years), with a mean missing and filled teeth index score of 8.3±4.4 SD. Patients with lower caries experience (prevalence ratio [PR]=0.93; 95 percent confidence interval [95% CI]=0.87 to 0.99) who received more appointments focused on oral health promotion based on dietary and oral hygiene instructions (PR=1.28; 95% CI= 1.03 to 1.58) had a greater rate of moving to caries-controlled status. The number of invasive treatments was not associated with a shift from caries-active to caries-controlled status (PR=0.98; 95% CI=0.87 to 1.11).
Conclusion: A preventive regimen focused on dental and diet guidance may play an important role in arresting active carious lesions in high caries risk children.

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Abstract Introduction Longevity and clinical success of dental restorations can be influenced by many factors during the restorative procedures. Objective This study aimed to evaluate the influence of different placement techniques on color stability and surface roughness of two resin composites. Material and method The groups of specimens (n=10) were divided according to resin composite (FiltekTM Z250 XT and FiltekTM Z350 XT) and placement technique: Mylar strip, spatula, dry brush, modeling liquid, and surface sealant. Color stability and surface roughness were accessed using a spectrophotometer (CIELab color space) and a rugosimeter (standard cutoff of 0.8 mm), respectively, after water storage. Subsequently, the specimens were immersed in coffee for 48 h and final color was measured. The data were analyzed using ANOVA and the Tukey's post hoc test (α=5%) and the correlation between surface roughness (Ra) and color change (∆Eab) was assessed using the Pearson's correlation coefficient. Result The different placement techniques influenced Ra and ∆Eab on both resin composites. The groups treated with surface sealant showed greater difference in ∆Eab for both resin composites. The FiltekTM Z250 XT resin showed greater color stability compared with the FiltekTM Z350 XT resin regardless of the placement technique used. Ra of each placement technique was similar among the resin composites except for the FiltekTM Z350 XT modeling liquid group, which presented lower Ra values compared with those of FiltekTM Z250 XT. A correlation between Ra and staining was identified (p=0.268). Conclusion Color stability and Ra are influenced by different placement techniques.

Resumo Introdução A longevidade e o sucesso clínico das restaurações dentárias podem ser influenciados por muitos fatores durante os procedimentos restauradores. Objetivo Avaliar a influência da técnica de alisamento na estabilidade de cor e rugosidade superficial de duas resinas compostas. Material e método Os grupos de amostras (n=10) foram divididos conforme a resina composta (FiltekTM Z250 XT e FiltekTM Z350 XT) e as técnicas empregadas: tira de poliéster, espátula, pincel seco, selante de superfície. A cor e a rugosidade da superfície foram avaliadas por espectrofotômetro (espaço de cor CIELab) e rugosímetro (corte padrão de 0,8 mm), respectivamente, após o armazenamento em água. Posteriormente, as amostras foram imersas em café por 48h e a cor final foi aferida. Os dados foram analisados usando teste ANOVA e Tukey post hoc (α = 5%) e a correlação entre rugosidade da superfície (Ra) e variação de cor (∆Eab) através do coeficiente de correlação de Pearson. Resultado As técnicas de alisamento influenciaram a Ra e a ∆Eab em ambas as resinas compostas. Os grupos tratados com selante de superfície apresentaram maior diferença na ∆Eab. A resina FiltekTM Z250 XT apresentou maior estabilidade de cor comparada à FiltekTM Z350 XT, independentemente da técnica utilizada. A Ra das técnicas de alisamento foi semelhante entre os compósitos, exceto para o grupo do líquido modelador da FiltekTM Z350 XT, que apresentou os menores valores. Uma correlação entre Ra e manchamento (p = 0,268) foi identificada. Conclusão A estabilidade da cor e a Ra são influenciadas pelas técnicas de alisamento utilizadas.

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OBJECTIVES: We investigated factors associated with failure of adhesive restorations in primary teeth and whether repair may increase the survival of failed restorations placed in high-caries risk children. MATERIALS AND METHODS: The sample comprised children who attended a university dental service to perform restorative treatment in primary teeth. Data were collected retrospectively from clinical records to assess the longevity of restorations. The outcomes were calculated in two levels: "Success" (Level 1)-when any re-intervention was considered as failure; "Survival" (Level 2)-when repaired restorations were considered clinically acceptable. The Kaplan-Meier survival test was used to analyze the longevity of restorations. Multivariate Cox regression with shared frailty was used to assess factors associated with failures (p < 0.05). RESULTS: A total of 584 primary teeth restorations (178 patients) were included in the analysis. The longevity of restorations up to 36 months (Level 1) was 34.8% (AFR 29.6%). Multi-surface restorations showed significantly more failures than single-surface ones (HR 1.69; 95% CI 1.18, 2.41), and endodontically treated teeth presented more failures compared to vital teeth (HR 2.22; 95% CI 1.35, 3.65). There was an increase in restoration survival when repair was not considered as failure (p < 0.001). The survival of repaired restorations (Level 2) reached 43.7% (AFR 24.1%). CONCLUSIONS: Adhesive restorations placed in primary teeth of high-caries risk children showed restricted longevity; however, the repair of failed restorations has increased its survival over time. CLINICAL RELEVANCE: Repair is a more conservative and technically simple procedure that increases the survival of failed restorations in primary teeth.

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AIM: This retrospective study investigated the prevalence of defective restorations in a public dental service and factors associated with re-intervention in primary teeth. DESIGN: The sample consisted of all clinical records (census) of children presenting restorations in primary teeth, who had undergone dental treatment in a public set during 1-year period. For analysis, only restorations presenting defects related to esthetic, functional, or biological reasons at first clinical examination were included. The outcome 'Success' was set when the restoration received no treatment (monitored), refurbishing, sealing of margins, or was repaired. Otherwise, 'Failure' was set whenever the restoration was either replaced or if another treatment affecting the restoration was necessary (endodontic treatment or tooth extraction). Poisson regression model was used to assess the prevalence of patient- and tooth-related factors that may influence the re-intervention decision (repair or replacement). RESULTS: From a total of 302 restorations placed in 114 children, 37.7% presented some type of defect. Restorations with recurrent caries were more frequently present in caries-active patients (P = 0.03) and were frequently replaced (95% CI, 1.05-3.22, RR = 1.84, P = 0.03). CONCLUSION: Presence of recurrent caries influences the re-intervention decision, leading to restoration replacement in most cases.

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Objective: To investigate the longevity of endodontic treatments and the survival of endodontic re-treatments performed in primary teeth. Material and Methods: The sample included endodontic treatments and re-treatments conducted in anterior and posterior primary teeth without sedation or general anesthesia among children attending a university dental service. Information collected retrospectively from clinical records was used for analyzing data. The Kaplan-Meier estimator test was used to analyze the longevity and survival of endodontic treatment and re-treatments, respectively. Results: A total of 73 patients with endodontic therapy in primary teeth were included in the study, and 116 teeth were analyzed. After one year, the longevity of endodontic treatments performed on primary teeth was 65.74% with an annual failure rate (AFR) of 34.2%. From 47 endodontic treatment failures, 14 teeth (29.8%) were endodontically re-treated. When the endodontic re-treatment was considered as survival, the longevity of treatments reached 68.06% with 31.9% of AFR after one year of follow-up. There was a significant increase in functional tooth retention in those patients that received an endodontic re-treatment (p<0.001). Retreatment provided an additional mean survival time of 8.3 months. Conclusion: Endodontic treatments performed in primary teeth presented a limited longevity. Endodontic re-treatment is a more conservative alternative for endodontically treated primary teeth that have failed and significantly increase tooth retention.

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PURPOSE: To evaluate the longevity and factors associated with failure of primary teeth restorations placed in high caries-risk children. METHODS: The sample was comprised of children treated in a University Dental Service. Patients' records were screened retrospectively to determine whether they had received restorative treatment in primary teeth presenting cavitated caries lesions. Kaplan-Meier estimator and Multivariate Cox regression analysis with shared frailty were used to assess restorations' survival and factors associated with failure, respectively. RESULTS: 123 high caries-risk children (10.3±4 DMF-T) with 316 restorations were analyzed. The 3-year survival reached 53.4% (AFR=18.8%). Restorations placed without rubber dam (P= 0.04), over selective caries removal (P= 0.03), with calcium hydroxide liner (P< 0.01) and glass-ionomer cement (P= 0.04) presented lower survival rates. Caries-controlled patients presented significantly (P= 0.03) higher rates of restoration survival (77.7%) than caries-active patients (49.9%). The adjusted model showed that restorations placed in teeth after selective caries removal showed 3.41 times higher risk of failure compared with restorations over complete caries removal (95%CI:1.37-8.46). CLINICAL SIGNIFICANCE: Adhesive restorations placed in high-caries experience patients have limited survival rates. Some treatment-related factors may influence the performance of these restorations. A strict preventive regimen to control dental caries activity must be followed in order to increase the restoration survival.

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OBJECTIVE: To evaluate the influence of the thickness of the adhesive layer and demineralized dentin on the decision to replace composite restoration. MATERIALS AND METHODS: Eighty human third molars with occlusal preparations (Class I) were randomly assigned to eight groups (n = 10): adhesive system (Clearfil SE Bond [CSE] or Scotchbond Universal Adhesive [SBU]); the number of adhesive layers (one or two); and substrate (sound or demineralized dentin). A blinded examiner evaluated radiographs of each restored tooth. Obtained scores for the presence or absence of radiolucent zone under restoration were submitted to a relative risk (RR) calculus and Z-test, and the scores for the decision to replace restorations were submitted to Fisher's exact test (p < 0.05). RESULTS: The relative risk of identifying a radiolucent zone under restoration in sound and demineralized dentin were, respectively, 2 and 1.85 times higher when two layers of adhesive were applied. Demineralized dentin did not increase the probability of identifying a radiolucent zone. A higher relative (1.6, p = 0.01) was observed when two layers of SBU were applied. The number of layers did not influence the relative risk for CSE (RR = 1.3, p = 0.13). CONCLUSION: Thicker layers of SBU increase the relative risk of identifying a radiolucent layer under restoration and the decision to replace a/composite restoration, irrespective of the substrate. The presence of demineralized dentin did not increase the probability of identifying a radiolucent zone when compared to sound dentin. CLINICAL SIGNIFICANCE: The results of this in vitro study suggest that thicker layers of a particular adhesive under resin composite restorations can negatively influence the decision to replace them. (J Esthet Restor Dent 29:193-200, 2017).

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BACKGROUND: Dental trauma and deep caries are frequent findings in children and adolescents that may lead to pulp necrosis in young permanent teeth. As a consequence, the root stops its development, and managing these immature teeth becomes challenging due to the presence of open apexes and fragile dentinal walls. AIM: We aimed to carry out a systematic review including a meta-analysis to compare the endodontic treatments available in the management of immature necrotic permanent teeth and determine which one provides the best clinical and radiographic outcomes. DESIGN: The literature was screened via PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials databases until August 2015 to select randomized clinical trials that compared at least two different treatments regarding immature necrotic permanent teeth comprising clinical and radiographic success as outcome. Two reviewers independently performed the screening and evaluation of the articles. A total of 648 studies were retrieved from the databases, in which only 14 were selected to full-text analysis by the appliance of inclusion criteria. After the exclusion criteria, the remaining seven studies had their data extracted and assessed for bias risk. Pooled-effect estimates were obtained comparing clinical and radiographic success rates among MTA Versus other treatments. RESULTS: Evaluation of clinical (Z = 2.32, P = 0.02, OR = 5.37, 95% CI: 1.29-22.23, I = 0%) and radiographic (Z = 2.45, P = 0.01, OR = 4.31, 95% CI: 1.34-13.82, I = 0%) outcomes favored the MTA (control group) when compared to other endodontic treatments (P < 0.05). No evidence of heterogeneity was detected among the studies (I < 50%), whereas a moderate risk of bias was identified in five of them. CONCLUSIONS: Although almost all of the identified studies presented moderate risk of bias, MTA apexification seems to produce overall better clinical and radiographic success rates among the endodontic treatment available in immature necrotic permanent teeth.

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