Quitosana é um biopolímero natural obtido a partir da desacetilação de quitina. Embora a quitosana já seja utilizada na Odontologia, seu papel sobre o substrato dentinário de dentes decíduos não está bem elucidado. Portanto, o objetivo do presente estudo foi avaliar o papel da incorporação do gel de quitosana a 2,5 % na dentina de dentes decíduos afetada por lesão de cárie. Dentes decíduos extraídos foram coletados e submetidos à indução de lesão de cárie artificial. Após teste de microdureza inicial (n=28), os dentes foram estratificados para receber gel de quitosana a 2,5%. A superfície dentinária hígida (n=3), dentina desmineralizada (n=3) e dentina biomodificada com gel de quitosana a 2,5% (n=3) foram submetidas à Espectroscopia de Energia Dispersiva de Raio-X (EDS) e Microscopia Eletrônica de Varredura (MEV). O teste de microdureza também foi realizado após a indução de lesão de cárie artificial e após a biomodificação da dentina. Os dados foram avaliados usando o teste paramétrico one-way ANOVA para medidas repetidas. A análise dos dados para EDS foi efetuada por meio de teste não paramétrico de Kruskal-Wallis seguido pelo ajuste dos valores de significância pela correção de Bonferroni para múltiplos testes, bem como por meio de estatística descritiva dos dados obtidos através da fórmula: Variável de estudo controle/ controle × 100. A biomodificação da dentina não alterou a microdureza da superfície dentinária (p=0,339). A porcentagem atômica de cálcio revelou diferenças estatisticamente significantes antre a dentina hígida e biomodificada com quitosana (p<0.022), assim como a porcentagem atômica de fósforo que se mostrou superior no grupo que sofreu a biomodificação. A MEV revelou um expressivo número de túbulos dentinários obliterados, porém com maior diâmetro. As imagens topográficas revelaram, ainda, uma superfície lisa e regular após a biomodificação. Embora a aplicação do gel de quitosana a 2,5% na dentina parcialmente desmineralizada em dentes decíduos não foi capaz de aumentar o valor de microdureza, a biomodificação gerou uma superfície dentinária apropriada para procedimentos restauradores adesivos / Chitosan is a natural biopolymer obtained from chitin deacetylation. Although chitosan is already used in dentistry, this role on the primary teeth dentin substrate is not well elucidated. So, the aim to this study was to evaluate the role of the 2.5% chitosan gel incorporation in primary caries-affected dentin teeth. Extracted primary teeth were collected and submitted to artificial caries induction. Teeth were stratified to receive 2.5% chitosan gel after dentin microhardness initial test (n= 28). Healthy dentin (n=3), demineralized dentin (n=3) and biomodified dentin with 2.5% chitosan gel (n=3) were submitted to Energy Dispersive X-ray Spectroscopy (EDS) and Scanning Electron Microscopy (SEM). Microhardness Test was performed too after artificial caries induction and after dentin biomodification. Data were evaluated using one-way ANOVA repeated measures parametric test. Data analysis for EDS was performed using non-parametric Kruskal-Wallis test followed by adjustment of significance values by Bonferroni correction for multiple tests, as well as by means of descriptive statistics of the data obtained using the formula: Study variable control/control × 100. Dentin biomodification did not alter the subsurface microhardness of dentin (p=0,339). The calcium atomic percentage showed statistically significant differences between healthy and biomodificated dentin (p<0.022) and too presented superior phosphorus atomic percentage. SEM revealed expressive number of dentinal tubules obliterated, but a larger diameter. Topographic images revealed a smooth and regular surface in biomodified dentin. Although 2.5% chitosan gel application on partially demineralized dentin in primary teeth was not able to increase microhardness, the biomodification generated an appropriate dentin surface for adhesive restorative procedures

Dental caries is the main reason for placement and replacement of restorations (Keene, 1981). More than 60 percent of dentists' restorative time is spent replacing existing restorations. The replacement of restorations can result in a cavity preparation larger than its predecessor which leads to weakening of the remaining tooth structure (Mjör, 1993). Considering the traditional surgical dental caries management philosophy, it was based on "extension for prevention" and restorative material needs rather than on preserving the healthy tooth structure (Black, 1908). In the 1970s, the surgical dental paradigm began shifting to a new approach for caries management: Minimally Invasive Dentistry (MID). It was based on the medical model that prioritizes caries risk assessment, early caries detection, remineralization of tooth structure, and especially preservation of tooth structure through minimal intervention in the placement and replacement of restorations (Yamaga et al, 1972). The minimal intervention paradigm emphasizes use of adhesive restorative materials in order to minimize the size of cavity preparation (Murdoch-Kinch & McLean, 2003). Hence, a cross-sectional study using an online survey instrument (30-item) was conducted among National Network for Oral Health Access (NNOHA) and American Association Community Dental Programs (AACDP) members. Besides demographics, the survey addressed the following items using a 5-point Likert scale: knowledge, attitudes and behavior concerning MID among general practitioners. Specific questions focused on practitioner and practice characteristics, previous training and knowledge of MID, knowledge use of restorative, diagnostic and preventive techniques and whether MID was considered to meet the standard of care in the U.S., which was the main outcome of the study. Chi-square, Fisher's exact test, Wilcoxon rank-sum test, and two-Sample t-test were used to identify factors associated with beliefs that MID meets the standard of care. Overall, 86% believed MID met the standard of care for primary teeth, and 77% believed this for permanent teeth. The study found that those with more favorable opinions of fluoride to be more likely to believe MID met the standard of care, but no demographic or practice characteristics were associated MID standard of care beliefs.

Disertační práce se zabývá mechanickou odezvou vrstevnatých kompozitů pro stomatologické aplikace. Různé skladby vrstev a různé částicové a vláknové kompozity jsou studovány v tříbodovém ohybu za pokojové teploty. Tyto výsledky jsou korelovány s výstupy dynamické termomechanické analýzy (DMTA) a optické analýzy (vysokorychlostní video záznam, SEM). Exeprimentální data byla použita pro srovnání s výsledky analytických a numerických modelů s cílem určit nejvhodnější model pro predikci základních mechanických vlastností vrstevnatých kompozitů. Na základě těchto analýz jsou navržena základní pravidla pro klinické použití vrstevnatých kompozitů ve stomatologických aplikacích jako jsou minimálně invazivní můstky nebo stabilizační dlahy.

Objectif : La dentisterie pédiatrique évolue vers des approches minimalement invasives pour la gestion des caries, transition accentuée par l'impact de la pandémie de la COVID-19. Parmi les procédures préconisées en dentition primaire, la technique de Hall s'est montrée efficace pour relever des défis tels que la coopération limitée des jeunes patients et l'accès restreint aux blocs opératoires. Malgré son efficacité avérée de 98%, son adoption demeure limitée parmi les dentistes pédiatriques. Le but de cette étude était d'évaluer l'enseignement de la technique de Hall dans les programmes de spécialité en dentisterie pédiatrique, d'analyser son utilisation, sa connaissance, et sa perception parmi les spécialistes américains et canadiens, ainsi que d'explorer les obstacles limitant son adoption. Méthodologie : Les dentistes pédiatriques du Canada et des États-Unis ont été sollicités à travers la liste de diffusion de l'American Academy of Pediatric Dentistry. Un questionnaire composé de 32 énoncés et d’une section spécifique destinée aux directeurs de programme a été distribué électroniquement en septembre (États-Unis) et en octobre (Canada) 2023, via la plateforme LimeSurvey. Des rappels ont été faits après 4 à 6 semaines. Résultats : Au sein de l'échantillon de 364 participants, l'analyse statistique a révélé des différences significatives dans l'utilisation de la technique en fonction de la région d'exercice (p=0,009), du type de pratique (p<0,001), de l'âge du professionnel (p<0,001), du nombre d'années d'expérience (p<0,001), des sources de remboursement (p=0,003) et si la technique leur avait été enseignée ou non (p<0,001). Conclusion : Les résultats indiquent une augmentation de l'utilisation de la technique de Hall parmi les dentistes pédiatriques, tout en soulignant la persistance d'obstacles. Ils proposent aussi des pistes d'intervention pour encourager davantage son adoption, en cohérence avec l'évolution vers des approches minimalement invasives de gestion de la carie. / Introduction: Pediatric dentistry increasingly favors minimally invasive approaches, discouraging extensive treatments such as complete caries removal. The COVID-19 pandemic hastened this shift, highlighting relevance of procedures like the Hall technique (HT) for managing carious lesions in primary dentition while addressing challenges such as patient cooperation and restricted access to operating rooms. Despite being recognized for its 98% efficacy, this technique continues to encounter limited adoption among pediatric dentists. Purpose: To assess the integration and teaching methods of the HT in graduate pediatric dentistry programs, evaluate its utilization, comprehension, and perception among American and Canadian specialists, and explore obstacles to its adoption. Methods: Pediatric dentists in Canada and United States (U.S.) were surveyed via the American Academy of Pediatric Dentistry mailing list, featuring a dedicated section for program directors. Using the LimeSurvey platform, a questionnaire of 32 potential inquiries was electronically available in early September (U.S.) and early October (Canada) of 2023, with reminders issued 4-6 weeks later. Results: Of 364 participants, statistical analysis indicated significant differences in HT use according to practice regions (p=0.009), settings (p<0.001), age (p<0.001), years of experience (p<0.001), reimbursement sources (p=0.003), and education exposure (p<0.001). This offers a comprehensive understanding of the nuanced landscape surrounding the HT among pediatric dentists in Canada and the U.S. Conclusion: This investigation reveals a growing acceptance of the HT, despite persistent challenges faced by pediatric dentists in Canada and the U.S. These findings provide actionable insights for improving the adoption of the HT in contemporary pediatric dentistry practices, aligning with today's emphasis on minimally invasive approaches.