Efficacy of different protocols for at-home bleaching: A randomized clinical trial.

PURPOSE: To evaluate the efficacy of two products used for at-home bleaching with different application times. METHODS: 80 participants were enrolled and divided into four groups, (1) 10% carbamide peroxide 1 hour a day; (2) 10% carbamide peroxide overnight; (3) 7.5% hydrogen peroxide 1 hour a day; and (4) 7.5% hydrogen peroxide overnight. The duration of treatment was 14 days. Color measurement was performed using a dental spectrophotometer on the right maxillary central incisor and the canine, at baseline and 2 weeks after. Participants recorded daily tooth sensitivity. To evaluate the influence of concentration and time on bleaching results (ΔE) the one-way ANOVA with Bonferroni post-hoc test and the Student's t-test were used. RESULTS: Group 2 showed the highest value of ΔE (ΔE = 10.59 ± 2.68), followed by Group 4 (ΔE = 8.95 ± 2.32), Group 1 (ΔE = 8.05 ± 3.86), and Group 3 (ΔE = 7.08 ± 1.99). There were differences between Groups 2 and 3 (P= 0.001) and between Groups 2 and 1 (P= 0.032). The same product applied overnight was more effective than applied 1 hour a day (P< 0.05). Different concentrations during the same application time achieved similar results. The reported tooth sensitivity was mild. CLINICAL SIGNIFICANCE: At-home bleaching is time but not concentration dependent and its secondary effects depend on the active agent concentration; therefore, there is no need to use high concentration products. The most effective protocol is low concentrations (10% carbamide peroxide) with overnight use.

Treatment of enamel hypoplasia in a patient with Usher syndrome.

BACKGROUND: Usher syndrome (USH) is a group of autosomal recessive diseases characterized by the association of retinitis pigmentosa with sensorineural hearing loss. There are three types of USH. In addition, in people with USH and hypoplasia, the thickness of the enamel is reduced. CASE DESCRIPTION: The authors describe a case of a patient with USH type II associated with severe enamel hypoplasia and multiple unerupted teeth. The authors placed direct composite crowns and extracted severely affected and impacted molars. CLINICAL IMPLICATIONS: There is little information available on the oral pathologies of USH. Because the authors did not know how the patient's condition would progress and the patient still was growing, the authors treated the patient conservatively by placing direct composite crowns. The treatment has met both esthetic and functional expectations for 10 years.

Relationship between lactate dehydrogenase activity in saliva and oral health status.

OBJECTIVE: Lactate dehydrogenase (LDH) activity in serum increases as a marker of cellular necrosis. LDH activity in saliva could constitute a specific indicator of oral mucosal lesions with tissue breakdown including periodontal disease. The aim of this study was to determine LDH activity in saliva, assessing inter-individual variations with regard to the oral health status. MATERIALS AND METHODS: An oral and perioral examination was performed on a study group of 175 volunteers, to assess the number of missing teeth, caries, fillings, dental prosthesis, periodontal status and temporomandibular joint condition. LDH activity was determined from stimulated whole saliva. RESULTS: After adjustment by age, gender, smoking habits, missing teeth and use of removable prosthesis, the multivariate analysis showed that increased LDH activity was associated with periodontal disease, specifically with the presence of calculus and pockets greater than 5mm. CONCLUSION: LDH activity in whole saliva could be useful as a biochemical marker of periodontal status.

Direct composite coronal reconstruction of two fractured incisors: an 8-year follow-up.

Dental fractures of the anterior teeth are a relatively frequent accident during childhood. However until maxillary maturation is completed, the employment of porcelain crowns is not recommended, the treatment of choice, instead, would be direct composite restoration. The procedure for restoration of two extensive superior central incisor fractures is presented. Composite crowns were customized directly over the teeth. Root canal treatment was performed in one of the pieces and subsequently a post was cemented, around which a composite core was constructed. Acetate crowns were filled with composite, adapted to the dental contour and photo cured before removal to reproduce the anatomy. After follow-up of 8 years restorations remained esthetic and fully functional.

Effect of ultrasonic scaling on salivary lactate dehydrogenase.

PURPOSE: To determine Lactate Dehydrogenase Activity (LDHA) in whole saliva in individuals with periodontal disease and the effect of ultrasonic scaling on this enzyme activity. METHODS: A study group of 50 patients with PD (Community Periodontal Index of Treatment Needs > or = 3) was selected at random. Half of the patients (n=25) received ultrasonic periodontal treatment (Group 1). In the other 25 patients with PD the ultrasonic scaling was not performed (Group 2). A control group was selected (Group 3) consisting of 25 adults without PD (Community Periodontal Index of Treatment Needs = 0), with age and gender distribution similar to the study group. LDHA determinations were carried out with a Cobas Mira Plus II autoanalyzer pursuant to the recommendations of the French Society of Clinical Biology. A baseline determination of LDHA was carried out on all the participants and a second determination was performed 3 months later. RESULTS: Baseline determination of LDHA was higher in patients with PD than in the control group. These differences were statistically significant (P< 0.001). LDHA was significantly reduced in patients with PD after ultrasonic scaling with respect to baseline determination (P< 0.0001). LDHA differences between Groups 2 and 3 were statistically significant (P< 0.0001), but it was not so between Groups 1 and 3.