RESUMO
OBJECTIVE: To propose the development and validation of criteria for evaluating the clinical performance of indirect restorations, considering the variables related to the operator, material, and/or patient. MATERIALS AND METHODS: The experimental design of this study was divided into three stages. Stage 1: development of the new criteria items by specialists in Prosthodontics. Step 2: creation of the criteria, named UERJ criteria, with the description of the parameters that indicate the quality of the restoration, the possible associated complications, and a detailed description of each classification. As well as the development of a form of variables. Step 3: validation of the UERJ criteria. RESULTS: Cohen's Kappa statistic registered for both intra- and inter-examiner agreements a coefficient >0.91 with a p-value <0.0001. The validity of the UERJ criteria was evaluated by tests of sensitivity (0.96) and specificity (0.91) and had a satisfactory accuracy (92.7%), a positive (10.99), and negative (0.05) likelihood ratio and high values predictive variables, with positive (PPV) 0.84 (high specificity) and negative (VPN) 0.98 (high sensitivity), with a confidence interval of 95%. CONCLUSION: The UERJ criteria is a valid instrument for evaluating the clinical performance of indirect restorations. CLINICAL SIGNIFICANCE: The UERJ criteria, developed exclusively for the analysis of indirect restorations, elucidates the details necessary to identify the causes of failures and complications of these restorations.
Assuntos
Resinas Compostas , Restauração Dentária Permanente , Humanos , Seguimentos , Falha de Restauração DentáriaRESUMO
Abstract The aim of this study was to evaluate the survival of laminate veneers constructed using a recent polymer-infiltrated ceramic network material following the aesthetic pre-evaluative temporary (APT) technique of tooth preparation in comparison to traditional technique. Six patients received 54 laminate veneers. They were divided into two equal groups (n=27) according to the technique of tooth preparation: group T: traditional technique and group A: aesthetic pre-evaluative temporary technique. VITA ENAMIC material was used for CAD/CAM construction of laminate veneers. Cementation was performed using a light cured resin cement. The laminate veneers were evaluated at baseline, after 3, 6 and 12 months according to the modified United States Public Health Service (USPHS) criteriea. The data was collected, tabulated and statistically analyzed. Secondary caries, endodontic complications, cracks and loss of retention were not noted in any laminate veneer. Extensive fractures were not detected in both study groups through the study period. There was a statistically significant decrease of color match criteria between the two groups at the 6 and 12 months recalls. Based on this study, both preparation techniques resulted in successful clinical performance. After 12 months, all the veneers in both groups showed no post-operative sensitivity and all patients were highly satisfied regarding their veneers. However, there was a deterioration in color match criteria through the study period in both study groups.
Resumo O objetivo deste estudo foi avaliar a sobrevivência de facetas laminadas construídas utilizando um material recente de rede de cerâmica impregnada de polímero, seguindo a técnica estética pré-avaliadora temporária (APT) de preparação de dentes em comparação com a técnica tradicional. Seis pacientes receberam 54 facetas de laminados. Foram divididos em dois grupos iguais (n=27) de acordo com a técnica de preparação do dente: grupo T: técnica tradicional e grupo A: técnica temporária pré-avaliativa estética. O material VITA ENAMIC foi utilizado para a construção de facetas de CAD/CAM de laminados. A cimentação foi realizada utilizando um cimento de resina fotopolimerizável. Os laminados foram avaliados na linha de base, após 3, 6 e 12 meses de acordo com os critérios modificados do Serviço de Saúde Pública dos Estados Unidos (USPHS). Os dados foram recolhidos, tabulados e analisados estatisticamente. Cáries secundárias, complicações endodônticas, fissuras e perda de retenção não foram observadas em nenhuma faceta laminada. Não foram detectadas fraturas extensas em ambos os grupos de estudo durante o período do estudo. Verificou-se uma diminuição estatisticamente significativa dos critérios de correspondência de cor entre os dois grupos nos 6 e 12 meses. Com base neste estudo, ambas as técnicas de preparação resultaram num desempenho clínico bem sucedido. Após 12 meses, todos os laminados de ambos os grupos não mostraram qualquer sensibilidade pós-operatória e todos os pacientes ficaram altamente satisfeitos com os seus laminados. No entanto, houve uma deterioração dos critérios de correspondência de cor durante o período de estudo em ambos os grupos de estudo.
RESUMO
OBJECTIVES: This randomized, double-blind clinical trial, , evaluated the behavior of two universal adhesives used in etch-and-rinse (ER) or self-etch (SE) approach in non-carious cervical lesions (NCCLs). METHODS: Two hundred and eleven NCCLs were selected in 54 participants and randomly allocated into four experimental groups: Scotchbond Universal Adhesive - SBU (3M Oral Care) and Prime & Bond Elect - PB (Dentsply Sirona) used in ER and SE modes. Two trained operators placed all resin composite restorations (Filtek Z250, 3M Oral Care). Restorations were evaluated at baseline and after 6 months using both FDI and USPHS modified criteria by a blinded calibrated examiner. Kruskal-Wallis and Mann-Whitney U non-parametric tests were used to compare the restoration failures among experimental groups. RESULTS: Statistically significant differences were found among groups regarding failures (p=0.000 for both FDI and USPHS criteria). PB-SE presented more failures (p<0.05) than other experimental groups. No significant difference was found between any other pair of groups (p>0.05). CONCLUSIONS: The etch and rinse approach affected the clinical performance of Prime and Bond Elect. For this material, the self-etch approach generated lower criteria scores after a six-month follow-up. The bonding strategy did not influence Scotchbond Universal Adhesive clinical performance. (RBR-2GQMVF) CLINICAL SIGNIFICANCE: The clinical behavior of mild universal adhesive Prime & Bond Elect depends on the bonding strategy. The etch-and-rinse approach is recommended for this adhesive system. Scotchbond Universal Adhesive can be used in both bonding strategies without impairing clinical performance.
Assuntos
Colagem Dentária , Adesivos Dentinários , Adesivos , Resinas Compostas , Cimentos Dentários , Falha de Restauração Dentária , Restauração Dentária Permanente , Diagnóstico Bucal , Humanos , Cimentos de ResinaRESUMO
Aim: To compare different methods for evaluating composite resin restorations in posterior teeth and to evaluate the reliability of each method by determining the intraobserver agreement. Material and methods: 136 class I resin composite restorations were evaluated by a trained examiner using modified Ryge criteria to assess selected restoration characteristics with three different methods: clinical, photographic and dental cast models.Results: The results showed that intraexaminer agreement was better on dental cast models evaluations for marginal integrity and anatomic form and was similar between photographic and clinical evaluations for marginal integrity and marginal discoloration. Surface texture showed the lowest degree of intraexaminer agreement with all the methods tested. Direct clinical method and the two indirect methods were significantly different for all the characteristics assessed (p<0.05). Photographs and dental cast models methods gave higher mean ranks than direct clinical method for marginal integrity and anatomic form. Photographs and dental cast models evaluations were similar for all the characteristics assessed, except for surface texture (p<0.05). Conclusion: All of the methods were different for all the characteristics assessed. The highest Intraexaminer agreement was obtained from dental cast models evaluation. All the methods showed that are not adequate to evaluate surface texture.
Objetivo: Comparar diferentes métodos para avaliação de restaurações de resina composta em dentes posteriores e avaliar a confiabilidade de cada método através da determinação deconcordância intraexaminador.Materiais e Métodos: 136 restaurações Classe I de resina composta foram avaliadas por um examinador treinado utilizando o critério de Ryge modificado através três métodos diferentes: clínico, fotográfico e modelos de gesso.Resultados: Os resultados mostraramque a concordância intraexaminador foi melhor em avaliação em modelos de gesso para integridade marginal e forma anatômica, e foi similar entre fotografiase avaliação clínica para integridade marginal e descoloração marginal. A textura superficial mostrou a menor concordância intraexaminador para todos os métodos testados. O método clínico direto e os dois métodos indiretos foram diferentes significativamentepara todas as características analisadas (p<0,05). Fotografias e modelos de gesso forneceram maio res médias ranqueadas do que o método clínico direto para integridade marginal e forma anatômica. As avaliações através de fotografias e modelos de gesso foram similares para todas as categorais avaliadas, exceto para textura superficial (p<0,05). Conclusões: Todos os métodos foram diferentes para as características avaliadas. A maior concordância intraexaminador foiobtida com a avaliação através de modelos de gesso. Nenhum dos métodos foi adequado para avaliação da textura superficial.
Assuntos
Humanos , /métodos , Resinas Compostas , Restauração Dentária Permanente , Reprodutibilidade dos TestesRESUMO
A aplicação de selantes de superfície, através da penetração nas irregularidades superficiais e na interface dente/restauração, é realizada ao final do procedimento restaurador e pode minimizar algumas limitações, prolongando a longevidade clínica das restaurações de resina composta. Este estudo clinico randomizado se propôs a avaliar o efeito da aplicação de um selante de superfície no comportamento clínico de restaurações posteriores de resina composta do tipo classe I. Vinte e sete pares de dentes molares ou pré-molares, superiores ou inferiores, que apresentavam lesões de cárie (classe I) ou restaurações de amálgama ou resina composta (classe I) insatisfatórias, que necessitavam de substituição completa, foram aleatorizados e preparados e restaurados com a resina composta Esthet-X. Sobre a superfície da resina de apenas um dente de cada par foi aplicado o selante de superfície Lasting Touch utilizando o modelo experimental de boca dividida. A avaliação única foi realizada empregando-se o método direto USHPS modificado, nos tempos: baseline, 6 meses, 12 meses, por dois operadores. Radiografias interproximais e réplicas das faces oclusais foram obtidas por meio da moldagem com silicona de adição e vazadas com resina epóxica para avaliação qualitativa com Microscópio Eletrônico de Varredura. Os dados foram submetidos ao teste de Mc Nemar (p<0,05). Para a integridade marginal, após 6 meses de avaliação, apenas 1 (4%) restauração do grupo com selante de superfície recebeu o escore Bravo. Aos 12 meses, a integridade marginal apresentou 1 (4%) do grupo sem selante e 2 (7%) restaurações com selante com escore Bravo. Os resultado apresentados nos períodos de avaliação não apresentaram diferenças estatisticamente significantes (p=1,0, para todas as condições. Não houve diferença no desempenho clínico de restaurações de resina composta com e sem selante de superfície, sendo aceitáveis após 12 meses de avaliação. As observações em MEV demonstraram...
The finishing, polishing and surface sealant application, by superficial irregular penetration and between restoration interface, are applied at the end of the restoration and decrease these limitations, and extend the clinical longevity of composite resin restorations. This clinical randomized controled study however aimed to evaluate the effect of the surface sealant application in the clinical behavior of composite posterior resin class I restorations. Twenty seven pairs of upper or lower molars or premolars with carious lesions (class I), and unsatisfactory amalgam or composite resin restorations, which needed total replacement, were randomized and prepared and restored with Esthet X composite resin. The composite resin surface of one tooth from each pair was covered with Lasting Touch surface sealant (Split Mouth Design). The clinical evaluation was made by using the modified direct method USPHS, at the following times: baseline, 6 months and 12 months, by two different operators. Bitewing radiographs and replicas of the occlusal surfaces were obtained by using a silicone impression material poured with epoxy resin for the qualitative evaluation with Scanning Electron Microscopy. The data was analyzed with the McNemar test (p <0.05). Results showed that for the marginal integrity, after 6-month evaluation, only 1 (4%) sealed restoration had a Bravo rating. At the end of 12 months, the marginal integrity showed 1 (4%) sealed restoration and 2 (7%) non sealed Bravo restorations. Results at all evaluations periods did not show statistical significant differences (p=1.0) for all conditions. There was no difference in the clinical performance of the composite resin restorations (Esthet X) with or without the surface sealant (Lasting Touch), demonstrated good behavior after 12 months. Based on SEM examinations, the surface sealant application promoted a regular and smooth surface, for all the evaluation times. In a 12 months evaluations period, the surface...
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Resinas Compostas/farmacologia , Restauração Dentária Permanente/métodos , Selantes de Fossas e Fissuras/farmacologia , Teste de Materiais , Resinas Compostas/uso terapêutico , Selantes de Fossas e Fissuras/uso terapêutico , Fatores de Tempo , Resultado do TratamentoRESUMO
A aplicação de selantes de superfície, através da penetração nas irregularidades superficiais e na interface dente/restauração, é realizada ao final do procedimento restaurador e pode minimizar algumas limitações, prolongando a longevidade clínica das restaurações de resina composta. Este estudo clinico randomizado se propôs a avaliar o efeito da aplicação de um selante de superfície no comportamento clínico de restaurações posteriores de resina composta do tipo classe I. Vinte e sete pares de dentes molares ou pré-molares, superiores ou inferiores, que apresentavam lesões de cárie (classe I) ou restaurações de amálgama ou resina composta (classe I) insatisfatórias, que necessitavam de substituição completa, foram aleatorizados e preparados e restaurados com a resina composta Esthet-X. Sobre a superfície da resina de apenas um dente de cada par foi aplicado o selante de superfície Lasting Touch utilizando o modelo experimental de boca dividida. A avaliação única foi realizada empregando-se o método direto USHPS modificado, nos tempos: baseline, 6 meses, 12 meses, por dois operadores. Radiografias interproximais e réplicas das faces oclusais foram obtidas por meio da moldagem com silicona de adição e vazadas com resina epóxica para avaliação qualitativa com Microscópio Eletrônico de Varredura. Os dados foram submetidos ao teste de Mc Nemar (p<0,05). Para a integridade marginal, após 6 meses de avaliação, apenas 1 (4%) restauração do grupo com selante de superfície recebeu o escore Bravo. Aos 12 meses, a integridade marginal apresentou 1 (4%) do grupo sem selante e 2 (7%) restaurações com selante com escore Bravo. Os resultado apresentados nos períodos de avaliação não apresentaram diferenças estatisticamente significantes (p=1,0, para todas as condições. Não houve diferença no desempenho clínico de restaurações de resina composta com e sem selante de superfície, sendo aceitáveis após 12 meses de avaliação. As observações em MEV demonstraram...
The finishing, polishing and surface sealant application, by superficial irregular penetration and between restoration interface, are applied at the end of the restoration and decrease these limitations, and extend the clinical longevity of composite resin restorations. This clinical randomized controled study however aimed to evaluate the effect of the surface sealant application in the clinical behavior of composite posterior resin class I restorations. Twenty seven pairs of upper or lower molars or premolars with carious lesions (class I), and unsatisfactory amalgam or composite resin restorations, which needed total replacement, were randomized and prepared and restored with Esthet X composite resin. The composite resin surface of one tooth from each pair was covered with Lasting Touch surface sealant (Split Mouth Design). The clinical evaluation was made by using the modified direct method USPHS, at the following times: baseline, 6 months and 12 months, by two different operators. Bitewing radiographs and replicas of the occlusal surfaces were obtained by using a silicone impression material poured with epoxy resin for the qualitative evaluation with Scanning Electron Microscopy. The data was analyzed with the McNemar test (p <0.05). Results showed that for the marginal integrity, after 6-month evaluation, only 1 (4%) sealed restoration had a Bravo rating. At the end of 12 months, the marginal integrity showed 1 (4%) sealed restoration and 2 (7%) non sealed Bravo restorations. Results at all evaluations periods did not show statistical significant differences (p=1.0) for all conditions. There was no difference in the clinical performance of the composite resin restorations (Esthet X) with or without the surface sealant (Lasting Touch), demonstrated good behavior after 12 months. Based on SEM examinations, the surface sealant application promoted a regular and smooth surface, for all the evaluation times. In a 12 months evaluations period, the surface...
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Resinas Compostas/farmacologia , Restauração Dentária Permanente/métodos , Selantes de Fossas e Fissuras/farmacologia , Teste de Materiais , Resinas Compostas/uso terapêutico , Selantes de Fossas e Fissuras/uso terapêutico , Fatores de Tempo , Resultado do TratamentoRESUMO
Este estudo avalia o comportamento clínico de restaurações diretas de resina composta em dentes posteriores. Para tanto, toma uma série de casos de acompanhamento longitudinal, com a realização de 55 restaurações de classe I e II. Os operadores são alunos de Odontologia do Centro Universitário Franciscano (Unifra, RS). A avaliação foi feita seis meses após a confecção das restaurações, e foi utilizado o critério United States Public Health Service (USPHS) modificado: forma anatômica, estabilidade da cor, descoloração marginal, integridade marginal e lesão de cárie secundária. Foram avaliadas 54 (98,2%) restaurações, delas, duas falharam, e o índice de sobrevivência foi de 91,78%. Conclui que o desempenho clínico das restaurações é aceitável.
This article aims to evaluate the clinical performance of direct composite resin restorations in posterior teeth. Methods: Case series of longitudinal, with the completion of 55 restorations, class I and II. The operators were dental students from Franciscan University Center (Unifra) RS, Brazil. The evaluation was conducted six months after making these, and criterion was utilized United States Public Health Service (USPHS) modified: anatomical form, color stability, marginal discoloration, marginal integrity and caries secondary. A total of 54 (98.2%) restorations, of whom two failed, and the survival rate was 91.78%. In conclusion, it finds that the clinical performance of the restorations was acceptable.
Assuntos
Resinas Compostas , Restauração Dentária Permanente , United States Public Health ServiceRESUMO
Aims: Compactable composite resins have been indicated as amalgam substitutes. However, longitudinal clinical trials are necessary to verify their wear resistance and integrity maintenance. The purpose of this study was to evaluate the clinical performance of a packable resin in Class I restorations after 7 years. Methods: Forty restorations were placed in 15 young patients aged 13 to 30 years. The restorative material (Prodigy/OptiBond-KERR®) was used according to standard recommendations. The restorations were assessed at baseline at the year 2000 and after 2 and 7 years according to the USPHS (United State Public Health Service) criteria. Results: After 7 years, 50% of the restorations were scored Alpha and 37.5% scored Bravo for color match, marginal discoloration and marginal adaptation. Secondary caries were observed in only one restoration and none of them presented postoperative sensibility. Conclusion: In accordance with the USPHS method used, the packable resin presented appropriate clinical performance after a 7-year clinical evaluation.
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Humanos , Adolescente , Adulto , Resinas Compostas , Materiais Dentários/análise , Restauração Dentária Permanente/métodos , Propriedades de SuperfícieRESUMO
OBJECTIVE: To assess the accuracy of three clinical case definitions for advanced HIV disease: the World Health Organization (WHO) case definition, and the original and revised Caracas case definitions. DESIGN: Retrospective chart review. SETTING: A clinic for patients with all stages of HIV infection at the Johns Hopkins Hospital, Baltimore, [correction of Bethesda] Maryland, USA, a tertiary care university hospital. PATIENTS, PARTICIPANTS: Two hundred and twenty-four HIV-positive adults who underwent initial evaluation between 1 January 1990 and 31 December 1990. MAIN OUTCOME MEASURES: A score for each definition was assigned based on initial evaluation. The sensitivity, specificity, and predictive values were calculated using the Centers for Disease Control (CDC) staging criteria, and results were correlated with total CD4 cell counts. RESULTS: The sensitivities of the WHO, and the original and revised Caracas definitions were 40, 67, and 60%, respectively, using CDC disease stage IV as a positive standard. Specificities were between 99 and 100%, using CDC stage II-III disease as a negative standard. Mean CD4 cell counts for patients with positive scores were 184, 160, and 158 x 10(6)/l, respectively, compared to 191 x 10(6)/l for CDC stage IV patients. Sensitivity was lower when the positive standard was expanded to include all patients with CD4 cell counts less than 200 x 10(6)/l. CONCLUSIONS: In our study population, case definitions were specific, but only moderately sensitive for advanced HIV disease. Prospective studies should be conducted in diverse geographic regions, using lymphocyte or CD4 cell counts when possible.
PIP: The 1st case definition for AIDS was developed by the Centers for Disease Control (CDC) in 1982. WHO adopted CDC definitions for use in some countries and also developed a clinical case definition where HIV serology tests were not feasible. A multivariate analysis of data of Brazilian AIDS patients with positive HIV serology provided the basis for the Caracas definition in 1989 and it subsequent revision. The accuracy of these 3 clinical definitions was evaluated to see their predictive value in an advanced stage of AIDS. The records of 224 HIV-positive adults were reviewed in 1990. Scores were assigned to various symptoms. 80% of men and 20% of women with a median age of 33 years; 1/4 were white and 2/3 were black. 1/3 were homosexuals and 1.2 were iv drug users. 139 were asymptomatic (CDC stage I-II) and 85 were symptomatic (CDC stage IV). 58 patients had total CD4 cell counts of over 500 x 1 million/1; 91 had 200-500 x 1 million/l; and 70 had 200 x 1 million/1. 48 were taking zidovudine and Pneumocytis carinii drugs. The sensitivities of the WHO, original Caracas definition, and revised Caracas definition were 40%, 67%. and 60%, respectively, with 99-100% specificities and positive predictive values of 97-100%. The mean CD4 cell counts for the WHO, original and revised Caracas definitions were 184, 160, and 158 x 1 million/1, respectively, compared with 199 x 1 million/1 of patients with CDC stage IV disease. The predictive values of the 3 definitions for CD4 cell counts 200 x 1 million/1 reached 62%, 73%, and 71% vs. only 59% for CDC stage IV patients. The combination of stage IV symptoms or a CD4 cell count 200 x 1 million/1 produced sensitivities of 31%, 53%, and 47%, respectively, with 100% specificity and positive predictive values. The definitions were highly specific, but only moderately sensitive for advanced AIDS; the Caracas definitions were more sensitive than the WHO definition.
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Síndrome da Imunodeficiência Adquirida/classificação , Infecções por HIV/diagnóstico , Síndrome da Imunodeficiência Adquirida/diagnóstico , Síndrome da Imunodeficiência Adquirida/epidemiologia , Adulto , Idoso , Brasil , Linfócitos T CD4-Positivos , Centers for Disease Control and Prevention, U.S. , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Estados Unidos , Organização Mundial da SaúdeRESUMO
PIP: In the Dominican Republic 45 cases of pediatric AIDS have been confirmed, which appears to be a small number and could be only the harbinger of an explosion with major socioeconomic impact as well as an impact on infant mortality. The majority of cases reported in children recently proved to be positive for HIV. The first cases of children with HIV were the consequence of blood transfusions. It is not known at what exact time the infection appears in the uterus, but the virus was detected in the placenta and in the fetus at 15-20 weeks of gestation. During labor, transmission is possible through contact with blood and vaginal secretions of the mother. Transmission through maternal milk is rare, therefore the World Health Organization has called for the continuation of breast feeding in developing countries. It is estimated that 20-50% of newborn infants of HIV-positive mothers may become infected. The diagnosis of the infection before 15 months of age constitutes the problem of passive transmission of HIV antibodies from the mother. That is why immunoglobulin G type serological tests do not distinguish between antibodies of the mother or the infant, because positive tests in infants under 15 months of age indicate exposure and not necessarily infection. The classification made in 1987 by the Center for Disease Control in Atlanta is considered useful and practical. The large size of women in reproductive age infected with HIV does mean that in the near future pediatric AIDS will be common, with disastrous economic implications for hospitals that are not prepared for receiving and treating such patients, which involves not only human resources but also psychological input. What started in 1985 as the first described case of pediatric AIDS has turned into a pressing public health problem.^ieng