Cost-effectiveness of selective caries removal versus stepwise excavation for deep caries lesions

Abstract A multicenter, randomized controlled clinical trial evaluated the effectiveness of two treatments for deep caries lesions in permanent molars - selective caries removal (SCR) to soft dentin with restoration in a single visit, and stepwise excavation (SW) - regarding pulp vitality for a 5-year follow-up period. The present study aimed to determine the cost-effectiveness of these treatments. Treatments were conducted in two Brazilian cities (Brasília and Porto Alegre). At baseline, 299 permanent molars (233 patients) were treated and 229 teeth (174 patients) were evaluated after 5 years. The discounted cash flow method was adopted. The total cost of each treatment was calculated, and the failure cost (endodontic treatment + restoration) was added to the final cost, according to the 5-year failure rates of each therapy (20% for SCR and 44% for SW). A public health service unit composed of three dentists in 4-hour work shifts was used to calculate the monetary value of the treatments, assuming a total of 528 treatments/month. Considering the 229 teeth evaluated after 5 years (115 SCR and 114 SW), SCR provided savings of 43% (amalgam) and 41% (resin composite) per treatment, compared to SW. The SCR technique provides benefits for public finances (direct economy) and for public health services (increase in the number of treatments performed). Considering that maximizing profit and reducing costs are powerful motivating factors for adopting a certain treatment, this study provides data to better support the decision-making process, regarding the management of deep caries lesions in permanent molars.

Sense of coherence and oral health-related quality of life among southern Brazilian male adolescents

Abstract This study evaluated the association between sense of coherence (SoC) and oral health-related quality of life (OHRQoL) among conscripts of the Brazilian Army, in two cities of southern Brazil. A cross-sectional study included all 18-19-year-old adolescents who joined the Brazilian Army as draftees for mandatory military service in the cities of Itaqui, RS, and Santiago, RS (n = 505). Data collection was conducted from 2019 to 2021, and included the application of questionnaires and a clinical oral examination to record gingivitis, malocclusion, and dental caries. OHRQoL was collected through the Brazilian short version of the Oral Health Impact Profile (OHIP), composed of 14 questions. The adolescents' SoC was assessed using the validated Brazilian version of the SOC-13 scale. The primary outcome of this study was OHRQoL, modeled as a discrete variable (OHIP-14 scores). The main predictor variable was SoC, categorized as low, moderate, or high. The association between predictor variables and OHRQoL was assessed by Poisson regression models using a hierarchical approach. Unadjusted and adjusted rate ratios (RR), and 95% confidence intervals (CI) were estimated. All the analyses were performed using STATA software version 14.2. Adolescents with a moderate and high SoC had 27% (RR = 0.73, 95%CI = 0.64-0.84) and 51% (RR = 0.49, 95%CI = 0.41-0.58) lower mean OHIP-14 scores, respectively, than those with a low SoC score, after the inclusion of behavioral and clinical variables. This study showed a significant association between SoC and OHRQoL among 18-19-year-old southern Brazilian adolescents. Strengthening the SoC as a psychosocial resource may improve the well-being and OHRQoL of adolescents.

Association between toothbrushing frequency and dental caries and tooth loss in adolescents: a cohort study

Abstract This cohort study assessed the association between toothbrushing frequency and the increment of dental caries and tooth loss in a population-based sample of southern Brazilian adolescents, to investigate whether there is any additional benefit in performing a third daily brushing. At baseline, 1,528 12-year-old schoolchildren attending 42 schools were examined for gingivitis and dental caries, and answered a questionnaire. After a mean period of 2.5 years, 801 schoolchildren were re-examined. Dental caries and tooth loss increment were outcomes of the study. The main predictor variable was toothbrushing frequency (≥3 times/day vs. twice/day or ≤1 time/day). Poisson regression models were used to estimate the risk for caries and tooth loss increment. Incidence risk ratios (IRR) and 95% confidence intervals (CI) were estimated. The final model adjusted for sociodemographic, behavioral, and clinical variables showed that brushing twice/day afforded 40% greater risk (IRR = 1.40; 95%CI: 1.02-1.92) for caries increment than ≥3 times/day. Regarding the tooth loss increment, adolescents who brushed their teeth twice/day had a fourfold greater risk (IRR = 3.92; 95%CI: 1.23-12.49) than those who brushed ≥ 3 times/day. Sex, school type, and gingivitis were found to act as effect modifiers, inasmuch as a third daily brushing presented advantages against tooth loss only for girls, public school attendees, and those with ≥ 50% of bleeding sites. This study suggests that adolescents benefit from a third daily toothbrushing. Increasing brushing frequency to 3 times/day may be a suitable strategy to control dental caries and tooth loss among high-risk adolescents.

Association between the city region and traumatic dental injuries among adolescents from Santa Maria, South Brazil

Abstract This study investigated the association between the city region and traumatic dental injury (TDI) among adolescents from Santa Maria, Rio Grande do Sul, Brazil. A population-based cross-sectional survey was conducted from March to November 2018, which included a representative sample of adolescents (15-19-year-old) attending public and private high schools. A questionnaire on sociodemographic information was sent to the parents/legal guardians of the selected adolescents. TDI in the upper and lower permanent incisors and canines was recorded based on the O'Brien classification. Environmental variables (sociodemographic and structural characteristics of the neighborhoods) were obtained from official publications. Multilevel Poisson regression models were used, and prevalence ratios (PR) and 95% confidence intervals (CI) were calculated. A total of 1,146 adolescents participated in this study. The overall prevalence of TDI was 17.3%, mild trauma was 12.7%, and severe trauma was 5.8%. Adolescents living in the southern region had a prevalence of TDI of 25.3%, compared with 13.6% in the northern region. After adjusting for important cofactors, adolescents living in the southern region were more likely to have TDI than their counterparts in the northern region (PR, 1.91; 95%CI: 1.18-3.11; p = 0.009). Analyzing the number of environmental risk indicators in different regions, the southern region presented a higher mean and median than all other regions. In conclusion, living in the southern region was associated with a higher prevalence and severity of TDI among adolescents from Santa Maria, southern Brazil. Our findings suggest the role of the environment in the epidemiology of TDI.

Efficacy of fluoride gel in arresting active non-cavitated caries lesions: a randomized clinical trial

Abstract: This study evaluated the efficacy of fluoride gel in arresting active non-cavitated caries lesions in permanent teeth. This randomized, triple-blind, placebo-controlled clinical trial randomized 100 schoolchildren aged 10.7 ± 2.2 years to test treatment (1.23% acidulated phosphate fluoride [APF] gel) or control treatment (placebo gel) for 4-6 applications at weekly intervals. Data collection included the visible plaque index, gingival bleeding index, visible plaque accumulation on the occlusal surfaces, eruption stage, and dental caries. The association between group and lesion arrestment was assessed using logistic regression, and estimates were adjusted for plaque accumulation over the lesion at baseline, surface type, and tooth type. Models were fitted using generalized estimating equations for accounting for the clustering of data (i.e., the same individual contributed > 1 lesion). Ninety-eight children completed the study (48 fluoride and 50 placebo). When all dental surfaces were analyzed, the likelihood of lesion arrestment was similar between both groups (p > 0.05). A secondary analysis including only the occlusal lesions in molars showed that for teeth under eruption, lesions receiving the 1.23% APF gel were about 3-fold more likely to become arrested than lesions receiving the placebo gel (OR = 2.85; 95%CI = 1.23-6.61; p = 0.01). No significant difference was detected for molars with complete eruption (p > 0.05). The benefit of fluoride gel for arresting non-cavitated caries lesions could not be identified by clinical assessment in this short-term trial. Notwithstanding, when the cariogenic challenge was greater (as on the occlusal surfaces of erupting molars), 1.23% APF gel treatment was an important tool for caries control.

Self-perceived neighborhood factors and OHRQoL among adolescents: a population-based study in southern Brazil

Abstract This study aimed to assess the relationship between self-perceived neighborhood factors and oral health-related quality of life (OHRQoL) among adolescents from southern Brazil. A representative sample of 15-19-year-old students from Santa Maria, Brazil, was included. The Oral Health Impact Profile (OHIP-14) was used to assess the OHRQoL. Self-perceived neighborhood factors were assessed through a structured questionnaire and included characteristics of the neighborhood where the adolescents lived, such as the presence of paved streets, tap water, community social networks, and availability of dental services and the Family Health Strategy (FHS). In addition, socioeconomic, behavioral, and clinical variables (dental caries and malocclusion) were also evaluated. Multilevel Poisson regression analysis with a hierarchical approach was used to assess the association between predictors and OHIP-14. The rate ratio (RR) and 95% confidence intervals (CIs) were estimated. A total of 1,197 adolescents were included in this study (participation rate: 72.3%). The mean OHIP-14 score was 8.4 (standard error = 0.2), ranging from 0 to 49. Living in residences with unpaved streets (RR = 1.11, 95%CI:1.06−1.17), no tap water (RR = 1.11, 95%CI: 1.02−1.20), absence of the FHS services (RR = 1.15, 95%CI: 1.09−1.20), and the availability of dental services (RR = 1.08, 95%CI: 1.03−1.14) were associated with higher OHIP-14 scores, indicating a poorer OHRQoL. In addition, lower socioeconomic status, visiting the dentist for curative reasons, lower frequency of brushing teeth, and higher sugar consumption were also associated with higher OHIP-14 scores. In conclusion, self-perceived neighborhood characteristics were associated with OHRQoL in adolescents. Adolescents who perceived their neighborhood as deprived had poorer OHRQoL.

Prevalence and risk indicators for underlying dentin shadows among 12-year-old southern Brazilian schoolchildren

Abstract This study aimed to assess the prevalence, extent, and associated factors of underlying dentin shadows (UDS) in the occlusal surfaces of permanent posterior teeth among 12-year-old schoolchildren from southern Brazil. A population-based cross-sectional study that included a representative sample of 1,528 schoolchildren was conducted in Porto Alegre, southern Brazil (participation rate: 83.2%). A questionnaire on sociodemographic characteristics, behavioral habits, and access to dental services was sent to parents/legal guardians of each student selected. Caries examination included the recording of non-cavitated and cavitated lesions, including the presence of UDS, as defined by the ICDAS Group (i.e., a shadow of discolored dentin visible through an apparently intact enamel surface that may or may not show signs of localized breakdown - ICDAS Code 4). The association between predictor variables and UDS prevalence was assessed using survey Poisson regression models. The prevalence of UDS was 6.3% (95%CI = 1.2 -11.3). The mean number of affected teeth among the schoolchildren presenting UDS was 1.51 (95%CI = 1.40 -1.61), ranging from 1 to 6. Type of school (public, PR = 2.23, 95%CI = 1.22 -4.07) and caries experience (DMFT 1-2, PR = 2.41, 95%CI = 1.15 -5.04; DMFT ≥ 3, PR = 3.09, 95%CI = 1.52 -6.27) were significantly associated with UDS prevalence. In conclusion, this population-based cross-sectional study found a low prevalence of UDS in the occlusal surfaces of the permanent posterior teeth of 12-year-old southern Brazilian schoolchildren. Overall caries experience and type of school were associated with UDS in this population.

Oral health status of schoolchildren living in rural and urban areas in southern Brazil

Abstract This study assessed the effect of area of residence (rural vs. urban) on dental caries experience among southern Brazilian schoolchildren. This cross-sectional survey was conducted in Rosário do Sul, southern Brazil, and included 373 9-14-year-old schoolchildren attending public municipal schools (122 living in the rural area, and 251, in the urban area). Data collection included a questionnaire and a clinical examination. Clinical examination of the permanent dentition involved visible plaque index, gingival bleeding index and dental caries experience (non-cavitated and cavitated, inactive and active lesions). Samples of water were collected to check the fluoride concentration. Caries prevalence and extent using different criteria were compared between rural and urban schoolchildren using the chi-square test and the Mann-Whitney test, respectively. The association between explanatory variables and the extent of caries activity (number of active caries lesions) was assessed using Poisson regression. When caries was recorded at the cavity level (WHO criterion), no difference was observed between rural and urban populations (p ≥ 0.05). Conversely, higher caries prevalence and extent were found among urban schoolchildren when active non-cavitated lesions were also computed (p < 0.05). In the adjusted Poisson regression model, urban schoolchildren were 57% more likely to present more active lesions than rural students (RR = 1.57; 95%CI = 1.29-1.92). Rural communities did not have sufficient fluoride in the water supply, whereas ideal concentrations were detected in the urban areas. In conclusion, this cross-sectional study found that urban schoolchildren showed greater caries experience than rural students, and that this increment was related to active non-cavitated lesions.

Obesity and dental caries among South Brazilian schoolchildren: a 2. 5-year longitudinal study

Abstract The aim of this study was to assess the association between weight status and ΔDMFS among 12-year-old schoolchildren from South Brazil. A total of 801 12-year-old schoolchildren were followed-up for 2.5 ± 0.3 years. Data collection included questionnaire, recording of anthropometric measures (height and weight), and caries examination. The outcome was the difference between DMFS (number of decayed, missing or filled surfaces) at follow-up and baseline (ΔDMFS). Weight status, based on body mass index-for-age Z-scores, was considered the main predictor variable. Negative binomial regression models were used to model the association, and rate ratios and their 95% confidence intervals were estimated. A multivariable fractional polynomial model was used to further explore the relationship between obesity and dental caries. DMFS increased by 0.86 (95%CI = 0.65-1.07), 0.91 (95%CI = 0.59-1.23), and 0.42 (95%CI = 0.03-0.80) for normal weight, overweight, and obese schoolchildren, respectively. Obese adolescents had significantly lower ΔDMFS than normal weight ones (p < 0.05). No significant association between categories of weight status and ΔDMFS was found (overweight, IRR=0.92, 95%CI = 0.69-1.21, p = 0.54; obese IRR = 0.75, 95%CI = 0.51-1.12, p = 0.16). However, the multivariable fractional polynomial model showed an inverted U shaped relationship with a decreasing ΔDMFS with increasing BMI (p < 0.05). This population-based longitudinal study showed an inverse association between obesity and ΔDMFS over a 2.5-year period among South Brazilian adolescents.

A randomized clinical trial on the sealing of occlusal carious lesions: 3-4-year results

Abstract This randomized clinical trial aimed to assess the efficacy of sealing occlusal carious lesions in permanent teeth. The sample consisted of 54 occlusal carious lesions in permanent molars and premolars of 49 patients aged 8–43 years (median: 19 years). The inclusion criteria comprised the presence of a cavity with no access allowing biofilm control. The maximum depth of the lesion was the middle third of the dentin thickness, as assessed by bitewing radiography. The teeth were randomly assigned to sealant treatment (n = 28) or restorative treatment (n = 26). Clinical and radiographic examinations were performed after 1 year and after 3–4 years. The outcomes depended on the clinical performance of the sealant/restoration and the control of caries progression observed radiographically. Survival analysis was performed to assess success rates. Over the 3-4 years of monitoring, 2 sealants were totally lost, 1 needed repair, and 1 showed caries progression, totaling 4 failures in the sealant group. In the restoration group, 1 failure was observed (in need of repair). The success rates were 76% and 94% in the sealant and the restoration groups, respectively (p > 0.05). The sealing of occlusal carious lesions in permanent teeth succeeded in controlling caries over a 3–4-year period. However, sealed carious lesions require patient compliance in attending regular follow-ups to control the occurrence of clinical failures of the sealants.

Perception and Knowledge of Dentists in Southern Brazil Related to use of Atraumatic Restorative Treatment in the Public Health Service

Objective: To investigate the perception and knowledge of dentists regarding use of the Atraumatic Restorative Treatment (ART) in public health services of cities in the central region of Rio Grande do Sul (RS), Brazil. Material and Methods: A crosssectional study was conducted using a self-administered questionnaire with 60 dentists who work with public dentistry services. To evaluate possible associations between the use of ART and the independent variables we used the chi-square test and logistic regression models (α = 0.05). Results: Forty-four questionnaires were completed, resulting in a response rate of 73%. Of the respondents, 70.4% supported the use of ART and 81.8% reported having some training in the technique. However, 72.7% consider ART to be a temporary or urgent treatment. Professionals who do not advocate the use of ART were 76% less likely to use the technique when compared to their colleagues who defend the use of the technique (OR = 0.24, 95% CI = 0.06 to 0.98). Conclusion: While most dentists have knowledge and positive attitude towards ART, greater dissemination is required for this technique can be used effectively on the public service.

Dentes fluoróticos tratados e não tratados: aspecto clínico após 21 anos / Treated and untreated fluorotic teeth: clinical aspect after 21 years

O aumento na ocorrência de fluorose dentária, observado nos últimos anos, tende a promover maior procura pela resolução estética dos manchamentos, o que é geralmente feito com a aplicação de técnicas de erosão-abrasão. Pode-se supor que a abrasão fisiológica e a erosão ácida que ocorrem ao longo da vida atuem no sentido de atenuar a severidade das manchas de fluorose. O presente artigo apresenta um caso de atenuação de manchamentos por fluorose dentária nos dentes anteriores de um paciente de 36 anos que aos 15 havia recebido tratamento erosivo-abrasivo apenas em seus incisivos 11 e 21. Isso permitiu que, após duas décadas, fosse possível comparar os dentes tratados com aqueles que sofreram apenas desgaste fisiológico e a constatação de que, embora as manchas ainda permaneçam, o aspecto de ambos é estético e socialmente aceitável.

The increased prevalence of dental fluorosis observed in recent years tends to promote an increased demand for esthetic resolution of tooth staining, which is usually made by erosion-abrasion techniques. It can be assumed that the physiological abrasion and acid erosion that occur throughout life act to mitigate the severity of fluorosis. This article presents a case of mitigation of fluorosis stains in the anterior teeth of a 36-year-old patient who had received, at 15 years, erosive/abrasive treatment only on his incisors 11 and 21. After two decades, it was possible to compare the treated teeth with those who suffered only physiological wear. It was possible to find that in spite the stains were still present, their clinical aspect is esthetic and socially acceptable.

Indicação de tratamento restaurador para lesões cariosas: uma reflexão / Indicating restorative treatment for carious lesions: some thoughts

O presente artigo discute a indicação do tratamento restaurador para lesões cariosas, utilizando como exemplo o caso de uma paciente com atividade de doença cárie durante o período de erupção dos molares permanentes. O diagnóstico precoce da lesão permitiu sua inativação, por meio de abordagem não invasiva. O controle longitudinal do caso foi possível por 18 meses. Após 10 anos sem contato com a paciente, ela retornou com o dente em questão restaurado. O “selamento biológico”, o estabelecimento da oclusão funcional e a superficialidade e amplitude da restauração permitem questionar a indicação do procedimento restaurador executado

This paper discusses the indication of restorative treatment for carious lesions considering a young patient with caries active disease, treated during the period of eruption of permanent molars. Early diagnosis led to caries inactivation by means of a non-invasive approach. Longitudinal control of the disease was possible for 18 months. After 10 years without contact, the patient returned and it was possible to observe that the tooth has been restored. The quality of the “biological sealing”, the occlusal function and the thinness and extension of the restoration led us to question the indication of the restorative procedure executed

Percepção materna sobre atenção odontológica e fonoaudiológica na gravidez / Maternal perception of dental, speech and hearing care during pregnancy

Objetivo: Conhecer a percepção das gestantes atendidas no Pré-Natal Obstétrico do Hospital Universitário de Santa Maria (RS) sobre a atenção odontológica e fonoaudiológica durante a gravidez. Método: Foram entrevistadas 75 gestantes por meio de questionário contendo perguntas relacionadas à saúde materna e do bebê. A análise foi de natureza descritiva. Resultados: Apenas 58,7% das gestantes frequentaram o consultório odontológico durante a gestação, embora todas as entrevistadas consideram importante cuidar da saúde bucal durante este período. A maioria das grávidas apresentou dúvidas sobre até que período o bebê deveria ser amamentado e qual o momento adequado para o desmame. A maioria (96,0%) informou que é necessário realizar a higiene bucal do recém-nascido, porém houve inúmeras dúvidas com relação ao modo de como fazê-la. Um número significativo de gestantes (77,0%) considerou prejudicial beijar o filho na boca assim como provar o leite e a comida. Sessenta e dois por cento tiveram controle da ingestão de açúcar durante o período gestacional e 92,0% das gestantes nunca ouviram falar do teste da orelhinha. Conclusão: Pôde-se observar que as gestantes detêm algum conhecimento sobre as questões abordadas, no entanto, alguns pontos precisam de maiores esclarecimentos, sobretudo em saúde, com enfoque odontológico e fonoaudiológico, propiciando uma atenção holística para o binômio mãe-bebê.

Objective: The objective of this study is to investigate how pregnant women seen at the Prenatal Obstetric Clinic of the University Hospital in Santa Maria perceive dental, speech and hearing care. Method: A questionnaire was administered to 75 pregnant women with questions related to mother and baby health. The analysis was of a descriptive nature. Results: Only 58.7% of the pregnant women saw a dentist on a regular basis during pregnancy, although all interviewees believed that oral care during this period was important. The majority of the pregnant women were uncertain about how long to breastfeed and when to wean. Most of them (96%) stated that oral hygiene of the newborn was necessary, but there were many doubts on how to do it. A significant number (77%) of pregnant women thought kissing the baby´s mouth or tasting his or her milk or other foods was harmful. More than half (62%) of the women controlled their sugar intake during pregnancy and 92% of them had never heard of the ear test. Conclusion: The results showed that pregnant women have some knowledge of the issues discussed; however, some points need clarification, especially health issues. There should be a focus on teeth, speech and hearing so as to provide a holistic care for the mother-child dyad.

Health promotion and dental caries

The central idea of the Brazilian health system is to prevent the establishment of disease or detect it as early as possible. Prevention and treatment of dental caries are related to behavioral factors, including dietary and oral hygiene habits, which are related to many chronic diseases. Dental health promotion therefore should be fully integrated into broadly based health-promoting strategies and actions such as food and health policies, and general hygiene (including oral hygiene), among others. For decades, a linear relationship between sugar consumption and caries has been observed. Recent data has indicated that this relationship is not as strong as it used to be before the widespread use of fluoride. However, diet is still a key factor acting in the carious process. Oral hygiene is a major aspect when it comes to caries, since dental biofilm is its etiological factor. Oral hygiene procedures are effective in controlling dental caries, especially if plaque removal is performed adequately and associated with fluoride. An alternative to a more efficient biofilm control in occlusal areas is the use of dental sealants, which are only indicated for caries-active individuals. If a cavity is formed as a consequence of the metabolic activity of the biofilm, a restorative material or a sealant can be placed to block access of the biofilm to the oral environment in order to prevent caries progress. The prevention of dental caries based on common risk-factor strategies (diet and hygiene) should be supplemented by more disease-specific policies such as rational use of fluoride, and evidence-based dental health care.

The history and global market of oral home-care products: [review]

This literature review reports the history and the current market of oral home-care products. It provides information extending from the products used by our ancestors to those currently available, as well as on the changes in the supply and consumption of these products. Although the scientific knowledge about oral diseases has improved greatly in recent years, our ancestors had already been concerned with cleaning their teeth. A variety of rudimentary products and devices were used since before recorded history, like chewing sticks, tree twigs, bird feathers, animal bones, tooth powder and home-made mouth rinses. Today, due to technological improvements of the cosmetic industry and market competition, home-use oral care products available in the marketplace offer a great variety of options. An increase in the consumption of oral care products has been observed in the last decades. Estimates show that Latin America observed a 12 percent increase in hygiene and beauty products sales between 2002 and 2003, whereas the observed global rate was approximately 2 percent. A significant increase in the per capita consumption of toothpaste, toothbrush, mouthrinse and dental floss has been estimated from 1992 to 2002, respectively at rates of 38.3 percent, 138.3 percent, 618.8 percent and 177.2 percent. Pertaining to this increased supply and consumption of oral care products, some related questions remain unanswered, like the occurrence of changes in disease behavior due to the use of new compounds, their actual efficacy and correct indications, and the extent of the benefits to oral health derived from consuming more products.

Restabelecendo anatomia, função e estética mediante a técnica da réplica oclusal / Reestablishing the anatomy, function and esthetics using an occlusal replica technique

A superfície oclusal dos dentes posteriores apresenta características anatômicas complexas, o que dificulta sua reprodução em restaurações diretas de resina composta. A técnica da réplica oclusal aparece como alternativa conservadora para o restabelecimento da anatomia, função e estética em molares acometidos por “cárie oculta”, um padrão distinto de cárie oclusal caracterizado pela preservação das características oclusais. Essa técnica prevê a cópia fiel da anatomia oclusal por meio de moldagem prévia da superfície com resina acrílica autopolimerizável. A técnica demonstrou ser de fácil execução, simplifica etapas restauradoras, minimiza o desgaste inadvertido de tecido sadio e privilegia a harmonia oclusal, por permitir fiel reprodução dos detalhes anatômicos perdidos durante o preparo cavitário.

Comparative scanning electron microscopic study of the effect of different dental conditioners on dentin micromorphology

This study evaluated comparatively by scanning electron microscopy (SEM) the effect of different dental conditioners on dentin micromorphology, when used according to the same protocol. Forty dentin sticks were obtained from 20 caries-free third human molars and were assigned to 4 groups corresponding to 3 conditioners (phosphoric acid 37 percent, Clearfil SE Bond and iBond) and an untreated control group. After application of the conditioners, the specimens were immersed in 50 percent ethanol solution during 10 s, chemically fixed and dehydrated to prepare them to SEM analysis. In the control group, dentin surface was completely covered by smear layer and all dentinal tubules were occluded. In the phosphoric acid-etched group, dentin surface was completely clean and presented exposed dentinal tubule openings; this was the only group in which the tubules exhibited the funnel-shaped aspect. In the groups conditioned with Clearfil SE Bond primer and iBond, which are less acidic than phosphoric acid, tubule openings were occluded or partially occluded, though smear layer removal was observed. SE Bond was more efficient in removing the smear layer than iBond. In the Clearfil SE Bond group, the cuff-like aspect of peritubular dentin was more evident. It may be concluded all tested conditioners were able to change dentin morphology. However, it cannot be stated that the agent aggressiveness was the only cause of the micromorphological alterations because a single morphological pattern was not established for each group, but rather an association of different aspects, according to the aggressiveness of the tested conditioner.