In-vitro effect of a single application of CPP-ACP pastes and different fluoridated solutions on the prevention of dental caries around orthodontic brackets

ABSTRACT Objective: To assess the in-vitro effect of single applications of CPP-ACP pastes and different fluoridated solutions on the prevention of dental caries around orthodontic brackets. Material and Methods: Tooth/bracket sets (n=65) were immersed in artificial saliva (1h at 37ºC) and randomly subjected to single applications (100µL; 1min) of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP emulsion), CPP-ACP with fluoride (CPP-ACPF emulsion), solutions of titanium tetrafluoride (TiF4) or sodium fluoride (NaF), or no treatment (CG). Multispecies biofilm (5 x 105 CFU/mL) was formed in the presence of 2% sucrose. After 24 h, the pH and the concentration of total soluble fluoride (TSF) were analyzed by culture medium. The presence of active white spot lesions (WSL) evaluated by macroscopic examination and the percent surface mineral loss (%SML) were analyzed. Also, the topography of enamel was detected by analysis of scanning electron microscopy (SEM). The data was assessed by chi-square, Kruskal-Wallis, and Mann-Whitney tests (p < 0.05). Results: Fluoride-containing compounds led to a smaller pH reduction than did CPP-ACP and CG (p<0.05). There was difference in TSF between the groups (p<0.05), denoted as TiF4> NaF > CPP-ACPF > CPP-ACP > CG. Regarding the presence of WSL and %SML, the NaF group obtained lower values (p<0.05), while TiF4 and CPP-ACPF were similar (p>0.05). SEM demonstrated that fluoride-free groups had a larger surface dissolution. Conclusion: Fluoridated groups including solutions and CPP-ACPF were more effective than CPP-ACP in reducing enamel demineralization around orthodontic brackets after a single application.

RESUMO Objetivo: Avaliar in-vitro o efeito de uma aplicação única de cremes dentais de CPP-ACP e diferentes soluções fluoretadas na prevenção da cárie dentária ao redor de braquetes ortodônticos Material e Métodos: O conjunto dentes/braquetes (n=65) foi imerso em saliva artificial (1h em 37°C) randomizado e submetido a tratamento único (100µL; 1 min) de emulsão de fosfopeptídeo de caseína-fosfato de cálcio amorfo (CPP-ACP) e CPP-ACP associado ao flúor (CPP-ACPF); soluções de tetrafluoreto de titânio (TiF4) e fluoreto de sódio (NaF); e ausência de tratamento (GC). Biofilmes multiespécie (5 x 105 CFU/mL) foram formados na presença de sacarose a 2%. Após 24h, o pH e a concentração de fluoreto solúvel total (FST) foram analisados pelo meio de cultura. Foram avaliadas a presença de lesões de mancha branca (LMB), por meio da análise de macroscopia visual, e a porcentagem de perda de dureza (%PD). Também foi verificada a topografia do esmalte, usando microscopia eletrônica de varredura (MEV). Os dados foram analisados pelos testes Qui-quadrado, Kruskal-Wallis e Mann-Whitney (p < 0,05). Resultados: Os compostos contendo flúor levaram a uma redução do pH menor do que o CPP-ACP e GC (p<0,05). Houve diferença no FST entre os grupos (p <0,05), sendo TiF4> NaF > CPP-ACPF > CPP-ACP > GC. Quanto à presença de LMB e à %PD, o grupo NaF obteve os menores valores (p<0,05), enquanto TiF4 e CPP-ACPF foram semelhantes (p> 0,05). A MEV demonstrou que os grupos sem flúor tiveram uma dissolução superficial maior. Conclusão: Os grupos fluoretados, incluindo soluções e CPP-ACPF, foram mais eficazes do que o CPP-ACP sem flúor na redução da desmineralização do esmalte ao redor dos braquetes ortodônticos após uma única aplicação.

In vitro effect of experimental nanocomposites solutions on the prevention of dental caries around orthodontic brackets

Abstract This study aimed to evaluate the in vitro effect of a single application of experimental nanocomposite solutions on the prevention of dental caries around orthodontic brackets. The specimens were exposed to mesoporous silica (MS) nanocomposites containing fluoride by association with titanium tetrafluoride (TiF4) or sodium fluoride (NaF). Nanocomposites also could contain calcium and groups were described as MSCaTiF4, MSTiF4, MSCaNaF, MSNaF, and controls (TiF4, and NaF). Specimens were subjected to the formation of a multispecies biofilm to generate a cariogenic challenge. After 24h, both pH and total soluble fluoride concentration of the culture medium were assessed. Mineral loss was evaluated by percentage of surface mineral loss (%SML), mineral volume variation (ΔZ) of inner enamel and polarized light microscopy (PL). Linear (Ra) and volumetric (Sa) surface roughness and scanning electronic microscopy (SEM) were used to assess enamel topography. Statistical analyses were conducted considering p<0.05. MSNaF had the highest value of culture medium pH after cariogenic challenge, similarly to MSTiF4. All nanocomposite solutions released less fluoride than their controls NaF and TiF4 (p<0.05). All nanocomposite solutions presented lower %SML compared to their respective control groups (p<0.05). Lower Ra, Sa and ΔZ were observed for experimental groups compared to TiF4 (p<0.05). The results were confirmed by PL and SEM analysis. The experimental nanocomposite solutions contributed for lower enamel demineralization around orthodontic brackets.

RESUMO Este estudo teve como objetivo avaliar o efeito in vitro de uma única aplicação de soluções experimentais de nanocompósitos na prevenção de cárie dentária em braquetes ortodônticos. Os espécimes foram expostos a nanocompósitos de sílica mesoporosa (MS) contendo fluoreto por associação com tetrafluoreto de titânio (TiF4) ou fluoreto de sódio (NaF). Os nanocompósitos também podem conter cálcio e os grupos foram descritos como MSCaTiF4, MSTiF4, MSCaNaF, MSNaF e controles (TiF4 e NaF). Os espécimes foram submetidos à formação de um biofilme multiespécie para gerar um desafio cariogênico. Após 24h, o pH e a concentração de flúor solúvel total do meio de cultura foram avaliados. A perda mineral foi avaliada pela porcentagem de perda mineral superficial (% SML), variação do volume mineral (ΔZ) do esmalte interno e microscopia de luz polarizada (PL). A rugosidade superficial linear (Ra) e volumétrica (Sa) e a microscopia eletrônica de varredura (MEV) foram utilizadas para avaliar a topografia do esmalte. As análises estatísticas foram realizadas considerando p <0,05. MSNaF apresentou o maior valor de pH do meio de cultura após o desafio cariogênico, semelhante ao MSTiF4. Todas as soluções de nanocompósitos liberaram menos flúor do que seus controles NaF e TiF4 (p <0,05). Todas as soluções de nanocompósitos apresentaram% SML menor em comparação com seus respectivos grupos de controle (p <0,05). Ra, Sa e ΔZ menores foram observados para os grupos experimentais em comparação ao TiF4 (p <0,05). Os resultados foram confirmados por análises PL e SEM. As soluções experimentais de nanocompósitos contribuíram para a menor desmineralização do esmalte ao redor dos braquetes ortodônticos.

Comparative effect of calcium mesoporous silica versus calcium and/or fluoride products against dental erosion

Abstract The aim of this study was to compare the effects of a single application of a new calcium mesoporous silica nanoparticle (Ca2+-MSN) versus other calcium and/or fluoride products against dental erosion. Enamel blocks were half-covered and assigned to six groups (n = 10): Ca2+-MSNs; casein phosphopeptide-amorphous calcium phosphate mousse (CPP-ACP); CPP-ACP/F− (900 ppm F−); titanium tetrafluoride (TiF4 1%); sodium fluoride (NaF 1.36%); and Milli-Q® water (negative control). A single application for each product was completed on the exposed areas of the blocks and were submitted to an erosive challenge. Differences in volumetric roughness (Sa), and tooth structure loss (TSL) by use of three-dimensional noncontact optical profilometry were evaluate. Scanning electron microscopy (SEM) was performed. Analysis of variance and Tukey's test for Sa and the Kruskal-Wallis and Mann-Whitney U tests (p< 0.05) for TSL, respectively. Results: When evaluating Sa, all products presented differences in roughness when compared with the control group (p< 0.05) but not with each other (p > 0.05). However, when analyzing the TSL, it was observed that Ca2+-MSNs, TiF4, and NaF were more effective in preventing dental erosion versus CPP-ACP, CPP-ACP/F−, and Milli-Q® water (p< 0.05). In the SEM images, the negative control presented the worst loss of dental structure, with more porous enamel. Ca2+-MSNs were as effective as TiF4 and NaF to reduce the tooth structure loss.

Resumo O objetivo deste estudo foi comparar os efeitos de uma única aplicação de uma nova nanopartícula de sílica mesoporosa de cálcio (Ca2+ -MSN) versus outros produtos à base de cálcio e / ou fluoreto contra a erosão dentária. Blocos de esmalte foram parcialmente cobertos e distribuídos em seis grupos (n = 10): Ca2+ -MSNs; fosfopeptídeos de caseína/fosfato de cálcio amorfo (CPP-ACP); CPP-ACP / F- (900 ppm F-); tetrafluoreto de titânio (TiF4 1%); fluoreto de sódio (NaF 1,36%); e água Milli-Q® (controle negativo). Uma única aplicação para cada produto foi realizada nas áreas expostas dos blocos e submetida a desafio erosivo. Diferenças na rugosidade volumétrica (Sa) e na perda de estrutura dentária (TSL) por meio de perfilometria tridimensional de não contato foram avaliadas. Microscopia eletrônica de varredura (MEV) foi realizada. Foram realizadas análise de variância e teste de Tukey para os testes Sa e Kruskal-Wallis e Mann-Whitney (p<0,05) para TSL, respectivamente. Na avaliação de Sa, todos os produtos apresentaram diferenças de rugosidade quando comparados ao grupo controle (p<0,05), mas não entre si (p> 0,05). No entanto, ao analisar o TSL, observou-se que Ca2+ -MSNs, TiF4 e NaF foram mais eficazes na prevenção da erosão dental versus CPP-ACP, CPP-ACP / F- e Milli-Q® (p<0,05). Nas imagens de MEV, o controle negativo apresentou a pior perda de estrutura dentária, com o esmalte mais poroso. A Ca2+ -MSNs foi tão eficaz quanto o TiF4 e o NaF para reduzir a perda da estrutura dentária.

The use of a new calcium mesoporous silica nanoparticle versus calcium and/or fluoride products in reducing the progression of dental erosion

Abstract Objective There is increasingly common the consumption more times a day of foods and acidic drinks in the diet of the population. The present study aimed to evaluate and compare the effects of a calcium mesoporous silica nanoparticle single application of other calcium and/or fluoride products in reducing the progression of dental erosion. Methodology Half of the eroded area was covered of 60 blocks of enamel, after which the block was submitted to the following treatments: (Ca2+-MSN), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP); CPP-ACP/F-(900 ppm F−); titanium tetrafluoride (TiF4 1%) (positive control); sodium fluoride (NaF 1.36%) (positive control); and Milli-Q® water (negative control) before being submitted to a second erosive challenge. A surface analysis was performed via a three-dimensional (3D) noncontact optical profilometry to assess the volumetric roughness (Sa) and tooth structure loss (TSL) and and through scanning electron microscopy (MEV). An analysis of variance (ANOVA) and Tukey's test were performed. Results Regarding Sa, all experimental groups exhibited less roughness than the control (p<0.05). The TSL analysis revealed that the Ca2+-MSN and NaF groups were similar (p>0.05) and more effective in minimizing tooth loss compared with the other groups (p<0.05). Conclusions The Ca2+-MSN and NaF treatments were superior compared with the others and the negative control.

Comparative Effect of Calcium Mesoporous Silica Versus Calcium and/or Fluoride Products on the Reduction of Erosive Tooth Wear and Abrasive Enamel Lesion

Abstract Objective: To evaluate the effect of a calcium nanocompound on the reduction of erosive tooth wear and abrasion. Material and Methods: Bovine enamel specimens (BE), were randomly assigned to the following groups (n = 10): G1 = Calcium mesoporous silica nanoparticles (Ca2+MSNs); G2 = casein phosphopeptide-amorphous calcium phosphate (CPP-ACP, 2% CPP-ACP, GC®); G3 = casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP, 2% CPP-ACP + 900 ppm F-, GC®); G4 = sodium fluoride NaF (900 ppm F-, positive control); and G5 = distilled and deionized water (negative control). Each product was applied to the exposed area for one minute, three times per day for three consecutive days, and followed by the immersion of the specimens in Sprite Zero™ - a low-pH solution (2.58) for five minutes (Coca-Cola™). After the first and last erosive challenges of the day, the specimens were submitted to abrasion in a toothbrush machine for 15 seconds (200 g/BE). The specimens were analysed using 3D non-contact optical profilometry, with tooth structure loss (TSL) measurements and scanning electron microscopy (SEM). TSL values were analysed by Kruskal-Wallis and Mann-Whitney tests (p<0.05). Results: There were no significant differences between G1 (10.95 µm) and G3 (10.80 µm) treatments for TSL values; however both resulted in significantly reduced TSL values compared with the G5 (16.00 µm) (p<0.05). The G4 (12.26 µm) showed no statistically significant difference when compared to the G5 (16.00 µm). The groups G1 and G3 presented higher surface preservation than the G5. Conclusion: Ca2+MSNs was effective for reducing tooth surface loss caused by erosive tooth wear and abrasion.

Topography and Microhardness Changes of Nanofilled Resin Composite Restorations Submitted to Different Finishing and Polishing Systems and Erosive Challenge

Abstract Objective: To evaluate the topography and microhardness of composite resin restorations submitted to different finishing and polishing systems before and after erosive challenge. Material and Methods: Thirty standardized cavities prepared in enamel-dentin blocks of bovine incisors were restored with Z350 composite resin, and randomly distributed into three groups (n=10) according to the finishing and polishing systems: G1 = Soflex 4 steps, G2 = Soflex Spiral 2 steps and G3 = PoGo (single step). The specimens were half protected with nail varnish and submitted to five immersions in Pepsi Twist®, for 10 minutes each, five times/day during six consecutive days. The initial and final challenge surface microhardness (SMHinitial and SMHfinal) of the composite resin was evaluated and the percentage of SMH loss (%SMHL) was calculated. After protection removal, the topographic change linear (Ra) and volumetric (Sa) roughness was evaluated in initial and final areas by using 3D non-contact optical profilometry and scanning electron microscopy (SEM). Data were analyzed by paired Student's t-test, Kruskal-Wallis test, and by ANOVA and Tukey's test. Results: There was significant intra-group %SMHL in composite resin (p<0.05). Differences among groups in %SMHL, Ra/Sa in resin composite were not observed (p>0.05). SEM images revealed structural changes between the initial and final surfaces for all groups. Conclusion: The three types of finishing and polishing systems had a similar influence on %SMHL, Ra and Sa in the nanofilled composite resin.

Oral findings in Robinow Syndrome: a case report in pediatric patient

Objective: The aim of this article was to describe a case of Robinow syndrome in a pediatric patient. Case Report: Clinically, the patient had frontal bossing, flat facial profile with macrocephaly, midfacial hypoplasia, hypertelorism, wide palpebral fissures, triangular mouth, short upturned nose, short philtrum, ankyloglossia, prolonged retention of primary teeth and abnormal aligment of teeth. The radiographic exams indicated the presence of three impacted permanent supernumerary teeth, agenesis of eight permanent teeth and dental root shortening of all permanent teeth. The treatment proposed was the extraction of all retained primary teeth and the supernumerary teeth, dietary and oral hygiene instructions and orthodontic treatment. Also, important aspects to avoid complications associated with Robinow syndrome were discussed. Conclusion: This case describes uncommon oral findings and some important aspects to avoid complications associated with the Robinow syndrome. Early professional advice, treatment, and periodical follow-ups can improve the quality of life of these patients.

Objetivo: O objetivo deste artigo foi descrever um caso de síndrome de Robinow em um paciente pediátrico. Relato de Caso: Clinicamente, o paciente apresentava bossas frontais, perfil facial plano com macrocefalia, hipoplasia da face média, hipertelorismo, fissuras palpebrais amplas, boca triangular, nariz curto, filtro curto, anquiloglossia, retenção prolongada de dentes decíduos e dentes desalinhados. Os exames radiográficos indicaram a presença de três elementos supranumerários permanentes impactados, agenesia de oito dentes permanentes e encurtamento radicular de todos os dentes permanentes. O tratamento proposto foi a extração de todos os dentes decíduos retidos e os elementos supranumerários, instruções de higiene bucal e dietética e tratamento ortodôntico. Além disso, aspectos importantes para evitar complicações associadas à síndrome de Robinow são discutidos. Conclusão: Este caso descreve achados orais incomuns e alguns aspectos importantes para evitar complicações associadas à síndrome de Robinow. Aconselhamento profissional precoce, tratamento e acompanhamento periódico podem melhorar a qualidade de vida desses pacientes.

Dentomaxillofacial sequelae resulting from a chemoradiotherapy against rhabdomyosarcoma: 6-year follow-up

Introduction: Rhabdomyosarcoma is an aggressive malignant soft tissue neoplasm of immature mesenchymal cells treated with surgery and chemoradiotherapy. The effects of chemoradiotherapy in head induce a series of sequelae on oral cavity and growth development. Objectives: Report the case of a child undergoing treatment for rhabdomyosarcoma whose effects on the dento-maxillofacial development were cared for in order to safe guard the patient's quality of life. Case report: Describes a case of severe dento-maxillofacial defects resulting from chemoradiation therapy for embryonal rhabdomyosarcoma in a child as well as the dental management performed. Clinically, the patient had gingivitis, severe mobility of permanent teeth, hyposalivation, mucositis and severe trismus. The radiologic exams showed interruption of root formation of all permanent teeth and over-retention of primary teeth. Cephalometric analyses revealed mandibular and maxillary hypoplasia. Results: Was made extraction of the overretained primary teeth associated with a prophylactic program and use of artificial saliva due to hyposalivation in order to improve the quality of life of the patient. After 6 years of dental and phonoaudiologic follow-up her oral opening has increased and chewing and swallowing difficulties have decreased, there is no gingivitis or mucositis and she has remained free of recurrent or metastatic diseases 11 years after the initial diagnosis. Conclusion: Our report emphasizes the importance of dental treatment with a program of prevention and follow-up for patients undergoing anticancer therapies.

Introdução: O rabdomiossarcoma é uma neoplasia maligna agressiva de tecido mole de células mesenquimais imaturas tratadas com cirurgia e quimioradioterapia. Os efeitos da quimioradioterapia na cabeça induzem uma série de sequelas na cavidade oral e no desenvolvimento do crescimento. Objetivo: Relatar o caso de uma criança em tratamento de rabdomiossarcoma cujos efeitos no desenvolvimento dento-maxilofacial foram cuidados a fim de salvaguardar a qualidade de vida do paciente. Relato de caso: Descreve um caso de defeitos dento-maxilo-faciais graves resultante de quimioradioterapia para rabdomiossarcoma embrionário em uma criança, bem como o manejo realizado. Clinicamente, a paciente apresentava gengivite, severa mobilidade dos dentes permanentes, hipossalivação, mucosite e trismo severo. Os exames radiográficos mostraram interrupção da formação radicular de todos os dentes permanentes e retenção dos dentes decíduos. Análises cefalométricas revelaram hipoplasia mandibular e maxilar. Resultados: Foi realizada a extração dos dentes decíduos retidos associado a um programa profilático e uso de saliva artificial devido à hipossalivação, a fim de melhorar a qualidade de vida do paciente. Após 6 anos de acompanhamento odontológico e fonoaudiológico, sua abertura bucal aumentou e as dificuldades de mastigação e deglutição diminuíram, não há gengivite ou mucosite e ela permaneceu livre de doenças recorrentes ou metastáticas 11 anos após o diagnóstico inicial. Conclusão: Nosso relato enfatiza a importância do tratamento odontológico com um programa de prevenção e acompanhamento para pacientes submetidos a terapias antineoplásicas.

The use of hypnosis in dental care: a literature review

Introduction: Hypnosis is a technique that involves inducing a special state of consciousness in which the conscious mind relaxes while the unconscious mind manifests itself by working the imagination. Objective : To perform a literature review to evaluate the different techniques used to induce hypnosis and the need for its use in dental care, as well as, its results. Sources of data: A bibliographic search was performed in the Google Academic and PubMed databases to identify studies for review. There was no restriction on language or year. Inclusion criteria were studies that addressed the topic of interest. Synthesis of data : Hypnosis aims to improve care by controlling patients' anxiety, fear and phobias. However, its use is little known by patients and professionals in the context of dental treatment. There are two techniques of hypnosis, namely essential hypnosis and hypnosis by object fixation. The main indications are the need to control the patient's fear and anxiety during dental treatment and to prepare the patients before performing surgical procedures. It can be used in association with local anesthetics, but this combination is not essential. Conclusion : Hypnosis can be effective at controlling patients' feelings related to dental care, being the hypnosis by object fixation the most used technique with this purpose. It is considered easy, quick, painless, with low costs and accessible to any dentist who has completed specific training in this field.

Introdução: A hipnose é uma técnica que envolve a indução de um estado especial de consciência em que a mente consciente relaxa enquanto a mente inconsciente se manifesta trabalhando a imaginação. Objetivo : Realizar uma revisão de literatura para avaliar as diferentes técnicas utilizadas para induzir a hipnose e a necessidade de seu uso no atendimento odontológico, bem como, seus resultados. Fontes de dados : Uma pesquisa bibliográfica foi realizada nas bases de dados Google Acadêmico e PubMed para identificar estudos para revisão. Não houve restrição de idioma ou ano. Os critérios de inclusão foram os estudos que abordaram o tema de interesse. Síntese dos dados: A hipnose visa melhorar o atendimento, controlando a ansiedade, o medo e as fobias dos pacientes. Entretanto, seu uso é pouco conhecido pelos pacientes e profissionais no contexto do tratamento odontológico. Existem duas técnicas de hipnose, a saber, hipnose essencial e hipnose por fixação objetal. As principais indicações são a necessidade de controlar o medo e a ansiedade do paciente durante o tratamento odontológico e preparar os pacientes antes de realizar procedimentos cirúrgicos. Pode ser usado em associação com anestésicos locais, mas essa combinação não é essencial. Conclusão : A hipnose pode ser eficaz no controle dos sentimentos dos pacientes relacionados ao atendimento odontológico, sendo a hipnose pela fixação do objeto a técnica mais utilizada para esse fim. É considerado fácil, rápido, indolor, com baixos custos e acessível a qualquer dentista que tenha completado o treinamento específico neste campo.

Three year follow-up and management of a severely dislocated tooth after primary trauma

Objective: This case report describes the management and a 3-year follow-up of an unerupted and ectopic positioned anterior tooth. Case Report: The patient, a girl (9 years old) was referred due to the lack of a permanent maxillary left central incisor. When she was 2 years old suffered a complete intrusion of her primary maxillary left central incisor, and the tooth re-erupted after 4 weeks. Radiographic examination revealed the impaction and severe dislocation of the permanent maxillary left central incisor. The impacted tooth was surgically exposed and placed in orthodontic traction for alignment over a period of 12 months. Results: After this period the central incisor presented satisfactory periapical and periodontal health, adequate occlusion and a good esthetic outcome. After three years of follow-up, apically rounded and no extensive damage to tooth or tissues structures were observed Conclusion: The orthodontic management had been successfully performed with excellent functional and esthetic results. Treatment of an impacted incisor is a challenge, which should be carefully planned. A clinical and radiographic follow-up by a multi- rofessional group is of outmost importance.

Objetivo: Este relato de caso descreve o manejo e um acompanhamento de 3 anos de um dente anterior incluso e ectópico. Relato de Caso: O paciente, uma menina (9 anos de idade) foi encaminhada devido à falta de um incisivo central esquerdo superior permanente. Quando ela tinha 2 anos de idade, sofreu uma intrusão completa de seu incisivo central esquerdo superior decíduo, e o dente re- erupcionou após 4 semanas. O exame radiográfico revelou a impactação e deslocamento grave do incisivo central esquerdo superior permanente. O dente impactado foi cirurgicamente exposto e tracionado ortodonticamente para alinhamento ao longo de um período de 12 meses. Resultados: Após este período, o incisivo central apresentou saúde periapical e periodontal satisfatórias, oclusão adequada e bom resultado estético. Após três anos de acompanhamento, arredondamento apical e ausência de dano extensivo às estruturas dentárias ou teciduais foi observado. Conclusão: O manejo ortodôntico foi realizado com sucesso, com excelentes resultados funcionais e estéticos. O tratamento de um incisivo impactado é um desafio que deve ser cuidadosamente planejado. Um acompanhamento clínico e radiográfico por um grupo multiprofissional é de extrema importância.

Non-contact profilometry of eroded and abraded enamel irradiated with an Er: YAG laser

Abstract Literature has reported positive results regarding the use of lasers in the control of erosive lesions; however, evaluating whether they are effective in the control of the progression of erosive/abrasive lesions is important. Objectives This study aimed to evaluate the effect of the Er:YAG laser irradiation in controlling the progression of erosion associated with abrasive lesions in enamel. Material and methods Bovine incisors were sectioned, flattened and polished. Forty-eight enamel slabs were subjected to treatment in an intraoral phase. Twelve volunteers used an intraoral appliance containing one slab that was irradiated with an Er:YAG laser (5.2 J/cm2, 85 mJ, 2 Hz) and another non-irradiated slab on each side of the appliance, during one phase of 5 d, under a split-mouth design. Devices were subjected to erosive challenges (1% citric acid, 5 min, 3 times a day) and abrasive challenges one h after (brushing force of 1.5 N for 15 s) randomly and independently on each side of the device. Measurements of enamel loss were performed via 3D optical profilometry (μm). We analyzed data using the Kruskal-Wallis and Mann-Whitney tests and morphological characteristics via scanning electron microscopy. Results Following erosive and abrasive challenges, the group that was irradiated with the Er:YAG laser presented less loss of structure than the non-irradiated group. The group that underwent erosion and irradiation did not exhibit a significant difference from the non-irradiated group. Conclusion Irradiation with the Er:YAG laser did not control the loss of structure of enamel subjected to erosion but did control abrasion after erosion.

Fluoride Varnishes against Dental Erosion Caused by Soft Drink Combined with Pediatric Liquid Medicine

Abstract The present study evaluated the effect of NaF and CPP-ACP/NaF varnishes to reduce erosion produced by soft drink (SD) combined or not with pediatric liquid medicine. Enamel specimens were pre-treated with fluoride varnish, according to the following groups: NaF varnish (Duraphat®) or CPP-ACP/NaF varnish (MI varnishTM). Two types of erosive cycles were made: by soft drink erosion (SDE) or by pediatric liquid medicine plus soft drink erosion (PLM/SDE). Bovine enamel specimens were randomly assigned in six groups (n=10): G1=NaF + SDE; G2=CPP-ACP/NaF + SDE; G3=Distilled and deionized (DD) water + SDE; G4=NaF + PLM/SDE; G5=CPP-ACP/NaF + PLM/SDE and G6=DD water + PLM/SDE. Before treatments, the sample surface was divided in two areas (unexposed area-UA and exposed area-EA). The specimens were evaluated by 3D non-contact profilometry technique to determinate tooth structure loss (TSL) and surface roughness (Sa). Scanning electron microscopy (SEM) analysis was also performed. After SDE, G2 presented the lowest TSL values compared to G3 (p=0.008). G1 and G2 did not differ between them (p=0.203) and no groups differed among them despite Sa. Regarding TSL and Sa, G4 and G5 differed from G6 (p=0.0001), but not between them (p=1.00). Examining 3D and SEM images, the greatest differences between UA and EA were observed for G3 and G6. CPP-ACP/NaF varnish seems to be a promising treatment to reduce enamel loss from the erosion produced by a soft drink. Both varnishes also showed capacity to reduce TSL and Sa after erosion by soft drink combined to pediatric liquid medicine.

Resumo O presente estudo avaliou o efeito dos vernizes de NaF e CPP-ACP/NaF na redução da erosão promovida por refrigerante e associada a um medicamento líquido pediátrico. Os espécimes de esmalte foram pré-tratados com verniz fluoretado, de acordo com o grupo de alocação: verniz NaF (Duraphat®) ou verniz CPP-ACP NaF (verniz MITM). Dois tipos distintos de desafio erosivo foram realizados: erosão com refrigerante (ER) ou erosão com medicamento líquido pediátrico e refrigerante (MLP/ER). Espécies de esmalte bovino foram aleatorizados em seis grupos (n=10): G1 = NaF + ER; G2 = CPP-ACP/NaF + ER; G3 = Água destilada e deionizada (DD) + ER; G4 = NaF + MLP/ER; G5 = CPP-ACP/NaF + MLP/ER e G6 = DD água + MLP/ER. Antes dos tratamentos, a superfície das amostras foi dividida em duas áreas (não exposta-NE e área exposta-AE). Os espécimes foram avaliados pela técnica de perfilometria 3D de não-contato para determinar a perda de estrutura dentária (PED) e a rugosidade superficial (RS). A microscopia eletrônica de varredura (MEV) também foi utilizada. Após ER, G2 apresentou os menores valores de PED comparado ao G3 (p=0,008). G1 e G2 não diferiram entre si (p=0,203) e não houve diferença entre os grupos no que diz respeito a RS. Os resultados de PED e RS para a MLP/ER mostraram que G4 e G5 diferiram de G6 (p=0,0001), mas não diferiram entre si (p=1,00). Examinando as imagens 3D da perfilometria e de MEV, as maiores diferenças entre UA e EA foram observadas para G3 e G6. O verniz CPP-ACP/NaF parece ser um tratamento promissor para reduzir a perda de esmalte por erosão produzida por refrigerante e ambos os vernizes mostraram capacidade em reduzir a PED e RS após erosão com medicamento líquido pediátrico associado a refrigerante.

In situ effect of titanium tetrafluoride varnish on enamel demineralization

Abstract The effect of a 4% titanium tetrafluoride (TiF 4 ) varnish on enamel demineralization was evaluated. Twelve volunteers participated in this double-blind, randomized crossover study. Six enamel specimens were positioned in intraoral appliances throughout four treatment stages: 4% TiF 4 varnish (experimental varnish), 5% sodium fluoride (NaF) varnish (Duraphat ® ), placebo varnish, and negative control (deionized water). After 24 h, the varnishes were removed and plaques were allowed to accumulate. A 20% sucrose solution was dripped onto enamel blocks (10x/day). Enamel alterations were analyzed by surface microhardness (SMH), percentage of surface loss (%SML), cross-sectional microhardness (CSMH), scanning electron microscopy (SEM), and energy dispersive X-ray spectrometry (EDS). Student's paired t-test was used for SMH analysis and repeated-measures analysis of variance (ANOVA) for %SML and CSMH (∆Z) analyses (p-value=0.05). The TiF 4 varnish group had lower %SML than the placebo and control groups (p=0.044 and p=0.003, respectively), thus showing its capacity to inhibit surface demineralization. TiF 4 and NaF varnishes demonstrated a protective effect against mineral loss on the enamel subsurface. Both were statistically different from the control group when CSMH was analyzed (p=0.000). A titanium dioxide film was observed on enamel surfaces of the TiF 4 group SEM images. EDS confirmed the presence of titanium in all TiF 4 samples. The 4% TiF 4 varnish is a promising compound capable of reacting with enamel to protect it against surface and subsurface demineralization.

Do pediatric medicines induce topographic changes in dental enamel?

Abstract The purpose of the present study was to evaluate the effect of common pediatric liquid medicines on surface roughness and tooth structure loss and to evaluate the pH values of these medicines at room and cold temperatures in vitro. Eighty-four bovine enamel blocks were divided into seven groups (n = 12): G1-Alivium®, G2-Novalgina®, G3-Betamox®, G4-Clavulin®, G5-Claritin®, G6-Polaramine® and G7-Milli-Q water (negative control). The pH was determined and the samples were immersed in each treatment 3x/day for 5 min. 3D non-contact profilometry was used to determine surface roughness (linear Ra, volumetric Sa) and the Gap formed between treated and control areas in each block. Scanning electron microscopy (SEM) and energy dispersive spectrometry (EDS) were also performed. The majority of liquid medicines had pH ≤ 5.50. G1, G4, and G5 showed alterations in Ra when compared with G7 (p < 0.05). According to Sa and Gap results, only G5 was different from G7 (p < 0.05). Alteration in surface was more evident in G5 SEM images. EDS revealed high concentrations of carbon, oxygen, phosphorus, and calcium in all tested groups. Despite the low pH values of all evaluated medicines, only Alivium®, Clavulin®, and Claritin® increased linear surface roughness, and only Claritin® demonstrated the in vitro capacity to produce significant tooth structure loss.

In Situ Effect of Titanium Tetrafluoride and Sodium Fluoride on Artificially Decayed Human Enamel

This study compared in situ the application of 4% titanium tetrafluoride (TiF4) solution and 2% sodium fluoride (NaF) gel on artificial white-spot lesions in human enamel. A crossover, double-blind study using in situ caries models was carried out. Eleven volunteers used an intraoral appliance containing five demineralized human enamel blocks. The blocks (n=170) were randomly divided according to treatment into the following groups: TiF4 (n=55), NaF (n=55), positive control (n=55). A negative control group was composed of demineralized specimens (n=5). The microhardness test was performed using a Knoop penetrator. Energy dispersive spectrometer (EDS) was used to analyze the concentration of titanium, calcium, phosphate and oxygen. The enamel microhardness at different depths for TiF4, NaF and positive control samples was not statistically different (p>0.05). The samples from these three groups had statistically higher microhardness values than the negative control samples (p<0.05). EDS analysis did not provide conclusive results about the penetration of titanium in the TiF4 samples. While in some fragments it had substantial penetration, in other fragments it only had superficial penetration. It was possible to conclude that, under in situ conditions, 4% TiF4 solution and 2% NaF gel were able to remineralize artificial white-spot lesions in human enamel. However, the magnitude of the remineralization did not differ between groups.

Este estudo comparou in situ a aplicação de uma solução de tetrafluoreto de titânio (TiF4) a 4% e um gel de fluoreto de sódio (NaF) sobre lesões de mancha branca artificiais em esmalte dentário humano. Foi realizado um estudo cruzado, duplo-cego utilizando um modelo in situ de cárie. Onze voluntários usaram um aparelho intraoral contendo cinco blocos de esmalte humanos desmineralizados. Os blocos (n = 170) foram divididos aleatoriamente de acordo com o tratamento nos seguintes grupos: TiF4 (n = 55) , NaF (n = 55) , controle positivo (n = 55). Um grupo controle negativo foi composto de espécimes desmineralizados (n = 5). O teste de microdureza foi realizado utilizando um penetrador Knoop. Espectrômetro de energia dispersiva (EDS) foi utilizado para analisar a concentração de titânio, cálcio, fosfato e oxigênio. A microdureza do esmalte em diferentes profundidades para as amostras dos grupos TiF4, NaF e controle positivo não diferiram estatisticamente (p>0,05). As amostras destes três grupos apresentaram valores de microdureza estatisticamente maiores do que as amostras do controle negativo (p<0,05). A análise EDS não forneceu resultados conclusivos sobre a penetração de titânio nas amostras de TiF4. Apesar de apresentar, em alguns fragmentos, uma penetração substancial, em outros fragmentos apresentou apenas penetração superficial. Foi possível concluir que, sob as condições do estudo in situ, a solução de TiF4 a 4% e o gel de NaF a 2% foram capazes de remineralizar lesões de mancha branca em esmalte humano. No entanto, a magnitude da remineralização não diferiu entre os grupos.

Condições de saúde bucal, acesso aos serviços odontológicos e autopercepção de saúde bucal em escolares de 12 anos / Oral health status, access to dental services and self-perception of oral health in 12 years Old schoolchildren

Objetivo: Avaliar a condição de saúde bucal em escolares de 12 anos, na cidade de João Pessoa-PB, e identificar informações sobre acesso aos serviços odontológicos e autopercepção em saúde bucal. Método: Do universo composto por todos os indivíduos de 12 anos matriculados em estabelecimentos de ensino, a casuística foi constituída por 286 crianças que foram avaliadas por examinadores previamente calibrados. As crianças responderam a uma entrevista estruturada com variáveis referentes ao acesso aos serviços odontológicos e a autopercepção em saúde bucal. Os dados foram analisados descritivamente. Resultados: O CPO-D médio foi de 3,62 (DP=±2,95), constatando-se que 35,09% dos escolares se apresentavam livres de cárie. Dentre as necessidades de tratamento, restaurações de uma superfície foram as mais freqüentes (5,75%). A presença de sangramento gengival foi detectada em 8,86% dos sextantes examinados nos escolares e 8,22% apresentavam cálculo. Quanto às anormalidades dento-faciais, 38,14% das crianças necessitavam de algum tipo de intervenção clínica e apenas 0,35% delas apresentou fluorose dentária (Grau 2 - muito leve). Dos 286 escolares, 94,05% foram ao dentista ao menos uma vez na vida e 53,5% relataram uma situação de saúde bucal péssima, ruim ou regular. Conclusão: a prevalência de cárie dentária para escolares de 12 anos é moderada e a necessidade de tratamento se caracteriza especialmente por procedimentos clínicos de baixa complexidade e de fácil resolução. É expressivo o número de escolares que apresentam sinais de alteração gengival, constatou-se uma elevada prevalência de má oclusão e baixa ocorrência de fluorose dentária na população estudada. Os serviços odontológicos se mostraram disponíveis a um número considerável de escolares de 12 anos, que, em sua maioria, não demonstrou possuir uma boa autopercepção de sua saúde bucal.

Objective: to evaluate the oral health status at the population of 12 years of the city of Joao Pessoa-PB and to identify at the sample information about the access to dental services and self-perception in oral health. Method: From the universe composed by all subjects with 12 years old enrolled in educational institutions, the sample consisted of 286 children who were evaluated by examiners previously calibrated. Children answered to a structured interview with variables related to access to dental services and self-perception in oral health. The findings were analyzed of descriptive form. Results: The index DMFT founded was 3.62 (SD=±2.95), noting that 35,09% of the students presented caries free. Among the needs for treatment, restorations of a surface were the most frequent (5.75%). In relation to the DMFT, carious component had the highest percentage (59.86%), followed by obturated (37.52%) and lost (2.61%). The presence of gingival bleeding was detected in 8.86% of sextants examined in scholars and 8.22% had calculus. About the facial abnormalities, 38.14% of the children needed some type of clinical intervention e only 0.35% showed dental fluorosis (grade 2 - very slight). From the 286 interviewed students, 94.05% went to the dentist at least once in their lives and 53.5% reported a situation of poor, bad or regular oral health. Conclusion: the prevalence of caries to scholars of 12 years is moderate and the treatment need is characterized especially by clinical procedures of low complexity and easy resolution. It is expressive the number of scholars who shows signs of gingival alterations, noting a high prevalence of malocclusion and low occurrence of dental fluorosis in the sampled population. Access to dental services was available to a large number of schoolchildren with 12 years, that, in their majority, have not shown a good self-perception of oral health.

Avaliação in vitro da Desmineralização do Esmalte Bovino Submetido a Variações de pH e Tempo de Imersão em Solução Indutora de Cárie / In Vitro Evaluation of the Demineralization of Bovine Enamel Subjected to pH and Immersion Time Variations in Caries-Inducing Solution

Objetivo: Analisar, in vitro, o padrão de desmineralização do esmaltebovino frente a variações de pH e de tempo de imersão de umasolução desmineralizante utilizada para simular o processo naturalde cárie.Método: Compuseram a amostra 80 blocos de esmalte alocadosao acaso em quatro grupos (n=20): GA – solução de pH 5,0 por 16horas, GB – solução de pH 5,0 por 32 horas, GC – solução de pH4,7 por 16 horas e GD – solução de pH 4,7 por 32 horas, os quaispermaneceram em estufa a 37ºC durante o período experimental.Após a exposição à solução desmineralizante, as amostras forampreparadas e avaliadas em microscopia de luz polarizada emicroscopia eletrônica de varredura. Os dados referentes à análiseem microscopia eletrônica de varredura (MEV) foram avaliadosdescritivamente, enquanto os resultados obtidos pela análise emmicroscopia de luz polarizada (MLP) foram submetidos aos testesANOVA e Tukey, adotando-se o nível de significância de 95 por cento(p<0,05 por cento).Resultados: Os valores de profundidade de lesão (média ± DP)encontrados na MLP para GA, GB, GC e GD foram,respectivamente: 27,28 ± 5,48a; 42,33 ± 6,80b; 37,11± 5,60ab e59,47± 23,80b (resultados seguidos por letras distintas diferemestatisticamente entre si). Observou-se que em todos os gruposhouve formação de lesão de cárie, sendo que apenas GA, apesarde não diferir em valores numéricos do GC, apresentou lesõescaracterísticas de subsuperfície, enquanto GB, GC e GDapresentaram áreas típicas de erosão.Conclusão: A desmineralização promovida pela solução em pH5,0 por 16 horas, foi capaz de induzir a formação de lesõessubsuperficiais adequadas para estudos de remineralização emesmalte, fato não encontrado quando utilizados tempos superioresa 16 horas ou diante da diminuição do pH da solução.