O PAPEL DO CIMENTO DE IONÔMERO DE VIDRO EM DENTINA INFECTADA DE MOLARES PERMANENTES COM LESÕES PROFUNDAS DE CÁRIE TRATADOS PELA MÍNIMA INTERVENÇÃO

Abstract

This study described the changes in infected dentin in permanent teeth before and after cavity sealing, as well as the influence of lining material in this process. Forty five molars with deep and active caries lesions were selected, from patients aging 7 to 15 years old. Clinical, radiographic and laboratorial criteria were used to compare dentin conditions before and after 60-days and 10-15 months after dental restoration. The experimental group (G1) was lined with glass ionomer cement (GIC) and the control group (G2) with an inert material (wax). Composite resin was the selected restorative material for both groups. The caries cavities were divided into two equivalent portions (mesial and distal) and the dentin fragments were removed in two moments: baseline (mesial portion) and 60-days after restoration (distal portion). The clinical criteria for G1 and G2 were infected dentin fluorescence (baseline and 60- days) and the quality of the resin restorations (USPHS criteria) (baseline, 60-days and 10-15 months). For both groups, the laboratorial criteria were ultra structural (SEM), mineral (SEM/EDS - calcium, phosphorus and fluoride) and radiographic analysis (digital subtraction - 60-days and 10-15 months). The data from dentin fluorescence in G1 and G2 were analyzed by Wilcoxon Signed Rank test and in the different moments of evaluation with Mann-Whitney test. The paired Student's t test was used to verify differences in the percentage of weight of calcium, phosphorus and fluoride between groups after 60-days and the ANOVA and Tukey test between both groups and the moments of evaluation, as well as the radiographic changes in the gray levels along time. The intensity and distribution of immunostaining in both moments was analyzed with chi-square test. The results showed that, 60 days after restoration, there were significant reduction in dentin fluorescence in both groups (p<0.05), better tissue organization with a more compact fibril arrangement and a reduction in the number of bacteria, as well as a significant increase in the percentage in weight of calcium (p<0.001) and phosphorus (p=0.003) for both groups. No difference was observed in percentage of weight of fluorine (p>0.05). There was a significant reduction in the expression of MMP-8 60 days after restoration (p=0.02). The MMPs were generalized located in intertubular dentin in both evaluation moments ((MMP-2 - p=0.172; MMP-8 - p=0.35; MMP-9 - p=0.28) and in the intratubular dentin they were absence or localized (p>0.28). After 10-15 months, the resin restorations were judged clinically suitable and the digital subtraction of radiographic showed that the mean levels of gray tones incresead in sound and infected dentin (p<0.001) for both groups. It's possible to conclude that the lining material placed over infected dentin is not fundamental for caries arrestment; when the cavity is properly sealed, the tissue tends to reorganize in a short period of time (60 days) and the remineralization process continues for longer periods.