Influência da adição de partículas de vidro bioativas em adesivos resinosos, na cimentação de bráquetes ortodônticos / Influence of the addition of bioactive glass particles in resin adhesives in the cementation of orthodontic brackets

O objetivo deste estudo foi desenvolver e avaliar um adesivo resinoso modificado com a incorporação de partículas de vidro bioativas (SCHOTT Bioactive Glass) em diferentes concentrações. Foram avaliados a resistência ao cisalhamento (RU), o índice de remanescente dentário (IRA), o grau de conversão (GC) e a liberação de cálcio. Foram utilizados 50 incisivos bovinos que foram fixados, através de suas raízes, em um molde de PVC, com resina acrílica autopolimerizável. As amostras foram alocadas em 5 grupos (n=10): TXT - Adesivo Transbond XT (3M Unitek, Monrovia, CA, EUA) sem adição de partículas de vidro bioativas, TXT20, TXT30, TXT50 ­ Adesivo Transbond XT acrescido respectivamente de 20%, 30% e 50% de partículas de vidro bioativas e SH - Adesivo resinoso FL BOND ll (SHOFU Inc.) com biomaterial SPRG. As amostras receberam uma profilaxia com pedra pomes e condicionamento com ácido fosfórico à 37%. Em seguida foi aplicada uma fina camada do sistema adesivo indicado na face vestibular dos incisivos bovinos, em todos os grupos e fotopolimerizado por 20 segundos, utilizando-se um fotopolimerizador RADII-Cal (SDI, Victoria, Austrália). Depois foi aplicada uma pequena quantidade de pasta resinosa fotopolimerizável Transbond XT (3M Unitek, Monrovia, CA, EUA) sobre a superfície dos bráquetes autoligados (MORELLI, Sorocaba, São Paulo, Brasil) e estes foram devidamente colados na face vestibular, no centro da coroa clínica do incisivo bovino e fotopolimerizado por 20 segundos, em cada face. Posteriormente as amostras foram submetidas ao teste de resistência ao cisalhamento. O índice de remanescente adesivo foi avaliado em estereomicroscópio DISCOVERY V20 (ZEISS). Os adesivos resinosos foram submetidos ao teste de grau de conversão e liberação de cálcio. Os dados foram inicialmente submetidos ao teste de normalidade e depois submetidos ao teste de ANOVA um fator, seguido do teste de Tukey para análise de comparações múltiplas, com nível de significância de 0,05. De acordo com os resultados obtidos na resistência de união ao cisalhamento (MPa±Dp) a maior média foi observada no grupo TXT 19,50±1,40A, seguida do grupo TXT20 18,22±1,04AB, seguida do grupo SH 17,62±1,45B, seguida do grupo TXT30 14,48±1,46C e a menor média TXT50 14,13±1,02C. No grau de conversão a maior média foi observada no grupo TXT20 73,02±3,33A que foi estatisticamente semelhante ao grupo SH 68,50±1,09A, seguida do grupo TXT 60,28±1,06B e TXT30 58,84±4,06B e a menor média foi do grupo TXT50 40,67±1,21C.Para a liberação de cálcio a maior média foi TXT50 2,23±0,11D, seguida por TXT30 0,74±0,00C, TXT20 0,55±0,00B, SH 0,47±0,04B e TXT 0,14±0,00A. Concluiu-se que a incorporação de partículas de vidro bioativas influenciou na resistência de união ao cisalhamento, no grau de conversão e na liberação de cálcio (AU).

The objective of this study was to develop and evaluate a resin adhesive modified with the incorporation of bioactive glass particles (SCHOTT Bioactive Glass) in different concentrations. Shear bond strength (SBS), adhesive remnant index (ARI), degree of conversion (DC) and calcium release were evaluated. Fifty bovine incisors were used, which were fixed through their roots in a PVC mold with self-curing acrylic resin. The samples were allocated into 5 groups (n=10): TXT ­ Transbond XT Adhesive (3M Unitek, Monrovia, CA, USA) without addition of bioactive glass particles, TXT20, TXT30, TXT50 ­ Transbond XT Adhesive rescpectively increased by 20%, 30% and 50% bioactive glass particles and SH ­ FL BOND ll resin adhesive (SHOFU Inc.) with SPRG biomaterial. The samples received prophylaxis with pumice stoe and conditioning with 37% phosphoric acid. Then, a thin layer of the indicated adhesive system was applied to the buccal surface of the bovine incisors, in all groups, and light cured for 20 seconds, using a RADII-Call curing light (SDI, Victoria, Australia). Then, a small amount of Transbond XT light-curing resinous paste (3M Unitek, Monrovia, CA, USA) was applied on the surface of the self-ligating brackets (MORELLI, Sorocaba, São Paulo, Brazil) and these were duly bonded on the buccal surface, in the center of the clinical crown of the bovine incisor and light cured for 20 seconds, on each side. Subsequently, the samples were submitted to the shear bond test. The adhesive remnant index was evaluated using a DISCOVERY V20 stereomicroscope (ZEISS). The resin adhesives were submitted to the degree of conversion and calcium release test. The data were initially submitted to the normality test and then submitted to the one-way ANOVA test, followed by the Tukey test for analysis of multiple comparisons, with a significance level of 0.05. According to the results obtained in the shear bond strength (MPa±Dp), the highest average was observed in the TXT group 19.50±1.40A, followed by the TXT20 group 18.22±1.04AB, followed by the SH group 17.62±1.45B, followed by the TXT30 group 14.48±1.46C and the lowest mean TXT5014.13±1.02C. In the degree of conversion, the highest average was observed in the TXT20 73.02±3.33A group, wich was statiscally like the SH group 68.50±1.09A, followed by the TXT 60.28±1.06B and TXT30 group 58.84±4.06B and the lowest mean was for the TXT50 group 40.67±1.21C. For calcium release, the highest mean was TXT50 2.23±0.11D, followed by TXT30 0.74±0.00C, TXT20 0.55±0.00B, SH 0.47±0.04B and TXT 0.14±0.00A. It was concluded that the incorporation of bioactive glass particles influenced in the shear bond strength, in the degree of conversion and in the release of calcium (AU).

Experimental study on the therapeutic effect of different bleaching methods on white-spot lesions of the enamel using optical coherence tomography / 口腔医学

Objective@#To investigate the efficacy of different bleaching methods on white-spot lesions of the enamel using optical coherence tomography and to evaluate its feasibility for monitoring the therapeutic effects on white-spot lesions. @*Methods@#Forty-eight sound premolars extracted for orthodontic reasons were selected and cut for 4 mm×4 mm×2 mm enamel blocks in buccal surfaces of the crowns. The samples were covered with acid-resistant varnish (except for the buccal surfaces) and immersed in demineralization solution for 18 days to establish the white-spot lesion models of the enamels. Samples were randomly divided into four groups (n=12). Group A was given demineralization only. Specimens in Group B, C and D were treated with 40% hydrogen peroxide, resin infiltration and 40% hydrogen peroxide combined with resin infiltration, respectively. Eight samples in each group were randomly selected. OCT was applied to observe the optical changes of the enamel surface and according to the OCT scanning results, the demineralization depth of enamel samples in each group was calculated. Then, the enamel blocks were embedded in epoxy resins, except the buccal surfaces, and measured for the microhardness values of the enamel surface by a microindentation hardness tester. Four samples in each group were cut longitudinally, and the ultrastructural changes of enamel samples in each group were observed by scanning electron microscope. @* Results@#OCT showed that the light scattering characteristics of enamel surface changed in all groups, and the bright layer was formed, but the thickness of bright layer in Group C and D was significantly lower than that in Group A and B (P<0.05). The microhardness values (kg/mm2) of the samples in Group A-D were (214.99±31.70), (250.66±33.64), (312.42±18.01) and(286.53±26.65), respectively. The microhardness of enamel surfaces in Group C and D was significantly higher than that in Group A and B (P<0.05), and the ultrastructure of enamel surfaces in Group C and D were more flat and dense in SEM observation (P<0.05). @*Conclusion@#The methods of resin infiltration therapy or 40% hydrogen peroxide combined with resin infiltration could effectively improve white-spot lesions of the enamel and the non-invasive OCT can be used as a better evaluation method for the diagnosis and treatment of white-spot lesions of the enamel.

Effectiveness of Laser Fluorescence–Based Device in Detecting the Extent of Re-Mineralisation in Primary Teeth Compared to the Conventional Method: An In vitro Study

Background: Laser fluorescence (LF)–based clinical device DIAGNOdent™ is at present being used to detect caries. Can the same be used to detect therapeutic remineralisation of early white spot lesions? Aims: To explore the feasibility of using LF?based device in monitoring the changes following remineralisation of demineralised primary teeth. Materials and Method: The sample number for the present experimental in vitro study was 10. The LF based device readings were correlated with surface microhardness (SMH) test values to evaluate its efficiency. SMH analysis was performed using a microhardness tester (Tescol?HT1000AD). All the samples were demineralised, followed by remineralisation using fluoride varnish and pH cycling. The data was analysed using the Statistical Package for the Social Sciences (SPSS) version 17.0 (IBM SPSS®) software. Paired t?test was performed to compare laser fluorescence readings and SMH test result values at baseline, after demineralisation, and after remineralisation. Pearson’s correlation was used to compare the relation between the laser fluorescence and SMH test. Results: A good negative correlation was seen between the two methods at the baseline readings even though it was not statistically significant (P = 0.069). A positive correlation between the methods existed following demineralisation which was not significant (P = 0.074). The correlation between the parameters following remineralisation showed a moderate negative correlation but was not significant (P = 0.55). Conclusion: DIAGNOdent™ values at baseline, after demineralisation, and after remineralisation was consistent with SMH values. Thus, DIAGNOdent™ can be explored to provide chairside assistance in identifying remineralisation of white spot lesions.

Lasers for Prevention of White Spot Lesion: A Scoping Review

@#Lasers have been identified as one of the preventive tools that can be utilised to prevent white spot lesion in orthodontic practice. The aim of this scoping review was to evaluate the current scientific literature on the use of lasers specifically to prevent white spot lesion in orthodontic cases. Search was performed in PubMed, Web of Science, Scopus and EBSCO databases from the past ten years. The records obtained were peruse considering specific inclusion and exclusion criteria. From the total of 1123 studies that were evaluated, 68 papers were included for this review. A variety of laser types has been reported including Er;YAG, Er,Cr:YSGG, Argon and CO2 lasers. CO2 laser has a good number of evidence of it’s positive result and can be suggested to be use in clinical practise. However, since most data for the other type of lasers were derived from in vitro studies, they must be interpreted with care. Randomised clinical trials would be beneficial to give more meaningful evidence for clinicians to adopt lasers in their practice.

Remineralizing potential of CPP-ACP in white spot lesions – A systematic review

The aim of this systematic review was to assess the long term remineralizing potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) only in paste form compared with fluoride varnish, and or placebo in both naturally occurring and post-orthodontic white spot lesions in vivo. Data Sources: The literature search covered the electronic databases: PubMed and Google scholar from 2005-2016. Only articles published in English were included. Randomized control trials in which CPP-ACP delivered by paste form were included. All studies which met inclusion criteria underwent two independent reviews. Study Selection: Two ninety five articles were identified from the search after excluding duplications. Abstracts of forty one articles were reviewed independently. Twenty nine articles were excluded after reading abstract. Full text articles were retrieved for fifteen relevant studies. After reviewing articles independently, three articles were excluded after full text reading. Finally twelve studies were selected based on the eligibility criteria. The remineralizing effect of CPP-ACP were compared with placebo and fluoridated toothpaste and fluoride varnish in randomized control trial. Conclusion: A high level evidence of remineralizing potential of CPP-ACP on naturally occurring white spot lesion and WSL post orthodontic treatment was found in comparison with placebo/fluoridated toothpaste and fluoride varnish without any statistically significant difference. Well-designed RCTs are, therefore, required to improve the level of evidence in this area.

Infiltration of white-spot-lesions and developmental enamel defects

ABSTRACT: Purpose: To provide an overview of different indications suitable for treatment with the technique of resin infiltration (Icon, DMG), such as white-spot lesions (WSL), enamel fluorosis, and molar-incisor hypomineralisation (MIH), and to propose a valid and strategy feasible in dental surgeries for screening of dental color improvement and -stability. Method: A non-systematic review of the literature was performed to characterise inhibition of lesion progression, and the esthetic effects induced by resin infiltration of decalcified enamel, enamel fluorosis, and molar-incisor hypomineralisation (MIH), using the online database Pubmed and a suitable search strategy. Database search was complemented by a hand-search of references of retrieved articles. Results: Of 34 retrieved articles, 29 were included in the review. Evidence of an assimilation of WSL color to surrounding enamel following infiltration is available on the level of RCTs, and the results were found to be stable in color with no significant changes over at least twelve months. Evidence of an esthetic improvement of fluorotic or MIH affected teeth is available on the level of case reports and case control studies. Conclusion: As a micro-invasive approach to infiltrate and seal different types of enamel lesions, with a subsequent improvement of the esthetic appearance, resin infiltration is considered to be a useful complementation of the dental therapeutic specter.

Remineralization effect of casein phosphopeptide-amorphous calcium phosphate for enamel demineralization: a system review / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study  aims  to  assess  the  remineralization effect of casein phosphopeptide (CPP)-amorphous calcium phosphate (ACP) on enamel demineralization by  performing  system review of  randomized  controlled  trials (RCT)  involving  the  treatment of enamel demineralization with  CPP-ACP.</p><p><b>METHODS</b>The  study  was  developed  based  on  the 
Cochrane handbook  for  systematic  reviews of  interventions (Version 5.1.0) and included  the  following: search  strategy, selection  criteria, data  extraction, and  risk  of  bias  assessment. We  searched electronic  databases  such  as  PubMed, Embase, Cochrane Library, CNKI, Wanfang and VIP up  to  September  2016. RCT of  treating  enamel demineralization with  CPP-ACP were  included. Data  extraction  and  domain-based  risk  of  bias  assessment  were independently  performed  by  two  reviewers.</p><p><b>RESULTS</b>Twelve  RCTs  were  included.  Because of the difference of experimental design and evaluation standards, the quantitative analysis can not be carried out.</p><p><b>CONCLUSIONS</b>There is no strong evidence that CPP-ACP is superior to conventional fluoride formulations in enamel remineralization. However, due  to the limitations of sample size, follow-up time and study design,  more high quality and large-sample RCT are needed to  further  verify  the evidence.</p>

Oral findings in West syndrome ­ A Case Report / Achados bucais na síndrome de West- Relato de um caso

West syndrome is a severe form of epilepsy syndrome which is characterized by a triad of infantile spasms, characteristic EEG findings (Hypsarrhythmia) and developmental delay. Minimal literature is available on dental findings of West syndrome. This case report presents an eight year old male child with cryptogenic form of West syndrome having a history of multiple clusters of infantile spasms. Orodental manifestations of west syndrome have been described and its dental management has been discussed in this report. (AU)

A síndrome de West é uma forma severa da síndrome de epilepsia que é caracterizada pela tríade de espasmos infantil, achados EEG (hipsarritimia) e atraso no desenvolvimento. A literatura disponível é escassa a respeito dos achados dentais e manejo da síndrome de West. Este caso relata uma criança de 8 anos de idade, masculino com a forma criptogênica da síndrome de West com história de múltiplos episódios de espasmos infantis e achados dentais típicos. O tratamento odontológico do caso é discutido e mediadas preventivas e tratamento da síndrome de West é descrito. (AU)

Management of post-orthodontic white-spot-lesions: clinical handling of the resin infiltration technique (Icon®, DMG) / Manejo de lesiones de manchas blancas post-ortodoncia: manejo clínico de la técnica de infiltración de resina (Icon, DMG)

To treat initial caries lesions using the technique of resin infiltration for a restoration of natural enamel appearance. Case report of a 19 year old female who presented with moderate post-orthodontic white-spot lesions (WSLs) at the upper central and lateral incisors following two years of active treatment with a fixed orthodontic appliance, and requested an aesthetic improvement of decalcified enamel surfaces. The technique of resin infiltration (Icon®, DMG, Hamburg, Germany) is presented as a means for not only inhibiting lesion progression, but also for an adequate rehabilitation of dentofacial esthetics. Practical tips and cues for clinical handling of the infiltration technique are provided. Resin infiltration augments the therapeutic spectrum for orthodontist as well as pediatric or general dentists in that enamel areas affected by post-orthodontic WSLs can be restored to their original appearance.

El objetivo fue mostrar el tratamiento de lesiones de caries iniciales usando la técnica de infiltración de resina para una restauración de la apariencia natural del esmalte. Reporte de caso de una joven de 19 años de edad, de sexo femenino que presentó lesiones moderadas de manchas blancas (WSLs) en los incisivos centrales y laterales superiores, luego del tratamiento de ortodoncia con aparatos fijos por dos años, y solicitó una mejoría estética de las superficies descalcificadas del esmalte. La técnica de infiltración de resina (Icon®, DMG, Hamburgo, Alemania) se presenta como un medio efectivo, no sólo para inhibir la progresión de la lesión, sino también para una rehabilitación adecuada de la estética dentofacial. Se proporcionan además consejos prácticos y claves para el manejo clínico de la técnica de infiltración. La infiltración de resina aumenta el espectro terapéutico del ortodoncista, así como de odontopediatras y odontólogos generales en las áreas del esmalte afectadas con WSLs post-ortodoncia y que pueden ser restauradas a su apariencia original.

Measuring color change of tooth enamel by in vitro remineralization of white spot lesion / Medición del cambio de coloración del esmalte dental en la remineralización in vitro de la lesión incipiente de caries

Abstract: objective colour determination is based on calculating the colorimetricdistance (Delta E) within a colour space. So far, the most used colour space in dentistry is CIE L*a*b (Comission Internationale de l´Éclairage). CIE L*C*h* has been recently developed, showing a better correlation with the perception of the human eye. Objective: To determine the ability of an in vitro remineralisation substance to blend the colour of white spot lesions (WSL) with sound enamel, determining Delta E by using the CIE L*C*h* colour space. Methods: In vitro WSL was generated by immersing 10 samples obtained from human third molars in a demineralization solution for 72h. Amorphous calcium phosphate stabilized by casein phosphopeptide (CPP-ACP) was then applied for 60 days while maintaining the samples in artificial saliva at 37ºC. To evaluate the colour of enamel, images were taken from the samples placed in specifically designed silicone moulds after generating the WSL (pre-stage) and after remineralisation by scanning, applying the colorimetric distance equation (Delta E*CMC) according to the Colour Measurement Committee. Results: Treatment with CPP-ACP caused a significant Delta E decrease with respect to the pre-stage (p smaller than 0.001), while the analysis of parameters that make up the colour showed a reduction in the difference of hue (Delta H) (p smaller than 0.001) and brightness (Delta L) (p smaller than 0.01) after applying CPP-ACP. Discussion: CPP-ACP penetrated to the depth of the white spot lesion, making its appearance similar to that of the sound enamel, probably because of the formation of different mineral phases than that of the original structure, although pores were not completely filled.

Resumen: la determinación objetiva del color se basa en el cálculo de la distancia colorimétrica (Delta E) dentro de un espacio cromático. Hasta el momento el más usado en odontología ha sido CIE L*a*b (Comission Internationale de l´Éclairage). Recientemente se ha desarrollado CIE L*C*h*, que tiene mayor correspondencia con la percepción del ojo humano. Objetivo: evaluar la capacidad de una sustancia remineralizante de mimetizar el color de la mancha blanca (MB) in vitro con el esmalte sano, determinando Delta E mediante el espacio cromático CIE L*C*h*. Método: se generó la MB in vitro sumergiendo 10 muestras obtenidas de terceros molares humanos en solución desmineralizante durante 72 h., luego se aplicó pasta con fosfato de calcio amorfo estabilizado por fosfopéptidos de caseína (CPP-ACP) durante 60 días manteniendo las muestras en saliva artificial a 37ºC. Para evaluar el color, se obtuvieron imágenes de las muestras ubicadas en moldes de silicona confeccionadas ad hoc luego de generar la MB (etapa pre) y del protocolo remineralizante (etapa post) mediante escáner y se aplicó la ecuación de Distancia colorimétrica según Color Measurement Committee. (Delta E*CMC). Resultados: el tratamiento con CPP-ACP provocó una disminución significativa de Delta E respecto de la etapa pre (p menor que 0,001) mientras que el análisis de los parámetros que componen el color mostró disminución en la diferencia del tono (Delta H) (p menor que 0,001) y la luminosidad ( Delta L ) (p menor que 0,01) luego de aplicar CPP-ACP. Discusión: CPP-ACP penetró a la profundidad de la lesión, acercando la apariencia de la MB a la del esmalte sano, probablemente por la formación de fases minerales distintas a las de la estructura original aun cuando lo poros no hayan sido completamente rellenados.

Toxicidad sistémica por anestésicos locales / Systemic toxicity by local anesthetics

Los anestésicos locales son medicamentos de uso generalizado y, aunque se consideran seguros, ocasionalmente pueden producir toxicidad con alteración del sistema nervioso central y cardiovascular y potencial compromiso de la vida. La prevención parece haber disminuido la toxicidad de los anestésicos locales y es más efectiva que el tratamiento. El manejo de la toxicidad sistémica por anestésicos locales se basa en medidas de reanimación y soporte, aunque las emulsiones lipídicas emergen como antídoto efectivo. El objetivo de este artículo es revisar las medidas disponibles según la evidencia actual, consistentes en soporte cardiopulmonar, manejo de convulsiones y uso de antídoto (emulsiones lipídicas).

Toothpastes use for caries prevention are considered the most effective preventive strategy, although it is necessary to implement appropriate protocols based on individual risk, severity and age of the child, in order to prevent irreversible side effects. The purpose of this study was to evaluate the remineralizing effects on white spot lesions of fluoridated toothpastes.

Evaluation of the antimicrobial and physical properties of an orthodontic photo-activated adhesive modified with an antiplaque agent: An in vitro study.

Introduction: This study was designed to investigate the antimicrobial and physical properties of orthodontic composite resin modified by the addition of an antimicrobial agent. Materials and Methods: Transbond XT (3M Unitek), a photo‑activated, light‑cured composite resin, modified by the addition of chlorhexidine, in concentrations 2.5 wt% was formed into a uniform disc and also used for direct bonding of the brackets on the freshly extracted premolars for testing. The tablets of each group and a control group were subjected to the agar plate diffusion test to measure the zone of bacterial inhibition. In addition, they were incubated for 24 h in brain heart infusion medium inoculated with Streptococcus mutans and examined for antimicrobial action. A total of 80 extracted premolars were collected and divided into two sets of 40 teeth each. Stainless steel preadjusted edgewise appliance (PEA) brackets were bonded by using control and experimental composites. A universal testing machine was used to determine the shear bond strength. The first set of teeth was tested after 24 h and the second set after 25 days of storage in distilled water. Time‑dependent release of antimicrobial agents from the modified composites was also monitored spectrophotometrically. Results: The findings indicated that (1) addition of chlorhexidine to the orthodontic composite resin enhanced its antimicrobial properties, (2) there was no significant difference between the bond strengths of the control and the experimental resins tested after 24 h and 25 days and (3) maximum release of chlorhexidine from the modified resin was much higher than the minimum inhibitory concentration level.

Eficacia de cremas dentales con fluoruros sobre lesiones de mancha blanca, ensayo clínico aleatorizado / Toothpaste efficacy with different Fluoride concentrations on white spot lesions, a randomized clinical trial

Introducción y objetivo: El uso de cremas dentales para prevención de caries es considerada la estrategia preventiva de mayor eficacia, aunque es necesario implementar protocolos adecuados al riesgo individual, gravedad de la lesión y edad del niño, para prevenir efectos secundarios irreversibles. Evaluar los efectos remineralizantes de las cremas dentales fluoradas sobre lesiones de mancha blanca. Materiales y métodos: Ensayo clínico aleatorizado doble ciego en 112 lesiones de mancha blanca en superficies lisas, las cuales recibieron 4 tipos de cremas dentales de (0, 500, 1100 y 1500 ppm de flúor). Los participantes fueron seleccionados de una población colombiana con alto riesgo de caries y evaluados durante seis semanas. Para medir la variable respuesta se utilizaron criterios visuales ICDAS; progresión, estabilidad y reversión. Las diferencias de proporciones entre grupos se analizaron con la prueba exacta de Fisher. Las diferencias en promedios de placa se analizaron con Kruskall Wallis y las diferencias antes-después de cada intervención con McNemar. El análisis multivariado se realizó por medio de la regresión logística. Resultados: Se encontró diferencias sólo en la sexta semana, siendo más alta la probabilidad de revertir las lesiones para el grupo tratado con crema dental de 1500 ppm de flúor. Entre los grupos que recibieron bajo o ningún contenido de flúor no hubo diferencias. Conclusiones: Las pastas dentales con alto contenido de flúor producen un mejor efecto de reversión de las lesiones, pero este efecto es equilibrado con el resto de los grupos después de seis semanas. Los efectos producidos con bajo contenido de flúor y sin flúor son similares, lo que muestra la importancia de la eliminación mecánica de la placa dental.

Introduction and objective: Toothpastes use for caries prevention are considered the most effective preventive strategy, although it is necessary to implement appropriate protocols based on individual risk, severity and age of the child, in order to prevent irreversible side effects. The purpose of this study was to evaluate the remineralizing effects on white spot lesions of fluoridated toothpastes. Materials and methods: A double blind randomized clinical trial was carried out in a Colombian high caries risk population; 112 white spot lesions assigned to four groups of toothpastes (0, 500, 1100, 1500 ppm) fluoride were assessed. ICDAS visual criteria which included progression, stability or reversal of the initial lesions were used in order to measure the response variable. Differences in proportions between groups were analyzed with Fisher´s test, the differences in dental plaque with Kruskall Wallis test and the McNemar test was used to compare differences before and after intervention. A multivariate analysis was performed with logistical regression. Forma de citar: Carmona-Arango LE, González-Martínez F, Lujan-Pardo MP. Eficacia de cremas dentales con fluoruros sobre lesiones de mancha blanca, ensayo clínico aleatorizado. Results: A statistical significance was found only at six weeks, with the possibility of reversal of the lesions higher for the group treated with 1500 ppm. Between the groups which received low content fluoride toothpastes and without fluoride there were no differences. Conclusions: Toothpastes with high ppm fluoride content produce a better effect at the beginning of the follow up period by reversal of white spot lesions, which is then balanced with the other groups with lower fluoride content, after six weeks. However, differences we observed between the effects produced with low and moderate fluoride content and without fluoride toothpastes, which reveals the importance of mechanical dental plaque removal.

Remineralização de lesões de mancha branca adjacentes aos bráquetes ortodônticos / Remineralization of white spot enamel lesions adjacent to fixed orthodontic appliance

Avaliar e quantificar, in vitro e in vivo, o efeito remineralizador de produtos fluoretados e antimicrobianos sobre lesões de mancha branca adjacentes ao bráquete ortodôntico. Materiais e métodos: Para o estudo in vitro, bráquetes ortodônticos metálicos foram colados em 30 pré-molares hígidos que foram submetidos a indução artificial de mancha branca e divididos aleatoriamente em 3 grupos (n=10): controle (GC), verniz fluoretado (VF) e clorexidina gel 2% (CHX). O processo de des-remineralização dos dentes foi quantificado por QLF (Quantitative Light-Induced Fluorescence) utilizando-se os valores de Delta F, %. Para o estudo in vivo foram selecionados trinta pacientes adolescentes (n=56 lesões) com idade media de 17.2 ± 2.3 anos, alocados aleatoriamente em três grupos: verniz fluoretado (VF), clorexidina gel 2% (CHX) ou pasta dental fluoretada – controle (CO). O processo de des-remineralização dos dentes foi avaliado e quantificado pelo exame visual com critérios Nyvad (NY) e DIAGNOdent Pen 2190 (DDpen). Tanto para o estudo in vitro quanto para o in vivo, os respectivos produtos foram aplicados sobre as lesões de mancha branca duas vezes, com intervalo de uma semana. Resultados: No estudo in vitro observou-se um aumento nos valores de fluorescência (Delta F, %) nos três grupos, sendo que as lesões tratadas com verniz fluoretado apresentaram uma resposta mais favorável à remineralização. No in vivo, os resultados evidenciaram uma diminuição nos valores de fluorescência nos três grupos durante todo o período experimental, e assim como no in vitro, as lesões tratadas com verniz fluoretado apresentaram uma resposta mais rápida e favorável à remineralização (teste t, p<0.0001). Após 3 meses, o grupo CHX foi semelhante ao CO e ambos diferentes de VF (ANOVA, p<0.05). Concluiu-se que duas aplicações de verniz fluoretado são suficientes para remineralização de lesões de mancha branca com controle de 3 meses, sempre que complementadas com adequada higiene oral

The aim of this study was to evaluate and quantify the remineralization process on white spot enamel lesions adjacent to orthodontic braces. In the in vitro study, orthodontic braces were bonded in 30 extracted premolars that remained in a special solution for artificial enamel lesion development. Teeth were divided into three gropus (n=10), control (CO), varnish fluoride (VF) and chlorehexidine gel 2% (CHX). The demineralization process was assessed by Quantitative Light-Induced Fluorescence (QLF). In the vivo study, 30 healthy adolescents (mean age ± standard deviation: 17.2 ± 2.3 years) (n=56 lesions) undergoing orthodontic treatment with fixed appliances were enrolled in a double blind, randomized, longitudinal trial lasting three months. The subjects were randomly divided into three groups, using varnish fluoride (n=20), chlorexidine gel 2% (n=17) or fluoride toothpaste (n=19). The remineralization process was evaluated and quantified by Nyvad criteria (NY) and DIAGNOdent pen (DDpen). In both studies, the products were applied twice with one-week interval. All groups in the in vitro study, showed an increase in fluorescence (Delta F, %), whereas lesions treated with varnish fluoride had a quicker and more favorable response to remineralization. In the vivo study, fluorescence decreased during the experimental period, and lesions in the VF group had a quicker and more favorable response to remineralization. The correlation between DDpen and NY was 0.67 (Sperman, p<0.05). Two applications of varnish fluoride supplementated with oral hygiene and fluoride tooth paste, are effective in reversing WSLs during orthodontic treatment

Color and hardness changes in artificial white spot lesions after resin infiltration

OBJECTIVES: The purpose of this study was to determine the effect of resin infiltration technique on color and surface hardness of white spot lesion (WSL) with various degrees of demineralization. MATERIALS AND METHODS: Ten human upper premolars were cut and divided into quarters with a 3 x 4 mm window on the enamel surface. Each specimens were separated into four groups (n = 10) and immersed in demineralization solution to create WSL: control, no treatment (baseline); 12 h, 12 hr demineralization; 24 h, 24 hr demineralization; 48 h, 48 hr demineralization. Resin infiltration was performed to the specimens using Icon (DMG). CIEL*a*b* color parameters of the enamel-dentin complex were determined using a spectroradiometer at baseline, after caries formation and after resin infiltration. Surface hardness was measured by Vickers Micro Hardness Tester (Shimadzu, HMV-2). The differences in color and hardness among the groups were analyzed with ANOVA followed by Tukey test. RESULTS: Resin infiltration induced color changes and increased the hardness of demineralized enamel. After resin infiltration, there was no difference in color change (DeltaE*) or microhardness among the groups (p < 0.05). CONCLUSION: There was no difference in the effect of resin infiltration on color and hardness among groups with different extents of demineralization.

Non-destructive management of white spot lesions by using tooth jewelry

Although several methods including composite resin restoration and microabrasion have been used for management of white spot lesion, tooth jewelry can be considered as another noninvasive option. This case report describes the management of white spot lesions by using tooth jewelry. This report also highlights the patients' preference for tooth jewelry as an esthetic concern.

Therapeutic potential of Brazilian fluoride varnishes: an in vivo study

The aim of this study was to assess in vivo the therapeutic effect of three fluoride varnishes available in the Brazilian market on the performance of white spot lesions (WSL). The sample included 36 children aged 7 to 13 years old, with a total of 67 active WSL in permanent anterior teeth. The children were randomly divided into 3 groups, according to fluoride varnish used: FL- Fluorniz (n=24), DUO - Duofluorid XII (n=22) and DF - Durafluor (n=21). Maximum WSL dimensions (mesiodistal and incisogingival) were measured in millimeters by a previously calibrated single examiner using a periodontal probe. WSL were also assessed regarding lesion activity. Initial and final S-OHI (Simplified Oral Hygiene Index) scores were recorded. Pearson's chi-square test revealed no statistically significant differences (p>0.05) in the performance of the varnishes. At the end of the 5th week, FL had 6 active and 18 inactive WSL; DUO had 7 active and 15 inactive WSL; and DL had 6 active and 15 inactive WSL. Taking into account all lesions, there was a 45.7 percent reduction in WSL dimensions. Paired Student's t-test revealed a statistically significant difference (p<0.05) between the initial size (1.88) and final size (1.02). After four applications, all varnishes obtained similar clinical results.

O propósito do presente estudo foi avaliar in vivo o efeito terapêutico de 3 vernizes fluoretados disponíveis no mercado brasileiro em lesões de mancha branca (MB). A amostra foi composta de 36 crianças entre 7 e 13 anos, portadoras de 67 MB ativas em elementos dentários permanentes anteriores. As crianças foram divididas aleatoriamente em 3 grupos FL - Fluorniz (n=24), DUO - Duofluorid XII (n=22) e DF - Durafluor (n=21). A dimensão máxima da MB (mésio-distal e cérvico-incisal) foi mensurada em milímetros por um único examinador previamente calibrado através de uma sonda periodontal. Em adição, foi verificada a atividade da MB. O IHO-S (Índice de Higiene Oral Simplificado) inicial e final foi registrado. O teste do qui-quadrado de Pearson mostrou não existir diferença estatisticamente significante (p>0,05) no comportamento dos vernizes estudados. No final da 5ª semana o FL apresentava 6 MB ativas e 18 inativas, DUO 7 MB ativas e 15 inativas e DF 6 MB ativas e 15 inativas. Levando em consideração o grupo total, houve uma redução de 45,7 por cento da dimensão das manchas brancas. O teste T pareado revelou uma diferença estatisticamente significante (p<0,05) entre o tamanho inicial (1,88) e final (1,02). Após 4 aplicações, todos os vernizes apresentaram resultados clínicos semelhantes.