RESUMO
Los cambios demográficos y epidemiológicos actuales determinarán un aumento en la prevalencia e incidencia de caries, específicamente lesiones de caries radicular (RCLs, por sus siglas en inglés) en personas mayores, por lo que la necesidad de tratamiento de mayor cobertura y efectividad será también cada vez mayor. Este artículo resume en español la evidencia actual disponible acerca de las recomendaciones clínicas para las intervenciones preventivas, no invasivas, micro o mínimamente invasivas e invasivas para el manejo de la caries dental en personas mayores, con especial énfasis en RCLs. La presente publicación se basa en un taller de consenso, seguido de un proceso de consenso e-Delphi, realizado por un panel de expertos nominados por la Organización Europea para la Investigación en Caries (ORCA), la Federación Europea de Odontología Conservadora (EFCD) y la Federación Alemana de Odontología Conservadora (DGZ). El propósito de este artículo es presentar las principales conclusiones alcanzadas en el consenso de ORCA/EFCD/DGZ para permitir una mejor difusión del conocimiento y la aplicación de estos conceptos en la práctica clínica, orientando la correcta toma de decisiones en el manejo de la enfermedad y RCLs en las personas mayores.
Current demographic and epidemiological changes will condition increased caries prevalence and incidence, specifically root caries lesions (RCLs) in the elderly. There will be a need, therefore, for therapeutic approaches with greater coverage and effectiveness. This article summarizes, in Spanish, the current available evidence leading to clinical recommendations for preventive, non-invasive, micro or minimally invasive and invasive interventions for the management of dental caries in older people, with special emphasis on RCLs. This publication is based on a consensus workshop, followed by an e-Delphi consensus process, conducted by a panel of experts nominated by the European Organization for Caries Research (ORCA), the European Federation of Conservative Dentistry (EFCD) and the German Federation of Conservative Dentistry (DGZ). The purpose of this article is to present the main conclusions reached in the ORCA/EFCD/DGZ consensus to allow a better dissemination of knowledge and the application of these concepts in clinical practice, guiding the correct decision-making for the disease management and the RCLs in the elderly.
Assuntos
Humanos , Idoso , Conferências de Consenso como Assunto , Cárie Radicular/terapia , Cárie DentáriaRESUMO
Introdução: algumas situações clínicas não se apresentam como ideais para o tratamento restaurador adequado e o profissional deve encontrar formas alternativas de acesso adequado à margem gengival. Objetivo: apresentar um caso de lesões cervicais com exposição vestibular de canais radiculares no qual a interação entre Endodontia, Odontologia Restauradora e Periodontia foi fundamental para seu sucesso. Relato de caso: o paciente apresentou lesões de cárie cervical subgengivais, com exposição dos canais radiculares dos dentes anteriores. O tratamento inicial foi realizado por meio de uma adaptação do isolamento com lençol de borracha. Após instrumentação, foi introduzida nos canais guta-percha recoberta com vaselina, para auxiliar na restauração temporária da superfície vestibular. O tratamento endodôntico e periodontal foi concluído posteriormente e os dentes foram restaurados durante a cirurgia periodontal, com resina composta. Conclusões: deve-se sempre considerar o planejamento multidisciplinar no tratamento de casos atípicos, bem como adaptar procedimentos convencionais para a abordagem de casos complexos, visando o restabelecimento da saúde, estética e função do paciente.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Resinas Compostas/uso terapêutico , Estética Dentária , Procedimentos Cirúrgicos Bucais , Cárie Radicular/terapiaRESUMO
Como todas las lesiones de caries, la caries de superficies radiculares (CSR) refleja un cambio tisular continuo. Es esencial diagnosticar los síntomas antes que esas lesiones lleguen a estar cavitadas. Por la misma razón, y para poder decidir entre modalidades invasivas y no-invasivas, deberá ser perfectamente comprendida la dinámica de la formación de la lesión cariosa. Este artículo revisa la etiología, los criterios de diagnóstico y los factores de riesgo en caries de superficies radiculares, y también discute la prevención y la terapéutica, haciendo un especial énfasis en procedimientos de remineralización y en un enfoque no-invasivo de este problema.
As all caries lesions, root caries reflect a continuous tissue change. It is essential to diagnose symptoms before these lesions become cavitated. For the same reason, and in order to be able to decide between invasive and non-invasive modalities, the dynamics of the formation of the carious lesion must be perfectly understood. This paper reviews the etiology, diagnostic criteria and risk factors for root surface caries, and also discusses prevention and therapeutics, with a special emphasis on remineralization procedures and a non-invasive approach to this problem.
Assuntos
Humanos , Cárie Radicular/classificação , Cárie Radicular/diagnóstico , Cárie Radicular/etiologia , Cárie Radicular/prevenção & controle , Cárie Radicular/terapia , Fatores de RiscoRESUMO
The aim of this study was to compare the clinical performance of root caries restorations after a six-month period using two methods, a conventional technique with rotary instruments and an atraumatic restorative technique (ART), in an institutionalized elderly population in the city of Bogotá, Colombia. Root caries represents a multifactorial, progressive, chronic lesion with softened, irregular and darkened tissue involving the radicular surface; it is highly prevalent in the elderly, especially in those who are physically or cognitively impaired. A quasi-experimental, double-blind, longitudinal study was carried out after cluster randomization of the sample. Two different experienced dentists, previously trained, performed the restorations using each technique. After six months, two new investigators performed a blind evaluation of the condition of the restorations. The results showed a significantly higher rate of success (92.9%) using the conventional technique (p < 0.03). However, we concluded that ART may have been the preferred technique in the study population because 81% of those restorations survived or were successful during the observation period.
Assuntos
Tratamento Dentário Restaurador sem Trauma/métodos , Instrumentos Odontológicos , Restauração Dentária Permanente/instrumentação , Cárie Radicular/terapia , Idoso , Idoso de 80 Anos ou mais , Assistência Odontológica para Idosos , Falha de Restauração Dentária , Restauração Dentária Permanente/métodos , Método Duplo-Cego , Feminino , Cimentos de Ionômeros de Vidro/uso terapêutico , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Casas de Saúde , Resultado do TratamentoRESUMO
Abstract The aim of this study was to compare the clinical performance of root caries restorations after a six-month period using two methods, a conventional technique with rotary instruments and an atraumatic restorative technique (ART), in an institutionalized elderly population in the city of Bogotá, Colombia. Root caries represents a multifactorial, progressive, chronic lesion with softened, irregular and darkened tissue involving the radicular surface; it is highly prevalent in the elderly, especially in those who are physically or cognitively impaired. A quasi-experimental, double-blind, longitudinal study was carried out after cluster randomization of the sample. Two different experienced dentists, previously trained, performed the restorations using each technique. After six months, two new investigators performed a blind evaluation of the condition of the restorations. The results showed a significantly higher rate of success (92.9%) using the conventional technique (p < 0.03). However, we concluded that ART may have been the preferred technique in the study population because 81% of those restorations survived or were successful during the observation period.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Cárie Radicular/terapia , Instrumentos Odontológicos , Restauração Dentária Permanente/instrumentação , Tratamento Dentário Restaurador sem Trauma/métodos , Método Duplo-Cego , Estudos Longitudinais , Assistência Odontológica para Idosos , Resultado do Tratamento , Falha de Restauração Dentária , Restauração Dentária Permanente/métodos , Cimentos de Ionômeros de Vidro/uso terapêutico , Pessoa de Meia-Idade , Casas de SaúdeRESUMO
Objetivo general: Entregar recomendaciones basadas en evidencia para prevenir y tratar las lesiones de caries radiculares en adultos de 60 años y más.
Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cárie Radicular/prevenção & controle , Cárie Radicular/terapia , Saúde BucalRESUMO
This research analyzed the influence of bur and erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser caries removal on cavity characteristics and marginal seal of composite resin restorations. One hundred and forty human dental root samples were used. After in vitro root caries induction using Streptococcus mutans, the carious lesions were removed either by a conventional technique using burs (G1=control) or by using an Er,Cr:YSGG laser (λ=2.78 µm, 20 Hz, pulse duration is approximately equal to 140 µs, noncontact mode using a 600-µm tip) with the following power outputs: G2: 1.0 W; G3: 1.25 W; G4: 1.5 W; G5: 1.75 W; G6: 2.0 W; G7: 2.25 W; G8: 2.5 W; G9: 2.75 W; G10: 3.0 W; G11: 3.25 W; G12: 3.5 W; G13: 3.75 W; and G14: 4.0 W. Samples in the 14 groups (n=10) were conditioned with Clearfil SE Bond and restored with a flowable composite. They were then thermocycled (1000 cycles) and immersed into a 2% methylene blue solution for microleakage analysis. The data were statistically compared (analysis of variance or Spearman correlation tests; p≤0.05). The lased groups showed significantly greater microleakage indexes, cavity depths, and presence of residual caries than did those of the control group. There was a strong positive correlation between residual caries and microleakage. The results indicate that Er,Cr:YSGG laser irradiation is not a good alternative to the use of burs for root caries removal since it may cause a significant loss of marginal sealing in composite resin restorations.
Assuntos
Preparo da Cavidade Dentária/instrumentação , Terapia a Laser/instrumentação , Lasers de Estado Sólido/uso terapêutico , Cárie Radicular/terapia , Corantes , Resinas Compostas/química , Colagem Dentária , Infiltração Dentária/classificação , Adaptação Marginal Dentária , Materiais Dentários/química , Restauração Dentária Permanente/métodos , Desenho de Equipamento , Humanos , Azul de Metileno , Cimentos de Resina/química , Cárie Radicular/microbiologia , Cárie Radicular/patologia , Streptococcus mutans/fisiologia , Temperatura , Fatores de TempoRESUMO
In this study we compared the microleakage of conventional glass ionomer cement (GIC) restorations following the use of different methods of root caries removal. In vitro root caries were induced in 75 human root dentin samples that were divided in five groups of 15 each according to the method used for caries removal: in group 1 spherical carbide burs at low speed were used, in group 2 a hand-held excavator was used, and in groups 3 to 5 an Er,Cr:YSGG laser was used at 2.25 W, 40.18 J/cm(2) (group 3), 2.50 W, 44.64 J/cm(2) (group 4) and 2.75 W, 49.11 J/cm(2) (group 5). The air/water cooling during irradiation was set to 55%/65% respectively. All cavities were filled with GIC. Five samples from each group were evaluated by scanning electron microscopy (SEM) and the other ten samples were thermocycled and submitted to a microleakage test. The data obtained were compared by ANOVA followed by Fisher's test (p≤0.05). Group 4 showed the lowest microleakage index (56.65 6.30; p<0.05). There were no significant differences among the other groups. On SEM images samples of groups 1 and 2 showed a more regular interface than the irradiated samples. Demineralized dentin below the restoration was observed, that was probably affected dentin. Group 4 showed the lowest microleakage values compared to the other experimental groups, so under the conditions of the present study the method that provided the lowest microleakage was the Er,Cr:YSGG laser with a power output of 2.5 W yielding an energy density of 44.64 J/cm(2).
Assuntos
Infiltração Dentária , Restauração Dentária Permanente/métodos , Cimentos de Ionômeros de Vidro , Cárie Radicular/terapia , Dentina/efeitos da radiação , Humanos , Técnicas In Vitro , Terapia a Laser , Lasers de Estado Sólido , Microscopia Eletrônica de Varredura , Dente Molar/efeitos da radiação , Dente Molar/ultraestrutura , Raiz Dentária/efeitos da radiaçãoRESUMO
OBJETIVO: Ilustrar um método alternativo para a restauração de perdas cervicais não cariosas utilizando compósitos e pinos dentinários. MÉTODO: Nos casos apresentados, extensas lesões cervicais não cariosas foram restauradas com resinas compostas e pinos dentinários, para avaliação dos resultados. RESULTADOS E CONCLUSÕES: Os pinos de dentina podem ser um suporte alternativo na restauração de dentes com grandes lesões cervicais não cariosas.
OBJECTIVE: To illustrate an alternative method for the restoration of non carious cervical tooth surface loss lesions using composite and dentin pins. METHOD: In these two cases, extensive Class V non carious cervical tooth surface lesions were restored with composite resins and dentin pins and results were evaluated. RESULT AND CONCLUSION: Dentin pins could be an alternative support in large non carious cervical lesions.