RESUMO
We aimed to evaluate the impact of 2 visual diagnostic strategies for assessing secondary caries and managing permanent posterior restorations on long-term survival. We conducted a diagnostic cluster-randomized clinical trial with 2 parallel groups using different diagnostic strategies: (C+AS) based on caries assessment, marginal adaptation, and marginal staining aspects of the FDI (World Dental Federation) criteria and (C) based on caries assessment using the Caries Associated with Restorations or Sealants (CARS) criteria described by the International Caries Detection and Assessment System (ICDAS). The treatment for the restoration was conducted based on the decision made following the allocated diagnostic strategy. The restorations were then clinically reevaluated for up to 71 mo. The primary outcome was restoration failure (including tooth-level failure: pain, endodontic treatment, and extraction). Cox regression analyses with shared frailty were conducted in the intention-to-treat population, and hazard ratios (HRs) and 95% confidence intervals (95% CIs) were derived. We included 727 restorations from 185 participants and reassessed 502 (69.1%) restorations during follow-up. The evaluations occurred between 6 and 71 mo. At baseline, C led to almost 4 times fewer interventions compared with the C+AS strategy. A total of 371 restorations were assessed in the C group, from which 31 (8.4%) were repaired or replaced. In contrast, the C+AS group had 356 restorations assessed, from which 113 (31.7%) were repaired or replaced. During follow-up, 34 (9.2%) failures were detected in the restorations allocated to the C group and 30 (8.4%) allocated to the C+AS group in the intention-to-treat population, with no significant difference between the groups (HR = 0.83; 95% CI = 0.51 to 1.38; P = 0.435, C+AS as reference). In conclusion, a diagnostic strategy focusing on marginal defects results in more initial interventions but does not improve longevity over the caries-focused strategy, suggesting the need for more conservative approaches.
Assuntos
Cárie Dentária , Falha de Restauração Dentária , Restauração Dentária Permanente , Humanos , Restauração Dentária Permanente/métodos , Cárie Dentária/terapia , Cárie Dentária/diagnóstico , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Adaptação Marginal DentáriaRESUMO
The aim of this systematic review is to characterize and discuss key methodological aspects of in vitro biofilm models for caries-related research and to verify the reproducibility and dose-response of models considering the response to anti-caries and/or antimicrobial substances. Inclusion criteria were divided into Part I (PI): an in vitro biofilm model that produces a cariogenic biofilm and/or caries-like lesions and allows pH fluctuations; and Part II (PII): models showing an effect of anti-caries and/or antimicrobial substances. Within PI, 72.9% consisted of dynamic biofilm models, while 27.1% consisted of batch models. Within PII, 75.5% corresponded to dynamic models, whereas 24.5% corresponded to batch models. Respectively, 20.4 and 14.3% of the studies reported dose-response validations and reproducibility, and 32.7% were classified as having a high risk of bias. Several in vitro biofilm models are available for caries-related research; however, most models lack validation by dose-response and reproducibility experiments for each proposed protocol.
Assuntos
Anti-Infecciosos/farmacologia , Biofilmes/crescimento & desenvolvimento , Cárie Dentária/microbiologia , Modelos Biológicos , Biofilmes/efeitos dos fármacos , Contagem de Colônia Microbiana , Meios de Cultura , Cárie Dentária/prevenção & controle , Relação Dose-Resposta a Droga , Humanos , Reprodutibilidade dos Testes , Saliva ArtificialRESUMO
Some dynamic biofilm models for dental caries development are limited as they require multiple experiments and do not allow independent biofilm growth units, making them expensive and time-consuming. This study aimed to develop and test an in vitro dynamic microcosm biofilm model for caries lesion development and for dose-response to chlorhexidine. Microcosm biofilms were grown under two different protocols from saliva on bovine enamel discs for up to 21 days. The study outcomes were as follows: the percentage of enamel surface hardness change, integrated hardness loss, and the CFU counts from the biofilms formed. The measured outcomes, mineral loss and CFU counts showed dose-response effects as a result of the treatment with chlorhexidine. Overall, the findings suggest that biofilm growth for seven days with 0.06 ml min(-1) salivary flow under exposure to 5% sucrose (3 × daily, 0.25 ml min(-1), 6 min) was suitable as a pre-clinical model for enamel demineralization and antimicrobial studies.
Assuntos
Biofilmes , Clorexidina/farmacologia , Cárie Dentária , Desmineralização do Dente , Animais , Biofilmes/efeitos dos fármacos , Biofilmes/crescimento & desenvolvimento , Bovinos , Contagem de Colônia Microbiana/métodos , Cárie Dentária/diagnóstico , Cárie Dentária/etiologia , Cárie Dentária/microbiologia , Cárie Dentária/prevenção & controle , Esmalte Dentário/efeitos dos fármacos , Esmalte Dentário/patologia , Relação Dose-Resposta a Droga , Testes de Dureza/métodos , Humanos , Modelos Biológicos , Antissépticos Bucais/farmacologia , Saliva/microbiologia , Desmineralização do Dente/diagnóstico , Desmineralização do Dente/prevenção & controleRESUMO
This study aimed to correlate the cariogenic responsiveness of biofilms generated from the saliva of mothers and children. The mother-child pairs were classified according to the children's caries levels: caries-free, early childhood caries (ECC) or severe ECC. Microcosm biofilms were grown on enamel discs for 10 days. Factors under evaluation were caries experience levels, inoculum source (mothers and children) and growth conditions including cariogenic challenge (growth medium provided with and without sucrose) and no cariogenic challenge (growth medium sucrose-free). Statistical analysis was performed with ANOVA and Tukey's test, and the Spearman correlation test. Regular sucrose exposure resulted in a higher surface hardness change (%SHC). The correlation between biofilms formed from saliva of mother-child pairs was significant regarding pH, total aciduric microorganisms and lactobacilli counts under cariogenic challenge. Biofilm growth originating from mother-child pairs under regular sucrose exposure promoted the same cariogenic response independently of caries experience and the microbiological profile of the donors.
Assuntos
Bactérias/crescimento & desenvolvimento , Fenômenos Fisiológicos Bacterianos , Biofilmes/crescimento & desenvolvimento , Esmalte Dentário/microbiologia , Sacarose/metabolismo , Criança , Pré-Escolar , Cárie Dentária/microbiologia , Feminino , Humanos , Mães , SalivaRESUMO
This practice-based retrospective study evaluated the survival of resin composite restorations in posterior teeth, focusing on the influence of potential patient risk factors. In total, 306 posterior composite restorations placed in 44 adult patients were investigated after 10 to 18 yrs. The history of each restoration was extracted from the dental records, and a clinical evaluation was performed with those still in situ. The patient risk status was assessed for caries and "occlusal-stress" (bruxism-related). Statistical analysis was performed by the Kaplan-Meier method and Cox-regression multivariate analysis. In total, 30% of the restorations failed, of which 82% were found in patients with 1 or 2 risk factors. Secondary caries was the main reason of failure within caries-risk patients, whereas fracture was the main reason in "occlusal-stress-risk" patients. The patient variables gender and age did not significantly affect survival, but risk did (p < .001). Tooth type (p < .001), arch (p = .013), and pulpal vitality (p = .003) significantly affected restoration survival. Within the limits of this retrospective evaluation, the survival of restorations is affected by patient risk factors, which should be included in survival analyses of restorations.
Assuntos
Resinas Compostas/química , Materiais Dentários/química , Falha de Restauração Dentária/estatística & dados numéricos , Restauração Dentária Permanente/estatística & dados numéricos , Adulto , Idoso , Bruxismo/complicações , Hidróxido de Cálcio/uso terapêutico , Arco Dental/patologia , Suscetibilidade à Cárie Dentária/fisiologia , Forramento da Cavidade Dentária/estatística & dados numéricos , Oclusão Dentária Traumática/complicações , Polpa Dentária/patologia , Método Duplo-Cego , Feminino , Seguimentos , Cimentos de Ionômeros de Vidro/química , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Cimentos de Resina/química , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Dente/patologia , Adulto JovemRESUMO
This study assessed the anti-biofouling performance of an experimental adhesive system containing a naturally occurring essential vegetable oil and examined the following physical and mechanical properties: water sorption (WS) and solubility (SL), microtensile bond strength to dentin (µTBS), and degree of conversion. The following six groups were tested: a self-etching experimental adhesive containing refined essential oil from the seeds of the Butia capitata tree (EAO); an oil-free version of the experimental adhesive (EANO); one group without adhesive as the control (C); and the three following commercial self-etching adhesives: Clearfil Protect Bond (CPB), Clearfil SE Bond, and Adper SE Plus. The antibacterial effect was estimated by microbiological culture on selective/non-selective media, and the results expressed as colony-forming units per unit weight of dry biofilm (CFU mg(-1)). The data were submitted to ANOVA and Tukey's post hoc test (α = 0.05). After 24 h, pH changes were similar in the storage medium of all tested adhesive systems. EAO showed similar levels of antimicrobial activity in a model biofilm microcosm as the commercial self-etching adhesive CPB. Both were effective against total microorganisms, aciduric bacteria, lactobacilli, and Streptococcus mutans. WS and SL were not affected by the presence of the essential oil; the values of EAO were similar to or less than those of commercial equivalents. The incorporation of an essential oil into an experimental adhesive did not influence its monomer conversion result. Immediate µTBS values of EAO and EANO were similar and were greater than those of commercial equivalents. After storage for 6 months, the µTBS of the EAO decreased significantly and became similar to the values of commercial equivalents, while the strength of the EANO was not affected.
Assuntos
Biofilmes/efeitos dos fármacos , Incrustação Biológica/prevenção & controle , Cimentos Dentários/química , Óleos Voláteis/química , Resistência à Tração , Análise de Variância , Animais , Antibacterianos/química , Antibacterianos/farmacologia , Arecaceae/química , Bovinos , Contagem de Colônia Microbiana , Cimentos Dentários/farmacologia , Dentina/química , Incisivo/química , Lactobacillus/efeitos dos fármacos , Óleos Voláteis/farmacologia , Sementes/química , Solubilidade , Streptococcus mutans/efeitos dos fármacosRESUMO
Microcosm biofilms formed in microplates have demonstrated complex community dynamics similar to natural dental biofilm. No simplified microcosm models to evaluate enamel demineralization and dose-response effect to anticariogenic therapies have yet been established, thus this study was designed to develop a pre-clinical model fulfilling this purpose. Experiments were carried out to establish the time of biofilm formation and the sucrose concentration and exposure regimen. Biofilms were initiated from saliva and grown for up to 10 days on bovine enamel discs in 24-well plates, with a saliva analogue medium. Data were collected as pH readings and the percentage enamel surface hardness change. A dose-response evaluation was performed with chlorhexidine, which significantly affected the pH and mineral loss. Overall, the established model parameters, 5 days of biofilm growth with intermittent 1% sucrose exposure of 6 h per day, was suitable as a pre-clinical model for enamel demineralization and dose-response studies.
Assuntos
Anti-Infecciosos Locais/farmacologia , Biofilmes/efeitos dos fármacos , Clorexidina/farmacologia , Modelos Biológicos , Desmineralização do Dente/microbiologia , Animais , Bovinos , Meios de Cultura , Cárie Dentária/microbiologia , Placa Dentária/química , Placa Dentária/microbiologia , Relação Dose-Resposta a Droga , Ecossistema , Humanos , Concentração de Íons de Hidrogênio , Saliva/química , Sacarose/farmacologiaRESUMO
OBJECTIVES: The source of saliva inocula and the individual characteristics of saliva donors could affect the cariogenic activity of in vitro biofilms, but this could also be modulated by environmental determinants, such as the frequency of sugar consumption. Therefore, the aim of this study was to compare the cariogenicity of microcosm biofilm growths from the saliva of caries-free (CF) children, children with early childhood caries (ECC) and with severe ECC (S-ECC), under regular sucrose exposure. METHODS: Microcosm plaque biofilms were initiated from the saliva of CF, ECC and S-ECC children. Biofilms were grown in 24-well microplates on bovine enamel discs for up to 10 days in artificial saliva, which was replaced daily. Growth conditions comprised cariogenic challenge (artificial saliva supplemented with 1% sucrose 6 h/day) or no cariogenic challenge. Daily pH was obtained from the artificial saliva, and after the experimental period, the biofilm formed on the enamel discs was collected for microbiological analyses. Mineral loss in enamel discs was estimated by percentage of surface hardness change. RESULTS: Overall, no statistically significant differences were found among saliva sources (p > 0.05). Streptococcus mutans and lactobacilli counts increased in the biofilms grown under cariogenic challenge (p < 0.05), while a substantial decrease in the artificial saliva pH was detected under the same condition (p < 0.001). Higher demineralization (p < 0.001) was observed under sucrose exposure regardless of caries experience of children. CONCLUSIONS: While the sucrose exposure determined the cariogenicity of the biofilms, the caries experience of children who provided the inocula did not affect mineral loss associated with these biofilms.