Browsing by Author "Mello-Moura, Anna Carolina Volpi"
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- Children’s self-reported discomfort of restorative treatments for deep caries lesions in primary teeth: results from a randomized clinical trialPublication . Silva, Gabriela Seabra da; Raggio, Daniela Prócida; Mello-Moura, Anna Carolina Volpi; Gimenez, Thais; Lara, Juan Sebastian; Floriano, Isabela; Tedesco, Tamara KerberThe aim of this study was to evaluate the impact of different restorative techniques to treat deep caries lesions of primary molars on children’s self-reported discomfort. A randomized clinical trial with two parallel arms (1:1) was conducted in São Paulo, Brazil. 4-8 years-old children with at least one occlusal or occlusoproximal deep caries lesion in primary molars were selected. Molars were randomly allocated into two groups: (1) restoration performed with calcium hydroxide cement followed by high-viscosity Glass Ionomer Cement (CHC+HVGIC), and (2) HVGIC restoration. Immediately after the intervention, children reported the experienced discomfort during restoration to an external examiner using a Wong-Baker face-scale. Children’s self-reported discomfort was analyzed using Poisson regression comparing both groups and assessing other variables’ influence (α=5%). One hundred and eight children fulfilled the eligibility criteria and were randomized in the two groups (n=54). Most of the children who received CHC+HVGIC restorations reported none or minimal discomfort (83.3%). Similar scores (92.6%) were reported for those treated with HVGIC (p=0.758). The mean reported discomfort in children with CHC+HVGIC restorations was 0.37(1.01), and 0.41(1.01) for those with HVGIC restorations. Children’s self-reported discomfort was associated with age, sex, children’s cooperation, and intervention duration. We can conclude that CHC+HVGIC or HVGIC restorations result in none or minimal discomfort in the management of deep caries lesions, being considered a reliable option.
- Deep carious lesions management with stepwise, selective, or non-selective removal in permanent dentition: a systematic review of randomized clinical trialsPublication . Figundio, Nicola; Lopes, Pedro; Tedesco, Tamara Kerber; Fernandes, Juliana Campos Hasse; Fernandes, Gustavo Vicentis Oliveira; Mello-Moura, Anna Carolina VolpiObjective: The goal of this systematic study was to investigate the effectiveness of selective, stepwise, and non-selective removal techniques for caries removal in permanent teeth with deep carious lesions. The primary focus was the results found comparing techniques for caries removal to check whether there was pulp exposition; the secondary was the materials used for pulp protection and clinical findings reported within the included studies. Methods: The search was performed in two databases (PubMed/MEDLINE and Web Of Science). The studies included in this systematic review were selected based on eligibility criteria. The inclusion criteria were: (1) randomized controlled trials (RCTs), (2) that compared the total removal of carious tissue with selective removal in permanent teeth with deep carious lesions, (3) with a follow-up period of at least 6 months, and (4) publications in English. Regarding the exclusion criteria, the following were not considered: (1) articles published in other languages, (2) articles that did not compare the different types of total/selective decay removal, and (3) articles published before January 2008. The risk of bias and the quality of the included studies were independently assessed by two reviewers using the RoB 2 tool. Results: 5 out of 105 potentially eligible studies were included. Regarding the teeth included in the study, three articles performed management only on permanent molars, while other studies also performed management on incisors/canines/premolars/molars. Management protocols were divided into nonselective caries removal and partial caries removal (selective/stepwise). The theory of non-selective caries removal was considered an excessive, unnecessarily invasive option and a form of outdated management, and selective removal was preferred. Conclusion: The selective removal technique presented a higher success rate and fewer incidences of pulpal exposure than total removal, after up to 18 months of follow up. Moreover, only one session seemed to be a better management choice compared to two sessions because the cavity re-opening procedure is more prone to pulp exposure and highly depends on patient commitment. Otherwise, at 5 years of follow up, there was no difference between selective removal and total removal in management longevity. In addition, there were also no differences between the success of the materials used for definitive restorations in teeth subjected to any of the techniques evaluated.
- Dentistry under a new light: antimicrobial photodynamic therapy as sustainable solution for periodontitis and periimplantitis treatmentPublication . Mello-Moura, Anna Carolina Volpi; Esteves, Diogo; Andreolli, Daniel; Gomes, Ana T. P. C.Oral health conditions can significantly impact on the quality of life. Despite the scientific progress in the understanding of the pathogenesis and oral diseases causes, these are a global public health. Poor oral health results in pain, substandard nutrition, work absence and lowered self-esteem. Chronic oral infection is a proven risk factor for diabetes, heart, and lung disease. Periodontitis and periimplantitis are oral conditions that have an infection etiology. Despite of the current available techniques used for these diseases’ treatment, none guaranties the total eradication neither prevent (re)infection. It is urgent to find alternative treatments to mitigate these difficulties and improve the diseases’ prognosis. Antimicrobial Photodynamic Therapy (aPDT) arises as an alternative with unique features and presents advantages when compared the use of conventional antimicrobials, showing to be efficient and preventing the development of resistance. aPDT has been extensively studied to treat periimplantitis and periodontitis, but the developed protocols are restricted to phenothiazinium photosensitizers, such as methylene blue, and to the use of red lasers as light source. It is intended to develop an effective therapeutic approach to treat periimplantitis and periodontitis based on aPDT using porphyrins already approved for clinical and the dental curing light (DCL-available in all dental clinics) as light source. The in vitro photoinactivation assays of periodontopathogens (E. faecalis and C. albicans) were carried out in PBS, with the disodium salt of Protoporphyrin IX (Proto IX) as photosensitizer and DCL as a light source. The ex vivo antimicrobial inactivation of such periodontopathogens were also evaluated under the same aPDT protocol in teeth and dental implants. In vitro assays showed an effective photoinactivation of the periodontopathogens when exposed to different concentrations of Proto IX and with DCL. Ex vivo assays in dental implants showed promising results, with high photoinactivations rates of E. faecalis. However, probably due to the complex tooth matrix, the aPDT efficiency in teeth was modest. The aPDT protocol achieved by the combination of Proto IX and DCL showed to be efficient in the inactivation of periodontopathogens. These results open new perspectives for an efficient aPDT protocol development to treat periodontitis and periimplantitis that can be easily implemented in all dental clinics and available to entire population, contributing to the democratization of medical services.
- Evaluating glass ionomer cement longevity in the primary and permanent teeth - an umbrella reviewPublication . Panetta, Alessandro; Lopes, Pedro; Novaes, Tatiane Fernandes; Rio, Rute; Fernandes, Gustavo Vicentis Oliveira; Mello-Moura, Anna Carolina VolpiThe aim of this umbrella review was to evaluate the longevity of glass ionomer cement (GIC) as a restorative material for primary and permanent teeth. Research in the literature was conducted in three databases (MedLine/PubMed, Web of Science, and Scopus). The inclusion criteria were: (1) to be a systematic review of clinical trials that (2) evaluated the clinical longevity of GICs as a restorative material in primary and/or permanent teeth; the exclusion criteria were: (1) not being a systematic review of clinical trials; (2) not evaluating longevity/clinical performance of GICs as a restorative material; and (3) studies of dental restorative materials in teeth with enamel alterations, root caries, and non-carious cervical lesions. Twenty-four eligible articles were identified, and 13 were included. The follow-up periods ranged from 6 months to 6 years. Different types of GICs were evaluated in the included studies: resin-modified glass ionomer cement (RMGIC), compomers, and low- and high-viscosity glass ionomer cement. Some studies compared amalgam and composite resins to GICs regarding longevity/clinical performance. Analyzing the AMSTAR-2 results, none of the articles had positive criteria in all the evaluated requisites, and none of the articles had an a priori design. The criteria considered for the analysis of the risk of bias of the included studies were evaluated through the ROBIS tool, and the results of this analysis showed that seven studies had a low risk of bias; three studies had positive results in all criteria except for one criterion of unclear risk; and two studies showed a high risk of bias. GRADE tool was used to determine the quality of evidence; for the degree of recommendations, all studies were classified as Class II, meaning there was still conflicting evidence on the clinical performance/longevity of GICs and their recommendations compared to other materials. The level of evidence was classified as Level B, meaning that the data were obtained from less robust meta-analyses and single randomized clinical trials. To the best of our knowledge, this is the first umbrella review approaching GIC in permanent teeth. GICs are a good choice in both dentitions, but primary dentition presents more evidence, especially regarding the atraumatic restorative treatment (ART) technique. Within the limitation of this study, it is still questionable if GIC is a good restorative material in the medium/long term for permanent and primary dentition. Many of the included studies presented a high risk of bias and low quality. The techniques, type of GIC, type of cavity, and operator experience highly influence clinical performance. Thus, clinical decision-making should be based on the dental practitioner’s ability, each case analysis, and the patient’s wishes. More evidence is needed to determine which is the best material for definitive restorations in permanent and primary dentition.
- Management of deep caries lesions with or without pulp involvement in primary teeth: a systematic review and network meta-analysisPublication . Tedesco, Tamara Kerber; Reis, Thais Marchezini; Mello-Moura, Anna Carolina Volpi; Silva, Gabriela Seabra da; Scarpini, Samanta; Floriano, Isabela; Gimenez, Thais; Mendes, Fausto Medeiros; Raggio, Daniela PrócidaThere is a lack of evidence about the best approach for cavitated caries lesions with the possibility of pulpal involvement in primary teeth. Thus, the present authors aimed to verify the best treatment for deep caries lesions with or without pulp involvement in primary teeth. The search was conducted in MEDLINE/Pubmed and Web of Science databases until May 2020. Studies that compared techniques to manage deep caries lesions with at least 12 months of follow-up were included. The risk of bias was evaluated using the RoB tool. Network meta-analysis and pairwise meta-analyses were conducted considering the treatment clinical success as an outcome, according to the pulp health condition. From 491 potentially eligible studies, 9 were included. For deep caries lesions with pulp vitality, the Hall Technique presented the highest probability of success (78%). In the event of accidental pulp exposure, pulpectomy presented a 76% chance of providing the best clinical results. For pulp necrosis, no difference was observed between a pulpectomy and non-instrumented endodontic treatment (RR = 0.69; 95%CI: 0.21–2.33) Thus, it was concluded that the Hall Technique may be a better option for deep caries lesions with pulp vitality. In cases of accidental pulp exposure of vital teeth during caries removal, a pulpectomy may be considered the best option. However, there are insuficient studies to build up evidence about the best treatment option when irreversible pulpitis or pulp necrosis is present.
- Marginal bone level and clinical parameter analysis comparing external hexagon and Morse taper implants: a systematic review and meta-analysisPublication . Fuda, Samuele; Martins, Bruno Gomes dos Santos; Castro, Filipe Correia de; Heboyan, Artak; Gehrke, Sergio Alexandre; Fernandes, Juliana Campos Hasse; Mello-Moura, Anna Carolina Volpi; Fernandes, Gustavo Vicentis OliveiraThe goal of this systematic review was to verify the marginal bone loss (MBL) and other clinical parameters comparing external hexagon (EH) and Morse taper (MT) implants when they were evaluated within the same study. The focused question was, “For patients (P) treated with external connection (I) or Morse taper (C) dental implants, were there differences in the marginal bone crest maintenance after at least three months in occlusal function (O)”? As for the inclusion criteria that were considered, they included clinical studies in English that compared the MBL in implants with EH and MT, with follow-up of at least three months, that were published between 2011 and 2022; as for the exclusion criteria, they included publications investigating only one type of connection that analyzed other variables and did not report results for the MBL, reports based on questionnaires, interviews, and case reports/series, systematic reviews, or studies involving patients with a significant health problem (ASA Physical Status 3 and above). The PubMed/MEDLINE, Embase, and Web of Science databases were screened, and all of the data obtained were registered in a spreadsheet (Excel®). The Jadad scale was used to assess the quality of the studies. A total of 110 articles were initially identified; 11 were considered for full-text reading. Then, six articles (four RCTs and two prospective studies) met the eligibility criteria and were included in this study. A total of 185 patients (mean age of 59.71) were observed, and the follow-up ranged from 3 months to 36 months. A total of 541 implants were registered (267 EH and 274 MT). The survival rate ranged between 96% and 100% (the average was 97.82%). The MBL was compared among all periods studied; therefore, the common assessment period was the 12-month follow-up, presenting greater MBL for EH than for MT (p < 0.001). A mean MBL of 0.60 mm (95% CI 0.43–0.78) was found after the same period. BoP was reported in 5 studies and plaque index was reported in 4 (2 with more than 30%). Deep PD was observed in three studies. High heterogeneity was observed (I2 = 85.06%). Thus, within the limitation of this review, it was possible to conclude that there is higher bone loss in EH than in MT implants when evaluating and comparing this variable within the same study. However, the results must be carefully interpreted because of this review’s limited number of clinical studies, the short assessment period, and the high heterogeneity found.
- Oral health strategies: surveying the present to plan the future of community-based learningPublication . Veiga, Nélio Jorge; Couto, Patrícia; Correia, Patrícia; Mello-Moura, Anna Carolina Volpi; Lopes, Pedro Campos; Correia, Maria JoséIntroduction: Oral health literacy relates to the capacity of individuals to acquire, understand and to act upon oral health information to make appropriate health decisions. This scientific review’s main goal is to analyze the strategies that improve oral health literacy within the community, specifically oriented to a community-based learning model focused on the most vulnerable risk groups in society. Materials and Methods: The current review is based on the literature on oral health literacy within community-based learning strategies. The present review selected scientific studies by searching MEDLINE and related databases, such as Web of Science and PUBMED, and by consulting existing bibliographies. Results: Based on the application of the inclusion criteria to the abstracts, 45 publications were retrieved which explicitly dealt with the definitions of oral health literacy, community-based learning, and service learning. Several studies have demonstrated that health consumers with low health literacy fail to understand the available health information. Therefore, innovative oral health literacy strategies should be undertaken. Service learning is an example of an educational approach where the student learns specific soft skills in the classroom and collaborates directly with an agency or institution and engages in reflection activities to deepen their understanding of what is being taught. Conclusions: One of the main strategies used to incorporate the oral health professional in social responsibility and direct contact in the community is through experiencing community-based learning projects. The future graduate must be an educator capable of educating patients in order to themselves acquire high-level skills in oral health literacy.
- Physicochemical properties and filling capacity of an experimental iodoform-based paste in primary teethPublication . Marques, Renata Pereira de Samuel; Moura-Netto, Cacio; Oliveira, Natalia Matsuda de; Bresolin, Carmela Rampazzo; Mello-Moura, Anna Carolina Volpi; Mendes, Fausto Medeiros; Novaes, Tatiane FernandesIn this study, we evaluated the physicochemical properties (PCP; radiopacity, flow, pH, and solubility) and the quality of root canal filling provided by an experimental industrialized paste (EP), with the same active ingredients as those of the Guedes Pinto paste, compared with the Vitapex® paste. PCP were analyzed according to the ANSI/ADA laboratory testing methods for endodontic filling and sealing materials. To analyze filling capacity, 120 artificial primary teeth (60 maxillary incisors [MIs] and 60 mandibulary molars [MMs]) were endodontically treated. The teeth were divided into eight groups based on the dental group (MIs or MMs), filling material (Vitapex® or EP), and insertion method (syringe or lentulo). The Image J® software was used to analyze the initial an final digital radiographies of each tooth, measuring and comparing root canal and void areas. The percentage of filling failure areas was obtained. Data were submitted to ANOVA and Tukey test of mean comparison. Regarding PCP, both pastes presented results according the ANSI/ADA standards. Flow capacity: Vitapex: 19.6 mm, EP: 25 mm (p < 0.01); radiopacity: Vitapex: 4.47 mmAl, EP: 6.06 mmAl (p < 0.01); pH after 28 days: Vitapex: 7.79, EP: 8.19 (p = 0.12); and solubility after 28 days: Vitapex: 2.68%, EP: 2.89% (p > 0.05). Regarding filling capacity analysis, EP demonstrated 12.5% of failure against 31.5% of Vitapex (p < 0.01). Compared to Vitapex, EP presented statistically significantly better results in flow, radiopacity, pH, and filling capacity. Molars presented more filling failures than incisors. The insertion method using a syringe and a thin tip was significantly better than that using Lentulo spiral carriers.
- Pulp vitality of primary molars with deep caries treated with ART restorations: 2-year RCTPublication . Silva, Gabriela Seabra da; Raggio, Daniela Prócida; Mello-Moura, Anna Carolina Volpi; Gimenez, Thais; Montagner, Anelise Fernandes; Floriano, Isabela; Lara, Juan Sebastian; Calvo, Ana Flávia Bissoto; Pascareli-Carlos, Aline Maquiné; Tedesco, Tamara KerberThe aim of this study was to compare the pulp vitality of primary teeth with deep caries treated with two restorative techniques. The restoration survival rate was also evaluated as a secondary outcome. Children aged from 4 to 8 years with at least one deep carious lesion in molars were selected at the Ibirapuera University dental clinic. One hundred and eight deciduous molars were allocated into two groups: (1) restoration with calcium hydroxide cement lining followed by filling with high-viscosity glass ionomer cement (CHC+HVGIC) or (2) restoration with HVGIC. Pulp vitality and restoration survival were evaluated at 6, 12, and 24 months. Intent-to-treat analysis was used for pulp vitality, and survival analysis was performed with the Kaplan-Meier method (α=5%). Results: At 24 months, 86 restorations were evaluated, and 91 were evaluated at least once during the study. There was no significant difference between the restorative treatments regarding pulp vitality (CHC +HVGIC=70% and HVGIC=68.5%) (OR=1.091; CI95%=0.481-2.475). However, HVGIC (73%) restorations showed a higher survival rate than CHC+HVGIC (50%) (p=0.021). Thus, it can conclude that deep caries in primary molars should be restored with HVGIC, since the technique results in similar pulp vitality to the CHC +HVGIC, but with a higher restoration survival rate
- The influence of root prominence on the onset of gingival recession: a systematic reviewPublication . Raso, Girolamo; Santos, Nuno Bernardo Malta dos; Nassani, Leonardo M.; Mello-Moura, Anna Carolina Volpi; Fernandes, Juliana Campos Hasse; Fernandes, Gustavo Vicentis OliveiraThis systematic review aimed to identify, evaluate, and summarize the results of relevant studies on radicular prominence and its relationship with gingival recessions. This review was conducted according to the PRISMA (Preferred Reporting Reviews and Meta-Analysis) guidelines, and the focused PICO question was “In teeth with vestibular site-specific root or alveolar bone prominence, what are the chances that this will lead to gingival recession or difficulty in root coverage procedures, compared to teeth correctly positioned in the alveolar bone or without anatomical root prominence?”. A search was carried out on three databases: Embase, PubMed/MedLine, and Wiley Library. This initial search was complemented with manual research. It included any clinical study, such as a randomized clinical trial, controlled clinical trial, prospective/retrospective clinical study, case series, or case report, published in English from January 2012 to December 2023, which reported any involvement of the root/bone prominence approach. The exclusion criteria were clinical studies without report results/details of the case(s), studies based on questionnaires, editorial letters, any review, in vitro/in silica and animal studies, and interviews. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was applied for quality assessment. A total of 163 articles were found, but only three articles were included (k = 0.98). The included studies observed negative correlations when comparing the variables root prominence with linear root coverage, root surface area covered, and linear tissue thickness gain. It suggested a significant reduction in root coverage for prominences greater than 1 mm; therefore, relevant keratinized tissue gains can be achieved in gingival recession treatment after the application of the odontoplasty. The STROBE checklist evaluated 22 items, and all the included studies had a high-quality assessment (greater than 75%) with values greater than 85%. Then, it was not possible to draw conclusions due to the number of articles included, even though they had high-quality assessments. Otherwise, it is possible to suggest that the root prominence may impact gingival recession. Therefore, new and well-designed studies must be developed to establish a significant conclusion about this condition.