Spectrophotometric evaluation of coronal discoloration induced by bioceramic root canal filling materials / Evaluación espectrofotométrica de la decoloración coronal inducida por materiales biocerámicos de obturación del conducto radicular

The aim of this study is to evaluate the crown discoloration induced by bioceramic root canal filling materials (OrthoMTA and iRoot SP) compared to AH Plus. Material and Methods: Sixty intact mandibular single rooted premolars were sectioned 2 mm below the cemento-enamel junction, prepared, and randomly assigned into four groups according to the root filling materials: OrthoMTA, iRoot SP, AH Plus and unfilled. Results: Before placement of the materials in the pulp chamber and the coronal third of the root, the spectral reflectance lines of the crowns were recorded by a digital spectrophotometer at baseline, and after filling at 1 week and 1, 3 and 6 months and ∆Ε values were calculated. All materials used induced clinically perceptible crown discoloration (∆Ε>3.7) and no significant difference was detected between these materials (p>0.05). Regardless of the material, discoloration progressed significantly within the three months (p<0.05) however, at 6 months, the discoloration reduced for AH Plus and no further increase for bioceramic materials was detected. Conclusion: Bioceramic root filling materials tested induced clinically perceptible crown discoloration and their application in the esthetic zone should be performed with caution.

Objetivo: El objetivo de este estudio es evaluar la decoloración de la corona inducida por materiales biocerámicos de obturación del conducto radicular (OrthoMTA e iRoot SP) en comparación con AH Plus. Material y Métodos: Se seccionaron sesenta premolares mandibulares de raíz única intactos, 2 mm por debajo de la unión cemento-esmalte, se prepararon y se asignaron al azar en cuatro grupos de acuerdo con los materiales de obturación radicular: OrthoMTA, iRoot SP, AH Plus y sin relleno. Resultados:Antes de la colocación de los materiales en la cámara pulpar y el tercio coronal de la raíz, las líneas de reflectancia espectral de las coronas se registraron con un espectrofotómetro digital al inicio del estudio, y a la semana 1, así como a 1, 3 y 6 meses, y los valores ?? fueron calculados. Todos los materiales utilizados indujeron una decoloración de la corona clínicamente perceptible (??> 3,7) y no se detectaron diferencias significativas entre estos materiales (p> 0,05). Independientemente del material, la decoloración progresó significativamente dentro de los tres meses (p<0.05); sin embargo, a los 6 meses, la decoloración se redujo para AH Plus y no se detectó ningún aumento adicional para los materiales biocerámicos. Conclusiones: Los materiales biocerámicos de obturación radicular probados indujeron una decoloración de la corona clínicamente perceptible y su aplicación en la zona estética debe realizarse con precaución.

Alternative to avoid tooth discoloration after regenerative endodontic procedure: a systematic review

Abstract This systematic review aimed to evaluate whether alternative materials to conventional triple antibiotic paste (TAP - metronidazole, ciprofloxacin, and minocycline) and grey mineral trioxide aggregate (GMTA) could avoid tooth discoloration in teeth submitted to Regenerative Endodontic Procedure (REP). It was also investigated if dental bleaching is able to reverse the color of darkened teeth due to REP. The search was conducted in four databases (Medline via PubMed, Scopus, ISI Web of Science and BVS - Virtual health library), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The retrieved papers were uploaded in the software EndNoteTM and two reviewers independently selected the studies and extracted the data. Only studies in humans (case reports, case series, clinical trials) were included in the review. From 1,122 potentially eligible studies, 83 were selected for full-text analysis, and 38 were included in the review. The included studies were mainly case reports (76.3 %). The studies described a total of 189 teeth submitted to REP. From these, about 54% of teeth presented some degree of discoloration. Most teeth presenting color alteration were treated with TAP, especially when combined with GMTA. Only three studies performed dental bleaching to restore the color of teeth and neither bleaching technique was able to restore the original color of the crowns. The use of alternative materials to TAP and GMTA, such as double antibiotic paste or Ca(OH)2 pastes and white mineral trioxide aggregate or BiodentineTM, reduces the occurrence of tooth discoloration.

Resumo Esta revisão sistemática teve como objetivo avaliar se materiais alternativos à pasta tri-antibiótica convencional (TAP, em Inglês - metronidazol, ciprofloxacina e minociclina) e ao agregado trióxido mineral cinza (MTA cinza) poderiam evitar a descoloração dentária em dentes submetidos ao procedimento endodôntico regenerativo (REP, em Inglês). Também foi investigado se o clareamento dental é capaz de reverter a cor dos dentes escurecidos devido ao REP. A busca foi realizada em quatro bases de dados (Medline via PubMed, Scopus, ISI Web of Science e BVS - Biblioteca Virtual de Saúde), seguindo os Principais Itens para Relatar Revisões Sistemáticas e Meta-análises. Os artigos obtidos foram carregados no software EndNoteTMe dois revisores independentes selecionaram os estudos e extraíram os dados. Apenas estudos em humanos (relatos de casos, séries de casos, ensaios clínicos) foram incluídos na revisão. De 1.122 estudos potencialmente elegíveis, 83 foram selecionados para análise do artigo completo, e 38 foram incluídos na revisão. Os estudos incluídos foram principalmente relatos de casos (76,3%). Os estudos descreveram um total de 189 dentes submetidos ao REP. Destes, cerca de 54% dos dentes apresentaram algum grau de descoloração. A maioria dos dentes com alteração de cor foi tratada com TAP, principalmente quando combinada com MTA-cinza. Apenas três estudos realizaram o clareamento dental para restaurar a cor dos dentes e nem a técnica de clareamento conseguiu restaurar a cor original das coroas. O uso de materiais alternativos à TAP e ao MTA cinza, como a pasta bi-antibiótica, pasta de Ca(OH)2e MTA branco ou BiodentineTM, reduz a ocorrência de descoloração dentária.

Crown discoloration promoted by materials used in regenerative endodontic procedures and effect of dental bleaching: spectrophotometric analysis

Abstract Regenerative endodontic procedure (REP) has been proposed as a new approach to treat immature permanent teeth. However, materials used in REP for root canal disinfection or cervical sealing may induce tooth discoloration. Objectives To assess tooth crown’s color after intracanal treatment with triple antibiotic paste (TAP) or calcium hydroxide (CH); cervical sealing with glass ionomer cement (GIC) or mineral trioxide aggregate (MTA); and bleaching with carbamide peroxide. Material and Methods After pulp removal and color spectrophotometer measurement, 50 bovine incisors were divided into 4 experimental groups and one control (untreated). Experiments were performed in phases (Ph). Ph1: TAP (ciprofloxacin, metronidazole, minocycline), TAPM (ciprofloxacin, metronidazole, amoxicillin), DAP (ciprofloxacin, metronidazole), or CH treatment groups. After 1 and 3 days (d); 1, 2, 3 weeks (w); and 1, 2, 3 and 4 months (m), color was measured and medications were removed. Ph2: GIC or MTA cervical sealing, each using half of the specimens from each group. Color was assessed after 1d, 3d; 1w, 2w, 3w; 1m and 2m. Ph3: Two bleaching sessions, each followed by color measurement. Data were analyzed with ANOVA and post-hoc Holm-Sidak method. Results Ph1: Specimens of TAP group presented higher color alteration (ΔE) mean than those of TAPM group. No significant difference was found among TAP or TAPM and CH, DAP or Control groups. Ph2: cervical sealing materials showed no influence on color alteration. Ph3: Different ΔE means (from different groups), prior to bleaching, became equivalent after one bleaching session. Conclusions TAP induces higher color alteration than TAPM; color alteration increases over time; cervical sealing material has no influence on color alteration; and, dental bleaching was able to recover, at least partially, the tooth crown’s color.

Spectrophotometric analysis of crown discoloration induced by MTA- and ZnOE-based sealers

Crown discoloration can be induced by root canal sealer remnants following root canal treatment. Objective: The aim of this study was to evaluate chromatic alterations in human tooth crowns induced by a Mineral Trioxide Aggregate-based sealer (MTA Fillapex®) and a commonly used ZnOE-based sealer (Roth-811). The tested null hypothesis was that the application of the materials did not induce clinically perceptible crown discoloration (Ho: CIE color difference ΔE<3.7). Material and Methods: Forty five fully developed, intact, mandibular third molars were sectioned 1 mm below the cemento-enamel junction. The pulp chambers were chemomechanically debrided via the cervical access. The specimens were randomly assigned into three groups Group 1: MTA Fillapex, Group 2: Roth 811, Group 3: Negative control (unfilled) and immersed in individually marked vials containing distilled water up to the cervix (37±1°C). The spectral reflectance lines were recorded by utilizing a UV-VIS spectrophotometer equipped with integration sphere in the visual spectrum at baseline, 1 week, 1 and 3 months after material placement. Data were transformed into values of the CIE L*a*b* color system and the corresponding ΔE values were calculated. Statistical analysis was performed using two-way mixed ANOVA models, at p=0.05 level of significance. Results: A statistically significant increase in a* and b* chromatic parameters of the MTA Fillapex Group was measured. However, ΔE values did not exceed the human eye perceptibility threshold (set at ΔE<3.7) during the experimental period (ΔEt3=2.88). In Roth-811 Group, a statistically significant decrease in L* and a statistically significant increase in a* and b* chromatic parameters was measured, during all observation periods. Resultant ΔE values exceeded the human eye perceptibility threshold after 1 week (ΔEt1=5.65). Conclusions: Application of MTA Fillapex in tooth crowns resulted in minimal color alterations, while Roth 811 induced severe discoloration, in vitro. It could be suggested that, in terms of aesthetics, the use of MTA Fillapex appears to be favorable.

Impact of rehabilitation with metal-ceramic restorations on oral health-related quality of life

Dental ceramics present excellent ability to reproduce the natural teeth regarding esthetic and biomechanics. Recently, due to the advancement of ceramic technology, metal-free restorations were developed. However, the traditional metal-ceramic restorations still present the requirements of high strength, long survival in the oral environment and favorable aesthetics. In this context, it is essential to know the specificity of each ceramic system available in order to apply it properly to various clinical situations. This report describes an integrated rehabilitation using metal-ceramic restorations of a patient at 50 years of age, who presented edentulous spaces, and previous unsatisfactory composite and amalgam restorations, and indirect metallic restorations, leading to compromised quality of life in both functional and psychosocial aspects. The impact on quality of life was measured using a generic instrument, OHIP-14, validated for the World Health Organization, which covers both the biological and the psychosocial dimensions. This instrument was applied to the patient before and after treatment. The patient had an overall OHIP-14 score of 28 before the treatment and after treatment the score decreased to 0, showing that dental and oral health conditions are factors that do impact on the quality of life. Rehabilitation has provided functional and aesthetic restorations, harmony of the stomatognathic system and improvement of life quality.

As cerâmicas dentais são conhecidas pela excelência em reproduzir artificialmente dentes naturais. Recentemente, devido ao aprimoramento da tecnologia cerâmica, surgiram as restaurações livres de metal. Entretanto, as tradicionais metalocerâmicas ainda preenchem adequadamente os requisitos de alta resistência, longa sobrevida em meio bucal e estética favorável. Neste contexto, é fundamental conhecer a especificidade de cada sistema cerâmico a fim de indicá-lo adequadamente às diversas situações clínicas. Este artigo relata um caso de reabilitação integral e integrada de paciente de 50 anos de idade, portador de espaços edêntulos, restaurações protéticas posteriores e restaurações diretas anteriores insatisfatórias, resultando em comprometimento da qualidade de vida nos âmbitos funcional e psicossocial, utilizando coroas metalocerâmicas. O impacto na qualidade de vida foi mensurado utilizando um instrumento genérico, OHIP-14, validado pela Organização Mundial de Saúde, que abrange tanto a dimensão biológica, como a dimensão psicossocial. Este instrumento foi aplicado à paciente antes e após o tratamento, obtendo pontuação total de 28 e 0 respectivamente, o que mostra que a condição de saúde oral representa fator de grande impacto sobre a qualidade de vida. A reabilitação oral proporcionou restabelecimento funcional e estético, harmonia do sistema estomatognático e melhoria da qualidade de vida da paciente.

Fluorides in groundwater and its impact on health.

Fluoride is a naturally occurring toxic mineral present in drinking water and causes yellowing of teeth, tooth problems etc. Fluorspar, Cryolite and Fluorapatite are the naturally occurring minerals, from which fluoride finds its path to groundwater through infiltration. In the present study two groundwater samples, Station I and Station II at Hyderabad megacity, the capital of Andhra Pradesh were investigated for one year from January 2001 to December 2001. The average fluoride values were 1.37 mg/l at Station I and 0.91 mg/l at Station II. The permissible limit given by BIS (1983) 0.6-1.2 mg/l and WHO (1984) 1.5 mg/l for fluoride in drinking water. The groundwaters at Station I exceeded the limit while at Station II it was within the limits. The study indicated that fluoride content of 0.5 mg/l is sufficient to cause yellowing of teeth and dental problems.

Tetraciclinas y esmalte dental / Tetracyclines and dental enamel

Las tetraciclinas son antibióticos de amplio espectro frecuentemente usadas en dermatología por sus acciones antiinflamatorias en acné vulgar y en rosácea. Uno de los efectos secundarios más temidos es la alteración del esmalte dental, por lo que no se recomienda su uso en menores; sin embargo, la edad exacta no ha sido claramente determinada. Las tetraciclinas provocan manchas permanentes en el esmalte dental definitivo por su gran afinidad con el calcio y el hierro, aunque el mecanismo exacto esta en discusión. La odontogénesis para la dentadura definitiva termina a los ochos años, excepto para los terceros molares, y es durante la odontogénesis donde se produce la alteración del esmalte, secundario a estas drogas. Por ende, se puede emplear las tetraciclinas con seguridad en pacientes mayores de ocho años. Numerosos otros agentes pueden causar daños similares al esmalte. Existen diversos tratamientos de resorte odontológico para blanquear el esmalte.

Tetracyclines are broad spectrum antibiotics that are frequently used in dermatology because of their anti-inflammatory effects in acne vulgaris and rosacea. One of their worst side effects is the alteration in dental enamel, which is why it is not recommended for children; nevertheless, the exact age has not been clarified. Tetracyclines can stain permanent dental enamel for life due to their great affinity with calcium and iron; however, that exact mechanism is still under discussion. Odontogenesis for permanent teeth finishes at age 8, except for 3rd molars, and it during the odontogenesis that these drugs cause the aforementioned effects. Therefore, tetracyclines can be used in patients older than 8 years without fear of damaging the enamel. Numerous other agents can cause similar damage. There are many whitening treatments and procedures carried out by dentists.

Avaliaçäo in vitro do escurecimento dental por meio de escala de cor e análise computadorizada / Dental darkening evaluation using a scale and computer analysis in vitro

O objetivo deste trabalho foi investigar in vitro uma técnica de escurecimento dental com sangue, para usá-la em pesquisas de clareamento. Após o preparo dos dentes, sangue hemolisado foi injetado em seu interior, exceto no grupo controle (VI). As variáveis velocidade de centrifugaçäo, acesso apical ou lingual à câmara pulpar e tempo de permanência no sangue foram analisadas. Os resultados mostraram que o grupo I apresentou os maiores graus de alteração de cor, sendo, portanto, sugerida como uma técnica eficaz de escurecimento dental

Traitements chimiques des dyschromies dentaires : Revue systématique de la littérature

Depuis quelques années, la dentisterie esthétique suscite une attention grandissante, due à l'intérêt croissant des patients pour l'apparence esthétique de leur sourire.Un sourire éclatant est un atout sociologique, qui non seulement impacte fortement la psychologie du sujet lui-même, mais également les personnes qui l'entourent. Il est synonyme de santé.De plus, l'aspect naturel et esthétique d'une dent est déterminé non seulement par sa morphologie et sa position par rapport aux autres dents, mais aussi et surtout par sa couleur.Pour cela et face à la demande croissante des patients,il semble aujourd'hui important de s'intéresser à la valeur des différentes technique d'éclaircissement, en évaluant et en comparant leur efficacité, et surtout leur niveau d'innocuité