Adhesión a dentina parte I: características del sustrato y sistemas adhesivos / Dentin bonding part I: substrate characteristics and bonding systems

La Odontología Restauradora contemporánea no puede concebirse sin la adhesión de los materiales restauradores a las estructuras dentarias. En mu-chos procedimientos restauradores, no sólo el esmal-te sino también la dentina se encuentra involucrada, por lo tanto, la adhesión a esta última juega un rol cla-ve en el éxito clínico. No obstante, todavía supone un gran desafío lograr una adhesión estable y predeci-ble en el tiempo. El propósito del presente artículo es analizar las características principales de la dentina como sustrato adhesivo y describir los sistemas ad-hesivos actuales y sus mecanismos de acción (AU)

Contemporary Restorative Dentistry cannot be conceived without the adhesion of restorative materials to dental structures. In many restorative procedures not only the enamel, but also the dentin is involved, therefore dentin bonding plays a key role in their success. However, it is still a great challenge to achieve stable and predictable dentin bonding over time. The aim of this article is to analyze the main characteristics of dentin as an adhesive substrate and to describe current adhesive systems and their bonding mechanisms (AU)

Evaluation of the remineralization potential of amorphous calcium phosphate and fluoride containing pit and fissure sealants using scanning electron microscopy.

Aim: To evaluate the remineralization potential of Amorphous Calcium Phosphate (ACP) and Fluoride containing pit and Fissure Sealants using Scanning Electron Microscopy. Materials and Methods: Thirty maxillary first premolars were divided into three groups of ten each and were randomly selected for ACP containing (Aegis- Opaque White, Bosworth Co. Ltd.), Fluoride containing (Teethmate F1 Natural Clear, Kuraray Co. Ltd.), resin based (Concise- Opaque White, 3M ESPE Co. Ltd.) pit and fissure sealant applications. The Concise group served as a control. The teeth weresubjected to the pH-cycling regimen for a period of two weeks. After two weeks, the teeth were sectioned bucco-lingually into 4mm sections and were observed under Scanning Electron Microscope at 50X, 250X, 500X, 1000X and 1500X magnifications. The qualitative changes at the tooth surface and sealant interface were examined and presence of white zone at the interface was considered positive for remineralization. Results: Both ACP containing (Aegis) and Fluoride containing (Teethmate F1) group showed white zone at the tooth surface-sealant interface. The resin based group (Concise) showed regular interface between the sealant and the tooth structure, but no clear cut white zone was observed. Conclusion: Both, Aegis and Teethmate F1 have the potential to remineralize. Release of Amorphous Calcium Phosphate molecules in Aegis group and formation of Fluoroapetite in Teethmate F1 group, were probably responsible for the remineralization.

pH-cycling models for in vitro evaluation of the efficacy of fluoridated dentifrices for caries control: strengths and limitations

Despite a plethora of in situ studies and clinical trials evaluating the efficacy of fluoridated dentifrices on caries control, in vitro pH cycling models are still broadly used because they mimic the dynamics of mineral loss and gain involved in caries formation. This paper critically reviews the current literature on existing pH-cycling models for the in vitro evaluation of the efficacy of fluoridated dentifrices for caries control, focusing on their strengths and limitations. A search was undertaken in the MEDLINE electronic journal database using the keywords "pH-cycling", "demineralization", "remineralization", "in vitro", "fluoride", "dentifrice". The primary outcome was the decrease of demineralization or the increase of remineralization as measured by different methods (e.g.: transverse microradiography) or tooth fluoride uptake. Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were solved by discussion and consensus or by a third party. One hundred and sixteen studies were included, of which 42 addressed specifically the comparison of dentifrices using different pH-cycling models. The other studies included meta-analysis or reviews, data about the effect of different fluoride sources on de-remineralization, different methods for analysis de-remineralization and chemical variables and characteristics of dental hard tissues that might have influence on de-remineralization processes. Generally, the studies presented ability to detect known results established by clinical trials, to demonstrate dose-related responses in the fluoride content of the dentifrices, and to provide repeatability and reproducibility between tests. In order to accomplish these features satisfactorily, it is mandatory to take into account the type of substrate and baseline artificial lesion, as well as the adequate response variables and statistical approaches to be used. This critical review of literature showed that the currently available pH-cycling models are appropriate to detect dose-response and pH-response of fluoride dentifrices, and to evaluate the impact of new active principles on the effect of fluoridated dentifrices, as well as their association with other anti-caries treatments.

Enamel remineralization by fluoride-releasing materials: proposal of a pH-cycling model

This study proposes a pH-cycling model for verifying the dose-response relationship in fluoride-releasing materials on remineralization in vitro. Sixty bovine enamel blocks were selected for the surface microhardness test (SMH1). Artificial caries lesions were induced and surface microhardness test (SMH2) was performed. Forty-eight specimens were prepared with Z 100, Fluroshield, Vitremer and Vitremer » diluted - powder/liquid, and subjected to a pH-cycling model to promote remineralization. After pH-cycling, final surface microhardness (SMH3) was assessed to calculate percent recovery of surface microhardness ( percentSMHR). Fluoride present in enamel (μg F/mm3) and in the pH-cycling solutions (μg F) was measured. Cross-sectional microhardness was used to calculate mineral content (∆Z). There was no significant difference between Z 100 and control groups on analysis performed on - percentSMHR, ∆Z, μg F and mg F/mm3 (p>0.05). Results showed a positive correlation between percentSMHR and μg F/mm3 (r=0.9770; p=0.004), percentSMHR and μg F (r=0.9939; p=0.0000001), ∆ and μg F/mm3 (r=0.9853; p=0.0002), ∆ and μg F (r=0.9975; p=0.0000001) and between μg F/mm3 and μg F (r=0.9819; p=0.001). The pH-cycling model proposed was able to verify in vitro dose-response relationship of fluoride-releasing materials on remineralization.

Este trabalho propôs um modelo de ciclagem de pH verificando a relação dose-resposta de materiais que liberam flúor na remineralização in vitro. Foram selecionados 60 blocos de esmalte bovino pelo teste de microdureza de superfície (SMH1). Realizou-se indução de cárie e microdureza de superfície pós-cárie (SMH2). Corpos-de-prova (n=48) dos grupos Z 100, Fluroshield, Vitremer e Vitremer diluído » foram fabricados e submetidos à ciclagem de pH para promover a remineralização. Após, avaliou-se a microdureza de superfície final (SMH3) para cálculo da porcentagem de recuperação da microdureza de superfície ( por centoSMHR). Determinou-se o flúor presente no esmalte (μg F/mm3) e nas soluções de ciclagem (μg F). O teste de microdureza em secção longitudinal foi realizado para cálculo do conteúdo mineral (∆Z). Entre os grupos controle e Z100 não houve diferença significativa nas análises realizadas - por centoSMHR, ∆Z, μg F e μg F/mm3 (p>0,05). Houve correlação positiva entre a por centoSMHR e μg F/mm3 (r=0,9770; p=0,004), por centoSMHR e μg F (r=0,9939; p=0,0000001), ∆Z e μg F/mm3 (r=0,9853; p=0,0002), ∆Z e μg F (r=0,9975; p=0,0000001) e também entre μg F/mm3 e μg F (r=0,9819; p=0,001). O modelo de ciclagem de pH proposto foi adequado para verificar relação dose-resposta in vitro de materiais que liberam flúor na remineralização.

Visual evaluation of in vitro cariostatic effect of restorative materials associated with dentifrices

O objetivo deste trabalho foi avaliar, in vitro, o efeito cariostático de 6 materiais restauradores contendo ou não flúor (Fuji II LC, F-2000, Degufil Mineral, Sure Fil and Z-250) associados à aplicação de dentifrícios (fluoretado e não-fluoretado; Sensodyne Fórmula Original and Sensodyne Sodium Bicarbonate) em esmalte dental humano. Cavidades classe V foram preparadas no esmalte de 240 fragmentos dentais, aleatoriamente divididos em 12 grupos (6 materiais e 2 dentifrícios). Após serem restauradas as cavidades, os fragmentos foram submetidos a ciclos térmicos e de desmineralização e remineralização, simulando um alto desafio cariogênico. Sobre os fragmentos restaurados, ainda, foram aplicados dentifrícios contendo ou não flúor, 5 min por dia. As diferenças no desenvolvimento de lesões experimentais de cárie adjacente às restaurações foram avaliadas por 5 examinadores calibrados, através de inspeção visual, atribuindo-se escores de 0 a 3. Os resultados foram avaliados pelo teste de Kruskal-Wallis seguido pelo teste de comparações múltiplas (a=0,05). Quando associados ao dentifrício fluoretado, os materiais restauradores não diferiram entre si em relação ao potencial cariostático (p>0,05). Quando os materiais foram utilizados em associação com o dentifrício não-fluoretado o Ketac-Fil apresentou o maior potencial cariostático, seguido pelo Fuji II LC e pelos demais materiais. O Ketac-Fil foi o único material que não diferiu significativamente quando associado com o dentifrício com ou sem flúor. Sob as condições experimentais do estudo, a associação dos materiais restauradores ao dentifrício fluoretado resultou em uma maior ação cariostática, exceto para o cimento de ionômero de vidro convencional, que não diferiu com a aplicação dos dentifrícios.

Esmalte aprismático yuxtadentinario y caries, en dientes permanentes / Yuxta-dentinal aprismatic enamel and caries in permanent teeth

Se describen las características del esmalte aprismático yuxtadentinario, empleando microscopía de transparencia, incidencia y polarización. Su presencia es constante, su espesor uniforme y por setores esfumado, adoptando una configuración estructural particular identificada por la microscopía de polarización y es travesado por laminillas, penachos y husos adamantinos. Su comportamiento ante la progresión de la caries, es similar a una barrera natural, ofreciendo resistencia a la desmineralización cariogénica

Práctica preventiva en la lesión de caries / Preventive practice in the carious lesion

Para comprender el proceso de desmineralización-remineralización debemos partir de la base que la superficie del esmalte no es una superficie estática, sino que actúa como una membrana de actividad selectiva que permite la entrada de ciertos iones. La maduración del esmalte es consecuencia de un intercambio contínuo entre película-placa, superficie de esmalte y fluído bucal. Cuando los cristales de hidroxiapatita pierden su capa de iones absorbidos, produciendo la salida de iones CO y PO4, se tiene en consecuencia la desmineralización. Por el contrario, cuando los cristales puden absorber iones aumentan de tamaño y cierran las porosidades favoreciendo la remineralización. Nosotros contamos con la valiosa ayuda del flúor en sus distintas formas que facilitan la absorción de iones a través de la fase fluída produciendo la recristalización de la superficie del esmalte

Procesos de desmineralización y remineralización del esmalte dental / Process of demineralization and remineralization in dental enamel

Se describen los aspectos más importantes del complejo mecanismo físico-químico de de-remineralización del esmalte dental. Como fuera demostrado en modelos in vitro e in vivo, la OH-Ap y sus formas posibles, actúan como un sistema dinámico, donde se reconocen como principales factores: la influencia inhibitoria de las proteínas salivales y del fluoruro, las variaciones anatómicas de los elementos dentarios, el comportamiento químico de los fosfatos, la importancia de la carga y los coeficientes de difusión sobre el gradiente. Si las condiciones del medio lo permiten, la OH-Ap, principal componente de la fase sólida, se convierte en diferentes tipos de fosfatos, correspondiendo al fosfato dicálcico dihidratado (BSH), el octacálcico y el amorfo las formas más estudiadas. La estabilidad-inestabilidad del sistema dependen de pH del medio, de la concentración de fluoruros y de la fuerza iónica. Tanto in vitro como in vivo, la persistencia de la acidez favorece la disolución, mientras que la reducción del tiempo de exposición estimula la remineralización

Esmalte aprismático en surcos de dientes permanentes y caries incipientes / Prismless enamel in grooves from permanent teeth and incipient caries

En 50 dientes permanentes extraídos por diferentes razones, se demuestra la presencia de esmalte aprismático en un 60 por ciento de los mismos, en las vertientes que configuran fosas y surcos oclusales. En un 22 por ciento guardan relación con las estrías de Retzius de los surcos, en forma imbricada, y en un 78 por ciento, la forma laminar. La metodología empleada: microscopía de polarización y microscopía electrónica de barrido (M.E.B.), permiten determinar su aspecto irregular cuando esta zona es afectada por la caries incipiente. Los procesos de pérdida de sales minerales y remineralización se dan principalmente en esta zona