ABSTRACT
ABSTRACT In recent years, a reduction has been observed in the prevalence of dental caries in the global population. However, caries is still considered a public health problem. Currently, total removal of decayed tissue has been questioned and replaced by less invasive therapeutic approaches, which offer the possibility of incomplete removal of decayed tissue in one or two clinical sessions. Other techniques aim at sealing the carious lesion or use prefabricated metal crowns on the cavitated tooth without removal of the decayed tissue, preventing direct contact of the substrates with the carious lesion. Recently, ultra-conservative treatment has gained scientific prominence, and is able to control carious lesions through the disorganization of dental biofilm via supervised brushing. Each therapeutic approach has its advantages and limitations, and it is the responsibility of dental professionals to plan their patients' treatments according to their individual needs, allowing for better functional, aesthetic and psychological conditions for patients by preserving primary teeth until their physiological exfoliation.
RESUMO Nos últimos anos, foi perceptível a diminuição na prevalência da cárie dentária na população mundial. Entretanto, a doença cárie continua sendo considerada um problema de saúde pública. Atualmente, a remoção total do tecido cariado vem sendo questionada e substituída por abordagens terapêuticas menos invasivas, as quais oferecem a possibilidade de remoção incompleta do tecido cariado em uma ou duas sessões clínicas. Outras técnicas visam o selamento da lesão cariosa ou o emprego de coroas metálicas pré-fabricadas sobre o dente cavitado sem que haja remoção de tecido cariado, impedindo o contato direto dos substratos com a lesão cariosa. Recentemente, o tratamento ultraconservador tem ganhado destaque científico, o qual tem a capacidade de conduzir o controle da lesão de cárie através da desorganização do biofilme dentário pela escovação supervisionada. Cada abordagem terapêutica apresenta suas vantagens e limitações, sendo responsabilidade do profissional planejar o tratamento do seu paciente de acordo com as suas necessidades individuais, possibilitando melhores condições funcionais, estéticas e psicológicas para o paciente através da manutenção dos dentes decíduos até a sua esfoliação fisiológica.
ABSTRACT
Objective: To evaluate the ability of different periods of salivary exposure and two different removable appliances to rehardening initial erosive lesions. Material and Methods: This randomized, single blind in situ study was conducted with 2 crossover phases. The factors under study were: period of salivary exposure (15 minutes, 30 minutes, 1 hour and 2 hours) and type of oral appliance (maxillary or mandibular). Two hundred enamel blocks were selected by initial surface hardness (SHi). Enamel blocks were demineralized in vitro (0.05M citric acid; pH2.5 for 15 seconds), surface hardness (SHd) was remeasured and 160 blocks were selected and randomized among groups. Thus, there were 2 blocks per period of salivary exposure in each type of oral appliance for each one of the 10 volunteers. In each phase, one of the removable appliances was tested. The response variable was percentage of surface hardness recovery (%SHR=[(SHf-SHd)/SHi)]x100). Two-way ANOVA and Tukey's post hoc test were applied adopting 5% of significance. Results: No difference was found among oral appliances on enamel rehardening (p>0.01). Salivary exposure of 2 hours promoted similar enamel rehardening when compared to 1 hour (p>0.05), which showed similar rehardening to 30 min. All mentioned period of salivary exposure promoted superior rehardening than 15 min (p>0.01). Conclusion: The salivary time exposure between erosive attacks might be 2 hours to achieve a feasible maximum rehardening. In addition, both maxillary and the mandibular appliance have presented a similar rehardening ability.
Subject(s)
Hardness , Saliva/microbiology , Single-Blind Method , Tooth Erosion/chemically induced , Tooth Remineralization/methods , Analysis of Variance , BrazilABSTRACT
Abstract This in situ study assessed the effect of different times of salivary exposure on the rehardening of acid-softened enamel. Bovine enamel blocks were subjected in vitro to a short-term acidic exposure by immersion in 0.05 M (pH 2.5) citric acid for 30 s, resulting in surface softening. Then, 40 selected eroded enamel blocks were randomly assigned to 10 volunteers. Intraoral palatal appliances containing 4 enamel blocks were constructed for each volunteer, who wore the appliance for 12 nonconsecutive hours: initial 30 min, followed by an additional 30, and then by an additional 1 hour. For the last additional 10 hours the appliances were used at night, during the volunteers' sleep. Surface hardness was analyzed in the same blocks at baseline, after erosion and after each period of salivary exposure, enabling percentage of surface hardness recovery calculation (%SHR). The data were tested using repeated measures ANOVA and Tukey's test (α = 0.05). Increasing periods of salivary action promoted a progressive increase in the surface hardness (p < 0.001). However a similar degree of enamel rehardening (p = 0.641) was observed between 2 hours (49.9%) and 12 hours (53.3%) of salivary exposure. Two hours of salivary exposure seems to be appropriate for partial rehardening of the softened enamel surface. The use of the intraoral appliance during sleep did not improve the enamel rehardening after erosion.