Anticaries potential of a fluoride foam

Abstract Foam has been used worldwide as a vehicle for the professional application of fluoride and hypothetically should have the same anticaries potential as conventional fluoride gel (F-gel) in terms of the formation of reaction products with enamel. Thus, the ability of Flúor Care® foam (FGM, Joinville, SC, Brazil, 12,300 ppm F, acidulated) to react with enamel was evaluated in comparison with Flúor gel® (DFL, Rio de Janeiro, RJ, Brazil, 12,300 ppm F, acidulated). Slabs (n=10/group) of sound enamel and with caries lesion were used, in which the concentrations of total fluoride (TF), and loosely (CaF2-like) and firmly (FAp) bound types were determined. The importance of agitation during application was previously tested. The determinations were made with fluoride ion-specific electrode and the results were expressed in μg F/cm² of the treated enamel area. ANOVA and Tukey tests were used to analyze the difference among treatments, independently for sound and carious enamel. The agitation of the products during application significantly increased the reactivity of the foam (p<0.05), but not that of the gel (p>0.05). The foam did not differ from F-gel (p>0.05) concerning the formation of TF and CaF2-like in sound or carious enamel. Regarding FAp, the foam did not differ from F-gel (p>0.05) in the carious enamel, but the concentration in the sound was lower (p<0.05). The results show that this commercial fluoride foam tested needs to be agitated during application to improve its reactivity with enamel, which raises a question about other brands.

Resumo A espuma tem sido utilizada mundialmente como veículo para aplicação profissional de fluoreto e hipoteticamente deveria ter o mesmo potencial anticárie que o gel fluoretado convencional (F-gel) em termos de formação de produtos de reação com o esmalte. Assim, a capacidade da espuma Flúor Care® (FGM, Joinville, SC, Brasil, 12.300 ppm F, acidulada) de reagir com o esmalte foi avaliada em comparação com o Flúor gel® (DFL, Rio de Janeiro, RJ, Brasil 12.300 ppm F, acidulado). Foram utilizados blocos (n=10/grupo) de esmalte hígido e com lesão de cárie, nos quais foram determinadas as concentrações de flúor total (FT), e os tipos de flúor fracamente (tipo-CaF2) e firmemente (FAp) ligados ao esmalte. A importância da agitação durante a aplicação foi previamente testada. As determinações foram feitas com eletrodo íon específico para fluoreto e os resultados foram expressos em μg F/cm² da área tratada do esmalte. A diferença entre os tratamentos foi analisada por ANOVA e Tukey (α=5%), independentemente para esmalte hígido e cariado. A agitação dos produtos durante a aplicação aumentou significativamente a reatividade da espuma (p<0,05), mas não a do gel (p>0,05). A espuma não diferiu do F-gel (p>0,05) quanto à formação de FT e tipo-CaF2 no esmalte hígido ou cariado. Em relação à FAp, a espuma não diferiu do F-gel (p>0,05) no esmalte cariado, mas a concentração no hígido foi menor (p<0,05). Os resultados mostram que esta espuma fluoretada comercial testada precisa ser agitada durante a aplicação para melhorar sua reatividade com o esmalte, o que levanta questão sobre outras marcas.

Efeito de dentifrício com alta concentração de flúor na remineralização e resistência de união de cimento de ionômero de vidro em substratos dentários com cárie artificial / Effect of dentifrice with high concentration of fluoride under remineralization and bond strength of glass ionomer cement on dental substrates with artificial caries

O objetivo do presente estudo foi avaliar a influência de diferentes dentifrícios na dureza de superfície, em secção transversal e perfil de desgaste do esmalte, assim como na resistência de união de cimentos de ionômero de vidro de alta viscosidade (CIV-AV) à dentina, após indução de cárie artificial, ciclagem de pH e escovação. Foram utilizados 80 dentes bovinos, divididos em blocos de esmalte e dentina. Os espécimes de esmalte foram polidos e selecionados de acordo com a microdureza. Em seguida, metade de cada bloco de esmalte foi protegida com verniz ácido resistente. Os espécimes de dentina foram incluídos em resina acrílica e planificados. O protocolo de cárie artificial foi feito através de ciclos de desmineralização em esmalte (n=20) e pela imersão da dentina (n=40) em solução desmineralizadora. Vinte amostras de dentina não foram submetidas à cárie, sendo o grupo controle. Todas as amostras foram submetidas à ciclagem de pH e escovação durante 7 dias de acordo com cada dentifrício: Colgate Total 12 1450 ppm F (CT) e Clinpro 5000 ppm F + TCP (CL). Em seguida, os blocos de esmalte foram submetidos às análises de dureza de superfície, em secção transversal e perfilometria. Microscopia eletrônica de varredura foi realizada em três blocos representativos de cada grupo. Os espécimes de dentina foram subdivididos de acordo com material restaurador: CIV-AV Ketac Molar (KM) e cimento ionomérico híbrido Equia Forte (EF). Em seguida, as amostras foram armazenadas sob umidade relativa durante 24 horas e preparados para o teste de microcisalhamento. Os dados obtidos foram submetidos ao teste de normalidade, análise de variância (ANOVA) 1 critério para avaliar a recuperação mineral e perfil de desgaste, ANOVA 2 critérios com medidas repetidas para avaliar a dureza de superfície e em secção transversal, ANOVA 3 critérios para avaliar o microcisalhamento e pós teste de Tukey para comparações múltiplas, com significância de 5%. Observou-se recuperação parcial da dureza de superfície, independente do dentifrício. Os dados da dureza em secção transversal evidenciaram que CL obteve valores inferiores a CT até 90 micrômetros (m) no lado teste. O dentifrício CT apresentou maior desgaste quando comparado à CL. Em dentina, ao comparar os dentifrícios dentro de cada CIV, CT apresentou maior resistência adesiva para ambos os materiais. A comparação entre CIVs dentro do mesmo dentifrício evidenciou resistência adesiva superior para KM quando comparado à EF na dentina tratada com CL. Conclui-se que o dentifrício com maior concentração de flúor promoveu menor dureza em secção transversal no esmalte e o dentifrício convencional resultou em maior desgaste superficial. Na superfície dentinária, o dentifrício com maior concentração de flúor diminuiu a resistência adesiva de cimentos de ionômero de vidro(AU)

The aim of the present study was to evaluate the influence of different dentifrices on surface hardness and cross-sectional hardness, wear profile on enamel, as well as on the bond strength of high viscosity glass ionomer cements (HV-GIC) to dentin, after to produce artificial caries, pH cycling and brushing. Eighty bovine teeth were used, divided into enamel and dentin blocks. The enamel specimens were polished and selected according to microhardness. Then, half of each enamel block was covered with resistant acid varnish. Dentin specimens were embedded in acrylic resin and flattened. The artificial caries protocol was carried out through enamel demineralization cycles (n= 20), and the dentin (n= 40) was immersed in demineralizing solution. Twenty dentin specimens were not subjected to artificial caries, being the control group. All blocks were subjected to pH cycling and brushing for 7 days according to each dentifrice: Colgate Total 12 1450 ppm F (CT) and Clinpro 5000 ppm F + TCP (CL). Then, the protected enamel surfaces were exposed for the analysis of surface hardness, cross sectional hardness and profilometry. Scanning electron microscopy was performed in three representative blocks of each group. The dentin specimens were subdivided according to restorative material: HVGIC Ketac Molar (KM), and hybrid GIC Equia Forte (EF). Then, the specimens were stored under relative humidity for 24 hours and prepared for the micro-shear test. The data were submitted to normality test, one-way analysis of variance (ANOVA) to assess mineral recovery and wear, two-way repeated measures ANOVA to assess surface and cross-sectional hardness, and three-way ANOVA to analyze the bond strength. Tukey post-test was used for multiple comparisons, with a significance level of 5%. It was observed a partial recovery of superficial microhardness, regardless of the dentifrice. Cross sectional hardness data showed that CL obtained values below CT up to 90 micrometers (m) on the test side. CT dentifrice presented greater wear when compared to CL. In dentin, when the dentifrices were compared within each GIC, CT showed greater adhesive resistance for both materials. A comparison between GICs within the same dentifrice showed superior adhesive resistance for KM when compared to EF in dentin treated with CL. It was concluded that the dentifrice with the highest fluoride concentration promoted less cross-sectional hardness in the enamel and the conventional dentifrice resulted in greater surface wear. On the dentin, the dentifrice with the highest fluoride concentration decreased the adhesive strength of glass ionomer cements(AU)

Influencia del nivel de pH de geles blanqueadores en la rugosidad superficial del esmalte bovino / Influence of pH Value of Bleaching Gels on Surface Roughness of Bovine Enamel

Resumen: Objetivo: El propósito de este estudio fue evaluar la influencia de los niveles de pH de tres geles de blanqueamiento de consultorio en la rugosidad superficial del esmalte bovino, después del protocolo del blanqueamiento. Materiales y métodos: Se obtuvo 36 muestras de esmalte bovino, las cuales fueron cortadas y divididas en tres grupos (n=15): peróxido de hidrógeno 40% (Opalescence Boost 40%), peróxido de hidrógeno 35% (Whiteness HP AutoMixx) y peróxido de hidrógeno 35% (Whiteness HP Blue), recibiendo una aplicación de 40 minutos de blanqueamiento. Los valores del promedio del pH fueron determinados utilizando un pHmetro durante la aplicación inicial y final del gel. Un rugosímetro fue utilizado para evaluar la rugosidad superficial (Ra) antes y después del blanqueamiento. Los datos fueron analizados con la prueba de Friedmann y wilcoxon (diferencia entre grupos); la prueba Kruskall Wallis y U de mann (diferencia en cada grupo), así como prueba de Pearson o Spearman para la correlación. Resultados: Hay un aumento en los valores del pH del inicio al final del blanqueamiento en todos los grupos, excepto para el grupo peróxido de hidrógeno 35% (Whiteness HP Automixx). Para los resultados de rugosidad superficial existe un aumento en todos los grupos. No se encontró correlación entre niveles de pH de los geles blanqueadores y la rugosidad superficial del esmalte después del blanqueamiento. Conclusiones: Los geles blanqueadores de peróxido de hidrógeno con altas concentraciones que presenten un pH alto o bajo podrían causar alteraciones de la superficie del esmalte dental, como el aumento en la rugosidad superficial.

Abstract: Objective: The purpose of this study was to evaluate the influence of the pH levels of three in-office bleaching gels on the surface roughness of bovine enamel, after the bleaching protocol. Materials and methods: 36 samples of bovine enamel were obtained, which were cut and divided into three groups (n=12): 40%hydrogen peroxide (Opalescence Boost40%), 35% hydrogen peroxide (Whiteness HP AutoMixx) and 35% hydrogen peroxide (Whiteness HP Blue), receiving a 40-minute application of bleaching. The average pH values were determined using a pH meter during the initial and final application of the gel. A roughness meter was used to assess surface roughness (Ra) before and after bleaching. Data were analyzed with the Friedmann and wilcoxon test (difference between groups); the Kruskall Wallis and U Mann test (difference in each group), as well as Pearson or Spearman test for correlation. Results: There is an increase in pH values from the beginning to the end of bleaching in all groups, except for the 35% hydrogen peroxide group (Whiteness HP Automixx). For surface roughness results there is an increase in all groups. No correlation was found between pH values of the bleaching gels and the surface roughness of the enamel after bleaching. Conclusions: Hydrogen peroxide bleaching gels with high concentrations that have a high or low pH could cause alterations in the surface of the tooth enamel, such as increase in surface roughness.

Demineralization of tooth enamel following radiation therapy; An in vitro microstructure and microhardness analysis

Objective: The objective of this study is to evaluate the effects of radiotherapy doses on mineral density and percentage mineral volume of human permanent tooth enamel. Materials and Methods: Synchrotron radiation Xray microcomputed tomography (SRμCT) and microhardness testing were carried out on 8 and 20 tooth samples, respectively. Enamel mineral density was derived from SRμCT technique using ImageJ software. Microhardness samples were subjected to Vickers indentations followed by calculation of microhardness and percentage mineral volume values using respective mathematical measures. Data were analyzed using paired t-test at a significance level of 5%. Qualitative analysis of the enamel microstructure was done with two-dimensional projection images and scanned electron micrographs using μCT and field emission scanning electron microscopy, respectively. Results: Vickers microhardness and SRμCT techniques showed a decrease in microhardness and an increase in mineral density, respectively, in postirradiated samples. These changes were related to mineral density variation and alteration of hydroxyapatite crystal lattice in enamel surface. Enamel microstructure showed key features such as microporosities and loss of smooth homogeneous surface. These indicate tribological loss and delamination of enamel which might lead to radiation caries. Conclusions: Tooth surface loss might be a major contributing factor for radiation caries in head-and-neck cancer patients prescribed to radiotherapy. Such direct effects of radiotherapy cause enamel abrasion, delamination, and damage to the dentinoenamel junction. Suitable measures should, therefore, be worked out to protect nontarget oral tissues such as teeth while delivering effective dosages to target regions

Expresión inmunohistoquímica de la proteína de membrana asociada a lisosomas en ameloblastos de ratones

Introducción: La formación del esmalte dental comprenden cambios morfofuncionales de los ameloblastos. Estas modificaciones involucran la participación activa de organelas celulares, entre ellas los lisosomas. Objetivo: Identificar la distribución de la proteína de membrana asociada a lisosomas en los ameloblastos. Materiales y métodos: Incisivos en crecimiento continuo de ratones con edades de 7, 14 días y células epiteliales dentales de rata fueron utilizadas para identificar la proteína de membrana asociada a lisosomas tipo 1 (Lamp1) mediante la técnica de inmunohistoquímica. Resultados: Un marcaje citoplasmático de Lamp1 fue identificado en las células ameloblásticas durante todas las etapas del proceso de diferenciación de los ameloblastos, independientemente de sus edades. Lamp1 también fue detectado en las células epiteliales dentales. Conclusiones: Se evidencia la expresión de Lamp1 en los ameloblastos en incisivos de crecimiento continuo y células epiteliales dentales de rata. Próximos estudios deberían abordar el rol funcional de Lamp1 en la formación del esmalte.

Introduction: Tooth enamel formation includes morphological changes in ameloblasts. These modifications involve the active participation of cellular organelles, including lysosomes. Objective: To identify the lysosomal membrane protein distribution in ameloblasts. Materials and method: The lysosomal membrane protein type 1 (Lamp 1) was identified in continuous growth incisor from mice (7, 14 days old) and epithelial rat's cells using the immunohistochemistry technic. Results: A cytoplasmic Lamp 1 marker was identified in ameloblast cells during all the stages of the process, no matter the age. Lamp 1 was detected, too, in the epithelial dental cells. Conclusion: It is evident the expression of Lamp 1 in ameloblasts of continuous growth incisor and epithelial dental rat's cells. Next studies must be done about the functional role of Lamp 1 in tooth enamel formation.

Thermal and Mechanical Properties Analysis of Age-Based Human Tooth Enamel

@#Introduction: As the important part of tooth, enamel must be treated well in order to keep its function. The purpose of study is provide tooth composition for various condition and at different ages. Methods: Children (1-2 years), adults (13-40 years), and parents (41-70 years) tooth, aquabidest, abrasive paper, tooth bor, caliper, trimmer, Machines for Hardness test, compressive test and XRD. Each test sample will be cut, mashed, washed and soaked in aquabidest in refrigerator and then to be examined. Results: Micro test results were showed that the main components of the teeth are Hydroxy apatite, Fluorine apatite, and Calcium phosphate hydrate. Transition glass occurs in the age range 1-12 years old at 340o C and in the age range 13-40 years old at a temperature of 400o C , however at the age of 41-70 years old at temperatures of 360o C based on the thermal test results, melting point and boiling point. Mechanical test was showed the level of violence has increased from the age of 1-40 years old then later has decreased, as well as for compressive strength. Hydroxy apatite, Fluorine apatite increase, and Calcium phosphate hydrate decreases in line with age. Tooth enamel also tends to be able to withstand heat in line with age. Conclusion: The level of hardness and tooth strength tends to increase temporarily in older people’s teeth as the calcium content decreases, thus its mechanical strength decreases.

Influence of Different Time Intervals among the in-Office Bleaching Sessions on the Tooth Enamel Mass Variation / Influência do Intervalo de Tempo Entre as Sessões de Clareamento Profissional na Variação de Massa do Esmalte Dental

This study evaluated the effect of different time intervals between tooth bleaching sessions on the variation of tooth enamel mass, using a 35% hydrogen peroxide (HP35) gel. Twenty bovine incisor teeth were collected and cross-sectioned twice, leaving only the middle coronal portion. The dentin layer was removed, leaving only the buccal dental enamel. The samples were randomly divided into 2 groups (n = 10): G1 (with a 7-day time interval between each bleaching session), and G2 (with a 2-day time interval between each bleaching session). Three bleaching sessions were performed for each group. Each specimen's mass was measured using an electronic analytical scale, first at the beginning of the experiments (T0), and then immediately after each bleaching intervention (T1, T2 and T3, respectively). All samples were stored in artificial saliva and kept in a biological chamber during the time of the study. The data analysis was performed using ANOVA for the related samples (p = 0.05). The results showed a reduction in the enamel mass values in G2 after the 3rd session when comparing to enamel mass values presented at the beginning of the study. On the other hand, G1 presented an increase in the mass values at the end of the third session, and these intragroup differences were statistically significant (p <0.001). It was concluded that bleaching treatment with 7-day intervals between sessions leads to no tooth enamel mass loss, whereas the reduced 2­day time interval between sessions caused a significant tooth enamel mass loss. (AU)

Este estudo avaliou a influência de diferentes intervalos de tempo entre as sessões de clareamento com peróxido de hidrogênio a 35% (PH35) sobre a variação de massa do esmalte dental. Foram utilizados 20 dentes incisivos bovinos hígidos, seccionados em duas porções transversais, com a camada de dentina vestibular toda removida, restando apenas o esmalte dental vestibular. As amostras foram distribuídas em 2 grupos (n=10): G1 - intervalo de tempo de 7 dias entre as sessões de clareamento, e G2 - Intervalo de 2 dias entre as sessões de clareamento. Foram realizadas 3 aplicações de gel clareador em cada grupo. A pesagem dos espécimes foi realizada antes do início do tratamento clareador e ao final de cada intervenção clareadora, em uma balança analítica eletrônica. Os espécimes foram armazenados em saliva artificial, e mantidos em estufa biológica. Os dados foram submetidos à ANOVA para amostras relacionadas (p=0.05). O G2 apresentou uma redução nos valores de massa do esmalte quando comparados os tempos antes do clareamento (T0 - 0.1650g) e após a 3° sessão (T3 - 0.1643g). Entretanto, o G1 apresentou um aumento nos valores de massa ao término da terceira sessão (T0 - 0.1615g e T3 - 0.1624g), sendo essas diferenças intragrupos estatisticamente significantes (p<0.001). Foi possível concluir que no clareamento com intervalo de 7 dias entre as sessões não houve perda de massa do esmalte dental, ao passo que quando reduzido o intervalo entre as sessões para 2 dias, uma perda significativa de massa foi observada. (AU)

Effect of fermented milk with kefir grains on the in vitro demineralization of bovine tooth enamel / Efecto de la leche fermentada con granos de kéfir sobre la desmineralización in vitro del esmalte dental bovino

The dental caries is a progressive destruction of the teeth tissue due to the disbalance in the normal molecule interactions between the enamel and the bio!lm, which alters the demineralization-remineralization process. Milk fermentation produces caseinphosphopeptides with proved remineralizing capacity of the enamel. The presence of these peptides in fermented milk with ke!r grains has been described. The purpose of this work was to evaluate in vitro the capacity of milk ke!r to prevent the demineralization of dental enamel. Bovine incisors (n=68, 17 per group) were treated for 72 h with different solutions: I: artificial saliva at pH 7.2 , II: demineralizing solution at pH 4.5, III: supernatant of kefir fermented milk at pH 4.5, IV: milk supernatant at pH 4.5. The effects of treatments were evaluated by the change in the weight of the specimens, calcium concentration in the solution and by scanning electron microscopy (SEM) of the enamel. Kefir milk supernatant prevented the demineralization process, that was evidenced by a change in weight and calcium concentration that were not different from group I, although the pH was 4.5. In contrast, group IV showed a decrease in weight and an increase in calcium concentration, compared with group I (one way ANOVA, p<0.05). Images of SEM agree with the values of weight and calcium concentration. These results indicate that kefir milk supernatant has a protective effect on enamel demineralization in vitro. (AU)

La caries dental es una patología debido a un desequilibrio en las interacciones moleculares normales entre el esmalte y la biopelícula, que altera el proceso de desmineralización remineralización. La fermentación de la leche produce fosfopéptidos de caseína con probada capacidad remineralizante del esmalte, y se ha descripto la presencia de estos péptidos en la leche fermentada con granos de kéfir. El propósito de este trabajo fue evaluar in vitro la capacidad del kéfir de leche para prevenir la desmineralización del esmalte dental. Sesenta y ocho incisivos bovinos (17 por grupo) fueron tratados durante 72 h con diferentes soluciones: I: saliva artificial, pH 7.2, II: solución desmineralizante, pH 4.5, III: sobrenadante de leche fermentada con kefir, pH 4.5, IV: sobrenadante de leche, pH 4.5. El proceso de desmineralización se evaluó mediante el cambio en el peso de las muestras, la concentración de calcio en la solución y microscopía electrónica de barrido (SEM) del esmalte. El sobrenadante de leche fermentada con kéfir impidió el proceso de desmineralización, que se evidenció por un cambio en el peso y la concentración de calcio que no discreparon del grupo I, a pesar de haber tenido un pH de 4.5. En contraste, el grupo IV mostró una disminución en el peso y un aumento en la concentración de calcio, en comparación con el grupo I (ANOVA a un criterio, p<0.05). Las imágenes SEM concuerdan con los cambios en el peso y la concentración de calcio en los grupos estudiados. Los datos obtenidos demuestran que el sobrenadante de la leche tratada con kéfir tiene un efecto protector sobre la desmineralización del esmalte in vitro, inducida por el pH ácido. (AU)

Influence of Prolonged Tooth Bleaching on Enamel Mass Variation / Influencia del Blanqueo Dental Prolongado en la Variación de Masa del Esmalte Dental

ABSTRACT: The objective evaluate was the influence of prolonged tooth bleaching with 10 % carbamide peroxide (10CP) on tooth enamel mass variation. Ten healthy bovine incisor teeth were divided (n = 5) into G1 - storage in distilled water and G2 - storage in artificial saliva. The samples were weighed in an electronic analytical balance at the following times: T0 - before application of the bleaching gel, T1 - after 14 days of bleaching (the time recommended by the manufacturer), T2 - after 21 days of bleaching (50 % increase in the time recommended by the manufacturer), and T3 - after 28 days of bleaching (100 % increase in the time recommended by the manufacturer). The data were subjected to ANOVA for related samples (p = 0.05). The highest mean was observed in G2 (0.5982 g) and the lowest mean was observed in G1 (0.3074 g) at T2 and T3, respectively. Significant differences were observed between the groups at all times. Overall, 10CP caused variation in the enamel mass after a 100 % increase in the use time recommended by the manufacturer, with a decrease in mass when distilled water was used as the storage medium and an increase when artificial saliva was used.

RESUMEN: El objetivo fue investigar la influencia del blanqueamiento dental prolongado con peróxido de carbamida al 10 % (10CP) sobre la variación de masa del esmalte dental. Las muestras se dividieron en dos grupos: G1, diez dientes sanos de los incisivos bovinos (n = 5) en agua destilada, y G2, almacenamiento en saliva artificial. Las muestras se midieron en una escala analítica electrónica de precisión en los siguientes tiempos: T0-antes de la aplicación del gel blanqueador, T1-después de 14 días de blanqueo (el tiempo recomendado por el fabricante), T2-después de 21 días de blanqueo (aumento de 50 % en el tiempo recomendado por el fabricante), y T3-después de 28 días de blanqueo (aumento de 100 % en el tiempo recomendado por el fabricante). Los datos se presentaron al ANOVA para las muestras relacionadas (P = 0,5). La media más alta se observó en G2 (0,5982 g) y la media más baja se observó en G1 (0,3074 g) en T2 y T3, respectivamente. Se observaron diferencias significativas entre los grupos en todo momento. En general, la 10 CP causó variación en la masa del esmalte después de un aumento de 100 % en el tiempo de uso recomendado por el fabricante, con una disminución en la masa cuando el agua destilada se utilizó como medio de almacenamiento y aumentó cuando se usó saliva artificial.

Genes involved in amelogenesis imperfecta. Part II / Genes involucrados en la amelogénesis imperfecta. Parte II

ABSTRACT Amelogenesis imperfecta (AI) is a condition of genetic origin that alters the structure of tooth enamel. AI may exist in isolation or associated with other systemic conditions as part of a syndromic AI. Our goal is to describe in detail the genes involved in syndromic AI, the proteins encoded by these genes, and their functions according to current scientific evidence. An electronic literature search was carried out from the year 2000 to December 2017, pre-selecting 1,573 articles, 40 of which were analyzed and discussed. The results indicate that mutations in 12 genes are responsible for syndromic AI: DLX3, COL17A1, LAMA3, LAMB3, FAM20A, TP63, CNNM4, ROGDI, LTBP3, FAM20C, CLDN16, CLDN19. These genes participate in the coding of proteins involved in phosphorylation, ion exchange, and production and degradation of the constituent elements of the mineral and organic phase of tooth enamel. The scientific evidence confirms that AI can be part of the syndrome and requires special attention from the medical-dental community.

RESUMEN La amelogénesis imperfecta (AI) es una condición de origen genético que altera la estructura del esmalte dental. La AI puede existir de manera aislada o asociada a otras afecciones sistémicas en el contexto de una AI sindrómica. El objetivo es describir de manera detallada los genes involucrados en las AI sindrómicas, las proteínas codificadas por estos genes y sus funciones de acuerdo a la evidencia científica actual. Se realizó una búsqueda electrónica de literatura desde el año 2000 hasta diciembre de 2017, después de lo cual se preseleccionaron 1.573 artículos, de los cuales 40 fueron analizados y discutidos. Los resultados indican que mutaciones en 12 genes son responsables de una AI sindrómica: DLX3, COL17A1, LAMA3, LAMB3, FAM20A, TP63, CNNM4, ROGDI, LTBP3, FAM20C, CLDN16, CLDN19. Estos genes están implicados en la codificación de proteínas que participan en la fosforilación, intercambio de iones, y producción y degradación de los elementos constituyentes de la fase mineral y orgánica del esmalte dental. La evidencia científica confirma que la AI puede ser parte del síndrome y amerita una especial atención de la comunidad médica-odontológica.

Progress in clinical treatment and etiology of gingival recession / 口腔疾病防治

@#Gingival recession is one of the common oral symptoms. Periodontal soft tissue defects caused by gingival recession and problems related to aesthetics, prosthetics and orthodontic treatment have garnered increasing attention. This article reviews the etiology, classification and treatment of gingival recession to provide a reference for the diagnosis and treatment of gingival recession. Anatomical characteristics of teeth, bacterial and viral infection, Occlusion trauma, Improperbrushing methods and other daily behaviors and iatrogenic factors may lead to gingival recession. Miller classification is the most commonly used classification standard. It is divided into 4 degrees according to the relationship between gingival recession and the association between the gingival membrane and the loss of adjacent alveolar bone or interdental papilla. Gingival surgeries, such as coronally advanced flap, laterally positioned flap, subepithelial connective tissue graft for Miller Ⅰ degrees and Ⅱ gingival recession retreat, obtain a more satisfactory success rate. Regarding the Ⅲ degree gingival recession, the postoperative curative effect is poor and can only cover part of the root. Regarding Ⅳ degrees gingival recession, surgery cannot reach the root surface coverage. For patients with Miller Ⅳgingival recession caused by severe periodontitis, the surgical treatment is poor, and repair methods, such as sputum, can also be considered. In recent years, a variety of biological materials have been jointly applied to gingival surgery, such as tooth enamel matrix derivative (EMD), allograft acellular dermal matrix (ADM), porcine collagen matrix (PCM) and platelet-rich fibrin (PRF). The use of these biomaterials can improve root coverage, increase gingival thickness and keratinized gingival width, avoid the requirement of palatal flap removal, reduce the surgical risk and increase patient compliance.

Influence of Remineralizing Dentifrice in the Treatment of Erosive Enamel Lesions / Influência de Dentifrício Remineralizante no Tratamento de Lesões Erosivas em Esmalte

The objective of this in vitro study was to evaluate the influence of different remineralizing agents in the treatment of enamel erosive lesions. Specimens of 4mmx4mm and 3mm thickness were made from the buccal surface of bovine incisors (n=10) and randomly divided into 4 groups. G1 = application of the remineralizing dentifrice, G2 = application of the remineralizing agent, G3 = remineralizing dentifrice + remineralizing agente, G4 = application of fluoride varnish (positive control), G5 = no treatment Specimens were immersed in refrigerant solution during a period of 10 days. The surface roughness was analyzed by means of confocal laser scanning microscopy. The data were analyzed for homogeneity (Levene's) and normality (Kolmogorov-Smirnov). Parametric tests with analysis of variance were performed on two criteria: time factor and treatment factor, and Tukey post-test for differentiation of means. All tests were statistically significant at 5% (α = 0.05). The results showed statistically significant difference, demonstrating the reduction of surface roughness after the first treatment (G3) and the other groups (G1, G2 and G4) only after the second treatment. It was concluded that the use of dentifrice composed of calcium silicate and sodium phosphate influenced the roughness of the eroded tooth enamel of the bovine tooth. (AU)

O objetivo deste trabalho in vitro foi avaliar a influência de diferentes agentes remineralizantes no tratamento de lesões erosivas em esmalte. Foram confeccionados espécimes de 4mmx4mm e 3 mm de espessura a partir da superfície vestibular de incisivos bovinos (n=10) e divididos aleatoriamente em 4 grupos. G1=aplicação do dentifrício remineralizante, G2= aplicação do agente potencializador remineralizante, G3= dentifrício remineralizante + agente potencializador remineralizante, G4=aplicação de verniz fluoretado (controle positivo), G5=nenhum tratamento (controle negativo). Os espécimes foram imersos em refrigerante durante um período de 10 dias. A rugosidade superficial foi analisada por meio de microscopia confocal de varredura a laser. Os dados foram analisados quanto à homogeneidade (Levene's) e normalidade (Kolmogorov- Smirnov). Foram realizados testes paramétricos com análise de variância a dois critérios: fator tempo e fator tratamento, e pós-teste de Tukey para diferenciação das médias. Todos os testes estatísticos tiveram nível de significância de 5% (α=0,05). Os resultados obtidos mostraram diferenças estatisticamente significantes, demonstrando a redução da rugosidade da superfície do esmalte logo após o primeiro tratamento (G3) e para os demais grupos (G1, G2 e G4) somente após o segundo tratamento. Concluiu-se que a utilização de dentifrício composto por silicato de cálcio e fosfato de sódio influenciou na rugosidade do esmalte erodido do dente bovino. (AU).

Amelogénesis imperfecta en una familia / Amelogenesis imperfecta in a family

Introducción: la amelogénesis imperfecta consiste en un grupo de desórdenes hereditarios que afectan el desarrollo del esmalte dental, de tal forma que se ve comprometida la apariencia clínica de todos o casi todos los dientes, tanto temporales como permanentes. Objetivo: informar las características y condiciones clínicas de la dentición de tres individuos de una misma familia con diagnóstico presuntivo de amelogénesis imperfecta. Presentación de casos: se realizó examen intrabucal a tres individuos con rango de consanguinidad de primer grado (madre y dos hijos) quienes presentaban alterado estructuralmente el esmalte de los dientes. De acuerdo con las características clínicas dentales y el método de Witkop, los individuos fueron diagnosticados de forma presuntiva con amelogénesis imperfecta hipomadura tipo II (madre), caracterizada por hipomaduración del esmalte y fragmentación por desgaste en los bordes incisales; amelogénesis imperfecta hipoplásica tipo I (hijo mayor), con amplias zonas de dentina expuesta opaca y con manchas pardas generalizadas; y amelogénesis imperfecta hipomadura tipo II (hijo menor), con predominio de lesiones en forma de copo de nieve o motas de algodón. Conclusiones: el diagnóstico clínico de la amelogénesis imperfecta basado en métodos fenotípicos resulta impreciso debido a la imposibilidad de establecer el origen de las alteraciones macroestructurales del esmalte. Sin embargo, de acuerdo con la descripción de los tres casos, son las afecciones en la cantidad y calidad del esmalte las que permiten realizar un diagnóstico clínico presuntivo, que guía la implementación de un tratamiento odontológico direccionado a la solución del compromiso estético y a la prevención del compromiso del órgano dentino-pulpar. En esta presentación de casos, la manifestación fenotípica de la enfermedad pasó de la madre a ambos hijos, siendo la amelogénesis imperfecta hipomadura dominante en el hijo menor(AU)

Introduction: amelogenesis imperfecta consists of a group of hereditary disorders that affect the development of the dental enamel in such a way that the clinical appearance of all or almost all primary and permanent teeth is compromised. Objective: report the clinical characteristics and conditions of the dentition of three individuals from the same family with a presumptive diagnosis of amelogenesis imperfecta. Case presentation: intraoral examination was performed of three first-degree relatives (mother and two children) with structurally altered tooth enamel. Based on their clinical dental characteristics and the results of the Witkop method, the individuals were presumptively diagnosed with hypomaturation amelogenesis imperfecta type II (mother), characterized by enamel hypomaturation and fragmentation by wear on the incisal edges; hypoplastic amelogenesis imperfecta type I (elder son), with large areas of opaque exposed dentin and generalized brown spots; and hypomaturation amelogenesis imperfecta type II (younger son), with a predominance of lesions in the shape of snowflakes or cotton wads. Conclusions: clinical diagnosis of amelogenesis imperfecta based on phenotypic methods is imprecise, since it is not possible to establish the origin of the macrostructural alterations of the enamel. However, according to the description of the three cases, quantitative and qualitative damage to the enamel makes it possible to establish a presumptive clinical diagnosis which will guide the implementation of a dental treatment aimed at resolving the aesthetic commitment and preventing involvement of the dentine-pulp complex. In this case presentation, the phenotypic manifestation of the disease passed from the mother to both children, and hypomaturation amelogenesis imperfecta was dominant in the younger son(AU)

Efecto de agentes blanqueadores libres de peróxido sobre el color dental. Revisión sistemática / Effect of Peroxide-Free Dental Bleaching Agents on Dental Color. Systematic Review

Antecedentes: Los agentes blanqueadores oxidantes tales como los peróxidos generan daños irreversibles en el esmalte dental y afectan químicamente el componente orgánico e inorgánico del esmalte. Se reportan en la literatura sustancias alternativas que pueden mejorar el color del esmalte, sin causarle daño. Objetivo: Identificar las sustancias blanqueadoras tipo remineralizante reportadas en la literatura y su efecto en el color del esmalte dental. Métodos: Se consultaron las bases de datos PubMed, ScienceDirect, Embase, Scielo, Lilacs y Scopus, las palabras clave empleadas para la búsqueda fueron dental enamel, tooth bleaching, bleaching, calcium phosphate, hidroxyapatite, apatite, biomimetic, biomimetics, conectadas por el operador booleano AND y OR de diferentes maneras. Los criterios de elegibilidad de los artículos que harían parte de la revisión fueron que no incluyeran peróxidos de hidrógeno y carbamida con adición fluoruros y fosfatos de calcio y adicionalmente que emplearan un método de medición de color. Resultados: El resultado de la búsqueda arrojó 7 artículos, las sustancias encontradas de tipo remineralizante fueron hidroxiapatita sintética, fosfatos de calcio y el hexametafosfato de sodio. Según los criterios de evaluación definidos solo 4 de ellos tuvieron un nivel de evidencia alto, uno nivel medio y dos bajos. Todos los estudios reportan con los tratamientos probados, la capacidad de generar cambios en el color del esmalte dental. Conclusión: Las sustancias blanqueadoras remineralizantes encontradas, tienen la capacidad de producir cambios en el color del esmalte dental, lo cual se evidencia con modificación en las diferentes escalas de medición empleadas.

Background: Oxidizing bleaching agents such as peroxides generate irreversible damage to dental enamel and chemically affect the organic and inorganic component of the enamel. Alternative substances that can improve the color of the enamel without damaging it are reported in the literature. Purpose: To identify the remineralizing bleaching substances reported in the literature and their effect on the color of the dental enamel. Methods: The databases PubMed, ScienceDirect, Embase, SciELO, Lilacs and Scopus were consulted, the keywords used for the search were dental enamel, tooth bleaching, bleaching, calcium phosphate, hydroxyapatite, apatite, biomimetic, biomimetics, connected by the Boolean operator AND and OR in different ways. The eligibility criteria of the articles that would be part of the review were not to include hydrogen peroxide and carbamide peroxides with addition of fluorides and calcium phosphates and additionally using a color measurement method. Results: The result of the search yielded 7 articles, the substances found of remineralizing type were synthetic hydroxyapatite, calcium phosphates and sodium hexametaphosphate. According to the evaluation criteria defined, only 4 of them had a high level of evidence, one medium level and two low. All studies report with proven treatments the ability to generate changes in tooth enamel color. Conclusions: The remineralizing whitening substances found have the ability to produce changes in the color of the dental enamel, which is evidenced with modification in the different measurement scales used.

Infiltración de resina como tratamiento mínimamente invasivo de lesiones de caries dental incipiente / Resin infiltration as a minimally invasive treatment for incipient dental caries lesions

La mínima intervención en cariología ha sido definida como la filosofía de cuidados estomatológicos que se encarga del tratamiento de la primera aparición, la detección temprana y el tratamiento de la caries dental. Una de las técnicas para el tratamiento temprano y detención de lesiones incipientes es la infiltración de resina. El objetivo es mostrar la utilidad de las resinas fluidas para la infiltración de un primer y segundo molar inferior permanentes con una lesión incipiente de caries dental. Se trata de un paciente masculino de 17 años de edad sin antecedentes patológicos, que acude a consulta estomatológica. En hemiarcada inferior izquierda se observaron manchas en forma de punto de color marrón oscuro cerca de la fosita central y en la estría vestibular del 36 y 37 respectivamente, que no presentaban más de 1 mm de profundidad. Se diagnosticaron lesiones de caries dental incipiente y se decidió realizar una infiltración con resina compuesta de baja viscosidad o fluida en consulta única. El uso de resinas compuestas fluidas es beneficioso en la infiltración de lesiones cariosas incipientes de esmalte, pues evita su propagación y sella las brechas de esmalte afectado. Es una técnica de mínima intervención en cariología, que propicia una solución inmediata para estos procesos y mayor sencillez para la solución de la enfermedad caries dental al equilibrar las expectativas estéticas y de mantenimiento de las estructuras dentarias sanas(AU)

Minimal intervention in cariology has been defined as the philosophy of dental care that deals with the treatment of the first occurrence, early detection and treatment of dental caries. Resin infiltration is one of the techniques used for early treatment and arrest of incipient lesions. The objective is to show the usefulness of fluid resins for infiltration of a first and second lower permanent molar with an incipient dental caries lesion. A 17 year-old male patient with a healthy history attended dental consultation with dark brown point spots on the lower left hemiarch near the central pit and on the vestibular groove of 36 and 37, respectively, of not more than 1 mm in depth. Incipient dental caries lesions were diagnosed and it was decided to perform infiltration of low viscosity composite or fluid resin in a single visit. Use of fluid composite resins is suitable for infiltration of incipient enamel caries lesions, for it prevents spread and seals the gaps in the affected enamel. It is a minimal intervention technique in cariology providing immediate solution to these processes as well as greater ease to solve dental caries disease balancing esthetic expectations with expectations related to the maintenance of healthy dental structures(AU)

Wear properties of lithium disilicate glass-ceramic and bovine tooth enamel:An in vitro study / 实用口腔医学杂志

Objective:To investigate the wear characteristics of bovine enamel and lithium disilicate glass ceramic under simulated oral environment.Methods:18 cylindrical lithium disilicate glass-ceramic specimens with the length of 8 mm and diameter of 3 mm were randomly divided into 2 groups (n =9),9 lithium disilicate glass-ceramic specimens and 9 bovine enamel specimens were served as the antagonists respectively.The specimens were then loaded in a wear simulator and subjected to friction force of 10 N for 540 000 cycles in artificial saliva and room temperature(speed 100 r/min,turning radius of 2.5 mm,uniform circular motion) condition.During the testing,10 checkpoints were applied to measure the height loss of the specimens with 3D profilometer,then wear curves were plotted.Scanning electron microscopy were applied to investigate the worn surfaces at different wear stages.Results:At every checkpoints,bovine enamel wear height loss was larger than the lithium disilicate specimens (P ＜ 0.05);bovine enamel wear curve exhibits a runningin period,steady wear period and severe wear period 3 stages of wear,while wear curves of lithium disilicate glass ceramics exhibit onlyrunning-in period and steady wear period 2 wear stages.Both groups had the corresponding micro-morphological features in different periods.Conclusion:Bovine enamel and lithium disilicate glass ceramics show a phase dynamic evolution law under the simulated oral environment.Bovine enamel is more susceptible to wear than lithium disilicate,suggesting that clinical attention should be paid to prevent the excessive wear of natural teeth caused by lithium disilicate glass ceramic restorations.

Estudio comparativo in vitro de diferentes métodos de profilaxis y acondicionamiento del esmalte en la capacidad de adhesión de un sellador de fosas y fisuras / In vitro comparative study of different methods of prophylaxis and conditioning of enamel in the adhesiveness of a pit and fissure sealant

El objetivo de este estudio comparativo in vitro fue evaluar y comparar el efecto de diferentes métodos de profilaxis y acondicionamiento del esmalte, en la capacidad de adhesión de un sellador de fosas y fisuras fotopolimerizable. La porción coronaria de 50 premolares extraídos se seccionaron en dos mitades (vestibular y lingual) y se incluyeron en bloques de acrílico. Las muestras se dividieron en cinco grupos de acuerdo con los métodos de profilaxis: sin profilaxis, piedra pómez, gluconato de clorhexidina, pasta fluorada y limpiador por bicarbonato (air prophy); y técnicas de acondicionamiento del esmalte: grabado ácido con ácido fosfórico al 37% y adhesivo de autograbado. La fuerza de adhesión del sellador se midió en una máquina Instron® mediante una prueba de tracción. Los resultados no demostraron diferencias significativas en la resistencia a la tracción de acuerdo a las técnicas de acondicionamiento del esmalte utilizadas. En relación con los métodos de profilaxis estudiados, se observó que existieron diferencias significativas en los grupos tratados con pasta fluorada y limpiador por bicarbonato.

The aim of this in vitro comparative study was to evaluate and compare the effect of different methods of prophylaxis and conditioning of enamel, in the adhesiveness of a light-curing pit and fissure sealant. The coronal portion of 50 extracted premolars were sectioned into two halves (buccal and lingual) and embedded in acrylic blocks. The samples were divided into five groups according to the methods of prophylaxis: no prophylaxis, pumice powder, chlorhexidine gluconate, fluoridated paste and air prophy; and enamel conditioning techniques: etching acid with 37% phosphoric acid and self-etching adhesive. The sealant adhesion strength was measured using an Instron® machine for a tensile test. The results showed no significant differences in tensile strength according to the enamel conditioning techniques used. Regarding the methods of prophylaxis under study, a significant difference in groups treated with fluoridated paste and air prophy was observed.

Iatrogenic Effects of Orthodontic Procedures on Enamel: A Review.

Orthodontic treatment has the potential to cause some damage to dental enamel during cleaning with abrasives before bonding of brackets, the acid etching process itself, enamel fractures caused by forcibly removing brackets or debonding procedures, mechanical removal of composite remnants with rotary instruments or in the rebonding of failed brackets. In addition the enamel surface may be demineralised as the result of bacterial biofilm around orthodontic attachments and also may get worn or eroded due to contact more commonly with ceramic brackets. Structural damage may also be caused intentionally by clinicians when reducing enamel by interproximal enamel stripping. Clinicians should make every effort to minimize damage to tooth enamel.

Avaliação comparativa da ultraestrutura e propriedades físicas do esmalte bovino, bubalino e humano / Benchmarking of the ultrastructure and physical properties of bovine, buffalo and human enamel

Este estudo teve como finalidade comparar a morfologia e propriedades físicas da estrutura do esmalte dos dentes bovinos, bubalinos e humanos. A análise deste tecido foi realizada por meio de microscopia eletrônica de varredura, composição mineral, microdureza e rugosidade superficial do esmalte em 41 incisivos bubalinos (Bos taurus indicus), 41 incisivos bovinos (Pelorovis antiques) e 30 incisivos permanentes de humanos. Os resultados mostraram que a ultraestrutura do esmalte revela uma significativa similaridade das espécies estudadas com a encontrada em amostras humanas. No esmalte bovino e bubalino os elementos químicos que apresentaram maior concentração foram: O, Ca e P, justamente os que formam os cristais de hidroxiapatita - Ca10(PO4)6(OH)2. Na microdureza Knoop não houve diferença estatisticamente significante entre as três espécies. Porém, a rugosidade superficial do esmalte bubalino (2,16µm ±0,23) foi significativamente maior quando comparada aos dentes humano (0,36µm ±0,05) e bovino (0,41µm ±0,07). Conclui-se que as características e propriedades do esmalte bovino e bubalino, por meio de análises e testes, apresentou uma morfologia semelhante à de humanos, arquitetura ultraestrutural similar, microdureza e composição mineral equivalente ao tecido dental humano, tornando-se modelos de referência para pesquisas.

This study aimed to compare the morphology and physical properties of the enamel structure of bovine, buffalo and human teeth. Analysis of this tissue was performed by scanning electron microscopy, mineral composition, microhardness and surface roughness of enamel in 41 buffalo incisors (Bos taurus indicus), 41 bovine incisors (Pelorovis antiques), and 30 human permanent incisors. The results showed a significant similarity between the ultrastructure of enamel in these animal species and the one found in human samples. The chemical elements which presented higher concentration in bovine and buffalo enamel were: O,Ca and P, precisely those that form hydroxyapatite crystals - Ca10 (PO4)6 (OH)2. Knoop microhardness values showed no statistically significant differences between the three species. However, the surface roughness of buffalo enamel (2.16µm ±0.23) was significantly higher when compared with human (0.36µm ±0.05) and bovine teeth (0.41µm ±0.07). It is concluded that the characteristics and properties of bovine and buffalo enamel, as obtained from our analysis and testing, showed a similar morphology to that of humans. They showed a similar ultrastructural architecture, microhardness and mineral composition equivalent to the human dental tissue, becoming reference models for research.

Shear bond resistance and enamel surface comparison after the bonding and debonding of ceramic and metallic brackets

OBJECTIVE: To evaluate, in vitro, the shear bond strength presented by three brands of polycrystalline ceramic brackets and one brand of metallic bracket; verify the adhesive remnant index (ARI) after the tests, and analyze, through scanning electron microscopy (SEM) the enamel surface topography after debonding, detecting the release of mineral particles. METHODS: Sixty bovine lower incisors were used. Three ceramic brackets (Allure(r), InVu(r), and Clarity(r)) and one metallic bracket (Geneus(r)) were bonded with Transbond XT(r). Kruskal-Wallis's test (significance level set at 5%) was applied to the results of share bond and ARI. Mann Whitney's test was performed to compare the pairs of brackets in relation to their ARI. Brown-Forsythe's test (significance level set at 5%) was applied to the results of enamel chemical composition. Comparisons between groups were made with Games-Howell's and the Post-hoc tests. RESULTS: No statistically significant difference was observed in relation to the shear bond strength loads. Clarity(r) brackets were the most affected in relation to the surface topography and to the release of mineral particles of enamel (calcium ions). CONCLUSION: With regard to the ARI, there was a prevalence of score 4 (40.4%). As for enamel surface topography, the Geneus(r) bracket was the only one which did not show superficial tissue loss. The InVu(r) and Clarity(r) ones showed cohesive fractures in 33.3% and the Allure(r) in 50%, the latter being the one that presented most fractures during removal. .

OBJETIVO: avaliar, in vitro, a resistência ao cisalhamento apresentada por três marcas de braquetes ortodônticos cerâmicos policristalinos e uma marca de braquete metálico, verificando os índices de resina remanescentes (IRA) após os ensaios, e analisar, por meio de microscopia eletrônica de varredura, as topografias superficiais do esmalte após a descolagem, detectando o desprendimento de partículas minerais desse. MÉTODOS: foram utilizados 60 incisivos inferiores bovinos. Os braquetes cerâmicos (Allure, InVu e Clarity) e metálico (Geneus) foram colados utilizando-se o adesivo Transbond XT. Para os resultados referentes ao cisalhamento e ao IRA, foi utilizado o teste de Kruskal-Wallis, com nível de significância de 5%. A prova de Mann-Whtiney foi utilizada para comparar os diferentes tipos de braquetes aos pares, quanto ao IRA. Para a análise dos resultados referentes às composições químicas do esmalte, aplicou-se o teste de Brown-Forsythe, com significância de 5%. As comparações entre os grupos foram realizadas utilizando os testes Post Hoc e de Games-Hoewell. RESULTADOS: não foram observadas diferenças significativas quanto às cargas de cisalhamento. O Clarity foi o mais afetado em relação à topografia e ao desprendimento de partículas minerais do esmalte (íons Ca). CONCLUSÃO: em relação ao IRA, foi confirmada a prevalência do escore 4, com um percentual de 40,4%. Em relação à topografia superficial do esmalte, o Geneus foi o único que não apresentou perda de tecido . O InVu e o Clarity apresentaram fraturas coesivas de 33,3% de suas amostras, e o Allure de 50%, sendo o que mais fraturou durante a remoção. .