Clinical characterization of stomatitis cases with an epithelial growth factor receptor inhibitor in metastatic colorectal cancer patients: A study of 7 cases and literature review.

OBJECTIVE: The aim of this study was to report a case series of patients with metastatic colorectal cancer (mCRC) undergoing panitumumab-containing regimens affected by oral lesions and to review the current literature. STUDY DESIGN: Electronic medical records of mCRC patients referred to treat mouth sores during the treatment with the anti-epithelial growth factor receptor (EGFR)-panitumumab-were retrospectively reviewed. Patients' characterization, clinical profile of oral lesions, and management outcomes were documented. Additionally, modifications or discontinuation of the antineoplastic treatment as well as the occurrence of other adverse events (AEs) were analyzed. RESULTS: A total of 7 patients were included. The oral lesions appeared in a median time of 10 days (range 7-11 days) after the drug administration. The median reported pain score was 5 (range 1-9), causing feeding discomfort. Oral lesions with a marked aphthous-like appearance, among others, occurred in all cases and involved nonkeratinized mucosa more likely. At least 1 patient had dose reduction of the treatment and 1 patient needed discontinuation due to panitumumab-associated stomatitis. Dermatologic AEs were the most prevalent. Clinical improvement was obtained with topical corticosteroid therapy and/or photobiomodulation. CONCLUSIONS: In summary, panitumumab-containing regimens were associated with a particular pattern of oral lesions consistent with stomatitis. This event may eventually affect the tolerability of the treatment in patients with mCRC.

Micro-CT and FE-SEM enamel analyses of calcium-based agent application after bleaching.

OBJECTIVES: The objective of the present study is to evaluate the effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on bleached enamel. MATERIALS AND METHODS: A bleaching agent (35% hydrogen peroxide) was applied, 4 × 8 min on premolar teeth (n = 8). A CPP-ACP paste was applied for 7 days. Prior and post-treatment, microtomography images were obtained and 3D regions of interest (ROIs) were selected, from outer enamel, extending to 110.2-µm depth. CT parameters of structure: thickness (St.Th), separation (St.Sp), and fragmentation index (Fr.I.) were calculated for each (ROI). Data was submitted to paired t tests at a 95% confidence level. The samples were evaluated at 3000 to 100,000 magnification. Quantitative analysis of enamel mineral content was also determined by SEM EDX. RESULTS: There was a significant increase in structure thickness and calcium content. The phosphorus content increased after bleaching. There was also a decreased separation and fragmentation index on the outer enamel to a depth of 56.2 µm (p < 0.05). There were no changes at 110.2-µm depth for the bleaching CPP-ACP association. A covering layer and decreased spaces between the hydroxyapatite crystals appeared around the enamel prisms, 7 days after the CPP-ACP application. CONCLUSIONS: The application of a CPP-ACP provides a compact structure on the enamel's outer surface, for 7 days, due to calcium deposition. CT parameters seem to be a useful tool for mineralizing and remineralizing future studies. CLINICAL RELEVANCE: CPP-ACP neutralizes any adverse effects on enamel surface when applied during a week after bleaching and minimizes any side effects of the bleaching treatment due to a more compact structure.

Associação terapêutica conservadora para o tratamento das manchas de fluorose dental / Conservative treatment therapy for dental fluorosis staining

O excesso de ingestão de flúor durante o desenvolvimento do órgão dental pode resultar em alterações estruturais tanto em esmalte quanto em dentina. No esmalte, observa-se um aumento de porosidades causadas pela interação do flúor com os prismas em desenvolvimento, tanto na superfície quanto em profundidade. Clinicamente essas alterações são visíveis como manchas com aspecto que vai do branco opaco ao amarelo amarronzado. A presença de manchas no esmalte dental leva ao comprometimento estético do sorriso tão valorizado atualmente. Para a homogeinização de cor, nos casos mais brandos, recomenda-se a realização do tratamento clareador com agentes oxidantes de baixa concentração (clareamento caseiro). Em casos mais severos a associação do clareamento caseiro com o procedimento de microabrasão é indicada para remoção das manchas de fluorose. Na microabrasão, o uso simultâneo da abrasão e da erosão ácida é capaz de remover as manchas decorrentes de alterações superficiais em esmalte. Portanto, utilizando tratamentos conservadores é possível devolver a autoestima do paciente de forma bastante satisfatória.

The excess fluoride intake during dental organ development may result structural changes in enamel and dentin. Increase porosity was observed by fluorine interaction with enamel prisms development, both on surface and in depth. Clinically these changes are visible as spots with aspect that goes from opaque white to brownish yellow. The enamel spots leads to unpleasant smile. In mild cases, for color homogenization, it is recommended bleaching treatment with low concentration oxidizing agents (home bleaching). In more severe cases, the home bleaching and microabrasion procedure association are indicated for fluorosis stains removal. In microabrasion, the association of abrasion and acid erosion remove stains from changes on enamel surface. Thus conservative treatments can successfully restore patient's self- esteem.

In-Office Bleaching During Orthodontic Treatment.

OBJECTIVE: To demonstrate that it is possible to pursue teeth whitening treatment protocols during orthodontic treatment with no esthetic loss. CLINICAL CONSIDERATIONS: Many patients undergoing orthodontic treatment desire to have a straight and well aligned dentition, but also whiter teeth. For many years, it was believed that carrying out a whitening treatment with positioned orthodontic brackets in place would result in localized spots on the enamel labial surfaces of teeth. However, a deeper understanding of the bleaching process suggests that the oxidation caused by products, which results from hydrogen peroxide decomposition, are able to diffuse peripherally into the tooth structure and reach even that under the cemented brackets. Two in-office-bleaching treatments were performed in patients using orthodontic fixed braces in two or three 40-minute sessions using a 35% hydrogen peroxide. CONCLUSION: In-office bleaching is possible and effective, even with orthodontic brackets in position. The teeth were successfully bleached despite the presence of brackets. All biological criteria have been fulfilled satisfying patients' expectations of aligned and whitened teeth in less time than if treatments had been performed separately, with satisfactory results and no esthetic loss. CLINICAL SIGNIFICANCE: The whitening of teeth is possible during orthodontic treatment with fixed braces without any esthetic loss. The in-office bleaching treatment with brackets in position also may act as a motivation factor, preventing patient withdrawal or treatment interruption. Therefore, at the end of the orthodontic treatment, the patient is able to display an aligned, functional and whitened smile. (J Esthet Restor Dent 29:83-92, 2017).

Desproteinização do esmalte associada à técnica de remineralização no clareamento em consultório / Enamel deproteinization associated to remineralization technique on in-office bleaching

Objetivo: avaliar cor, brilho, rugosidade e alterações ultraestruturais do esmalte dental clareado com peróxido de hidrogênio a 35 %, submetido ao tratamento prévio com agente desproteinizante, ou ao tratamento posterior com o agente remineralizador fosforopeptídeo de caseína/fosfato de cálcio amorfo (ACP-CPP). Material e Métodos: Os grupos experimentais foram: GC (controle/consultório): H2O2 a 35 % - 4 sessões de 8 min; GE1 (primer+consultório): NaOCl 5,25 % por 1 min, aplicação do H2O2 a 35 % como no GC; e GE2 (consultório+ACP): GC + ACP-CPP diariamente por 7 dias. Fragmentos contendo esmalte e dentina (n=8), obtidos de dentes bovinos, foram utilizados para avaliar cor, brilho e a rugosidade. Alteração de cor (E), parâmetros L* e b* foram determinados com colorímetro e o brilho superficial com glossímetro antes, imediatamente após (1h), 4 e 7 dias após o tratamento. Parâmetros de rugosidades, Ra, Rt e RSm, foram obtidos com perfilômetro de contato antes, imediatamente após o tratamento e 7 dias após os tratamentos. Os resultados de E, brilho superficial e rugosidade foram avaliados separadamente usando ANOVA 2 fatores e teste de Tukey (p=0,05). Para avaliar a alteração ultraestrutural, dentes pré-molares humanos, seccionados nos sentidos vestibulo-lingual e mesio distal foram observados em microscópio eletrônico de varredura, por emissão de campo, e realizada a quantificação de elementos químicos por EDS. Análise tridimensional da estrutura do esmalte foi realizada por microtomografia computadorizada (micro-CT) com resolução 11,24 m (n=8). Foram realizadas análises dos parâmetros estruturais: espessura estrutural (St.Th.), separação estrutural (St.Sp.) e índice de fragmentação (Fr.I.) antes e após os tratamentos em duas regiões: ROI 1= 56,2 m e ROI 2= 110,2 m, ambas a partir da superfície vestibular. Foi utilizado o teste t pareado para análise estatística de cada parâmetro estrutural. Resultados: Não houve diferença estatística entre os diferentes tratamentos de superfície para E, Ra e RSm. Imediatamente após o clareamento (1h) ocorreu maior aumento do L* e queda do brilho superficial que se manteve por 7 dias. O uso de agente desproteinizante em dentes bovinos não acentuou a redução do brilho do esmalte, mas a aplicação de ACP-CPP acarretou em maior perda brilho e aumento nos valores de rugosidade após 7 dias para Rt. A aplicação do agente desproteinizante previamente ao clareamento em dente humano revelou uma superfície mais lisa, sem alterar os parâmetros estruturais. Há uma maior quantidade de cálcio, formação de um manto de recobrimento após aplicação de ACP-CPP em torno dos prismas de esmalte, aumento de St.Th de 4,1m, menor espaçamento entre os cristais de hidroxiapatita e redução de St.Sp em 0,8 m e de Fr.I em 0,01 no ROI-1 após 7 dias. Conclusão: O uso de agente desproteinizante não altera a cor, brilho e a ultraestrutura inorgânica. A aplicação de ACP-CPP após a técnica de clareamento de consultório não contribui para alteração de cor, mas reduz o brilho e altera a ultraestrutura da porção mais externa do esmalte após 7 dias.

Purpose: To evaluate color, gloss, roughness and ultrastructural changes of enamel bleached with 35% hydrogen peroxide, subjected to previous treatment with deproteinized agent, or later treatment with remineralizing agent casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). Materials and Methods: The experimental groups were: GC (control + in-office): 35% H2O2 - 4 sessions of 8 min; GE1(primer+in-office): 5.25% NaOCl during 1 min before the application of 35% H2O2 as done in GC, and GE2 (in-office+ACP-CPP): GC + ACP-CPP, daily applied during 7 days. Enamel and dentin blocks (n=8), obtained from bovine tooth, were used to evaluate color, gloss and roughness. Color changes (E), L* and b* parameters were done with a colorimeter and surface gloss with a glossimeter, before, immediately after (1h), 4 and 7 days after treatment. Roughness parameters, Ra, RT and Rsm, were done with a contact perfilometer before, immediately after and 7 days after treatments. ANOVA two-way and Tukeys test were performed to evaluate E, gloss and roughness separately (p=0.05). To access human pre-molar ultrastructural changes, teeth were cross-sectioned buccal-lingual and disto-mesio observed by scanning electron microscope, field emission gun, EDS to quantify chemical elements. Enamel three-dimensional images were analysed with microcomputed tomography (micro-CT) with resolution 11,24m (n=8). Structural parameters were analyzed: structural thickness (St.Th.), structural separation (St.Sp.) and fragmentation index (Fr.I.) before and after treatments in two regions of interest:ROI 1= 56,2m and ROI 2= 110,2 m, both from buccal surface. Paired t-test was done for analyses of each structural parameter. Results: There was no statistical difference among surface treatments to E, Ra and Rsm. Immediately after bleaching (1h) occured highest L* increase and decrease of surface gloss which remained until 7 days. Deproteinized agent applied on bovine tooth not emphasized enamel gloss reduction, but the CPP-ACP has resulted in a higher gloss reduction and roughness increase (Rt parameter) after 7 days. Deproteinized agent application previous to in- office bleaching observed a smooth surface, without structural parameters changes. There is a greater calcium quantity, forming a cover mantle after CPP-ACP application around enamel prisms, St.Th increase of 4,1m, less spacing between hydroxyapatite crystals and reductions of St.Sp of 0,8 m and Fr.I of 0,01 on ROI-1 after 7 days. Conclusion: Application of deproteinized agent does not change bovine enamel color, gloss and human enamel inorganic ultrastructure. CPP-ACP application after in-office bleaching does not contribute to color change, but decrease gloss of bovine enamel and change human enamel outermost ultrastructure portion after 7 days.

Clareamento dental: técnicas e conceitos atuais: [revisão] / Dental bleaching: current concepts and techniques: [review]

Este trabalho tem por objetivo revisar a literatura sobre o assunto clareamento dental, de modo que o cirurgião-dentista tenha subsídios técnicos e científicos para indicar com segurança e corretamente o melhor procedimento para cada paciente, frente a situações clínicas favoráveis, mas também frente às desfavoráveis. O mecanismo de clareamento dental é descrito de forma genérica e aplicada para cada procedimento. A estrutura mineral do dente, principalmente a do esmalte, é detalhada para que o processo de difusão dos produtos clareadores nesse tecido duro dental seja entendido, facilitando assim a compreensão da ação dos clareadores no dente, bem como o estágio atual da pesquisa odontológica sobre o assunto. As diferentes técnicas, tanto de autoaplicação (caseira) quanto de consultório, são detalhadas e discutidas. As vantagens, desvantagens, e riscos são estudados por técnica, e a aplicabilidade clínica do clareamento dental com base cientifica é esclarecida.

The aim of this paper was to review the literature on the subject of tooth bleaching in order to provide the dentist with scientific and technical information to be able to indicate safely and correctly the best procedure for each patient when faced with favorable clinical situations, but also when faced with unfavorable ones. The tooth bleaching mechanism is described in a generic and applied way for each procedure. The mineral structure of the tooth, mainly that of enamel, is described in detail so that the diffusion process of bleaching products through this dental hard tissue is understood, thus facilitating the understanding of the action of bleaching agents, as well as the current status of dental research on this subject. Both the at-home and in-office techniques are detailed and discussed. The advantages, disadvantages and risks of each technique are evaluated, and the clinical application of tooth whitening based on scientific evidence is clarified.

Effect of light irradiation on tooth whitening: enamel microhardness and color change.

The aim of this study was to evaluate the influence of light exposure associated with 35% hydrogen peroxide (Pola Office, SDI, Melbourne, Vic., Australia) or 15% hydrogen peroxide (BriteSmile, Discus, Culver City, CA, USA) on the microhardness and color changes of bovine enamel. Experimental groups were Britesmile + Light (BL) (15% hydrogen peroxide + plasm arc; 4 x 20 minutes), Britesmile + No Light (BN) (BL, no light), Pola office + Light (PL) (35% hydrogen peroxide + LED; 4 x 8 minutes), and Pola office + No light (PN) (PL, no light). Color changes (DeltaE) and the CIELAB (Commission Internationale de l' Eclairage, L* a* b* color system) parameters (L*, a*, and b*) were assessed with a spectrophotometer before (B), immediately (A), 1 day and 7 days after bleaching. The microhardness was measured before (B) and after (A), the obtained data were submitted to a two-way analysis of variance, and DeltaE were submitted to t-test for each period. Only Pola Office, in which the peroxide is associated with the light, improved DeltaE when evaluated immediately after bleaching (p < 0.001). Light exposure did not influence DeltaE after 1 day or 7 days for either bleaching system. The enamel microhardness was not altered after bleaching for BriteSmile. However, enamel microhardness was reduced after bleaching for Pola Office, 283 MPa (+/-21) and 265 MPa (+/-27), respectively. It was concluded that these two bleaching systems were efficient regardless of the light systems used. However, the 35% hydrogen peroxide altered the enamel microhardness. CLINICAL SIGNIFICANCE Enamel microhardness was affected by a 35% hydrogen peroxide in-office bleaching therapy. Moreover, the in-office bleaching outcome was not improved by using the light associated with systems tested in this study. (J Esthet Restor Dent 21:387-396, 2009).

Bond strength of hard chairside reline resins to a rapid polymerizing denture base resin before and after thermal cycling

PURPOSE: This study assessed the shear bond strength of 4 hard chairside reline resins (Kooliner, Tokuso Rebase Fast, Duraliner II, Ufi Gel Hard) to a rapid polymerizing denture base resin (QC-20) processed using 2 polymerization cycles (A or B), before and after thermal cycling. MATERIALS AND METHODS: Cylinders (3.5 mm x 5.0 mm) of the reline resins were bonded to cylinders of QC-20 polymerized using cycle A (boiling water-20 minutes) or B (boiling water; remove heat-20 minutes; boiling water-20 minutes). For each reline resin/polymerization cycle combination, 10 specimens (groups CAt e CBt) were thermally cycled (5 and 55 °C; dwell time 30 seconds; 2,000 cycles); the other 10 were tested without thermal cycling (groups CAwt ad CBwt). Shear bond tests (0.5 mm/min) were performed on the specimens and the failure mode was assessed. Data were analyzed by 3-way ANOVA and Newman-Keuls post-hoc test (alpha=.05). RESULTS: QC-20 resin demonstrated the lowest bond strengths among the reline materials (P<.05) and mainly failed cohesively. Overall, the bond strength of the hard chairside reline resins were similar (10.09±1.40 to 15.17±1.73 MPa) and most of the failures were adhesive/cohesive (mixed mode). However, Ufi Gel Hard bonded to QC-20 polymerized using cycle A and not thermally cycled showed the highest bond strength (P<.001). When Tokuso Rebase Fast and Duraliner II were bonded to QC-20 resin polymerized using cycle A, the bond strength was increased (P=.043) after thermal cycling. CONCLUSIONS: QC-20 displayed the lowest bond strength values in all groups. In general, the bond strengths of the hard chairside reline resins were comparable and not affected by polymerization cycle of QC-20 resin and thermal cycling.

OBJETIVO: Esse estudo avaliou a resistência de união ao cisalhamento de 4 resinas rígidas para reembasamento imediato (Kooliner, Tokuso Rebase Fast, Duraliner II, Ufi Gel Hard) a uma resina para base de prótese de rápida polimerização (QC-20) submetida a 2 ciclos de polimerização (A e B), antes e após termociclagem. MATERIAIS E MÉTODOS: Cilindros (3,5 mm x 5,0 mm) das resinas reembasadoras foram unidas aos cilindros de resina QC-20 polimerizados pelo ciclo A (água fervente - 20 minutos) ou B (água fervente; remoção do calor-20 minutos; água fervente-20 minutos). Para cada combinação resina reembasadora/ciclo de polimerização, 10 corpos-de-prova (grupos CAt e CBt) foram termociclados (5 e 55 °C; intervalo de tempo 30 segundos; 2.000 ciclos); os outros 10 foram testados sem termociclagem (grupos CAwt e CBwt). Os testes de resistência de união ao cisalhamento (0,5 mm/min) foram realizados sobre os corpos-de-prova e o tipo de falha avaliado. Os dados foram analisados por análise de variância (ANOVA) e teste de Newman-Keuls (alfa=0,05). RESULTADOS: A resina QC-20 demonstrou a menor resistência de união entre os materiais reembasadores (p<0,05) e apresentou falhas predominantemente coesivas. De modo geral, os valores de resistência de união das resinas rígidas para reembasamento imediato foram similares (10,09±1,40 a 15,17±1,73 MPa) e a maioria de falhas foram do tipo adesiva/coesiva (mista). Entretanto, a resina Ufi Gel Hard unida à resina QC-20 polimerizada pelo ciclo A e não termociclada apresentou a maior resistência de união (p<0,001). Quando as resinas Tokuso Rebase Fast e Duraliner II foram unidas à resina QC-20 polimerizada pelo ciclo A, a resistência de união aumentou (p=0,043) após a termociclagem. CONCLUSÕES: QC-20 apresentou os menores valores de resistência de união em todos os grupos. Em geral, os valores de resistência de união das resinas reembasadoras rígidas foram comparáveis e não foram influenciados pelo ciclo de polimerização...

Bond strength of hard chairside reline resins to a rapid polymerizing denture base resin before and after thermal cycling.

PURPOSE: This study assessed the shear bond strength of 4 hard chairside reline resins (Kooliner, Tokuso Rebase Fast, Duraliner II, Ufi Gel Hard) to a rapid polymerizing denture base resin (QC-20) processed using 2 polymerization cycles (A or B), before and after thermal cycling. MATERIALS AND METHODS: Cylinders (3.5 mm x 5.0 mm) of the reline resins were bonded to cylinders of QC-20 polymerized using cycle A (boiling water-20 minutes) or B (boiling water; remove heat-20 minutes; boiling water-20 minutes). For each reline resin/polymerization cycle combination, 10 specimens (groups CAt e CBt) were thermally cycled (5 and 55 degrees C; dwell time 30 seconds; 2,000 cycles); the other 10 were tested without thermal cycling (groups CAwt ad CBwt). Shear bond tests (0.5 mm/min) were performed on the specimens and the failure mode was assessed. Data were analyzed by 3-way ANOVA and Newman-Keuls post-hoc test (alpha=.05). RESULTS: QC-20 resin demonstrated the lowest bond strengths among the reline materials (P<.05) and mainly failed cohesively. Overall, the bond strength of the hard chairside reline resins were similar (10.09+/-1.40 to 15.17+/-1.73 MPa) and most of the failures were adhesive/cohesive (mixed mode). However, Ufi Gel Hard bonded to QC-20 polymerized using cycle A and not thermally cycled showed the highest bond strength (P<.001). When Tokuso Rebase Fast and Duraliner II were bonded to QC-20 resin polymerized using cycle A, the bond strength was increased (P=.043) after thermal cycling. CONCLUSIONS: QC-20 displayed the lowest bond strength values in all groups. In general, the bond strengths of the hard chairside reline resins were comparable and not affected by polymerization cycle of QC-20 resin and thermal cycling.