Aesthetic Restorations in Deciduous Anterior Teeth

Study Overview
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Brief Summary
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This study proposes to conduct a randomized clinical trial (RCT), composed of a sample of 194 deciduous central and lateral incisors with active cavitated lesions, simplified ICDAS C+ score, with involvement of more than two surfaces. This sample will be divided into two experimental groups, both with selective removal of carious tissue: a group in which conventional restoration will be performed using opaque resins; and another group with monochromatic resin with chameleon effect and polyvinyl crowns.

Official Title
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Aesthetic Restorations in Deciduous Anterior Teeth - Study Protocol for a Randomized Clinical Trial

Conditions
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Dental Caries in Children

Intervention / Treatment
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* Combination Product: Restoration with resin composite and polyvinyl crown
* Procedure: Restoration with conventional resin composite


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children ranging in age from 12 to 60 months with at least one active cavitated caries lesion involving more than 2 surfaces (C+ score) in deciduous upper incisors will be included. Exclusion Criteria: Patients with special needs, with general health conditions that may affect the oral cavity, whose guardians do not sign the Inform Consent Form will be excluded. In addition, teeth with pulp exposure, spontaneous pain, mobility, presence of swelling or fistula near the tooth and teeth with previous restorations.

Ages Eligible for Study
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Minimum Age: 12 Months
Maximum Age: 60 Months

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: This is a non-inferiority randomized clinical trial with parallel arms, with an allocation ratio of 1:1
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: conventional restoration group (control)<br>The teeth allocated in the conventional restoration group (control) will receive restorations in resin composed by incremental technique, using opaque resin. For this, 37% phosphoric acid (Condac37, FGM) will be applied for 15 seconds, and then, after washing and relative drying of the surface, application of universal adhesive (Universal Beautibond Adhesive, Shofu) with the aid of microbrush on the entire dental surface, photoactivation of the adhesive and restoration by incremental technique and photoactivation of each layer of resin for 20 seconds. The tooth will receive finishing and polishing through rotating instruments and abrasive discs (Supersnap, Shofu). | Procedure: Restoration with conventional resin composite<br>* Restorative treatment of anterior primary teeth with conventional composite resin, after selective removal of carious tissue<br>|
| Experimental: polyvinyl crown - experimental group<br>The teeth allocated in the experimental group will have the restorations carried out through monochromatic composite resin with chameleon effect in single insertion through polyvinyl crown. For this, 37% phosphoric acid (Condac37, FGM) will be applied for 15 seconds, and then, after washing and relative drying of the surface, application of universal adhesive (Universal Beautibond Adhesive, Shofu) with the aid of microbrush on the entire tooth surface, photoactivation of the adhesive and adaptation of the crown matrix in acetate filled with resin in the tooth. Photoactivation will be done for 20 seconds per dental face, and the acetate matrix is then removed. The tooth will receive finishing and polishing through rotating instruments and abrasive discs (Supersnap, Shofu). | Combination Product: Restoration with resin composite and polyvinyl crown<br>* Restorative treatment of anterior primary teeth with monochromatic composite resin in single insertion through polyvinyl crowns, after selective removal of carious tissue compared to the effectiveness of conventional restoration.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in progression of caries lesion through clinical criteria and longevity of restorations | The integrity of the restoration, its adaptation in all dental faces and identified possible failures related to structural fracture, resin wear, maladaptation or functional maintenance of the restored tooth will be verified. The clinical evaluation of the retention of the restorations will be performed after 6, 12, 18 and 24 months, using the criteria: total retention; Partial retention 1 - presence of the resin in two thirds of the surface of each dental face; Partial retention 2 - presence of the resin in one third d and each face of the dental surface, total loss of resin on the surface of the dental surface. It will also be evaluated the degree of tooth mobility and its relationship with the usual exfoliation period in the teeth belonging to both groups. In teeth where the restoration is intact and clinical features of associated lesions are not verified, the lesions will be considered as inactive. | Baseline and after 6, 12, 18 and 24 months. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the progression of caries lesion by radiographic criteria | For the evaluation of caries progression, the modified periapical radiographic examination for preschoolers will be used. The images will be compared two by two in order to evaluate whether or not there was progression of caries: Absent progression: when there is no increase in the radiolucent area of the lesion. Progression present: when there is an increase in the radiolucent area of the lesion. Teeth that present progression of caries lesion to signs of pulp involvement, will receive restorative or endodontic treatment compatible with the observed picture. | Baseline and after 6, 12, 18 and 24 months. | 
| Change in the perception of parents/guardians | To evaluate the perception of parents/guardians in relation to the treatment performed, the questionnaire Child's and parent's questionnaire about teeth appearance will be used soon after the first treatment session and 6 months after the treatment. The examiners will guide you to express your real opinion. | Baseline and after 6, 12, 18 and 24 months. | 
| Change in the satisfaction of parents/guardians | The parents/guardians will be asked about their satisfaction with the treatment performed on the child. They will answer 5 yes or no questions about how much they liked the procedures. The examiners will guide you to issue your real opinion after 6 months of treatment. | Baseline and after 6, 12, 18 and 24 months. | 
| Change in the impact of treatments on children's oral health-related quality of life | A questionnaire will be applied to assess the impact of treatments on children's oral health-related quality of life. The validated Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) should be answered by the parents or guardians of the participants in the initial consultations and at each return. The higher the score, the worse is the children's oral health-related quality of life. | Baseline and after 6, 12, 18 and 24 months. |