Effect of nanometric ß-calcium glycerophosphate supplementation in conventional toothpaste on enamel demineralization: An in vitro study.

The aim of this study was to evaluate the effects of supplementing toothpastes containing 1100 ppm F with micrometric or nanometric [beta]-calcium glycerophosphate (ß-CaGPm/ß-CaGPn) on artificial enamel demineralization, using a pH cycling model. Bovine enamel blocks (4 mm × 4 mm, n = 120) selected using initial surface hardness were randomly allocated to ten toothpaste groups (n = 12): without fluoride or ß-CaGPm or ß-CaGPn (Negative control), 1100 ppm F (1100 F), and 1100 ppm F plus 0.125%, 0.25%, 0.5%, and 1.0% of ß-CaGPm or ß-CaGPn. Blocks were treated two times per day with toothpaste slurry and subjected to five pH cycles (demineralizing and remineralizing solutions) at 37 °C. The final surface hardness, percentage of surface hardness loss (%SH), cross-sectional hardness (ΔKHN), and profile analysis and lesion depth subsurface were analysed using polarized light microscopy (PLM). Fluoride (F), calcium (Ca), and phosphorus (P) concentrations were also measured. Data were analysed using ANOVA and Student-Newman-Keuls tests ([alpha] = 0.001). Blocks treated with 1100 F toothpaste containing 0.5%ß-CaGPm or 0.25%ß-CaGPn showed with reduced %SH values when compared with those treated with 1100 F alone (p < 0.001). Reduced lesion depths (ΔKHN and PLM) were observed for the slurry made up of 1100 F and 0.25%ß-CaGPn (p < 0.001). The addition of ß-CaGPm and ß-CaGPn did not influence the enamel F concentration, with the 1100 F/0.25%ß-CaGPn group exhibiting the highest Ca and P enamel concentrations (p < 0.001). Based on the findings of this in vitro study, we can conclude that the fluoride toothpaste produced a superior effect when combined at an appropriate ß-CaGP molar ratio. This effect was achieved with a lower proportion of ß-CaGP in the form of nanometric particles.

Effect of the association of microparticles and nano-sized ß-calcium glycerophosphate in conventional toothpaste on enamel remineralization: In situ study.

OBJECTIVES: This in situ study aimed to assess the remineralizing effect of a fluoride toothpaste supplemented with ß-calcium glycerophosphate in both micro (ß-CaGPm) and nano-sized forms (ß-CaGPn). METHODS: This blind and cross-over study was performed in 4 phases, each spanning 3 days. Twelve volunteers utilized palatal appliances containing four bovine enamel blocks with artificial caries lesions. Volunteers were randomly assigned to the following treatment groups: Placebo (no F-ß-CaGPm-ß-CaGPn); 1100 ppm F alone (1100F); 1100F plus 0.5% micrometric ß-CaGP (1100F-0.5%ß-CaGPm); and 1100F plus 0.25%nano-sized ß-CaGP (1100F-0.25%ß-CaGPn). Participants were instructed to brush their natural teeth with the palatal appliances in the mouth for 1 min (3 times/day), ensuring that the enamel blocks were exposed to the natural toothpaste slurries. Following each phase, evaluations were conducted to determine the percentage of surface hardness recovery (%SHR), integrated recovery of subsurface hardness (ΔIHR), profile subsurface lesion through polarized light microscopy (PLM), as well as fluoride (F), calcium (Ca), and phosphorus (P) concentrations within the enamel. Data were analyzed by ANOVA and Student-Newman-Keuls test (p < 0.001). RESULTS: Treatment with 1100F-0.25%ß-CaGPn resulted in %SHR ∼69 % and ∼40 % higher when compared to 1100F and 1100F-0.5%ß-CaGPm (p < 0.001). The reduction in lesion body (ΔIHR; PLM) was ∼40 % higher with 1100F-0.25%ß-CaGPn (p < 0.001) compared to 1100F. The addition of ß-CaGPm and ß-CaGPn did not influence enamel F concentration (p > 0.001). Treatment with 1100F-0.25%ß-CaGPn led to an increase in the concentration of Ca and P in the enamel (p < 0.001). CONCLUSION: The addition of 0.25%ß-CaGPn into 1100F formulation increased the bioavailability of calcium and phosphate, promoting a higher remineralizing effect. CLINICAL SIGNIFICANCE: Toothpaste containing 1100F-0.25%ß-CaGPn showed a potential of higher remineralization to 1100 ppm F and 1100 ppm F micrometric ß-CaGP could be a strategy for patients at caries activity.

Pomegranate Extract Potentiates the Anti-Demineralizing, Anti-Biofilm, and Anti-Inflammatory Actions of Non-Alcoholic Mouthwash When Associated with Sodium-Fluoride Trimetaphosphate.

This study investigated the anti-caries and anti-inflammatory effects of mouthwash formulations containing Punica granatum (pomegranate) peel extract (PPE), sodium-trimetaphosphate, and low concentrations of fluoride. PPE was characterized using high-performance liquid chromatography (ellagic acid and punicalagin). Total phenolics were quantified among formulations, and their stability was analyzed for 28 days. The formulation effects were evaluated as follows: (1) inorganic component concentration and reduced demineralization on bovine enamel blocks subjected to pH cycling; (2) anti-biofilm effect on dual-biofilms of Streptococcus mutans ATCC 25175 and Candida albicans ATCC 10231 treated for 1 and 10 min, respectively; and (3) cytotoxicity and production of inflammatory mediators (interleukin-6 and tumor necrosis factor-alpha). The formulation containing 3% PPE, 0.3% sodium-trimetaphosphate, and 225 ppm of fluoride resulted in a 34.5% surface hardness loss; a 13% (treated for 1 min) and 36% (treated for 10 min) biofilm reduction in S. mutans; a 26% (1 min) and 36% (10 min) biofilm reduction in C. albicans; absence of cytotoxicity; and anti-inflammatory activity confirmed by decreased interleukin-6 production in mouse macrophages. Thus, our results provide a promising prospect for the development of an alcohol-free commercial dental product with the health benefits of P. granatum that have been recognized for a millennium.

In situ evaluation of 200 ppm fluoride toothpaste content trimetaphosphate, xylitol and erythritol on enamel demineralization and dental biofilm.

OBJECTIVE: To evaluate the effect of low-fluoride (F-) toothpaste and sodium trimetaphosphate (TMP) associated with xylitol and erythritol (XE) on enamel demineralization and biofilm composition. METHODS: This crossover double-blind in situ study consisted of five phases (seven days each), in which 14 volunteers wore oral appliances containing four enamel bovine blocks. The cariogenic challenge was performed by exposure to a 30% sucrose solution (6x/day). The toothpaste treatments (3x/day) were as follows: placebo (no F-/TMP/XE); 200 ppm F- (NaF) (200F); 1,100 ppm F- (1100F); 16% Xylitol and 4% Erythritol (XE); and 200 ppm F-, 0.2% TMP, 16% xylitol, and 4% erythritol (200F-TMP-XE). Percentage of surface hardness loss (%SH) and integrated loss of subsurface hardness (ΔKHN), and calcium (Ca2+), phosphate (PO43-), and F- on enamel and biofilm were determined; as well as insoluble extracellular polysaccharide (EPS). RESULTS: XE and 1100F groups showed no significant difference for %SH and ΔKHN values (p = 0.220 and p = 0.886), and the 200F-TMP-XE group had the lowest mineral loss (p < 0.001). Ca2+ and PO43- in the enamel showed the highest values (p < 0.001) for the 200F-TMP-XE group. Higher values of F- in the enamel and biofilm were observed for the 1100F group (p < 0.001). There was no difference for Ca2+ (p = 1.00) and EPS (p =0.918) values between XE and 200-TMP-XE groups in the biofilm, but their values were higher and lower than the 1100F (p = 0.002 and p = 0.029), respectively. CONCLUSIONS: 200F-TMP-XE promoted a greater protective effect against enamel demineralization and significantly affected the composition of biofilm formed in situ compared to 1100F toothpaste. CLINICAL SIGNIFICANCE: Low-F- toothpaste containing TMP and polyols can be considered an effective and safe measure to improve the oral health of individuals, especially patients with high caries activity.

Effect of fluoride, casein phosphopeptide-amorphous calcium phosphate and sodium trimetaphosphate combination treatment on the remineralization of caries lesions: An in vitro study.

OBJECTIVE: To evaluate the effects of combination of treatments with fluoridated toothpastes supplemented with sodium trimetaphosphate (TMP) and casein phosphopeptide-amorphous calcium phosphate (MI Paste Plus®), on the remineralization of dental enamel. DESIGN: Enamel blocks with artificial caries were randomly allocated into six groups (n = 12), according to the toothpastes: 1) without F-TMP-MI Paste Plus® (Placebo); 2) 1100 ppm F (1100 F), 3) MI Paste Plus®, 4) 1100 F + MI Paste Plus® (1100 F-MI Paste Plus®), 5) 1100 F + 3% TMP (1100 F-TMP) and 6) 1100 F-TMP + MI Paste Plus® (1100 F-TMP-MI Paste Plus®). Blocks were treated 2×/day with slurries of toothpastes (1 min). Furthermore, groups 4 and 6 received the application of MI Paste Plus® for 3 min. After pH cycling, the percentage of surface hardness recovery (%SHR); integrated loss of subsurface hardness (ΔKHN); profile analysis and lesion depth subsurface through polarized light microscopy (PLM), confocal laser scanning microscopy (LSCM), scanning electron microscopy (SEM), fluoride (F), calcium (Ca), phosphorus (P) concentrations in the enamel were determined. The data were analyzed by ANOVA (1-criterion) and Student-Newman-Keuls test (p < 0.001). RESULTS: 1100 F-TMP-MI Paste Plus® group showed the best results of %SHR, ΔKHN and PLM (p < 0.001). F concentration was similar between the 1100 F, 1100 F-MI Paste Plus®, and 1100 F-TMP-MI Paste Plus® groups (p > 0.001). 1100 F-TMP-MI Paste Plus® group showed the highest concentration of Ca and P in the enamel (p < 0.001). CONCLUSION: The association of 1100 F-TMP and MI Paste Plus® led to a significant increase in the remineralization of initial carious lesions.

Effect of daily use of fluoridated dentifrice and bleaching gels containing calcium, fluoride, or trimetaphosphate on enamel hardness: an in vitro study.

OBJECTIVE: This study evaluated the effects of calcium gluconate (CaGlu), sodium fluoride (NaF), sodium trimetaphosphate (TMP), and NaF/TMP added to a 35% hydrogen peroxide (HP) bleaching gel for the reduction in enamel demineralization in vitro, with and without the use of a fluoridated dentifrice. DESIGN: Enamel blocks (n = 100) were obtained from bovine incisors (n = 200) after flattening and subjected to initial surface hardness (SH) analysis. The blocks were divided according to the bleaching gel (35% HP; 35% HP + 0.05% NaF; 35% HP + 0.25% TMP; 35% HP + 0.05% NaF + 0.25% TMP; 35% HP + 2% CaGlu) and were treated with ether non-fluoridated or fluoridated (1100 ppm) dentifrice. The bleaching gels were applied thrice (40 min/session) at the intervals of 7 days between each application. After 21 days, the final SH for the calculation of the percentage of SH loss (%SH) and cross-sectional hardness for the evaluation of the integrated hardness area (IH) were determined. RESULTS: Bleaching containing HP + NaF + TMP presented lowest %SH (p < 0.001), regardless of the dentifrice used. HP + NaF + TMP bleaching gel led to lower subsurface enamel mineral loss (IH) compared to the other groups (p < 0.001), and these did not differ from each other (p > 0.05). Daily use of fluoride dentifrice led to higher IH values (p < 0.001), regardless of the bleaching gels. CONCLUSION: The addition of NaF/TMP to a 35% HP bleaching gel remarkably reduced the mineral loss compared to the cases of the other bleaching gels, regardless of dentifrice. CLINICAL RELEVANCE: The association of TMP/NaF can be used as a strategy for reducing mineral loss during the bleaching procedure, even without the daily use of fluoride dentifrice.

Combined effect of casein phosphopeptide-amorphous calcium phosphate and sodium trimetaphosphate on the prevention of enamel demineralization and dental caries: an in vitro study.

OBJECTIVE: To evaluate the effect of treatment with fluoridated toothpaste supplemented with a combination of sodium trimetaphosphate (TMP) and casein phosphopeptide-amorphous calcium phosphate (MI Paste Plus®) on the demineralization of dental enamel. METHODS: Bovine enamel blocks selected by initial surface hardness (SHi) were randomly allocated into six groups (n = 12), according to the test toothpastes: (1) without F-TMP-MI Paste Plus® (Placebo); (2) 1100 ppm F (1100F); (3) MI Paste Plus®; (4) 1100F + MI Paste Plus® (1100F-MI Paste Plus), (5) 1100F + 3 % TMP (1100F-TMP); and (6) 1100F-TMP + MI Paste Plus® (1100F-TMP-MI Paste Plus). Blocks were treated two times per day with slurries of toothpaste (1 min), and groups 4 and 6 received an application of MI Paste Plus (3 min). Next, the samples were subjected to five pH cycles (demineralizing/remineralizing solutions) at 37 °C, to produce subsurface enamel lesions.Thereafter, the blocks were maintained for 2 days in fresh remineralizing solution. After pH cycling, the following were obtained: percentage of surface hardness loss (%SH); integrated loss of subsurface hardness (ΔKHN); profile analysis and lesion depth subsurface through polarized light microscopy (PLM); scanning electron microscopy (SEM); and fluoride (F), calcium (Ca), and phosphorus (P) in the enamel. The data were subjected to ANOVA (1-criterion), followed by the Student-Newman-Keuls test (p < 0.001). RESULTS: The 1100F-TMP-MI Paste Plus group showed better results for SHR, ΔKHN, and PLM (p < 0.001). The F concentration was similar among all groups (p > 0.001). The 1100F-TMP-MI Paste Plus group showed the highest concentration of Ca and P in the enamel (p < 0.001). CONCLUSION: The application of 1100F-TMP-MI Paste Plus promoted a higher inhibitory effect against enamel demineralization. CLINICAL SIGNIFICANCE: The combination of treatments with F, TMP, and MI Paste Plus® can be an effective alternative to improve the oral health of individuals, especially those with high activity of dental caries and at high risk for its development.

Protective Effect of Fluoride Varnish Containing Trimetaphosphate against Dentin Erosion and Erosion/Abrasion: An in vitro Study.

This in vitro study evaluated the protective effect of fluoride varnishes containing sodium trimetaphosphate (TMP) against dentin erosion and abrasion. Specimens of coronal dentin were divided into: placebo, 2.5% NaF, 5% NaF, 2.5% NaF + 5% TMP, and 5% NaF + 5% TMP groups (n =24/group). After single application of the varnishes, the samples were immersed in citric acid (0.05 mol/L, pH = 3.2, 5 min) followed or not by brushing, and the dentin wear was assessed after 5 days. Varnishes containing fluoride + TMP led to the lowest wear. TMP varnishes showed a superior effect against dentin erosive wear.

Desenvolvimento, caracterização e determinação do efeito anticárie de dentifrícios contendo micropartículas e nanopartículas de isômero ß de glicerofosfato de cálcio (CaGP): estudos in vitro e in situ / Development, characterization and determination of the anti-caries effect of toothpaste containing microparticles and nano-sizeds of ß calcium glycerophosphate isomer (CaGP): in vitro and in situ studies

O objetivo geral deste estudo foi avaliar o efeito de diferentes concentrações de isômeros ß de Glicerofosfato de cálcio (ß-CaGP) microparticulado e nanoparticulado adicionados a dentifrícios convencionais (1100 ppm F) sobre o processo de desmineralização do esmalte in vitro e remineralização de lesões iniciais de cárie in situ. Para o Artigo 1 de desmineralização in vitro blocos bovinos (n = 120) foram selecionados pela dureza de superfície inicial (SHi) e divididos em 10 grupos de dentifrícios experimentais (n = 12): sem fluoreto/ß-CaGPm/ß-CaGPn (Placebo); 1100 ppm F (1100F); 1100F associado às concentrações de 0,125%; 0,25%; 0,5% e 1,0% de ß-CaGPm e ß-CaGPn. Os blocos foram tratados 2x/dia com os dentifrícios, sendo submetidos a 5 ciclagens de pH durante 7 dias. Após, determinou-se a porcentagem de perda de dureza de superfície (%SH), perda integrada de dureza de subsuperfície (∆KHN) e análise do perfil e profundidade da lesão de subsuperfície pela microscopia de luz polarizada (MLP). Concentração de fluoreto (F), cálcio (Ca) e fósforo (P) no esmalte foram avaliadas. Os dados foram submetidos à análise de variância (ANOVA-1-critério) seguido pelo teste Student-Newman-Keuls (p < 0,001). O tratamento com 1100F-0,25%ß-CaGPn levou à menores valores de %SH, ∆KHN e MLP (p < 0,001). A concentração de F do esmalte foi semelhante para todos os grupos fluoretados (p > 0,001). Com 1100F-0,5%ß-CaGPm e 1100F-0,25%ß-CaGPn, a concentração de Ca no esmalte aumentou (p < 0,001). A maior concentração de P foi observada para o grupo 1100F-0,25%ß-CaGPn (p < 0,001). O Artigo 2 de remineralização in situ foi um estudo duplo-cego e cruzado, realizado em 4 fases experimentais com duração de 3 dias cada e washout de 7 dias. Voluntários (n=12) utilizaram dispositivos palatinos, contendo 4 blocos de esmalte bovino com lesão de cárie artificial. Os regimes de tratamentos com dentifrícios foram: 1) Placebo; 2) 1100F; 3) 1100F-0,5%ß-CaGPm e 4) 1100F-0,25%ß-CaGPn. Os voluntários foram orientados a escovar os dentes naturais com os dispositivos palatinos na cavidade bucal, sendo os blocos tratados com o slurry dos dentifrícios por 1 minuto (3x/dia). Após cada fase determinou-se a dureza de superfície final para o cálculo da porcentagem de recuperação de dureza de superfície (%SHR), recuperação da perda integrada de dureza de subsuperfície (ΔIHR) e concentração de F, Ca e P no esmalte. Os dados foram analisados por ANOVA 1-critério de medidas repetidas seguida pelo teste de Student-Newman-Keuls (p < 0,001). A adição de ß-CaGPm e ß-CaGPn ao dentifrício fluoretado não influenciou a concentração de F no esmalte (p > 0,001). O tratamento com 1100F-0,25%ßCaGPn promoveu um aumento na concentração de Ca e P no esmalte (p < 0,001). Concluise que a adição de 0,25%ß-CaGPn a um dentifrício convencional promoveu um maior efeito protetor na inibição da desmineralização do esmalte in vitro e uma ação remineralizadora in situ significativamente mais elevada quando comparado ao dentifrício convencional (1100 ppm F)(AU)

The aim of this study was to evaluate the effect of isomer micro and nano-sizeds of ß calcium glycerophosphate (CaGP) in different concentrations added to conventional toothpastes (1100 ppm F) on the in vitro enamel demineralization process and remineralization of initial caries lesions in situ. For Manuscript 1 in vitro demineralization, bovine blocks (n = 120) were selected for initial surface hardness (SHi) and divided into 10 groups of experimental toothpastes (n = 12): without fluoride/ß-CaGPm/ß-CaGPn (Placebo); 1100 ppm F (1100F); 1100F associated with concentrations of 0.125%; 0.25%; 0.5% and 1.0% of ß-CaGPm and ß-CaGPn. The blocks were treated 2x/day with the toothpastes, being submitted to 5 pH cycles during 7 days. Then, the percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (∆KHN) and analysis of the profile and depth of the subsurface lesion by polarized light microscopy (MLP) were determined. Fluoride (F), calcium (Ca) and phosphorus (P) concentration in the enamel were evaluated. The data were submitted to analysis of variance (ANOVA-1-criterion) followed by the Student-Newman-Keuls test (p < 0.001). Treatment with 1100F-0.25%ßCaGPn led to lower values of %SH, ∆KHN and MLP (p < 0.001). The enamel F concentration was similar for all fluoride groups (p > 0.001). With 1100F-0.5%ß-CaGPm and 1100F-0.25%ß-CaGPn, the concentration of Ca in the enamel increased (p < 0.001). The highest concentration of P was observed for the group 1100F-0.25%ß-CaGPn (p < 0.001). Manuscript 2 of in situ remineralization was a double-blind, cross-over study, carried out in 4 experimental phases lasting 3 days each and washout of 7 days. Volunteers (n=12) used palatal devices, containing 4 blocks of bovine enamel with artificial caries lesion. The treatment regimens with toothpastes were: 1) without F/ß-CaGPm/ß-CaGPn (Placebo); 2) 1100 ppm F (1100F); 3) 1100F + 0.5%ß-CaGPm (1100F-0.5%ß-CaGPm) and 4) 1100F + 0.25%ß-CaGPn (1100F-0.25%ß-CaGPn). Volunteers were guided to brush their natural teeth with the palatal devices in the oral cavity, the blocks being treated with the toothpaste slurry for 1 minute (3x/day). After each phase the final surface hardness was determined for the calculation of the surface hardness recovery percentage (%SHR), recovery of the integrated loss of subsurface hardness (ΔIHR) and concentration of F, Ca and P in the enamel. The data were analyzed by ANOVA 1-criterion of repeated measurements followed by Student-Newman-Keuls test (p < 0.001). The treatment with 1100F-0.25% ß-CaGPn, promoted an increase in %SHR. In addition, the ability to reduce the body lesion (ΔIHR) was increased with 1100F-0.25%ß-CaGPn (p < 0.001). The addition of ß-CaGPm and ß-CaGPn to the fluoride toothpaste did not influence the concentration of F in the enamel (p > 0.001). The treatment with 1100F-0.25%ß-CaGPn promoted an increase in the concentration of Ca and P in the enamel (p < 0.001). It is concluded that the addition of 0.25%ß-CaGPn to a conventional toothpaste promoted a greater protective effect in inhibiting in vitro enamel demineralization and a significantly higher remineralizing action in situ when compared to conventional toothpaste (1100 ppm F)(AU)

Quiste dentígero en odontología / Cisto dentígero em odontologia / Dantigerous cyst in dentistry

El quiste dentígero es definido como una lesión quística que involucra la corona de un diente incluido que está relacionada con la unión amelocementaria. Clínicamente se manifiesta por un aumento del volumen asintomático, siendo generalmente descubierto en un examen radiográfico de rutina o por la investigación de un diente no erupcionado. Radiográficamente presenta una lesión radiolúcida unilocular asociada a un diente incluido. Este estudio presenta un caso clínico de un paciente con quiste dentígero en la región posterior de la mandíbula, tratado quirúrgicamente por medio de enucleación y exodoncia de los dientes involucrados. Paciente de género masculino, de 9 años de edad, que compareció a la Clínica de casoOdontología de la Universidad de Ribeirão Preto (UNAERP), Brasil, con queja de abultamiento inferior izquierdo de la cara y marcada asimetría facial, la radiografía panorámica y tomografía computarizada evidenciaron la presencia de un quiste dentígero extenso. Delante de este cuadro clínico y radiográfico, el plan de tratamiento establecido fue la enucleación del quiste para permitir la erupción de los dientes sucesores permanentes, seguido por la exodoncia de los elementos dentarios 74/75. El tratamiento quirúrgico se mostró rápido y resolutivo evidenciando que la elección del tratamiento debe ser cuidadosamente evaluado para cada caso.

O cisto dentígero é definido como uma lesão cística envolvendo a coroa de um dente incluso, estando este ligado a junção amelocementária. Clinicamente manifesta-se pelo aumento de volume assintomático, sendo geralmente descoberto pelo exame radiográfico de rotina ou pela investigação de dente não erupcionado. Radiograficamente, se apresenta como uma lesão radiolúcida unilocular em torno de um dente incluso. Este estudo apresenta um caso clínico de um paciente com cisto dentígero em região posterior de mandíbula, tratado cirurgicamente por meio de enucleação e exodontia de dentes envolvidos. Paciente do gênero masculino, 9 anos de idade, compareceu a Clínica de Odontopediatria da Universidade de Ribeirão Preto (UNAERP), Brasil, com queixa de abaulamento inferior esquerdo da face, com acentuada assimetria facial, cujo exame radiográfico panorâmico e tomografia computadorizada evidenciaram a presença de amplo cisto dentígero. Diante do quadro clínico e radiográfico, o plano de tratamento instituído foi a enucleação do cisto, para permitir a erupção dos sucessores permanentes, seguido da exodontia dos elementos dentários 74/75. O tratamento cirúrgico se mostrou rápido e resolutivo, evidenciando que a escolha do tratamento deve ser cuidadosamente ponderada para cada caso.

The dentigerous cyst is defined as a cystic lesion involving the crown of an included tooth, which is attached to the cement enamel junction. Clinically it is manifested by asymptomatic increase in volume, and is usually discovered by routine radiographic examination or by investigation of non-erupted tooth. Radiographically, it presents as a unilocular radiolucent lesion around an even tooth. This study presents a clinical case of a patient with a dentigerous cyst in the posterior region of the mandible, treated surgically by enucleation and exodontia of involved teeth. A 9-year-old male patient attended the Pediatric Dentistry Clinic of the University of Ribeirão Preto (UNAERP), Brazil, complaining of lower left bulging of the face, with marked facial asymmetry, whose panoramic radiographic examination and computed tomography evidenced the presence of large dentigerous cyst. In view of the clinical and radiographic findings, the treatment plan was to enucleate the cyst to allow eruption of the permanent successors, followed by the exodontia of the dental elements 74/75. Surgical treatment was fast and resolute, showing that the choice of treatment should be carefully weighted for each case.

Retención de molares primarios: diagnóstico, etiología, tratamiento y relato de caso clínico / Retenção de molares decíduos: diagnóstico, etiologia, tratamento e relato de caso clínico / Retention of primary molars: diagnosis, etiology, treatment and clinical case report

Este estudio presenta un relato de caso clínico sobre la retención de molares primarios, el objetivo es describir los medios de diagnóstico, la etiología, las implicaciones clínicas y el tratamiento de esta condición. Factores etiológicos locales, ambientales o genéticos pueden llevar a la retención de molares primarios, interfiriendo en la secuencia normal de erupción de los premolares. Paciente de sexo femenino, 12 años de edad, compareció a la clínica de Odontopediatría de la Facultad de Odontología de Araçatuba (FOA/UNESP), Brasil, con queja de dolor y aumento volumétrico en la región vestibular del diente 63 y cuadro casode erupción dentaria incompatible con la edad cronológica de los dientes 54/55, 75, 84/85. Exámenes complementarios fueron realizados para el establecimiento del diagnóstico, el cual se definió como retención prolongada de molares primarios. La conducta terapéutica fue basada en la realización de exodoncia de los dientes con retención prolongada, seguida del control clínico y radiográfico, hasta la erupción de los sucesores. Se concluye que el diagnóstico y la intervención temprana para la retención prolongada son de fundamental importancia para evitar daños a la oclusión.

Objetivo: Apresentar um relato de caso clínico sobre a retenção de molares de dentes decíduos, como o objetivo de descrever os meios de diagnóstico, a etiologia, as implicações clínicas e o tratamento desta condição. Fatores etiológicos locais, ambientais ou genéticos podem levar à retenção de molares decíduos, interferindo na sequência normal de erupção dos pré-molares. Paciente do sexo feminino, 12 anos de idade, compareceu à clínica de Odontopediatria da Faculdade de Odontologia de Araçatuba (FOA/UNESP), Brasil queixando-se de dor e aumento volumétrico na região vestibular do dente 63 e quadro de erupção dentária incompatível com a idade cronológica dos dentes 54/55, 65, 74/75, 84/85. Exames complementares foram realizados para o estabelecimento do diagnóstico, o qual foi definiu-se como retenção prolongada de molares decíduos. A conduta terapêutica baseou-se na realização de exodontia dos dentes com retenção prolongada, seguida do controle clínico e radiográfico, até a erupção dos sucessores. Conclui-se que o diagnóstico e a intervenção precoces para a retenção prolongada são de fundamental importância para evitar danos à oclusão.

This study shows a clinical case report about the retention of primary molars, with the aim of describing diagnosis, etiology, clinical implications and treatment of this condition. Local, environmental or genetic etiologic factors may lead to retention of primary molars, interfering with the normal sequence of eruption of the premolars. A 12-year-old female patient attended the Pediatric Dentistry Clinic of the Faculty of Dentistry of Araçatuba (FOA / UNESP), complaining of pain and volumetric increase in the buccal region of the tooth 63 and a scenario of age-incompatible eruption chronological analysis of teeth 54/55, 64/65, 74/75, 84/85. Complementary examinations were performed to establish the diagnosis, which was defined as prolonged retention of deciduous molars. Therapeutic conduct was based on the extraction of teeth with prolonged retention, followed by clinical and radiographic control until the successors erupted. It is concluded that the early diagnosis and intervention for prolonged retention are of fundamental Latinoamericanaimportance to avoid occlusal complications.

In situ effect of fluoride toothpaste supplemented with nano-sized sodium trimetaphosphate on enamel demineralization prevention and biofilm composition.

OBJECTIVE: To evaluate the effect of a fluoride toothpaste containing nano-sized sodium trimetaphosphate (TMPnano) on enamel demineralization in situ and composition of the biofilm. DESIGN: This crossover double-blind study consisted of four phases (seven days each) and 12 volunteers who wore oral appliances containing four enamel bovine blocks. The cariogenic challenge was performed by 30% sucrose solution (6x/day). The toothpaste treatments (3x/day) were as follows: no F/TMP/TMPnano (Placebo), 1100 ppm F (1100F), 1100F plus 3% micrometric or nano-sized TMP (1100F/TMP; 1100F/TMPnano). Percentage of surface hardness loss (%SH), and integrated loss of subsurface hardness (ΔKHN), as well as enamel calcium (Ca), phosphorus (P), and fluoride (F) were determined. Moreover, biofilm formed on the blocks were analyzed for F, Ca, P, and insoluble extracellular polysaccharide (EPS) concentrations. Data were analyzed using one-way ANOVA, repeated measures followed by Fisher LSD test (p < 0.001). RESULTS: 1100F/TMPnano promoted the lowest %SH and ΔKHN among all groups (p < 0.001). Regarding the F concentrations in the enamel and in the biofilm, there were no significant differences between 1100 F and 1100 F/TMPnano, but significantly increased enamel Ca concentrations (p < 0.001). 1100F/TMPnano showed lower values of EPS concentration when compared with 1100F (∼80%) (p < 0.001). CONCLUSION: 1100F/TMPnano promoted a greater protective effect against enamel demineralization and significantly affected the composition of biofilm formed in situ when compared to 1100F toothpaste.

Conducta clínica frente a la fractura de corono-esmalte y subluxación en dientes primarios: reporte de caso / Conduta clínica frente à fratura corono-esmalte e subluxação em dentes decíduos: relato de caso / Clinical management of corono-enamel fracture and subluxation in deciduous teeth: case report

Introducción: Los traumatismos en los dientes decimales son comunes de ocurrir, siendo su primer episodio normalmente en los niños cuando están aprendiendo a caminar. Los traumas nuevos o repetidos pueden ocurrir a lo largo del crecimiento y desarrollo del niño, siendo importante su diagnóstico, seguimiento y tratamiento cuando sea necesario. Objetivo: El objetivo del presente estudio fue relatar un caso clínico de fractura corono-esmalte y subluxación en dentición decidua, bien como sus complicaciones clínicas, radiográficas y conducta clínica. Relato de caso: Paciente de sexo femenino, 2 años y 8 meses de edad, compareció a la clínica de Odontopediatría de la Facultad de Odontología de Araçatuba (FOA/UNESP), Brasil, cuya mamá relataba la aparición de una "bolita" en la región superior del diente 51 y fractura corono-esmalte. Durante la anamnesis la mamá relato que la niña se había caído hace un mes y golpeado el diente 51 presentando sangramiento, leve movilidad y fractura corono-esmalte, y que según el odontopediatría que atendió la niña en el momento del trauma le informo que se trataba de un traumatismo tipo subluxación, y que la conducta clínica, debería ser acompañamiento. Al examen clínico se observó alteración en la coloración del diente 51 y presencia de fistula en la región. Al examen radiográfico fue posible observar inicio de reabsorción radicular y lesión periapical denotando necrosis pulpar. El plan de tratamiento instaurado fue endodoncia del diente 51, seguido por acompañamiento clínico y radiográfico del mismo. Después de 8 días, la niña retorno sin la presencia de fistula, mostrando la eficacia del tratamiento instaurado. Conclusión: Se concluye, por tanto que aunque la subluxación pueda traer daños al diente deciduo, cuando es diagnosticada precozmente, la alteración es susceptible de tratamiento efectivo y satisfactorio, llevando a la preservación del diente hasta el momento de su exfoliación(AU)

Introdução: Os traumatismos em dentes decíduos são comuns de ocorrer, sendo seu primeiro episódio normalmente nas crianças quando estão aprendendo a andar. Traumas novos ou repetidos podem ocorrer ao longo do crescimento e desenvolvimento da criança, sendo importante seu diagnóstico, acompanhamento e tratamento quando necessário. Objetivo: O objetivo do presente estudo foi relatar um caso clínico de fratura corono-esmalte e subluxação na dentição decídua, bem como suas complicações clínicas, radiográficas e conduta clínica. Relato de caso: Paciente do sexo feminino, 2 anos e 8 meses de idade, compareceu à clínica de Odontopediatria da Faculdade de Odontologia de Araçatuba (FOA/UNESP), Brasil, cuja mãe relatava o aparecimento de "bolinha" na região superior do dente 51 e fratura corono-esmalte. Durante a anamenese mãe relatou que a criança havia caído há 1 mês e batido o dente 51 apresentando sangramento, leve mobilidade e fratura corono-esmalte, e que segundo a odontopediatra que atendeu a criança no momento do trauma a informou que tratava-se de um traumatismo do tipo subluxação, e que como conduta clínica, deveria ser o acompanhamento. Ao exame clínico observou-se alteração na coloração do dente 51 e presença de fístula na região. Ao exame radiográfico foi possível observar início de reabsorção radicular e lesão periapical denotando necrose pulpar. O plano de tratamento instituído foi o tratamento endodôntico do dente 51, seguido pelo acompanhamento clínico e radiográfico do mesmo. Após 8 dias, a criança retornou sem a presença da fístula, mostrando a eficácia do tratamento insituído. Conclusão: Conclui-se, portanto que embora a subluxação possa trazer danos ao dente decíduo, quando diagnosticada precocemente, a alteração, é passível de tratamento efetivo e satisfatório, levando à preservação do dente até o momento de sua exfoliação(AU)

Introduction: Trauma to primary teeth is common, and is the first episode usually seen in children when they are learning to walk. New or repeated traumas may occur throughout the child's growth and development, and their diagnosis, follow-up and treatment are important when necessary. Aim: The aim of the present study was to report a clinical case of corono-enamel fracture and subluxation in the deciduous dentition, as well as its clinical, radiographic and clinical complications. Case report: A 2-year, 8-month-old female patient attended the Pediatric Dentistry Clinic of the Faculty of Dentistry of Araçatuba (FOA/UNESP), Brazil, whose mother reported the appearance of a "ball" on the upper tooth 51 and a corono-enamel fracture. During the anamnesis, the mother reported that the child had fallen for 1 month and beat the 51 tooth presenting bleeding, mild mobility and corono-enamel fracture, and according to the pediatric dentist who attended the child at the time of the trauma informed her that it was a traumatic type of subluxation, and that as a clinical course, it should be the follow-up. Clinical examination revealed a change in tooth color 51 and presence of fistula in the region. Radiographic examination revealed the beginning of root resorption and periapical lesion denoting pulp necrosis. The treatment plan was the endodontic treatment of tooth 51, followed by clinical and radiographic follow-up. After 8 days, the child returned without the presence of the fistula, showing the efficacy of the treatment. Conclusion: It is concluded, therefore, that although the subluxation can bring damage to the deciduous tooth, when it is diagnosed early, the alteration is capable of effective and satisfactory treatment, leading to the preservation of the tooth until the moment of its exfoliation(AU)

Remineralizing effect of a fluoridated gel containing sodium hexametaphosphate: An in vitro study.

OBJECTIVES: To evaluate in vitro the effect of neutral pH topical gels with reduced fluoride concentration (F), supplemented or not with sodium hexametaphosphate (HMP) on the remineralization of dental enamel, using a pH-cycling model. Materials and methods Bovine enamel blocks with caries-like lesions were randomly treated with five gels (n = 24/group): without F/HMP (Placebo); 4500 ppm F (4500F), 4500F plus 9% HMP (4500F + HMP); 9000 ppm F (9000F); and 12,300 ppm F (Acid gel). After pH-cycling, the percentage of surface hardness recovery (%SHR), integrated loss of subsurface hardness (ΔKHN), and concentrations of loosely- (CaF2) and firmly-bound (FA) fluoride formed and retained in/on enamel were determined. The results were analyzed by ANOVA followed by the Student-Newman-Keuls test (p < 0.001). RESULTS: The 4500F + HMP gel promoted the highest %SHR among all groups; the lowest ΔKHN was achieved by 4500F + HMP and Acid gel, without significant differences between these. The Acid gel group presented the highest CaF2 and FA formed and retained on/in enamel (p < 0.001). CONCLUSION: Based on the present results, the addition of 9% sodium hexametaphosphate to a gel with reduced fluoride concentration (4500F) was able to significantly enhance the remineralization of artificial carious lesions in vitro when compared to 4500F, reaching protective levels similar to an acidic formulation with ∼3-fold higher fluoride concentration.

In situ effect of the combination of fluoridated toothpaste and fluoridated gel containing sodium trimetaphosphate on enamel demineralization.

OBJECTIVE: This in situ study evaluated the effect of the association of low-F (4500µg F/g) gel containing TMP and FT (1100µg F/g) on enamel demineralization. METHODS: This crossover and double-blind study consisted of five phases of seven days each. Volunteers (n=12) wore palatal appliances containing four enamel blocks. The cariogenic challenge was performed with 30% sucrose solution (six times/day). Treatments were: placebo toothpaste (PT, no fluoride/TMP); 1100µg F/g toothpaste (FT); FT+4500µg F/g+5%TMP gel (FT+TMP gel); FT+9000µg F/g gel (FT+9000 gel) and FT+12,300µg F/g (FT+Acid gel). After topical application of treatments for one min, two blocks were removed for analysis of loosely bound fluoride (CaF2), calcium (Ca), phosphorus (P) and firmly bound fluoride (FA) formed in enamel. After the seven-day experimental periods, the percentage of surface hardness loss (%SH), integrated subsurface hardness loss (ΔKHN), CaF2, Ca, P and FA retained were determined. Moreover, the biofilms formed on the blocks were analyzed for F, Ca, P and insoluble extracellular polysaccharide (EPS) concentrations. RESULTS: FT+TMP gel promoted the lowest%SH and ΔKHN (p<0.001). The highest concentration of CaF2 formed was observed for the FT+Acid gel (p<0.001), followed by FT+9000 gel > FT+TMP gel > FT > PT. CaF2 retained on the blocks was reduced across all groups (p<0.001). Similar values were observed for the Ca/P/F and EPS in enamel and biofilm for all fluoride groups. CONCLUSION: The association of FT+TMP gel significantly reduced enamel demineralization in situ. CLINICAL SIGNIFICANCE: The association of treatments may be an alternative for patients with high caries risk.

Displasia ectodérmica en odontopediatría / Displasia ectodérmica em odontopediatria / Ectodermal dysplasia in pediatric dentistry

Ectodermal dyspasia (ED) is a hereditary disease that includes genetic and environmental changes. ED causes hypodontia, dystrophic nails, sparse hair and dental anomalies. Oral rehabilitation treatment for pediatric patients with ED is difficult because of continuous development and craniofacial growth. The aim of this study was to present a case report of oral rehabilitation in pediatric patients diagnosed with ED. A 5- year, 6-month-old girl reported to the clinic of Pediatric Dentistry in University Anhanguera UNIDERP-BR. Extraoral examination showed that the patient was an oral breather, and presented with decreased lower face height, protruding and everted lips, prominent forehead, "horse saddle" nose, lack of hair, eyelashes and eyebrows, thin and dry skin. Intraoral examination demonstrated absence of teeth: 51/52, 61/62/63, 71/72, 81/82 and tree conical teeth: 53, 73 and 83. The radiographic examination revealed agenesis of 9 primary teeth and of the buds of the following permanent teeth: 11/12/13, 21/22/23, 41/42, 31/32, we observed the presence of teeth buds of 33 and 43. Considering physical and radiographic characteristics hydrotic ectodermal was diagnosed. As clinical management, we opted for the installation of removable functional aesthetic maintainers, favoring the speech normality, swallowing, lip and lingual muscle tone and social development.

A displasia ectodérmica (DE) caracteriza-se por uma doença hereditária que consiste em alterações genéticas e ambientais, provocando hipodontia, unhas distróficas, cabelos escassos e anomalias dentárias. O tratamento reabilitador em pacientes pediátricos com DE se torna difícil devido ao contínuo desenvolvimento e crescimento crânio-facial dessas crianças. O presente trabalho tem como objetivo relatar um caso clínico de reabilitação oral em paciente pediátrico diagnosticado com DE. Paciente sexo feminino, com 5 anos e 6 meses de idade compareceu a clínica de Odontopediatria na UNIDERP. Ao exame físico, extra-oral, constatou-se que a paciente era respiradora bucal, e tinha como características a diminuição do terço inferior da face, lábios protusos e evertidos, fronte proeminente, nariz em "sela", escassez de pelos, cílios e sobrancelha, pele fina e seca. No exame intra-oral observou-se ausência dos elementos dentários, 51/52, 61/62/63, 71/72, 81/82, e os elementos 53, 73 e 83 apresentando aspecto conóide. Ao exame radiográfico constatou-se a agenesia de 9 dentes decíduos e dos germes dos seguintes dentes permanentes: 11/12/13, 21/22/23, 41/42, 31/32 e ainda observou-se a presença dos germes dos dentes 33 e 43. Baseado nas características físicas e radiográficas diagnosticou-se displasia ectodermica hidrótica. Como conduta clínica, optou-se pela instalação de mantenedores estéticos funcionais removíveis, favorecendo a normalidade da fala, deglutição, tonicidade muscular labial e lingual e do desenvolvimento social.

La displasia ectodérmica (DE) se caracteriza por ser una enfermedad hereditaria que consiste en alteraciones genéticas y ambientales, provocando hipodoncia, distrofia en uñas, cabello escaso y anomalías dentarias. El tratamiento de rehabilitación en pacientes pediátricos con DE es difícil debido al continuo crecimiento y desarrollo cráneo facial de estos niños. El presente trabajo tiene como objetivo relatar un caso clínico de rehabilitación oral en paciente pediátrico diagnosticado con DE. Paciente de sexo femenino, con 5 años y 6 meses de edad que compareció a la clínica de odontopediatría en la UNIDERP. Al examen físico, extra oral, se constató que la paciente era respiradora bucal, y presentaba disminución del tercio inferior de la cara, labios protruidos y evertidos, frente prominente, nariz en "silla de montar", escasez de cabello, pestañas y cejas, piel fina y seca. En el examen intraoral se observó ausencia de los siguientes dientes: 51/52, 61/62/63, 71/72, 81/82, y aspecto conoide de los dientes 53, 73 y 83. Al examen radiográfico se constató agenesia de 9 dientes primarios y de los gérmenes de los siguientes dientes permanentes: 11/12/13, 21/22/23, 41/42, 31/32, se observó la presencia de los gérmenes de los dientes 33 y 43. Con base en las características físicas y radiográficas se diagnosticó displasia ectodérmica hidrótica. Como conducta clínica, se optó por la instalación de mantenedores estéticos funcionales removibles, con el fin de favorecer la fonación, deglución, tonicidad muscular labial y lingual y el desenvolvimiento social.

Efeito in situ de dentifrício fluoretado e suplementado com nanopartículas de trimetafosfato de sódio sobre a desmineralização do esmalte e biofilme / In situ effect of fluoride toothpaste and supplemented with nano-sized sodium trimetaphosphate on enamel demineralization and biofilm

Objetivo: Avaliar o efeito de um dentifrício fluoretado contendo trimetafosfato de sódio de tamanho nanométrico (TMPnano) na desmineralização do esmalte in situ e composição do biofilme. Métodos: Este estudo foi duplo-cego cruzado consistindo em quatro fases experimentais (7 dias cada) com 12 voluntários que utilizavam dispositivos orais contendo quatro blocos de esmalte bovino. O desafio cariogênico foi realizado por solução de sacarose 30% (6x/dia). Os tratamentos com dentífricos (3x/dia) foram os seguintes: sem F/TMP/TMPnano (Placebo), 1100 ppm F (1100F), 1100F mais 3% de TMP micrométrico ou nanométrico (1100F/TMP; 1100F/TMPnano). A porcentagem de perda de dureza da superfície (%SH) e a perda integrada de dureza de subsuperfície (ΔKHN), bem como o cálcio (Ca), o fósforo (P) e o fluoreto (F) foram determinados. Além disso, o biofilme formado nos blocos foi analisado quanto às concentrações de polissacarídeos extracelulares (EPS), F, Ca, P. Os dados foram analisados utilizando ANOVA 1- critério de medidas repetidas seguidas pelo teste Fisher LSD (p < 0,001). Resultados: 1100F/TMPnano promoveu menor %SH e ΔKHN entre todos os grupos (p < 0,001). A adição de TMPnano a 1100F não aumentou a absorção de F no esmalte, mas aumentou significativamente as concentrações de Ca do esmalte (p <0 ,001). 1100F/TMPnano apresentou valores mais baixos de concentração de EPS quando comparados com 1100F (~ 80%) (p < 0,001). Quanto os graus de saturação, os grupos 1100F/TMP e 1100F/TMPnano mostraram a maior saturação em relação ao HA e similares entre si para CaF2 (p > 0,001). A atividade iônica de CaF+ e HF0 para os grupos 1100F/TMP e 1100F/TMPnano foi semelhante (p > 0,001). Conclusão: 1100F/ TMPnano promoveu um efeito protetor maior contra a desmineralização do esmalte e afetou significativamente a composição do biofilme formado in situ, quando comparado ao dentifrício com 1100F. Relevância clínica: Essa formulação testada pode ser uma alternativa viável para pacientes com alto risco de cárie(AU)

Objective: To evaluate the effect of a fluoride toothpaste containing nano-sized sodium trimetaphosphate (TMPnano) on enamel demineralization in situ and composition of the biofilm. Methods: This crossover double-blind study consisted of four phases (7 days each) and 12 volunteers who wore oral appliances containing four enamel bovine blocks. The cariogenic challenge was performed by 30% sucrose solution (6x/day). The toothpaste treatments (3x/day) were as follows: no F/TMP/TMPnano (Placebo), 1,100 ppm F (1100F), 1100F plus 3% micrometric or nano-sized TMP (1100F/TMP; 1100F/TMPnano). Percentage of surface hardness loss (%SH), and integrated loss of subsurface hardness (ΔKHN), as well as enamel calcium (Ca), phosphorus (P), and fluoride (F) were determined. Moreover, biofilm formed on the blocks were analyzed for F, Ca, P, and insoluble extracellular polysaccharide (EPS) concentrations. Data were analyzed using oneway ANOVA, repeated measures followed by Fisher LSD test (p < 0.001). Results: 1100F/TMPnano promoted the lowest %SH and ΔKHN among all groups (p < 0.001). The addition of TMPnano to 1100F did not enhance enamel F uptake, but significantly increased enamel Ca concentrations (p < 0.001). 1100F/TMPnano showed lower values of EPS concentration when compared with 1100F (~80%) (p < 0.001). As for phase saturation, the 1100F/TMP and 1100F/TMPnano groups showed the highest supersaturation with respect to HA and similar to each other for CaF2 (p > 0.001). The ionic activity of CaF+ and HF0 for the 1100F/TMP and 1100F/TMPnano groups were similar (p > 0.001). Conclusion: 1100F/TMPnano promoted a greater protective effect against enamel demineralization and significantly affected the composition of biofilm formed in situ when compared to 1100F toothpaste. Clinical Significance: This toothpaste could be a viable alternative to patients at high risk of caries(AU)