This study measures the one and two-year survival rates of restorations used to restore occlusal and approximal cavities of primary teeth, and occlusal cavities in the first permanent molars and premolars of children. Restorations were carried with / or without the use of local anaesthesia. The materials used were 'Dispersalloy', 'Dyract AP', 'Fuji II LC and 'Vitremer'. The unit of study was the individual tooth. A total of 288 restorations were placed and the teeth were randomly allocated to one of the four restorative materials. Following a standardised inclusion criteria, two groups of children took part in the clinical trial. In the first group, children and adolescents were recruited from the Caries Clinic of the Department of Paediatric Dentistry of the Eastman Dental Hospital. The mean age was 7.8 years. A total of 157 restorations were placed in 60 children. In the second group, children and adolescents of the United Arab Emirates were recruited from their Primary School Dental Clinic. The mean age was 7.3 years and 131 restorations were placed in 92 children. Caries diagnosis was carried out by both direct and tactile examination. Teeth with gross multi-surface caries and/or developmental enamel defects were excluded from the trial. All operative work was performed in a standard dental clinic environment. Rubber dam isolation was used whenever possible. High volume suction and a saliva ejector were used as an alternative. Cavity designs for both amalgam and resin restorations were based on a minimal intervention technique. Conventional high-speed and low-speed handpieces were used. The manufacturers' instructions in the placement of resin restorations were followed. Direct (in vivo) clinical assessment of all restorations was carried out following the modified Ryge criteria at baseline and after 6, 12 and 24 months. Clinical Photographs were used whenever possible. Indirect (in vitro) assessment of all the restorations using stone cast replicas was carried out using a modification of the Leinfelder cast rank ordering method. Restoration assessments and review appointments were made at 6, 12, 18 and 24 months from baseline respectively. Results showed that there was no significant difference between the four restorative materials tested over the 24 months trial period. Restoration failure was recorded in 10% of the 288 originally placed restorations (10 Amalgam, 9 Dyract AP, 7 Fuji II LC, 4 Vitremer) and was primarily due to bulk fracture and recurrent caries during the 12-18 months' review period. Marginal discolouration was present in 52% of the restorations by the end of the 18-month review period. After 2 years, 89% of restorations appeared to be discoloured. There was a significant difference between the UK group and UAE group in restoration survival. More restorations at the UAE needed replacement (P < 0.001) compared with those in the UK. The in vitro assessments of cast replicas showed evidence of marginal wear of the restorative material over time. The median wear change was 75pm -125 pm during the 18 -24 months' review period. In an attempt to calculate the in vitro volumetric (bulk) material loss, a pilot study was carried out using a light-body impression material and polyvinyl stent copings. The thickness of the impression material corresponded to the quantitative measure of over all material wear. The results of the pilot study were unsatisfactory, as reproducible values were only achieved at levels where the restoration was deemed to have failed.

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Orientador: Prof. Dr. Fabian Calixto Fraiz / Coorientadora: Profª. Drª. Luciana Reichert da Silva Assunção Zanon / Dissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Odontologia. Defesa: Curitiba, 2016 / Inclui referências : f. 32-37;52-59 / Resumo: A Política Nacional de Saúde Bucal determina a ampliação do atendimento às urgências, sendo que o cuidado longitudinal nas redes de atenção do Sistema Único de Saúde (SUS) é realizado na Atenção Primária à Saúde. A dor de dente, ainda prevalente na população brasileira, impacta na qualidade de vida e na demanda por serviços de saúde bucal. Este estudo buscou analisar os atendimentos de urgência odontológica de crianças e adolescentes na rede pública de atenção à saúde bucal de Curitiba. Como objetivos específicos, avaliou: I) de modo transversal os fatores relacionados com os atendimentos nas unidades básicas de saúde (UBS) e de pronto atendimento (UPA). II) de forma prospectiva a descontinuidade do cuidado em saúde bucal na atenção regular em um período de seis meses. Foram avaliados 1012 atendimentos de urgência em indivíduos de 0 a 17 anos e com cadastro definitivo no SUS/Curitiba. Foram coletados dos prontuários dados demográficos do atendido e da utilização dos serviços. Na análise estatística utilizou-se o teste do Qui Quadrado, estimando-se a razão de prevalência (RP) (IC95%) para o estudo transversal, enquanto para o estudo prospectivo estimou-se o risco relativo (RR) (IC95%). Os dados foram estratificados pela faixa etária (crianças e adolescentes) para o estudo transversal, e pelo Índice de Desenvolvimento Humano Municipal (IDHM) (médio/alto e muito alto) para o estudo prospectivo. Do total de atendimentos, o estudo transversal demonstrou que 68,2% e 31,8% eram crianças e adolescentes, respectivamente. Nas UBS ocorreram 89,7% dos atendimentos e nas UPA 10,3%, e 12,2% se caracterizaram como primeiro acesso ao sistema de saúde bucal. Adolescentes tenderam utilizar mais a UPA para o atendimento de urgência do que crianças (RP=1,84; IC95%: 1,28-2,64). Entre as crianças aquelas que não visitaram o dentista no último ano utilizaram mais a UPA para o atendimento de urgência (RP=1,86; IC95%: 1,09-3,17). Os adolescentes para os quais o atendimento de urgência foi o primeiro acesso ao sistema utilizaram mais a UPA (RP=2,16; IC95%:1,04-4,46). A proximidade entre a UBS de cadastro e a UPA mais próxima esteve associada com a maior utilização da UPA tanto para crianças como para adolescentes. No estudo prospectivo a incidência de descontinuidade do cuidado encontrada foi de 42,2%. No grupo de IDHM médio/alto o RR de descontinuar o cuidado foi maior nos menores de 05 anos de idade (RR=1,27; IC95%: 1,02-1,57), naqueles para os quais o atendimento foi caracterizado como primeiro acesso ao sistema (RR=1,37; IC95%: 1,11-1,69) e naqueles que não haviam visitado o dentista no último ano (RR=1,44; IC95%: 1,20-1,74). A utilização da UPA se demonstrou associada à descontinuidade independente do IDHM (RR=1,53; IC95%: 1,10-2,13). As UBS foram responsáveis pela maior parte dos atendimentos de urgência odontológica. Crianças e adolescentes com menor vínculo na UBS e residentes próximos as UPA apresentaram uma maior prevalência de utilização da UPA para um atendimento de urgência. Nos indivíduos com menor idade e menor vínculo na UBS provenientes de regiões de IDHM médio/alto, e ainda aqueles que buscaram as UPA apresentaram maior risco de descontinuidade do cuidado ao receberem atendimento de urgência. Palavras-Chave: Saúde bucal, odontalgia, sistema único de saúde, criança, adolescente. / Abstract: The national oral health policy in Brazil determines the broadening of urgent dental care units, whereas long-term care in the public healthcare system is performed in the primary care setting. Dental pain (toothache) continues to be prevalent in the Brazilian population, exerting an impact on quality of life and the demand for oral health services. The aim of the present study was to analyze urgent dental care for children and adolescents in the public oral healthcare network of the city of Curitiba, Brazil. The specific objectives were I) to perform a cross-sectional evaluation of factors related to treatment at primary care and urgent care units and II) perform a prospective evaluation of the discontinuity of urgent care by regular care in a six-month period. A total of 1012 cases of urgent oral health care for individuals aged 0 to 17 years definitively registered with the Curitiba public healthcare system were analyzed. Demographic characteristics and data on the utilization of services were collected from patient charts. Statistical analysis involved the chi-square test with the estimation of prevalence ratios (PR) and respective 95% confidence intervals (CI) in the cross-sectional study as well as relative risk (RR) and 95% CI in the prospective study. The data were stratified by age group (children and adolescents) in the cross-sectional study and by the Municipal Human Development Index (MHDI) (medium/high and very high) in the prospective study. The cross-sectional study revealed that 68.2% and 31.8% of the patients were children and adolescents, respectively. A total of 89.7% of treatments occurred in primary care and 10.3% in urgent care units. A total of 12.2% of cases were characterized as the first access to the oral healthcare system. The adolescents tended to use urgent care more than the children (PR=1.84; 95%CI: 1.28-2.64). Children with more than one year since the last appointment used urgent care units more (PR=1.86; 95%CI: 1.09-3.17). Adolescents for whom urgent care constituted the first access to the system used urgent care units more (PR=2.16; 95%CI: 1.04-4.46). Proximity to the primary care unit at which the individuals were registered and the closest urgent care unit was associated with greater utilization of the latter units among both children and adolescents. In the prospective study, the incidence of the discontinuity of care was 42.2%. In the group with a medium/high MHDI, the risk of discontinuity was greater among children less than five years of age (RR=1.27; 95%CI: 1.02-1.57), individuals for whom treatment constituted the first access to the system (RR=1.37; 95%CI: 1.11-1.69) and those with more than one year since their last appointment (RR=1.44; 95%CI: 1.20-1.74). The use of urgent care units was associated to discontinuity independently of the MHDI (RR=1.53; 95%CI: 1.10-2.13). Primary care units accounted for a larger portion of cases of urgent care. The prevalence of the utilization of urgent care units for cases of urgent care was higher among children and adolescents with less of a link to a primary care unit and those residing near an urgent care unit. The risk of discontinuity of oral care among individuals who received urgent care was higher among younger children, individuals with less of a link to primary care units in areas with a medium/high MHDI and those who sought urgent care units. Key words: Oral health, dental pain, Brazilian public healthcare system, child, adolescent.