Oral findings and dental care in a patient with myelomeningocele: case report of a 3-year-old child

Myelomeningocele (MMC) is a congenital malformation of the neural tube that occurs in the first weeks of pregnancy. This malformation refers to the caudal non-closure of the neural tube and neural tissue exposure, which lead to neurological problems, such as hydrocephalus, motor disability, genitourinary tract and skeletal abnormalities and mental retardation. Patients with MMC have an acknowledged predisposition to latex allergy and are usually at a high caries risk and activity due to poor oral hygiene, fermentable carbon hydrate-rich diet and prolonged use of sugar-containing medications. This paper addresses the common oral findings in pediatric patients with MMC, discusses the strategies and precautions to deal with these individuals and reports the dental care to a young child diagnosed with this condition.Mielomeningocele (MMC) representa uma malformação congênita do tubo neural que acontece nas primeiras semanas de gestação. Esta malformação refere-se ao não fechamento da coluna vertebral expondo a medula espinhal, que levará a problemas neurológicos, como hidrocefalia, dificuldades motoras, anomalias esqueléticas e do trato genito-urinário, além de retardo mental. Pacientes com MMC apresentam uma reconhecida predisposição à alergia ao latex e geralmente apresentam um alto risco e atividade de cárie dental decorrente de uma higiene oral deficiente, de uma dieta rica em carboidratos e do uso prolongado de medicamentos contendo açúcares. Este trabalho discorre sobre os achados bucais em crianças com MMC, discute as estratégias e precauções no manejo destes pacientes e descreve o tratamento odontológico de uma criança diagnosticada com esta condição

Bond strength of a pit-and-fissure sealant associated to etch-and-rinse and self-etching adhesive systems to saliva-contaminated enamel: individual vs. simultaneous light curing

This study evaluated in vitro the shear bond strength (SBS) of a resin-based pit-and-fissure sealant [Fluroshield (F), Dentsply/Caulk] associated with either an etch-and-rinse [Adper Single Bond 2 (SB), 3M/ESPE] or a self-etching adhesive system [Clearfil S3 Bond (S3), Kuraray Co., Ltd.] to saliva-contaminated enamel, comparing two curing protocols: individual light curing of the adhesive system and the sealant or simultaneous curing of both materials. Mesial and distal enamel surfaces from 45 sound third molars were randomly assigned to 6 groups (n=15), according to the bonding technique: I - F was applied to 37% phosphoric acid etched enamel. The other groups were contaminated with fresh human saliva (0.01 mL; 10 s) after acid etching: II - SB and F were light cured separately; III - SB and F were light cured together; IV - S3 and F were light cured separately; V - S3 and F were light cured simultaneously; VI - F was applied to saliva-contaminated, acid-etched enamel without an intermediate bonding agent layer. SBS was tested to failure in a universal testing machine at 0.5 mm/min. Data were analyzed by one-way ANOVA and Fisher's test (α=0.05).The debonded specimens were examined with a stereomicroscope to assess the failure modes. Three representative specimens from each group were observed under scanning electron microscopy for a qualitative analysis. Mean SBS in MPa were: I-12.28 (±4.29); II-8.57 (±3.19); III-7.97 (±2.16); IV-12.56 (±3.11); V-11.45 (±3.77); and VI-7.47 (±1.99). In conclusion, individual or simultaneous curing of the intermediate bonding agent layer and the resin sealant did not seem to affect bond strength to saliva-contaminated enamel. S3/F presented significantly higher SBS than the that of the groups treated with SB etch-and-rinse adhesive system and similar SBS to that of the control group, in which the sealant was applied under ideal dry, noncontaminated conditions.Este estudo avaliou in vitro a resistência ao cisalhamento (RC) de um selante resinoso [Fluroshield (F), Dentsply/Caulk] em associação com um sistema adesivo de condicionamento total [Adper Single Bond 2 (SB), 3M/ESPE] ou auto-condicionante [Clearfil S3 Bond (S3), Kuraray Co., Ltd.] após contaminação salivar do esmalte, comparando dois protocolos: fotopolimerização individual do sistema adesivo e do selante ou simultânea de ambos os materiais. Superfícies mesiais e distais de esmalte de 45 terceiros molares hígidos foram aleatoriamente alocadas em 6 grupos (n=15), de acordo com a técnica adesiva empregada: I - F foi aplicado sobre o esmalte condicionado com ácido fosfórico a 37%. Os demais grupos foram contaminados com saliva (0,01 mL por 10 s) após o condicionamento ácido. II - SB e F foram fotopolimerizados separadamente; III - SB e F foram fotopolimerizados simultaneamente; IV - S3 e F foram fotopolimerizados separadamente; V - S3 e F foram fotopolimerizados simultaneamente; VI - F foi aplicado sobre o esmalte condicionado e contaminado sem sistema adesivo. RC foi testada em uma máquina universal de ensaios (0,5 mm/min; 50 kgf) e os dados analisados por ANOVA a 1 fator e teste exato de Fisher (α=0,05). As interfaces adesivas foram analisadas quanto ao padrão de fraturas em estereomicroscópio. Três espécimes de cada grupo foram analisados qualitativamente em microscópio eletrônico de varredura. As médias de RC em MPa foram: I-12,28 (±4,29); II-8,57 (±3,19); III-7,97 (±2,16); IV-12,56 (±3,11); V-11,45 (±3,77); e VI-7,47 (±1,99). Conclui-se que a fotopolimerização individual ou simultânea do sistema adesivo e do selante não afetou os valores de RC ao esmalte contaminado. S3/F apresentou RC estatisticamente maior do que os grupos tratados com o sistema adesivo etch-and-rinse SB e estatisticamente semelhante ao grupo controle, no qual o selante foi aplicado em condições ideais, na ausência de contaminação salivar

Bonding agent underneath sealant: shear bond strength to oil-contaminated

This study evaluated in vitro the shear bond strength of a resin-based pit-and-fissure sealant (Fluroshield - F) associated with either an ethanol-based (Adper Single Bond 2 - SB) or an acetone-based (Prime & Bond - PB) adhesive system under conditions of oil contamination. Mesial and distal enamel surfaces from 30 sound third molars were randomly assigned to 2 groups (n=30): I - no oil contamination; II - oil contamination. Contamination (0.25 mL during 10 s) was performed after 37% phosphoric acid etching with an air/oil spray. The specimens were randomly assigned to subgroups, according to the bonding protocol adopted: subgroup A - F was applied to enamel without an intermediate bonding agent layer; In subgroups B and C, SB and PB, respectively, were applied, light-cured, and then F was applied and light-cured. Shear bond strength was tested at a crosshead speed of 0.5 mm/min in a universal testing machine. Means (± SD) in MPa were: IA-11.28 (±1.84); IIA-12.02 (±1.15); IB-9.73 (±2.38); IIB-9.62 (±2.29); IC-28.30 (±1.63); and IIC-25.50 (±1.91). It may be concluded that the oil contamination affected negatively the sealant bonding to enamel and the acetone-based adhesive system (PB) layer applied underneath the sealant was able to prevent its deleterious effects to adhesion.Este estudo avaliou in vitro a resistência ao cisalhamento (RC) de um selante resinoso [Fluroshield (F); Dentsply/Caulk] em associação com um sistema adesivo com solvente a base de etanol [Adper Single Bond 2 (SB); 3M/ESPE] ou a base de acetona [Prime & Bond (PB); 3M/ESPE] após contaminação com óleo do esmalte. Superfícies mesiais e distais de esmalte de 30 terceiros molares hígidos foram aleatoriamente alocadas em 2 grupos (n=30): I - contaminação com óleo; II - sem contaminação. A contaminação foi realizada (0,25 mL;10 s) com um jato de ar/óleo após o condicionamento do esmalte com ácido fosfórico a 37%. Os espécimes foram aleatoriamente alocados em subgrupos, de acordo com a técnica adesiva empregada: A - F foi aplicado sobre o esmalte condicionado sem sistema adesivo; B - SB + F; C - PB + F. RC foi testada em uma máquina universal de ensaios (0,5 mm/min; 50 kgf) e os dados analisados por ANOVA e t-teste (α=0,01). As médias de RC em MPa foram: IA-11,28 (±1,84); IIA-12,02(±1,15); IB-9,73 (±2,38); IIB-9,62 (±2,29); IC-28,30 (±1.63); e IIC-25,50 (±1,91). Conclui-se que a contaminação com o óleo afetou a adesão do selante resinoso ao esmalte e o sistema adesivo com solvente a base de acetona (Prime & Bond) aplicado sob o selante foi capaz de impedir os efeitos deletérios da contaminação com óleo

Clinical evaluation of the failure rate of metallic brackets bonded with orthodontic composites

The purpose of the present study was to evaluate in vivo the failure rate of metallic brackets bonded with two orthodontic composites. Nineteen patients with ages ranging from 10.5 to 38.7 years needing corrective orthodontic treatment were selected for study. The enamel surfaces from second premolars to second premolars were treated with Transbond Plus-Self Etching Primer (3M Unitek). Next, 380 orthodontic brackets were bonded on maxillary and mandibular teeth, as follows: 190 with Transbond XT composite (3M Unitek) (control) and 190 with Transbond Plus Color Change (3M Unitek) (experimental) in contralateral quadrants. The bonded brackets were light cured for 40 s, and initial alignment archwires were inserted. Bond failure rates were recorded over a six-month period. At the end of the evaluation, six bond failures occurred, three for each composite. Kaplan-Meyer method and log-rank test (Mantel-Cox) was used for statistical analysis, and no statistically significant difference was found between the materials (p=0.999). Both Transbond XT and Transbond Plus Color Change composites had low debonding rates over the study period

Surface and subsurface erosion of primary enamel by acid beverages over time

This study evaluated the influence of a cola-type soft drink and a soy-based orange juice on the surface and subsurface erosion of primary enamel, as a function of the exposure time. Seventy-five primary incisors were divided for microhardness test (n=45) or scanning electron microscopy (SEM) analysis (n=30). The specimens were randomly assigned to 3 groups: 1 - artificial saliva (control); 2 - cola-type soft drink; and 3 - soy-based orange juice. Immersion cycles in the beverages were undertaken under agitation for 5 min, 3 times a day, during 60 days. Surface microhardness was measured at 7, 15, 30, 45 and 60 days. After 60 days, specimens were bisected and subsurface microhardness was measured at 30, 60, 90, 120, 150 and 200 µm from the surface exposed. Data were analyzed by ANOVA and Tukey’s test (a=0.05). Groups 2 and 3 presented similar decrease of surface microhardness. Regarding subsurface microhardness, group 2 presented the lowest values. SEM images revealed that after 60 days the surfaces clearly exhibited structural loss, unlike those immersed in artificial saliva. It may be concluded that erosion of the surfaces exposed to the cola-type soft drink was more accentuated and directly proportional to the exposure time.Este estudo avaliou a influência de um refrigerante a base de cola e um suco de laranja a base de soja na erosão da superfície e subsuperfície do esmalte do dente decíduo, em função do tempo de exposição. Setenta e cinco incisivos decíduos foram divididos para o teste de microdureza (n=45) ou para a análise em microscópio eletrônico de varredura (MEV) (n=30). Os espécimes foram alocados aleatoriamente em 3 grupos: I - saliva artificial (controle); II - refrigerante a base de cola; e III - suco de laranja a base de soja. Ciclos de imersão nas bebidas foram realizados sob agitação durante 5 min, 3 vezes ao dia, durante 60 dias. A microdureza superficial foi mensurada aos 7, 15, 30, 45 e 60 dias. Após 60 dias, os espécimes foram seccionados e a microdureza subsuperficial foi mensurada aos 30, 60, 90, 120, 150 e 200 μm. Os dados foram analisados pelos testes ANOVA e Tukey (α=5%). Os grupos II e III apresentam uma diminuição similar da microdureza superficial. O grupo II apresentou menores valores de microdureza subsuperficial. As imagens de MEV revelaram que após 60 dias as superficies mostraram perdas de estruturas claramentes identificadas, diferentemente das superfícies imersas em saliva artificial. Pode-se concluir que a erosão das superficies expostas ao refrigerante a base de cola foi mais acentuada e diretamente proporcional ao tempo de exposição à bebida.The authors would like to acknowledge the contribution of Ms. Fatima Rizoli during the development of the experimental period. Authors are also grateful to Dr. Alberto Moreira Jorge Jr. from the Laboratory of Structural Characterization, Department of Material Engineering, Federal University of São Carlos, Brazil, for his assistance during SEM analysi

Effect of temporary cements on the shear bond strength of luting cements

OBJECTIVE: The purpose of this study was to evaluate, by shear bond strength (SBS) testing, the influence of different types of temporary cements on the final cementation using conventional and self-etching resin-based luting cements. Material and Methods: Forty human teeth divided in two halves were assigned to 8 groups (n=10): I and V (no temporary cementation); II and VI: Ca(OH)2-based cement; III and VII: zinc oxide (ZO)-based cement; IV and VIII: ZO-eugenol (ZOE)-based cement. Final cementation was done with RelyX ARC cement (groups I to IV) and RelyX Unicem cement (groups V to VIII). Data were analyzed statistically by ANOVA and Tukey's test at 5% significance level. RESULTS: Means were (MPa): I - 3.80 (&plusmn;1.481); II - 5.24 (&plusmn;2.297); III - 6.98 (&plusmn;1.885); IV - 6.54 (&plusmn;1.459); V - 5.22 (&plusmn;2.465); VI - 4.48 (&plusmn;1.705); VII - 6.29 (&plusmn;2.280); VIII - 2.47 (&plusmn;2.076). Comparison of the groups that had the same temporary cementation (Groups II and VI; III and VII; IV and VIII) showed statistically significant difference (p<0.001) only between Groups IV and VIII, in which ZOE-based cements were used. The use of either Ca(OH)2-based (Groups II and VI) or ZO-based (Groups III and VII) cements showed no statistically significant difference (p>0.05) for the different luting cements (RelyX TM ARC and RelyX TM Unicem). The groups that had no temporary cementation (Groups I and V) did not differ significantly from each other either (p>0.05). CONCLUSION: When temporary cementation was done with ZO- or ZOE-based cements and final cementation was done with RelyX ARC, there was an increase in the SBS compared to the control. In the groups cemented with RelyX Unicem, however, the use of a ZOE-based temporary cement affected negatively the SBS of the luting agent used for final cementation

Chemical and Physical properties of the enamel of deciduous and permanent teeth

A exata composição e a micromorfologia do esmalte de dentes decíduos ainda são pouco estudadas e conhecidas, e a literatura existente apresenta achados controversos. Os resultados de pesquisas realizadas em dentes permanentes são frequentemente extrapolados para dentes decíduos, sendo que a maioria dos trabalhos explora estes substratos de maneira isolada. É necessário, portanto, conhecer a composição e a estrutura do esmalte de dentes decíduos e determinar em quais aspectos este tecido realmente difere do esmalte de dentes permanentes. A comparação dos dois substratos é fundamental para que sejam estabelecidos protocolos preventivos e restauradores, bem como no desenvolvimento de materiais e técnicas específicos e efetivos para dentes decíduos e permanentes. Assim, o objetivo do presente estudo foi realizar uma análise comparativa in vitro do esmalte de dentes decíduos e permanentes, avaliando suas propriedades físicas e químicas. As propriedades químicas foram avaliadas por meio das análises de mapeamento de superfície do esmalte por Microfluorescência de Raios-X por Energia Dispersiva (&mu;FRX) (n=10) e Espectroscopia no Infravermelho por Transformada de Fourier (FTIR) (n=10). As propriedades físicas analisadas foram Permeabilidade (n=12), Microdureza (n=12), Radiodensidade (n=10) e Resistência Coesiva (n=15). Nos testes de &mu;EDX e FTIR, os dados da amostra não apresentaram distribuição normal, empregando-se o teste não paramétrico de Mann-Whitney. Para os demais testes, a distribuição apresentou-se normal e homogênea. Assim, na análise de Permeabilidade os dados foram submetidos à ANOVA a um critério: tipo de substrato (p<0,05) e na análise de Microtração os dados foram submetidos à ANOVA a dois critérios: tipo de substrato e direção dos prismas (p<0,05). Para os dados de Radiodensidade e Microdureza, foi utilizado o teste t de Student para comparação entre as médias. Considerando-se as limitações de um estudo in vitro, os achados demonstraram que em relação às propriedades físicas, o esmalte de dentes decíduos apresentou maior permeabilidade, maior radiodensidade, menor resistência coesiva e microdureza quando comparado ao esmalte de dentes permanentes. Para as propriedades químicas avaliadas, 20 constatou-se que o conteúdo em peso de cálcio (%), fósforo (%) e da proporção Ca/P (%) bem como os conteúdos de carbonato e água foram semelhantes entre os dois substratos avaliados. Portanto, as propriedades físicas do esmalte de dentes decíduos apresentaram características distintas em relação ao esmalte de dentes permanentes, apesar da semelhança nas propriedades químicas analisadas.There is still little research and information on the precise composition and the micromorphology of the enamel of deciduous teeth, and the existing literature reveals controversial findings. The results of studies in permanent teeth are frequently extrapolated to deciduous teeth, and the majority of works explores these substrates alone. It is thus necessary to know the composition and structure of the enamel of deciduous teeth and determine in which ways this tissue actually differs from the enamel of permanent teeth. Comparison of these substrates under different aspects is fundamental to establish preventive and restorative protocols, as well as materials and techniques that are specific and effective for deciduous and permanent teeth. Therefore, the aim of the present in vitro study was to perform a comparative analysis of the enamel of deciduous and permanent teeth by evaluating its physical and chemical properties. Chemical analysis comprised enamel surface mapping by Energy Dispersive X-ray Microfluorescence (&mu;FRX) (n=10) and Fourier Transform Infrared Spectroscopy (FTIR) (n=10). For the physical analysis, Permeability (n=12), Microhardness (n=12), Radiodensity (n=10) and Ultimate Tensile Strength (n=15) tests were performed. Data distribution and homogeneity were analyzed. In the &mu;FRX and FTIR data distribution was not normal and the Mann-Whitney non-parametric test was used for statistical analysis. For the other tests, data distribution was normal and homogenous. Thus, one-way analysis of variance (type of substrate) was used for the Permeability; twoway analysis of variance (type of substrate and depth) was used for the Microtensile Bond Strength test (p<0.05); data from Radiodensity and Microhardness test were analyzed using the Students t-test. Considering the limitations of an in vitro investigation, the findings revealed that with respect to the physical properties, the enamel of deciduous teeth presented greater permeability and radiodensity and lower ultimate bond strength and microhardness of substrate when compared with the enamel of permanent teeth. Regarding the chemical properties, the amount of calcium, phosphorus and Ca/P (wt%) as well as the amount of carbonate and water was similar for both types of substrates evaluated. 22 Therefore, the enamel of deciduous teeth presented different physical properties compared to the permanent teeth, despite the similarity in chemical properties analyzed

Shear bond strength of a pit-and-fissure sealant associated with two adhesive systems after salivary contamination: influence of individual and simultaneous light curing

Este trabalho teve por objetivo avaliar \"in vitro\" a resistência ao cisalhamento de um selante resinoso (Fluroshield - F) em associação com um sistema adesivo total-etch (Adper Single Bond 2-SB) e um self-etching (Clearfil S3 Bond-S3) em condições de contaminação salivar, comparando dois protocolos de fotopolimerização: individual do sistema adesivo e, em seguida, do selante ou simultânea de ambos materiais conjuntamente. Superfícies mesiais e distais de 45 terceiros molares humanos hígidos foram incluídas e planificadas, o sítio de adesão delimitado (Ø 3mm) e os corpos-de-prova alocados aleatoriamente em 6 grupos experimentais (n=15), de acordo com o tratamento empregado: I- F aplicado sobre o esmalte condicionado com ácido fosfórico a 37% (controle). Os demais grupos foram contaminados com saliva (0,01ml por 10 s) e a seguir foram aplicados: II- SB e F fotopolimerizados separadamente; III- SB e F fotopolimerizados conjuntamente; IVS3 e F fotopolimerizados separadamente; V- S3 e F fotopolimerizados simultaneamente; VI- F aplicado sem associação com adesivos sobre o esmalte condicionado e contaminado. A seguir, um cilindro de selante foi confeccionado com o auxílio de uma mesa metálica e de matriz de teflon bipartida sobre o sítio de adesão. Após armazenamento durante 24 horas a 37°C em água destilada, os espécimes foram submetidos ao teste de resistência ao cisalhamento em Máquina de Ensaios Universal (0,5mm/min; 50Kgf). As interfaces adesivas foram analisadas quanto ao tipo de fratura em microscópio óptico com 20x de aumento e para análise qualitativa, três espécimes de cada grupo, foram selecionados e analisados em microscópio eletrônico de varredura. As médias obtidas, em MPa, e os desvios padrão foram: I-12,28 (±4,29); II-8,57 (±3,19); III-7,97 (±2,16); IV-12,56 (±3,11); V- 11,45 (±3,77); e VI-7,47 (±1,99). A análise estatística, por meio da Análise de Variância e teste de Fisher, demonstrou que a contaminação salivar afetou negativamente a resistência adesiva. A associação do sistema adesivo self-etching ao selante resultou em uma média semelhante estatisticamente ao grupo controle. Comparando os protocolos de fotopolimerização, não houve diferença estatisticamente significante entre os grupos nos quais foi realizada a fotopolimerização simultânea ou individual dos materiais. Com base nestes resultados pôde-se concluir que o protocolo de fotopolimerização não afetou os valores de resistência adesiva ao esmalte condicionado e contaminado. A associação do sistema adesivo self-etching Clearfil S3 Bond ao selante Fluroshield aumentou a resistência ao cisalhamento com diferença estastísticamente significante em relação aos grupos nos quais foi utilizado o sistema adesivo Adper Single Bond 2 e com valor médio semelhante ao grupo controle, no qual o selante foi aplicado em condições ideais, na ausência de contaminação salivar.The purpose of this study was to evaluate in vitro the shear bond strength of a resin-based pit-and-fissure sealant (Fluroshield - F) associated with a total-etch (Adper Single Bond 2 - SB) and a self-etching adhesive system (Clearfil S3 Bond - S3) under conditions of salivary contamination, comparing two curing protocols: individual light curing of the adhesive system and the sealant or simultaneous curing of both materials. Mesial and distal surfaces from 45 sound third molars were embedded, flattened and a 3-mm-diameter bonding site was demarcated. The specimens were randomly assigned to 6 experimental groups (n=15), according to the bonding technique: I - F was applied to the enamel etched with 37% phosphoric acid. The other groups were contaminated with saliva (0.01 mL during 10 s). II - SB and F were light cured separately; III - SB and F were light cured together; IV - 3S and F were light cured separately; V - 3S and F were light cured simultaneously; VI - F was applied to salivary-contaminated etched enamel without an intermediate bonding agent layer. Thereafter, a sealant cylinder was fabricated using a metallic clamping device and a split Teflon matrix placed over the bonding site. After 24-hour storage in distilled water at 37°C, shear bond strength was measured using a knifeedge blade in a universal testing machine (0.5 mm/mm; 50 kgf). The debonded interfaces were examined with an optical microscope to determine the failure modes. For a qualitative analysis, 3 specimens from each group were selected and observed under scanning electron microscopy. Means (±SD) in MPa were: I-12,28 (±4,29); II 8,57 (±3,19); III-7,97 (±2,16); IV-12,56 (±3,11); V-11,45 (±3,77); and VI-7,47 (±1,99). Statistical analysis by ANOVA and Fisher\'s test showed that salivary contamination affected negatively the bond strength. The association between the self-etching adhesive system and sealant yielded bond strength mean statistically similar to that of the control group. Comparing the curing protocols, there was no statistically significant difference between the groups with simultaneous or individual light curing of the materials. Based on these results, it may be concluded that the curing protocol did not affect the bond strength to the contaminated etched enamel. The association of Clearfil S3 Bond self-etching adhesive system to Fluroshield sealant increased the shear bond strength with statistically significant difference from the groups with Adper Single Bond 2 adhesive system, and showing mean value similar to that of the control group, in which the sealant was applied under ideal conditions, without salivary contamination