Assessment of Efficiency of Bioactive Glass, Self-Assembling Peptide, and Ozone Remineralising Agents on Artificial Carious Lesion

ABSTRACT Objective: To assess the efficacy of bioactive glass, self-assembling peptide, and ozone-remineralizing agents on the artificial carious lesion. Material and Methods: On the extracted 60 premolar teeth, an artificial carious lesion/demineralization was created. Later, the remineralization of demineralized teeth was done with respective remineralizing agents (Group A: Calcium sodium phosphosilicate (bioactive glass), Group B: Self-assembling peptide, Group C: Ozone remineralizing agents and Group D (Control): De ionized water. The degree of demineralization and remineralization were evaluated using the Vickers Hardness Number. Results: There was a decrease in microhardness from baseline to demineralization in all the groups, and this reduction was found to be statistically considerable. After the remineralization of demineralized samples with respective remineralizing agents, there was an increase in microhardness of 312.38, 276.67, and 254.42 in groups A, B, and C, respectively. In contrast, in Group D, there were no changes. Conclusion: Bioactive glass and self-assembling peptides had higher remineralizing capacities, which can be used to treat early carious lesions.

Desensitizing Agent Previously Applied During In-Office Bleaching: A Double-Blind Randomized Clinical Trial

Abstract Objective: To compare the clinical effect of two desensitizing agents used before the application of a bleaching gel based on 35% hydrogen peroxide (HP). Material and Methods: 30 patients were selected, and two desensitizing agents with different mechanisms of action were applied: Fluorine Neutral 2% (FN), which acts by blocking dentinal canaliculi while Potassium Nitrate 5% with 2% Sodium Fluoride (PN/SF) that acts in nerve transmission and blockade. Desensitizers were used before the application of 35% HP. For whitening, three clinical sessions were performed, with an interval of seven days, with three applications of the bleaching gel for 15 minutes, totaling 45 minutes/session. Tooth sensitivity (TS) was assessed with the numerical analog scale, and a spectrophotometer was used to obtain the color variation (ΔE). ΔE were submitted to ANOVA and Tukey test (p<0.05), and TS data were submitted to a two-way ANOVA analysis. Results: For sensitivity experience, the Tukey test indicated differences between PN/SF and the placebo I, but there was no statistically significant difference between FN and the placebo II. The TS was lower when the desensitizing gel was used during the bleaching procedure compared to after treatment, regardless of the desensitizing agents. Conclusion: PN/SF before in-office tooth bleaching can reduce TS intensity, and the use of desensitizing gel before bleaching did not affect the bleaching efficacy.

The 100 Most-Cited Papers in Dentin Hypersensitivity: A Bibliometric Analysis

ABSTRACT Objective: To identify the 100 most-cited articles in DH and analyze their characteristics. Material and Methods: A search was performed on the Web of Science (WoS) and the 100 most-cited articles were selected. The following data were extracted: citations, year of publication, authorship, institution, country, journal, language, study design, topic of interest, conflict of interest (COI), and sponsorship. The VOSviewer software was used to visualize bibliometric networks. Poisson regression analysis was performed to measure associations between several citations and the characteristics of the studies. Results: The number of citations ranged from 346 to 48. The most-cited article was published in 1997 by Holland in the Journal of Clinical Periodontology. This journal published the most papers, followed by the Journal of Oral Rehabilitation and Journal of Dentistry. Laboratory research, review, and clinical trial were the study designs most prevalent. Reviews (p<0.05; PR= 1.853) and method development studies (p<0.05; PR= 1.853) had a more chance to present more citations. The main topics of interest were the clinical effectiveness of desensitizers and in vitro analysis of dentin morphology. Sponsorship and COI were underreported. England and USA presented the greatest number of citations and connections in the coauthorship network map. Conclusion: Most of the articles were original research, and their topics of interest were mainly the clinical effectiveness of desensitizing agents and dentin morphology.

Obliteration of Dentinal Tubules by Desensitizing Agents Based on Silver Fluoride/Potassium Iodide or Pre-Reacted Glass Particles: An in Vitro Study

Abstract Objective: To evaluate the efficacy of desensitizing agents for the obliteration of dentinal tubules subjected or not to a simulated oral environment. Material and Methods: Dentinal discs (n=8) treated with Riva-Star (RS) or PRG-Barrier-Coat (PRG) were submitted (cycled) or not submitted (control) to erosive-abrasive-thermal cycles and evaluated using scanning electron microscopy/energy dispersive spectroscopic analysis. The variables analyzed were tubule obliteration and dentin surface chemical composition. Data were analyzed by non-parametric tests (p<0.05). Results: The cycled and control groups did not differ significantly for the responses in each material. The PRG control and cycled groups had fewer visible tubules and a higher proportion of totally obliterated tubules than the RS groups. The percentages of silver coverage were higher in the RS-control than in the RS-cycled. There was a significant inverse correlation between the presence of silver and non-obliterated tubules (R=-0.791; p<0.001). The percentages of carbon, aluminum, strontium, and potassium were significantly higher in the PRG-control and PRG-cycled compared to the RS control. The percentages of calcium, phosphorus, and silver were significantly higher in the RS compared to the PRG groups. PRG-control showed a higher percentage of boron than RS-control. Conclusion: PRG promoted greater tubule obliteration than SR. Simulated stress did not affect the obliterating effect of each agent. Greater silver coverage corresponded to a lower proportion of non-obliterated tubules in RS. Carbon, aluminum, strontium, boron, and potassium predominated in the dentin surface treated with PRG, while calcium, phosphorus, and silver prevailed in RS groups (AU).

Effect of desensitizing dentifrices on eroded dentin wettability / Efeito de dentifrícios dessensibilizantes na molhabilidade da dentina erodida

Objective: To analyze the wettability on the surface of eroded dentin in teeth submitted to abrasive wear with desensitizing dentifrices. Material and Methods: Bovine dentin specimens were polished and immersed in 10 mL of citric acid (pH=3.2) for 2 h. The eroded specimens were submitted to mechanic brushing according to the 4 dentifrices adopted: Colgate Total (control); Colgate Sensitive Pro-Relief; Sensodyne Repair & Protect; or Sensodyne Rapid Relief. Afterwards, it was conditioned in 37% aqueous phosphoric acid solution. Wettability of 80 specimens (n=10) brushed for 7 or 21 days was evaluated by measuring the contact angle between the dentin surface and a drop of the adhesive Single Bond Universal® (3M) with a goniometer. Changes in the surface morphology of 12 specimens (n = 3) brushed for 21 days were followed by confocal laser scanning microscopy (CLSM). Data were analyzed by two-way ANOVA and Tukey test (p > 0.05). Results: Groups treated with desensitizing dentifrices did not differ significantly (p ≤ 0.05). Surface treatment and abrasive wear did not interact significantly (p ≤ 0.05). Brushing along 7 days gave the smallest contact angle value (p ≥ 0.05). CLSM images showed morphological changes for all the groups. Conclusion: The desensitizing dentifrices did not interfere in eroded dentin wettability after brushing along 7 or 21 days. Brushing with any of the dentifrices along 21 days promoted open dentinal tubules.(AU)

Objetivo: Analisar a aplicação de um adesivo na superfície de dentina erodida em dentes submetidos ao desgaste abrasivo com agentes dessensibilizantes. Material e Métodos: Espécimes de dentina bovina foram polidos e imersos em 10 mL de ácido cítrico (pH=3,2) por 2 h. Os espécimes erodidos foram submetidos à escovação mecânica de acordo com os 4 dentifrícios adotados: Colgate Total (controle); Colgate Sensitive Pro-Alívio; Sensodyne Repair & Protect; ou Sensodyne Rápido Alívio. Em seguida, foram condicionados em ácido fosfórico a 37%. A molhabilidade de 80 espécimes (n=10) escovados por 7 ou 21 dias foi avaliada medindo-se o ângulo de contato entre a superfície dentinária com uma gota do adesivo Single Bond Universal® (3M) por um goniômetro. Alterações na morfologia da superfície de 12 espécimes (n = 3) escovados por 21 dias foram seguidos por Microscopia Confocal de Varredura a Laser (MCVL). Os dados foram analisados por ANOVA dois fatores e teste de Tukey (p > 0,05). Resultados: Os grupos tratados com dentifrícios dessensibilizantes não diferiram significativamente (p ≤ 0,05). O tratamento de superfície e o desgaste abrasivo não interagiram significativamente (p ≤ 0,05). A escovação ao longo de 7 dias apresentou o menor valor de ângulo de contato (p ≥ 0,05). As imagens do MCVL mostraram alterações morfológicas para todos os grupos. Conclusão: Os dentifrícios dessensibilizantes não interferiram na molhabilidade da dentina erodida após escovação ao longo de 7 ou 21 dias. A escovação com qualquer um dos dentifrícios ao longo de 21 dias promoveu a abertura dos túbulos dentinários (AU)

Evaluation of desensitizing efficacy of nanohydroxyapatite on the treatment of dentine hypersensitivity following ultrasonic scaling: a randomized controlled trial / Avaliação da eficácia dessensibilizante da nanoidroxiapatita no tratamento da hipersensibilidade dentinária após raspagem ultrassônica: um ensaio clínico randomizado

Objective: This randomized controlled trial aimed to compare nanohydroxyapatite with fluoride on managing post ultrasonic scaling Dentine hypersensitivity (DH). Material and Methods: Thirty patients (aged 20-50 years) with post ultrasonic-scaling DH were included in this study. The sample was randomly divided into three equal groups of 60 teeth each: the first group received nanohydroxyapatite material, the second group received fluoride material and the third group received sterile water as a placebo (controls). The materials were applied once for each patient. All patients were instructed to rate the level of pain before treatment, and after 1 hour, 24 hours, 2 weeks and 1 month on the numerical rating scale (NRS). The Kruskal-Wallis test, Mann-Whitney tests, linear regression analysis were used for the statistical analysis. Significance level was set at 0.05. Results: Both nanohydroxyapatite and fluoride were successful in reducing pain associated with DH when compared with the placebo in subsequent follow-ups (p < 0.05). However, one-hour and one-day post application, nanohydroxyapatite could reduce hypersensitivity pain moreeffectively than fluoride (p < 0.05). Conclusion: Nanohydroxyapatite material was found to besignificantly more effective in reducing the DH that followed ultrasonic scaling one-hour and one-day post application as compared to fluoride and sterile water. Both fluoride and nanohydroxyapatite had similar effect on DH after two-weeks and one-month after application. (AU)

Objetivo: Este ensaio clínico randomizado teve como objetivo comparar a nano-hidroxiapatita com o flúor no manejo da hipersensibilidade dentinária (HD) pós-raspagem ultrassônica. Material e Métodos: Trinta pacientes (com idades entre 20-50 anos) com HD pós-raspagem ultrassônica foram incluídos neste estudo. A amostra foi dividida aleatoriamente em três grupos iguais com 60 dentes cada: o primeiro grupo recebeu material de nano-hidroxiapatita, o segundo grupo recebeu material de flúor e o terceiro grupo recebeu água esterilizada como placebo (controle). Os materiais foram aplicados uma vez para cada paciente. Todos os pacientes foram instruídos a avaliar o nível de dor antes do tratamento, e após 1 hora, 24 horas, 2 semanas e 1 mês na escala de avaliação numérica (NRS). Os testes de Kruskal-Wallis, Mann-Whitney e análise de regressão linear foram usados para a análise estatística. O nível de significância foi estabelecido em 0,05. Resultados: Tanto a nano- hidroxiapatita quanto o flúor foram bem-sucedidos na redução da dor associada à HD quando comparados ao placebo em acompanhamentos subsequentes (p <0,05). No entanto, 1 hora e 1 dia após a aplicação, a nano-hidroxiapatita pode reduzir a dor de hipersensibilidade de forma mais eficaz do que o flúor (p <0,05). Conclusão: O material da nano-hidroxiapatita foi significativamente mais eficaz na redução da HD que se seguiu à raspagem ultrassônica, 1 hora e 1 dia após a aplicação, em comparação com o flúor e a água estéril. Tanto o flúor, quanto a nano-hidroxiapatita apresentou efeito semelhante na HD após 2 semanas e 1 mês após a aplicação (AU)

Uso do fluoreto de sódio como dessensibilizante no clareamento dental: uma revisão de literatura / Use of sodium fluoride as a desensibilizer in dental bleaching: a literature review

Objetivo: Verificar, por meio de uma revisão de literatura, a efetividade do uso do fluoreto de sódio como dessensibilizante para casos de sensibilidade induzida por clareamento dental. Resultados: O clareamento dentário tornou-se um dos procedimentos estéticos mais procurados na odontologia. Atualmente, existem duas técnicas supervisionadas por dentistas: o clareamento caseiro e o de consultório. Os materiais mais utilizados são o peróxido de carbamida e o de hidrogênio, respectivamente. O clareamento dental baseia-se na premissa de que o peróxido de hidrogênio penetra na estrutura dentária para interagir com os cromóforos orgânicos. Embora o protocolo de clareamento exija o uso de agentes oxidantes de baixa concentração, a sensibilidade dentária ainda está presente e pode ser considerado o principal efeito adverso da técnica de clareamento. Para minimizar este problema, a aplicação tópica de dessensibilizantes antes e após o clareamento dentário tem mostrado bons resultados na redução da intensidade de sensibilidade. Considerações finais: Mediante revisão apresentada, constatou-se que fluoreto de sódio quando utilizado após o protocolo clareador, como dessensibilizante, não elimina a sensibilidade, mas diminui a intensidade da dor. Quando utilizado antes do clareamento dental, não apresenta resultados positivos. Ademais, salienta-se que quando o fluoreto é incorporado no gel clareador, resulta em menor desmineralização do esmalte dentário.(AU)

Objective: To verify, through a literature review, the effectiveness of using sodium fluoride as a desensitizer for cases of sensitivity induced by tooth whitening. Literature review: Teeth whitening has become one of the most desired aesthetic procedures in dentistry. Currently, there are two techniques supervised by dentists: home whitening and office whitening. The most used materials are carbamide peroxide and hydrogen peroxide, respectively. Teeth whitening is based on the premise that hydrogen peroxide penetrates the tooth structure to interact with organic chromophores. Although the whitening protocol requires the use of low concentration oxidizing agents, tooth sensitivity is still present and can be considered the main adverse effect of the whitening technique. To minimize this problem, the topical application of desensitizers before and after tooth whitening has shown good results in reducing the intensity of sensitivity. Final considerations: Upon the review presented, it was found that sodium fluoride, when used after the whitening protocol, as a desensitizer, does not eliminate sensitivity, but reduces the intensity of pain. When used before tooth whitening, it has no positive results. Furthermore, it should be noted that when fluoride is incorporated into the whitening gel, less enamel demineralization is induced.(AU)

In vitro dentin permeability and tubule occlusion of in-office desensitizing materials / Permeabilidade da dentina e oclusão tubular in vitro de materiais dessensibilizantes de consultório

Objetivo: O objetivo desse estudo foi investigar a permeabilidade dentinária e a oclusão tubular de materiais dessensibilizantes de uso em consultório. Métodos: Blocos de dentina bovina foram obtidos e imersos em EDTA 0,5 M para promover a abertura dos túbulos dentinários. Os materiais testados foram: verniz placebo (PLA); verniz fluoretado (FLU); verniz de NaF 5% + 5% trimetafosfato de sódio nanoparticulado (TMP); sistema adesivo universal (SBU); verniz contendo partículas S-PRG (SPRG); solução de Biosilicato (BIOS) e solução de amelotina (AMTN). Os materiais foram aplicados e os espécimes submetidos ao desafio erosivo-abrasivo. A permeabilidade dentinária foi avaliada em T0 (inicial), T1 (após a aplicação dos materiais) e T2 (após o desafio erosivo-abrasivo). As imagens confocais foram usadas para avaliar o comprimento e o número dos túbulos ocluídos e as imagens de microscopia eletrônica de varredura (MEV) para avaliar o número de tubulos abertos. Os dados de permeabilidade e MEV foram analisadas pelo teste ANOVA duas medidas repetidas e pós teste de Tukey. O comprimento e número de túbulos dentinários ocluídos foram analisadas pelo teste ANOVA um critério e pós teste de Tukey, Kruskal-Wallis e pós teste de Dunn's, respectivamente. Os testes de correlação de Spearman e Pearson também foram realizados. O nível de significância foi de 5%. Resultados: O grupo AMTN mostrou os menores valores de permeabilidade em T1 e a seguinte ordem decrescente ocorreu em T2: AMTN=SBU>BIOS=SPRG>TMP>FLU>PLA. O grupo SBU teve o maior comprimento médio de túbulos dentinários ocluídos. O grupo AMTN teve maior número de túbulos dentinários ocluídos do que PLA e FLU e os menores valores de túbulos dentinários abertos foram observados para os grupos AMTN e SBU. Uma correlação significativa foi encontrada entre as análises realizadas. Significância: O sistema adesivo universal e a proteína amelotina foram mais efetivos em reduzir a permeabilidade dentinária através da oclusão dos túbulos dentinários(AU)

Objectives: The aim of this study was to investigate the dentin permeability and tubule occlusion of in-office desensitizing materials. Methods: Bovine dentin blocks were obtained and immersed in 0.5 M EDTA to open dentinal tubules. The materials tested were: placebo varnish (PLA); fluoride varnish (FLU); NaF 5% + 5% nanoparticulate sodium trimetaphosphate varnish (TMP); universal adhesive system (SBU); S-PRG filler-containing varnish (SPRG); Biosilicate solution (BIOS) and amelotin solution (AMTN). The materials were applied, and specimens were submitted to an erosive-abrasive challenge. Dentin permeability was evaluated at T0 (initial), T1 (after application of materials) and T2 (after erosive-abrasive challenge). Confocal images were used to evaluate length and number of dentinal tubules occluded and images from scanning electron microscopy (SEM) to evaluate opened dentinal tubules. Permeability and SEM data were evaluated by two-way repeated measures ANOVA and Tukey tests. The length and number of dentinal tubules occluded were evaluated by one-way ANOVA and Tukey, Kruskal-Wallis and Dunn's tests, respectively. Spearman and Pearson correlation tests were also used. The significance level was 5%. Results: AMTN group showed the lowest permeability value in T1 and the following decreasing order occurred in T2: AMTN=SBU>BIOS=SPRG>TMP>FLU>PLA. SBU group had the highest mean value of dentinal tubules occluded lengths. AMTN group had greater number of dentinal tubules occluded than PLA and FLU and the lowest values of opened dentin tubules were observed for AMTN and SBU groups. A significant negative correlation was found between the analysis. Significance: Universal adhesive system and the AMTN solution were more effective to reduce dentin permeability by occluding dentin tubules(AU)

Analysis of permeability and biological properties of dentin treated with experimental bioactive glasses / Análise da permeabilidade e propriedades biológicas da dentina tratada com vidros bioativos experimentais

O objetivo deste estudo foi avaliar a capacidade obliteradora de diferentes agentes dessensibilizantes em dentina humana através da mensuração da permeabilidade dentinária, e suas performances biológicas através da análise de citotoxicidade em fibroblastos gengivais humanos. Cinquenta molares humanos foram utilizados, dos quais foram obtidos blocos de dentina (4x4x1mm) posteriormente distribuídos em grupos de acordo com o dessensibilizante a ser utilizado (n=10): Grupo 1 - Controle (Saliva artificial. Sem aplicação de agente dessensibilizante); Grupo 2 - Ultra EZ (Ultradent); Grupo 3 - Desensibilize Nano P (FGM); Grupo 4 - Vidro Bioativo T5-OH (solução experimental); Grupo 5 - Vidro Bioativo F18 (solução experimental). Os tratamentos dessensibilizantes foram realizados durante 15 dias. Além disso, os espécimes foram submetidos ao desafio com ácido cítrico para simular condições desmineralizantes do ambiente oral. As amostras foram submetidas à análise de permeabilidade antes e após os procedimentos dessensibilizantes e o desafio ácido. Análise de citotoxicidade foi realizada pelo ensaio Alamar Blue complementado pela quantificação de proteína pelo Método BCA (ácido bicinconínico) (N=3; n=3) nos tempos de avaliação de 15 minutos, 24 horas e 48 horas. Microscopia eletrônica de varredura (MEV) e Espectroscopia de Raio-X por Energia Dispersiva (EDS) foram realizadas para análise qualitativa da dentina tratada. Dados de permeabilidade dentinária foram analisados por ANOVA dois fatores medidas repetidas e Teste de Tukey (α=0,05). Para a citotoxicidade, foram utilizados os testes Kruskal-Wallis e Newman-Keuls (α=0,05). Os resultados mostraram que para a permeabilidade dentinária não houve diferença significante entre os agentes dessensibilizantes após os tratamentos (p> 0,05), porém o grupo controle apresentou os maiores valores (0,131 ± 0,076 Lp, p< 0,05). Após o desafio ácido, o grupo controle manteve os maiores valores (0,044 ± 0,014 Lp) com diferença significante para os demais grupos (p< 0,05), exceto para o Desensibilize Nano P (0,037 ± 0,019 Lp). Quanto à citotoxicidade, não houve diferença entre os grupos experimentais (p> 0,05). Assim, foi possível concluir que o uso de dessensibilizantes à base de biovidros causou efeito similar ao uso de produtos disponíveis comercialmente, em relação à permeabilidade e propriedades biológicas da dentina(AU)

The aim of this study was to evaluate the obliterating capability of different desensitizing agents on human dentin by measuring dentin permeability, and their biological performance by the analysis of cytotoxicity in human gingival fibroblasts. Fifty human molars were used, from which dentin blocks were obtained (4x4x1mm) and distributed in groups according to the desensitizing agent used (n=10): Group 1 - Control (Artificial saliva. No desensitizing agent applied); Group 2 ­ Ultra EZ (Ultradent); Group 3 ­ Desensibilize Nano P (FGM); Group 4 - T5-OH Bioactive Glass (Experimental solution); Group 5 - F18 Bioactive Glass (Experimental solution). The desensitizing treatments were performed for 15 days. In addition, the specimens were subjected to challenge with citric acid to simulate oral environment demineralizing conditions. Samples were subjected to permeability analysis before and after the desensitizing procedures and the acid challenge. Cytotoxicity analysis was performed by using Alamar Blue assay and complemented by total protein quantification by Pierce Bicinchoninic Acid (BCA) assay (N=3; n=3) at 15 minutes, 24-hour and 48-hour time points. Scanning electron microscopy (SEM) and energy dispersion X-ray spectroscopy (EDS) were performed for qualitative analysis of treated dentin. Data of dentin permeability was analyzed by twoway repeated measures ANOVA and Tukey's post-hoc test (α=0.05). For cytotoxicity, Kruskal-Wallis and Newman-Keuls tests were used (α=0.05). The results showed that for dentin permeability there was no significant difference among the desensitizing agents after treatment (p> 0.05), but the control group presented the highest values (0.131 ± 0.076 Lp, p< 0.05). And after acid challenge, the control group maintained the highest values (0.044 ± 0.014 Lp) with significant difference to the other groups (p< 0.05), except for Desensibilize Nano P (0.037 ± 0.019 Lp). For cytotoxicity, there were no significant differences among the experimental groups (p> 0.05). It was concluded that the use of bioglass-based desensitizers caused similar effects to commercially available products, regarding permeability and dentin biological properties(AU)

Association of Nd: YAG laser and calcium-phosphate desensitizing pastes on dentin permeability and tubule occlusion

Abstract Objective To evaluate the efficacy of Nd:YAG laser associated with calcium-phosphate desensitizing pastes on dentin permeability and tubule occlusion after erosive/abrasive challenges. Methodology Dentin specimens were exposed to 17% ethylene diamine tetra-acetic acid (EDTA) solution for 5 min and randomly allocated into five groups: G1, control (no treatment); G2, Nd:YAG laser (1 W, 10 Hz, 100 mJ, 85 J/cm2); G3, Laser + TeethmateTM Desensitizer; G4, Laser + Desensibilize Nano P; and G5, Laser+Nupro®. Specimens underwent a 5-day erosion-abrasion cycling. Hydraulic conductance was measured post-EDTA, post-treatment, and post-cycling. Post-treatment and post-cycling permeability (%Lp) was calculated based on post-EDTA measurements, considered 100%. Open dentin tubules (ODT) were calculated at the abovementioned experimental moments using scanning electron microscopy and ImageJ software (n=10). Data were analyzed using two-way repeated measures ANOVA and Tukey's test (α=0.05). Results G1 presented the highest %Lp post-treatment of all groups (p<0.05), without significantly differences among them. At post-cycling, %Lp significantly decreased in G1, showed no significant differences from post-treatment in G3 and G4, and increased in G2 and G5, without significant differences from G1 (p>0.05). We found no significant differences in ODT among groups (p>0.05) post-EDTA. At post-treatment, treated groups did not differ from each other, but presented lower ODT than G1 (p<0.001). As for post-cycling, we verified no differences among groups (p>0.05), although ODT was significantly lower for all groups when compared to post-EDTA values (p<0.001). Conclusion All treatments effectively reduced dentin permeability and promoted tubule occlusion after application. Combining Nd YAG laser with calcium-phosphate pastes did not improve the laser effect. After erosive-abrasive challenges, treatments presented no differences when compared to the control.

Influence of desensitizers agents on the dentin bond strength after one-year water storage

Aim: Evaluate the effect of adhesives systems combined with desensitizer agents on the microtensile bond strength (µTBS) of a composite resin to dentin. Methods: Cervical dentin of thirty-two human molars were used to simulate hypersensitivity areas. The teeth were divided into four groups (n=8), according to the type of adhesive system and desensitizer agents. No desensitizer was used in the control (Clearfil SE Bond ­ CS). Two experimental groups were pretreated with either MS Coat Bond (MS) or Biofluorid 12 (BF) immediately prior to bonding with CS. The last group corresponded to Gluma Comfort Bond + Desensitizer (GC) application. After dentin treatments, a composite block was built-up on dentin surface and after 24 hours teeth were serially sectioned to obtain bonded bean specimens. Beams were stored in water for 24 hours or one year. Subsequently, the specimens were submitted to the µTBS test. Data were analyzed by two-way mixed ANOVA and Bonferroni's test (α = 0.05). Results: At 24 hours, there was no significant difference in µTBS among groups. However, at one year, dentin treated with MS or BF demonstrated significantly lower µTBS of CS to dentin compared to control and GC, which kept their µTBS stable. Conclusion: The effect of MS and BF desensitizer agents on the µTBS of CS to dentin did not reduce the µTBS at 24 hours, but it decreases significantly after one year

Effects of desensitizing products on the reduction of pain sensitivity caused by in-office tooth bleaching: a 24-week follow-up

Abstract Objective To clinically assess the effect of desensitizing gels and dentifrices on the reduction in pain sensitivity and color variation during tooth bleaching. Methodology A total of 108 volunteers were randomly separated into the following groups of n=12: GT/S-glycerine and thickener/sucralose; NF/S-potassium nitrate and sodium fluoride/sucralose; NA/S-potassium nitrate and arginine/sucralose; GT/AC-glycerine and thickener/arginine and calcium carbonate; NF/AC-potassium nitrate and sodium fluoride/arginine and calcium carbonate; NA/AC-potassium nitrate and arginine/arginine and calcium carbonate; GT/PN-glycerine and thickener/potassium nitrate; NF/PN-potassium nitrate and sodium fluoride/potassium nitrate; and NA/PN-potassium nitrate and arginine/potassium nitrate. Sensitivity was assessed with the numerical analogue scale, and color variation (ΔE) was measured with a spectrophotometer. The sensitivity values obtained were subjected to a multivariate analysis of variance (MANOVA) and color variation values were subjected to a randomized analysis of variance (p<0.05). Results The NF/AC, NA/AC, NF/PN, and NA/PN groups presented lower sensitivity values and reduced sensitivity compared to those of the other groups throughout the clinical sessions. None of the groups showed sensitivity at the 24-week assessment. Statistically, no significant difference were observed in the color values among the groups four weeks after the beginning of bleaching (p=0.074). Additionally, the color assessment of all groups was statistically similar four weeks (p=0.084) and 24 weeks (p=0.118) after the beginning. Conclusion Our results indicate that adding NF/S, NA/S, NF/AC, and NA/AC desensitizers to tooth bleaching protocols reduces pain sensitivity without affecting its effectiveness.

Efeitos de diferentes dentifrícios na permeabilidade e rugosidade de dentina erodida / Effect of different toothpastes on permeability and roughness of eroded dentin

O objetivo deste estudo foi avaliar a rugosidade, a obliteração dos túbulos dentinários e a permeabilidade da dentina erodida e escovada com diferentes dentifrícios. Noventa dentes bovinos foram seccionadas em blocos, sendo que em trinta a hemiface foi protegida com verniz ácido resistente e sessenta foram submetidos ao teste de permeabilidade. Os espécimes foram divididos de acordo com os dentifrícios: sem flúor (SF), com fluoreto de sódio (NaF) e com fluoreto de estanho (SnF2). Em seguida, os blocos foram submetidos a um protocolo erosivo-abrasivo por 5 dias. As análises de rugosidade superficial e obliteração dos túbulos dentinários (n=10) foram realizadas nas hemifaces controle e teste do mesmo espécime e a análise da permeabilidade (n=20) foi realizada novamente. Os dados foram submetidos aos testes de ANOVA a dois critérios medidas repetidas e pós teste de Tukey (p≤0,05). Os grupos NaF e SnF2 apresentaram maior rugosidade comparando-se ao SF. O grupo SF apresentou a maior quantidade de túbulos abertos quanto comparado aos demais. Não houve diferença significativa na permeabilidade pós-ciclagem entre os dentifrícios SF e NaF, contudo o dentifrício SnF2 apresentou maior permeabilidade comparando-se aos demais. Ambos os dentifrícios contendo flúor tiveram oclusão efetiva dos túbulos dentinários; contudo, os efeitos da presença de fluoreto de estanho na permeabilidade podem ser neutralizados pela abrasão deste dentifrício(AU)

The aim of this study was to evaluate the roughness, dentin tubule occlusion and permeability of eroded dentin brushed with different toothpastes. Ninety bovine teeth were sectioned in blocks. The hemiface of thirty specimens was protect with acid resistant varnish and sixty were submitted to permeability test. The specimens were divided according to the dentifrices: without fluoride (WF), sodium fluoride (NaF) and stannous fluoride (SnF2). Then, the blocks were submitted to erosive-abrasive protocol for 5 days. The analysis of surface roughness and dentin tubule occlusion (n=10) were performed on control and test hemifaces of the same sample and permeability analysis (n=20) was again performed. Data were analyzed by two-way RM ANOVA and Tukey tests (p≤0.05). NaF and SnF2 groups presented higher roughness when compared with WF. WF group presented larger number of opened tubules compared to the others. No significant differences were found between WF and NaF for permeability; however, SnF2 presented higher hydraulic conductance compared to other dentifrices. In conclusion, both fluoride-containing toothpastes had promising tubule occlusion; however, the effects on permeability of stannous formulation may be counteracted by the effects of abrasion from this dentifrice(AU)

Hiperestesia dentinária: aspectos de interesse / Dentinal hyperesthesia: aspects of interest

A hiperestesia dentinária cervical se caracteriza como uma manifestação com sintomatologia dolorosa aguda, repentina, localizada e de curta duração, provocada por um estímulo tátil, químico, térmico ou osmótico. Cessa após a remoção e não é provocada em dentes saudáveis por estímulos considerados fisiológicos. Acomete geralmente o terço cervical dos elementos dentários como pré-molares e molares, com exposição da dentina e abertura dos túbulos dentinários após recessão gengival, perda de estrutura cementária ou adamantina, lesões não cariosas, hábitos deletérios, entre outros. Devido à alta prevalência dessa condição na população mundial e queixas frequentes no consultório odontológico, a hiperestesia tem sido exaustivamente estudada. O objetivo deste trabalho, por meio de revisão de literatura, é elucidar a etiologia, diagnóstico diferencial, terapias e efetividade no controle desse problema de saúde pública

The cervical dentinal hyperesthesia is characterized as a manifestation with sharp, sudden, located painful symptomatology and of short duration, provoked by a stimulus tactile, chemical, thermal or osmotic. It ceases after the removal and it isn´t provoked in healthy teeth by stimulus considered physiologic. It usually attacks the cervical third of the dental elements as premolar and molars, with exhibition of the dentine and opening of the dentinal tubules after gingival recession, loss of cementery or adamantine structures, non-carious lesions, harmful habits, among others. Due to the high prevalence of that condition in the world population and frequent complaints in the dentistry clinic, the hyperesthesia has been exhaustively studied. The aim of this paper, through review of literature, was to elucidate the aetiology, differential diagnosis,therapies and effectiveness in the control of that problem of public health

Efeito do uso e do momento de aplicação de dentifrícios dessensibilizantes na cor, refletividade, rugosidade e nanodureza do esmalte clareado / Effect of use and moment of application of desensitizing toothpastes on shade, reflectivity, roughness and nanohardness of bleached enamel

Este estudo in vitro teve como objetivo investigar o efeito de dentifrícios dessensibilizantes aplicados antes ou após o clareamento dental na cor, na refletividade (SRI), na rugosidade (Ra, RMS) e na nanodureza (NH) da superfície do esmalte. A reprodutibilidade das medidas de SRI e a sua associação com a cor e a rugosidade do esmalte foram também avaliadas. Blocos de esmalte e dentina (36 mm²) foram obtidos de 42 incisivos bovinos. Os espécimes foram divididos aleatoriamente em sete grupos (n = 6), de acordo com os dentifrícios dessensibilizantes e o momento da aplicação (G1: controle, clareado e armazenado em saliva artificial; G2: Sensodyne Repair & Protect + clareamento dental; G3: clareamento dental + Sensodyne Repair & Protect; G4: Colgate Sensitive Pró-alívio + clareamento dental; G5: clareamento dental + Colgate Sensitive Pró-alívio; G6: Elmex Sensitive + clareamento dental; G7: clareamento dental + Elmex Sensitive. Três sessões de clareamento com peróxido de hidrogênio 35% (Whiteness HP) foram realizadas, com intervalos de 7 dias, em T1, T2 e T3. Após cada dia de tratamento, as amostras foram armazenadas em saliva artificial. A cor foi mensurada por espectrofotômetro (VITA Easyshade) e sistema CIE L*a*b* antes do início do tratamento (T0) e 7 dias após o término do tratamento (T4). A SRI foi medida por dois examinadores (R1, R2) usando um reflectômetro óptico (Optipen 2) em T0, T1, T2, T3 e T4. Ra, RMS e NH (GPa) do esmalte foram avaliadas em microscópio de força atômica e nanoindentador (Asylum Research) em T4. Comparações múltiplas entre grupos foram realizadas pelo teste de Kruskal-Wallis e post hoc DunnBonferroni. Concordância entre avaliadores na mensuração de SRI foi avaliada pelo Coeficiente de Correlação Intraclasse (CCI). Comparações múltiplas dos valores de SRI entre os momentos de avaliação para cada grupo foram realizadas pelo teste de Friedman e post hoc de Dunn-Bonferroni. A correlação entre variáveis foi analisada pelo teste de correlação de Pearson. Para Ra (p = 0,007), RMS (p = 0,018), cor (p = 0,016) e SRI (p = 0,009) foram encontradas diferenças significativas entre os grupos. Para NH (p = 0,920), não foi encontrada diferença significativa entre os grupos. Após ajuste de Dunn-Bonferroni, foram encontradas diferenças significativas entre G1 e G5 para Ra (p = 0,033) e SRI (p = 0,004) em T4. Houve excelente concordância entre avaliadores (CCI = 0,873, Intervalo de Confiança 95% = 0,828/0,905). Considerando os tempos de avaliação, não houve diferença entre valores de SRI em T0 e T4 para todos os grupos. SRI apresentou correlação inversa moderada com Ra (r = -0.602) e RMS (r = -0.501). Concluiu-se que o dentifrício dessensibilizante Colgate Sensitive Pró-alívio aplicado após o clareamento dental apresentou maior rugosidade e menor refletividade que o grupo controle. Para os demais grupos, o dentifrício dessensibilizante aplicado antes ou após o clareamento dental não interferiu na nanodureza, na rugosidade, na cor e na refletividade final do esmalte. O reflectômetro Optipen 2 proporcionou excelente concordância interexaminadores. A refletividade não se alterou após clareamento e aplicação de dentifrícios dessensibilizantes com armazenamento em saliva artificial e mostrou correlação inversa com a rugosidade do esmalte.

This in vitro study aimed to investigate the effect of desensitizing toothpastes applied before or after dental bleaching on the enamel surface shade, reflection intensity (SRI), roughness (Ra, RMS) and nanohardness (NH). Inter-rater agreement for SRI measurements and SRI association with enamel shade and roughness were also evaluated. Enamel and dentin blocks (36 mm²) were obtained from 42 bovine incisors. The specimens were randomly divided into seven groups (n = 6) according to the desensitizing toothpastes and the moment of application (G1: control, bleached and stored in artificial saliva; G2: Sensodyne Repair & Protect + dental bleaching; G3: dental bleaching + Sensodyne Repair & Protect; G4: Colgate Sensitive Pro-Relief + dental bleaching; G5: dental bleaching + Colgate Sensitive Pro-Relief; G6: Elmex Sensitive + dental bleaching; G7: dental bleaching + Elmex Sensitive. Three bleaching sessions using 35% hydrogen peroxide were realized with seven day intervals (T1, T2, T3). After each day of treatment, the specimens were stored in artificial saliva. Dental shade was measured using spectrophotometer (VITA Easyshade) and CIE L*a*b* system before treatment beginning (T0) and 7 days after finishing treatment (T4). SRI was measured by two raters (R1, R2) using optical reflectometer at T0, T1, T2, T3 and T4. Enamel surface roughness (Ra, RMS) and NH (GPa) were evaluated with an atomic force microscope and nanoindenter (Asylum Research) at T4. Multiple comparisons among groups were assessed by Kruskal-Wallis and Dunn-Bonferroni post hoc tests. Inter-rater agreement was evaluated by Intraclass Correlation Coefficient (ICC). Multiple comparisons for SRI according to moments of evaluation for each group were assessed by Friedman and Dunn-Bonferroni post hoc tests. Correlation between variables was accessed by Pearson correlation test. For Ra (p = 0.007), RMS (p = 0.018), shade (p = 0.016) and SRI (p = 0.009) significant differences between groups were found. For NH (p = 0.920) no significant difference among groups was found. After Dunn-Bonferroni adjustment, significant differences between G1 and G5 for Ra (p = 0.033) and SRI (p = 0.004) at T4 were found. There was an excellent inter-rater agreement (ICC = 0.873, Confidence Interval 95% = 0.828/0.905). Considering times of SRI evaluation, no significant difference between T0 and T4 was found for all groups. SRI presented a moderate negative correlation with Ra (r = -0.602) and RMS (r = -0.501). It was concluded that Colgate Sensitive Pro-Relief applied after dental bleaching showed higher roughness and lower SRI than control group. For the other groups, the desensitizing toothpaste applied before or after dental bleaching did not interfere in NH, roughness, shade and SRI of enamel. Optipen 2 reflectometer provided excellent inter-rater agreement. SRI did not change after bleaching and desensitizing toothpaste application with storage in artificial saliva and has inverse correlation with enamel roughness.

Brazilian dentists perception of dentin hypersensitivity management

Abstract: The aim of this study was to investigate how Brazilian dentists perceive and manage dentin hypersensitivity (DH) in their clinical routine. A 13-item questionnaire-based survey was developed and sent electronically to a convenience sample of dentists. The questionnaire assessed the personal and dental practice characteristics of the sample, the occurrence of DH in their daily clinical practice, and management strategies. The data were analyzed descriptively and together with the chi-square test (a = 0.05). A total of 353 responses were obtained from September 2017 to March 2018. Of all the respondents, 62% were females, 49.9% reported fewer than five years of dental practice, and 70.5% were self-identified as private practitioners. Most of the dentists reported an estimated frequency (30-60%) of patients with DH in their practice. The most frequently cited (91.79%) trigger of DH was air blast and/or scratching with a probe. The first-choice strategy to manage DH was a dentin desensitizer (48.16%). The number of years in clinical practice did not influence DH relapse frequency (p = 0.76) significantly, or consider DH treatment as a problem (p = 0.22). The present findings indicate that, regardless of clinical experience, dentists in Brazil still consider DH management a challenge in their daily dental practice. In addition, the results suggest that guidelines should be developed to disseminate the available knowledge regarding this condition in ways that may influence decision-making processes among practitioners.

Effect of dental bleaching on pulp oxygen saturation in maxillary central incisors - a randomized clinical trial

Abstract Objective To assess pulp oxygen saturation levels (SaO2) in maxillary central incisors after dental bleaching. Materials and Methods 80 participants (160 teeth) were randomly allocated to four groups: G1 In-office bleaching with two applications of 35% hydrogen peroxide (HP) (20 minutes), followed by at-home bleaching with 10% carbamide peroxide (CP) (2 hours/day for 16 days); G2 - Same protocol as G1, plus desensitizing toothpaste; G3 - In-office bleaching with 35% HP and one application of placebo gel (20 minutes), followed by at-home bleaching with 10% CP (2 hours/day for 16 days); and G4 - Same protocol as G3, plus desensitizing toothpaste. Pulp SaO2 levels were measured before (T0) and immediately after (T1) in-office bleaching; on the 5th (T2), 8th (T3), 12th (T4), and 16th days of at-home bleaching (T5); and on the 7th (T6) and 30th (T7) days. Mean (SD) pulp SaO2 levels were compared within groups by generalized estimating equations (GEE) and Student's t-test (P<0.05). Results Mean pulp SaO2 at T0 was 84.29% in G1, 84.38% in G2, 84.79% in G3, and 85.83% in G4. At T1, these values decreased to 81.96%, 82.06%, 82.19%, and 81.15% in G1, G2, G3, and G4 respectively, with significant difference in G4 (P<0.05). During home bleaching, pulp SaO2 levels varied in all groups, with 86.55%, 86.60%, 85.71%, and 87.15% means at T7 for G1, G2, G3, and G4, respectively; G2 presented significant difference (P<0.05). Conclusions Pulp SaO2 level in maxillary central incisors was similar at baseline, reducing immediately after in-office bleaching, regardless of using desensitizing toothpaste and increasing at 30 days after dental bleaching.

Lesões cervicais não cariosas: uma abordagem no controle da dor e tratamento

Objetivo: o objetivo deste trabalho é relatar um caso clínico de hipersensibilidade severa associada a múltiplas lesões cervicais não cariosas, entender o mecanismo de ação e a eficácia dos agentes dessensibilizantes. Relato de caso: paciente do gênero masculino, 38 anos de idade, compareceu à clínica da Faculdade Morgana Potrich com um quadro de hipersensibilidade em vários elementos, bem como, a presença de lesão cervical não cariosa em alguns desses elementos. Durante a anamnese o paciente relatou o hábito de escovar os dentes várias vezes ao dia logo após se alimentar, exercendo muita força durante o ato, relatou também fazer consumo diário de cerveja que possui um pH ácido. Ao realizar análise da oclusão notou-se um desequilíbrio oclusal e contato prematuro nos dentes 24 e 34. O tratamento de escolha para esse caso foi o ajuste oclusal seguido do uso de dessensibilizantes e restaurações em resina composta nos dentes que havia a presença de lesões cervicais não cariosas com perda de estrutura dentária. Considerações finais: após esse tratamento, realizado em várias sessões, foi possível devolver ao paciente a função e eliminar a dor provocada pela hipersensibilidade, proporcionando uma melhor qualidade de vida para esse paciente.

Objective: This study aims to report a clinical case of severe hypersensitivity associated with multiple non-carious cervical lesions and to understand the mechanism of action and the efficacy of desensitizing agents. Case report: A 38-year-old male patient attended the clinic at Faculdade Morgana Potrich with the hypersensitivity of several elements and the presence of non-carious cervical lesion in some of these elements. During anamnesis, the patient reported the habit of toothbrushing several times a day soon after eating, exerting a lot of force in such activity; he also reported the daily consumption of beer, which has an acidic pH. The occlusal analysis showed occlusal disorder and premature contact in teeth 24 and 34. The treatment of choice for this case was the occlusal adjustment followed by the use of desensitizers and composite resin restorations on the teeth with non-carious cervical lesions with loss of dental structure. Final considerations: After this treatment, which was performed in several sessions, it was possible to return function to the patient and eliminate the pain caused by hypersensitivity, providing a better quality of life for this patient.(au)

A novel application of nano eggshell/titanium dioxide composite on occluding dentine tubules: an in vitro study

Abstract To synthesize Nano eggshell-titanium-dioxide (EB@TiO2) biocomposite and to evaluate its effectiveness in occluding opened dentine tubules. EB@TiO2 was synthesized and characterized using X-ray diffraction (XRD), and Transmission Electron Microscope (TEM). Sixteen simulated bovine dentine discs were prepared and randomly assigned into four groups according to the following treatment (n = 4): Group 1: No treatment; Group 2: eggshell powder; Group 3: EB@TiO2; Group 4: Sensodyne. These were then agitated in a solution of 1g powder and 40mL water for 3hours. Thereafter, each dentine discs from the respective groups were post-treated for 5 min with 2wt% citric acid to test their acid resistant characteristics. Scanning Electron Microscope (SEM) was used to observe the effectiveness of occluded dentine pre-and post-treatment. The cytotoxicity of the synthesized EB@TiO2 was tested using NIH 3T3 assay. ANOVA was used to evaluate the mean values of the occluded area ratio and the data of MTS assay. This was followed by a multi-comparison test with Bonferroni correction (α = .05). The XRD confirmed that EB@TiO2 was successfully modified through ball-milling. The TEM revealed the presence of both spherical and irregular particle shape powders. The SEM result showed that EB@TiO2 could effectively occlude open dentine tubules. Equally, the result demonstrated that EB@TiO2 exhibited the highest acid resistant stability post-treatment. NIH 3T3 assay identified that EB@TiO2 had little effect on the NIH 3T3 cell line even at the highest concentration of 100µg/ml. This study suggests that the application of EB@TiO2 effectively occluded dentine tubules and the occlusion showed a high acid resistant stability.

Effects of in-office bleaching agent combined with different desensitizing agents on enamel

Abstract Objective: To analyze color change, microhardness and chemical composition of enamel bleached with in-office bleaching agent with different desensitizing application protocols. Materials and Methods: One hundred and seventeen polished anterior human enamel surfaces were obtained and randomly divided into nine groups (n = 13). After recording initial color, microhardness and chemical composition, the bleaching treatments were performed as G1: Signal Professional White Now POWDER&LIQUID FAST 38% Hydrogen peroxide(S); G2: S+Flor Opal/0.5% fluoride ion(F); G3: S+GC Tooth Mousse/Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) paste(TM); G4: S+UltraEZ/3% potassium nitrate&0.11% fluoride(U); G5: S+Signal Professional SENSITIVE PHASE 1/30% Nano-Hydroxyapatite (n-HAP) suspension(SP); G6: S-F mixture; G7: S-TM mixture; G8: S-U mixture; G9: S-SP mixture. Color, microhardness and chemical composition measurements were repeated after 1 and 14 days. The percentage of microhardness loss (PML) was calculated 1 and 14 days after bleaching. Data were analyzed with ANOVA, Welch ANOVA, Tukey and Dunnett T3 tests (p<0.05). Results: Color change was observed in all groups. The highest ΔE was observed at G7 after 1 day, and ΔE at G8 was the highest after 14 days (p<0.05). A decrease in microhardness was observed in all groups except G6 and G7 after 1 day. The microhardness of all groups increased after 14 days in comparison with 1 day after bleaching (p>0.05). PML was observed in all groups except G6 and G7 after bleaching and none of the groups showed PML after 14 days. No significant changes were observed after bleaching at Ca and P levels and Ca/P ratios at 1 or 14 days after bleaching (p>0.05). F mass increased only in G2 and G6, 1 day after bleaching (p<0.05). Conclusions: The use of desensitizing agents containing fluoride, CPP-ACP, potassium nitrate or n-HAP after in-office bleaching or mixed in bleaching agent did not inhibit the bleaching effect. However, they all recovered microhardness of enamel 14 days after in-office bleaching.