Tratamento restaurador atraumático como opção restauradora para hipomineralização molar-incisivo

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2016.Hipomineralização molar incisivo (HMI) é um defeito qualitativo do esmalte dentário envolvendo 1 ou até 4 primeiros molares permanentes, associado ou não a defeitos nos incisivos permanentes. Clinicamente, os dentes apresentam esmalte poroso nas áreas demarcadas que, frequentemente, apresentam fratura de esmalte pós-eruptiva, expondo dentina e facilitando o desenvolvimento de cárie. A literatura mostra que crianças com HMI recebem mais tratamentos dentários que crianças não afetadas. Além disso, os tratamentos tendem a ser mais invasivos, desafiando o profissional quanto à escolha da melhor opção restauradora. Assim, o objetivo deste trabalho foi avaliar a sobrevida de restaurações realizadas de acordo com o Tratamento Restaurador Atraumático (ART) em primeiros molares afetados por HMI. Para isso, um estudo epidemiológico identificou 1971 escolares dos quais 184 eram portadores de HMI diagnosticadas por meio do critério da Academia Européia de Odontopediatria - EAPD. Destas, 60 crianças apresentavam grau severo de HMI com cárie e sem envolvimento pulpar, das quais 44 compuseram a amostra desse estudo. Os tratamentos foram realizados na escola por um único dentista utilizando-se ionômero de vidro de alta viscosidade (Equia Forte, GC America) de acordo com a técnica ART. Após 6 e 12 meses, um examinador independente avaliou as restaurações por meio do critério ART modificado. Foram realizadas análise descritiva dos dados e regressão logística [P≤0.05; 95% intervalo de confiança]. Foram tratados 60 dentes em um total de 44 crianças, sendo 24 meninas (54,54%) e 20 (45,45%) meninos com idade média de 10,55 (±1,25) anos. Considerando o número de superfícies, 29 (48,3%) das restaurações envolveram 1 face, 20 (33,3%) duas e 11 (18,4%) mais que duas faces. Quanto à extensão das restaurações, 25 (41%) apresentavam lesão em dentina sem enfraquecimento de cúspide, 23 (37,7%) com lesão em dentina e enfraquecimento de cúspide, e 13 (21,3%) com lesões em dentina com destruição de uma ou mais cúspides. A anestesia foi necessária em 4 casos. A taxa de sucesso após 6 e 12 meses foi de 98,3%, observando-se falhas em somente 1 restauração. Uma análise bivariada mostrou que dentre as variáveis idade, sexo, dente, número de faces e extensão das cavidades apenas a variável número de faces mostrou-se se estatisticamente associada a falhas (p=0,016), uma vez que a mesma ocorrereu em dente com três ou mais faces envolvidas. Porém, no modelo de regressão logística no qual todas as variáveis foram incluídas, não se apresentou significativo (p=0,276). Diante do exposto, concluiu-se que a maioria dos dentes com HMI não apresentou necessidade de tratamento, e aqueles com necessidade de tratamento, requerem majoritariamente restaurações diretas. Dentes afetados por HMI apresentam cavidades atípicas, uma vez que foram associadas à quebra pós-eruptiva, não seguindo um padrão comum definido como ocorre para cárie dentária. As restaurações ART, colocadas em campo, para restauração em primeiros molares permanentes afetados por HMI, mostraram-se eficazes para preservação da estrutura dentária desses dentes. Restaurações envolvendo três ou mais faces tiveram maior chance de falhar no período de 12 meses.Molar-Incisor Hypomineralisation (MIH) is a qualitative enamel defect that involves hypomineralisation of 1 to 4 first permanent molars (FPM) associated or not with affected permanent incisors. Clinically, MIH teeth present with demarcated enamel opacities that very often envolves post eruptive breakdown (PEB) wich exposes dentine facilitating caries development. The literature shows that children with MIH receive more dental treatments than those who are not affected. Moreover, treatments tend to be more invasive, challenging the professional with respect to the best restorative approach. Thus, the aim of this study was to evaluate the survival rate of Atraumatic Restorative Treatment (ART) restorations in first permanent molars affected by MIH. An epidemiological survey detected 1971 schoolchildren from whom 184 individuals were diagnosed with MIH using the EAPD criteria. From this total, 60 schoolchildren presented severe MIH molars associated to carious dentine lesions without pulp involvement, from wich 44 composed the sample included in this trial. Treatments were performed by one trained dentist using the ART approach at school premises. A high viscosity glass ionomer cement (GIC) restorative system (Equia Forte, GC®) was used according to ART technique. Treatments were evaluated after 6 and 12 months by an independent examiner using the ART modified criteria. Data analysis involved descriptive statistics and logistic regression [P≤0.05; 95% confidence interval (95% CI)]. A total of 60 teeth were treated in 44 children, 24 (54.54%) girls and 20 (45.45%) boys with a mean age of 10.55 (±1.25) years. In regard to the number of surfaces involved in the restorations, 29 (48.3%) of them involved one surface, 20 (33.3%) two and 11 (18.4%) more than two surfaces. Considering cavity size of the restorations, 25 (41%) presented dentine cavitation without cusp weakness, 23 (37.7%) large dentine cavitation with cusp weakness and 13 (21.3%) large dentine cavitation with one or more cusp breakdown. Only 4 children required the use of local anaesthesia. A survival rate, after 6 and 12 months of 98,3% was observed, as only one restoration failed. A bivariate analysis showed that variables age, gender, tooth, number of surfaces and cavity size only ‘number of surfaces’ was considered significant (p=0.016) as all failures occurred in restorations of three or more surfaces. However, in a logistic regression model, with all variables included, it were not considered significant (p= 0.276) as all the failures occurred in one restorations of three or more surfaces. From this preliminary data, it is possible to conclude that the majority of the teeth diagnosed with MIH didn’t require treatment and those who need it, direct restorations were indicated. MIH teeth have a different pattern of cavities design (atypical cavities) resulting from post eruptive enamel breakdown. The ART restorations, performed in the field, showed to be an effective treatment to preserve first permanent molars affected by MIH. Restorations with three or more surfaces had a higher chance to fail

Análise histológica dos tecidos periapicais de dentes decíduos de cães após obturação de canais com diferentes materiais

The problem of finding an ideal material for filling root canals of deciduous teeth has not been solved yet. This fact led to the development of an experiment to histologically analyze the periapical tissue reaction to 3 root canal filling materials. Eighty root canals of dog deciduous anterior teeth from 6 animals, 60 days old, were used in this study. After biomechanical preparation, the root canals were filled with the following materials: slowly resorbable Maisto paste, Sealer 26 with iodoform, L&C paste (calcium hydroxide with olive oil) and as a control group, canals that were prepared but not filled. At thirty days after the treatment the animals were killed and the teeth prepared for histological analysis. The materials were ranked statistically from the best to the worst as follows: a - Maisto paste, b - Sealer 26 with iodoform, c - control group, d - L&C paste. There was significant difference (p = 0.01) only when the results of the other groups were compared with the L&C paste group. It was also observed that L&C paste was not biologically compatible and that the other materials were biocompatible but their resorption was not at the same rate as that of the deciduous teeth roots.O objetivo de encontrar um material ideal para obturar canais radiculares de dentes decíduos ainda não foi alcançado. Esse fato estimulou a realização de uma experimentação para analisar histologicamente a reação dos tecidos periapicais a 3 materiais obturadores de canal. Assim, oitenta canais radiculares de dentes decíduos anteriores de 6 cães, com 60 dias de idade, fora empregados neste estudo. Após o preparo biomecânico, os canais radiculares foram obturados com os seguintes materiais: pasta lentamente reabsorvível de Maisto, Sealer 26 com iodofórmio, pasta L&C (hidróxido de cálcio com óleo de oliva) e, como grupo controle, dentes cujos canais foram preparados biomecanicamente mas não obturados. Trinta dias após o tratamento os animais foram mortos e as peças processados para análise histológica. Os resultados permitiram ordenar estatisticamente os materiais do melhor para o pior da seguinte maneira: a- Pasta de Maisto, b- Sealer 26 com iodofórmio, c- grupo controle, d- Pasta L&C. Foi observado diferença significante (p=0,01) somente quando os resultados dos diferentes grupos foram comparados com o grupo da pasta L&C. Foi também observado que a pasta L&C não foi biologicamente compatível enquanto os outros materiais foram biocompatíveis, porém suas velocidades de reabsorção não foram a mesma observada com as raízes dos dentes decíduos

Glass hybrid restorations as an alternative for restoring hypomineralized molars in the ART model

Abstract Background This study aimed to evaluate the survival rate of glass hybrid restorations placed under the atraumatic restorative treatment (ART) technique in first permanent molars affected by molar incisor hypomineralization (MIH). Methods Sixty teeth with severe MIH associated to carious dentin lesions without pulp involvement were included. Treatments were performed by one trained dentist using the ART approach and restored with a glass hybrid restorative system (Equia Forte, GC®) on school premises. Treatments were evaluated after 6 and 12 months by an independent examiner using the modified ART criterion. Data analysis involved descriptive statistics and actuarial success analysis. Results The sample comprised 24 (54.54%) girls and 20 (45.45%) boys with a mean age of 10.55 (±1.25) years. In regard to the number of surfaces involved in the restorations, 29 (48.3%) comprised one surface and 31 (51.7%) two or more surfaces. Considering cavity extent, 25 (41%) presented dentin cavitation without cusp weakness, 23 (37.7%) with large dentin cavitation with cusp weakness and 13 (21.3%) with large dentin cavitation with the breakdown of one or more cusps. Only 4 teeth required local anesthesia. A success rate of 98.3% after 6 and 12 months was observed, as only one restoration failed. The only failure occurred in a restoration involving three or more sur-faces presenting the breakdown of all cusps. Conclusion Restorations using a glass hybrid restorative system and performed in the field with the ART technique proved, after 12 months of evaluation, to be an effective approach to preserving first permanent molars affected by MIH. Trial registration REBEC-RBR-8drccq (17/06/15)

Histological analysis of the periapical tissues of dog deciduous teeth after root canal filling with diferent materials Análise histológica dos tecidos periapicais de dentes decíduos de cães após obturação de canais com diferentes materiais

The problem of finding an ideal material for filling root canals of deciduous teeth has not been solved yet. This fact led to the development of an experiment to histologically analyze the periapical tissue reaction to 3 root canal filling materials. Eighty root canals of dog deciduous anterior teeth from 6 animals, 60 days old, were used in this study. After biomechanical preparation, the root canals were filled with the following materials: slowly resorbable Maisto paste, Sealer 26 with iodoform, L&C paste (calcium hydroxide with olive oil) and as a control group, canals that were prepared but not filled. At thirty days after the treatment the animals were killed and the teeth prepared for histological analysis. The materials were ranked statistically from the best to the worst as follows: a - Maisto paste, b - Sealer 26 with iodoform, c - control group, d - L&C paste. There was significant difference (p = 0.01) only when the results of the other groups were compared with the L&C paste group. It was also observed that L&C paste was not biologically compatible and that the other materials were biocompatible but their resorption was not at the same rate as that of the deciduous teeth roots.O objetivo de encontrar um material ideal para obturar canais radiculares de dentes decíduos ainda não foi alcançado. Esse fato estimulou a realização de uma experimentação para analisar histologicamente a reação dos tecidos periapicais a 3 materiais obturadores de canal. Assim, oitenta canais radiculares de dentes decíduos anteriores de 6 cães, com 60 dias de idade, fora empregados neste estudo. Após o preparo biomecânico, os canais radiculares foram obturados com os seguintes materiais: pasta lentamente reabsorvível de Maisto, Sealer 26 com iodofórmio, pasta L&C (hidróxido de cálcio com óleo de oliva) e, como grupo controle, dentes cujos canais foram preparados biomecanicamente mas não obturados. Trinta dias após o tratamento os animais foram mortos e as peças processados para análise histológica. Os resultados permitiram ordenar estatisticamente os materiais do melhor para o pior da seguinte maneira: a- Pasta de Maisto, b- Sealer 26 com iodofórmio, c- grupo controle, d- Pasta L&C. Foi observado diferença significante (p=0,01) somente quando os resultados dos diferentes grupos foram comparados com o grupo da pasta L&C. Foi também observado que a pasta L&C não foi biologicamente compatível enquanto os outros materiais foram biocompatíveis, porém suas velocidades de reabsorção não foram a mesma observada com as raízes dos dentes decíduos

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora

Proceedings Of The 23Rd Paediatric Rheumatology European Society Congress: Part Two

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