Effect of air-abrasion pretreatment with three desensitizing agents on efficacy of in-office tooth bleaching.

OBJECTIVE: To evaluate the influence of air-abrasion of enamel with three different desensitizing powders on the whitening effect of a bleaching gel containing 40% H2O2, which was used for in-office tooth bleaching. MATERIALS AND METHODS: Forty human incisors, extracted and prepared, were acquired for this study and subsequently randomized into four groups (n = 10). The control group specimens underwent no pretreatment prior to the bleaching procedure, whereas the remaining three groups underwent air abrasion using distinct desensitizing powders; (a) Sylc, which contains bioglass 45S5; (b) BioMinF, which contains calcium phospho-fluoro-silicate glass; and (c) MI Pearls, which contains nano-hydroxyapatite, 1 h preceding the Opalescence Boost PF 40% bleaching procedure. Color measurements were conducted using a double-beam UV-Vis spectrophotometer at four distinct time points (prior to bleaching, 24 h, 15 days, and 30 days post-bleaching). RESULTS: Tooth color change outcomes revealed that there were no statistically significant results with respect to the interaction of the two criteria (treatments and time) (p = 0.990). Additionally, there were no statistically significant results with respect to the main effects of treatments (p = 0.385), while there were statistically significant effects with respect to the time criterion (p = 0.013). CONCLUSIONS: The use of the tested desensitizing powders prior the bleaching procedure did not affect the tooth color change induced by the tested bleaching agent. CLINICAL SIGNIFICANCE: Tooth color change and whiteness are not affected by air-abrasion desensitizing treatments when applied prior to in-office bleaching procedures.

Efficiency of cavitary varnishes containing experimental bioglass particles in the occlusion of dentinal tubules.

This research aims to evaluate the efficiency of cavitary varnishes containing experimental bioglasses in the occlusion of dentinal tubules. One hundred and sixty-eight cervical buccal dentin samples were obtained from bovine teeth. Samples were randomized into the following groups: I. Distilled Water (DW); II. Cavity Varnish (CV); III. Colgate® Sensitive Pro-Relief™ (CS); IV. 45S5 Bioglass (45S5); V. KSr Bioglass strontium potassium (KSr); VI. P Bioglass phosphorus (P); and VII. PSi Bioglass phosphorus silica (PSi). The treatments were applied to the surfaces of the samples, which were then subjected to simulated brushing. The samples were analyzed for a) characterization of bioactive glasses; b) surface roughness; c) descriptive analysis of the dentin surface; d) total versus occluded number of dentinal tubules; e) diameter of the dentinal tubules; f) chemical composition of the dentin surfaces, and g) dentin permeability. All groups treated with biomaterials without the brushing challenge showed an increase in roughness and (total or partial) occlusion of the dentinal tubules. The PSi group had the best values for occlusion, while the KSr group had the highest calcium and phosphorus concentrations. After the brushing challenge the roughness was controlled by the presence of biomaterials; 45S5, KSr, and PSi showed occlusion of the dentin tubules. All bioactive glasses showed reduced tooth permeability compared to distilled water. The PSi group had the smallest tubule diameter and highest phosphorus concentration. KSr and PSi bioglasses are promising materials for dentin occlusion and remineralization and are promising new biomaterials for the treatment of dentin hypersensitivity.

Analysis of dentin wear and biological properties promoted by experimental inoffice desensitizing materials.

BACKGROUND: This study aimed to evaluate dentin wear and biological performance of desensitizing materials. METHODS: Seventy bovine root dentin blocks were sectioned. Half of the surface of each specimen was untreated (control) and the other half was immersed in EDTA and treated with the following desensitizing materials: placebo varnish (PLA), fluoride varnish (FLU), sodium fluoride (NaF) varnish + sodium trimetaphosphate (TMP), universal adhesive (SBU), S-PRG varnish (SPRG), biosilicate (BIOS), and amelotin solution (AMTN). After application, the specimens were submitted to an erosive-abrasive challenge and the wear analyzed by optical profilometer. Serial dilutions of extracts obtained from the culture medium containing discs impregnated with those desensitizers were applied on fibroblasts and odontoblasts-like cells cultures. Cytotoxicity and production of total protein (TP) by colorimetric assays were determined after 24 h. Data were statistically analyzed using Kruskal-Wallis, Dunn's, One-way ANOVA and Tukey tests (p ≤ 0.05). RESULTS: No dentin wear was observed only for SBU. The lowest dentin wear was observed for AMTN and TMP. Cell viability was significantly reduced after treatment with undiluted extracts of PLA, FLU, TMP and SBU in fibroblasts and TMP and SBU in odontoblast-like cells. SPRG, BIOS and AMTN were cytocompatible at all dilutions tested. Considering TP results, no statistical difference was observed among the groups and high levels for TP were observed after TMP and FLU treatments. CONCLUSIONS: Universal adhesive system may protect dentin with opened tubules from wear after challenge. Extracts of adhesive and fluoride varnishes presented cytotoxic mainly on fibroblasts. The enamel protein may be a future alternative to treat dentin with opened tubules because it may cause low wear under erosive-abrasive challenge with low cytotoxic effects.

Combined Effects of Glutaraldehyde-based Desensitizer and Nd: YAG Laser on Dentinal Tubules Occlusion.

AIM: The aim of this study was to assess the impact of Nd:YAG laser, glutaraldehyde-based desensitizer (GD), or their combination on occluding dentinal tubules. MATERIALS AND METHODS: Fifty dentin samples were obtained from non-carious human third molars and randomly divided into five groups (n = 10): (1) Control group treated with 37% phosphoric acid, (2) GD group, (3) Nd:YAG laser group (1064 nm, 100 µs, 10 Hz, 300 µm fiber, 1 W power, 100 mJ energy, and 85 J/cm2 energy density), (4) GD followed by Nd:YAG laser group, and (5) Nd:YAG laser followed by GD group. Scanning electron microscopy (SEM) was used to capture five images from each sample for analysis of dentinal tubules using Image J software. SEM/EDX elemental analysis was performed to determine the main mineral contents. Data analyzed using one-way ANOVA and Tukey's post hoc test for statistical comparisons. RESULTS: Laser and combination groups showed a significant decrease in dentinal tubule counts compared with the control and GD groups (p < 0.0001). There were no significant differences in open dentinal tubule counts between the control and GD groups, as well as between the laser and combination groups. However, significant differences were observed in the total area, average size of the tubules, and percentage area between the control group and the treatment groups (GD, laser, GD + laser, laser + GD). No significant difference was found in the Ca/P ratio between the tested groups. CONCLUSION: The use of Nd:YAG laser alone or in combination with GD was more effective in occluding dentinal tubules compared to GD alone. CLINICAL SIGNIFICANCE: This study has shown that Nd:YAG laser alone and in combination with GD has superior dentinal tubule occlusion in vitro. Its clinical use in the treatment of dentinal hypersensitivity may overcome the drawback of conventional treatment approaches for dentin hypersensitivity needing repeated applications to achieve continuous relief from pain since acidic diet and toothbrushing result in the continuing elimination of precipitates and surface coatings. How to cite this article: Alzarooni AH, El-Damanhoury HM, Aravind SS, et al. Combined Effects of Glutaraldehyde-based Desensitizer and Nd: YAG Laser on Dentinal Tubules Occlusion. J Contemp Dent Pract 2024;25(1):52-57.

Evaluation of Fluoraphat Pro and VivaSens® In-Office Desensitizing Agents in Controlling Natural Dental Hypersensitivity: A Clinical Study.

Introduction Dental erosion from acidogenic diets, vigorous tooth brushing, excessive tooth whitening, gingival recession, periodontal debridement, or surgery may induce dentine hypersensitivity (DH). It manifests as a phenomenon observed in structurally intact teeth devoid of pathological or defective conditions. Hence, this study aimed to evaluate DH risk reduction after using Fluoraphat Pro (Neumunster, Germany) and VivaSens® (Ivoclar Vivadent, Schaan, Liechtenstein, Switzerland) in-office desensitizing agents. Method Twenty-two participants with at least two hypersensitive teeth were randomly selected. Participants were divided into two groups with 22 teeth each, and a desensitizing agent (Fluoraphat Pro and Vivasens) was applied accordingly. Participants were recalled the next day, and a decrease in sensitivity (if any) was evaluated by self-reporting using a 5-point Likert-type scale. Relative Risk (RR) was used to compare the likelihood of sensitivity between two groups and Cohen's d to measure the effect size. A value of p<0.05 was considered significant for all statistical purposes. Result The relative risk (RR) results indicated that Fluoraphat Pro has significantly lower RR than Vivasens for patients with dental sensitivity (RR = 0.350, 95% CI 0.187 - 0.654, z = 3.28, p = 0.001). Fluoraphat Pro was significantly more effective concerning lower sensitivity in teeth located in the upper right (dCohen = 3.217, p = 0.038) and lower right (dCohen = 3.193, p = 0.017) of the mouth than VivaSens®. Conclusion The two commercially available desensitizing agents Fluoraphat Pro and Vivasens tested in this study were effective in controlling DH. Fluoraphat Pro was more efficient in relieving the risk of dental hypersensitivity than VivaSens®. Further research is needed to evaluate the long-term effects of the desensitizing agents and compare DH reduction with other marketed desensitizing products.

Bioactive glass and arginine dentifrices reduce root sensitivity during daily activities following non-surgical periodontal therapy: A randomized controlled trial.

BACKGROUND: Evidence on the efficacy of calcium sodium phosphosilicate (CSPS) and arginine dentifrices on reducing root sensitivity (RS) following non-surgical periodontal therapy (NSPT) is limited. The aim of this study was to compare the efficacy of these dentifrices in reducing RS during daily activities in patients undergoing NSPT. METHODS: Using a double-blind randomized controlled trial, CSPS, arginine, or control dentifrices were randomly assigned to 45 RS individuals following NSPT. The participants used the dentifrices 2×/day for 8 weeks. A self-reported visual analog scale (VAS) was assessed during daily activities. RESULTS: Self-reported VAS scores were similar among the three groups at each time point. The with-in group analysis revealed that the arginine dentifrice reduced RS from Week 1-8 compared with baseline in response to cold. Similarly, the CSPS dentifrice reduced RS at Week 4 and 8. The CSPS and arginine dentifrices exhibited RS relief resulting from toothbrushing starting at Week 4 and 2, respectively. In response to air, RS relief was observed from Week 4 in the arginine group. The number of patients with VAS > 2 in response to cold declined at Week 2 and 4 in the CSPS and arginine groups, respectively. In response to toothbrushing, only 10% in the test groups still had RS at Week 8. In response to air, the number of RS patients only in the arginine group decreased at Week 4. CONCLUSION: The CSPS and arginine dentifrices provided comparable RS relief during daily activities within 2-4 weeks and remained effective up to 8 weeks.

Dentists' education, knowledge, and professional behavior concerning the diagnosis and treatment of dentin hypersensitivity: An exploration.

OBJECTIVES: Dentin hypersensitivity (DH) affects patients' oral health-related quality of life, but is not always optimally treated in dental offices. The objectives were to assess dentists' DH-related education, knowledge, and professional behavior and explore relationships between education, knowledge, and behavior. METHODS: Survey data were collected from 220 ADA members in the United States. Descriptive and correlational analyses were performed. RESULTS: About half of the respondents agreed/strongly agreed that their dental school had educated them well about diagnosing DH in classroom-based (53.6%) and clinical settings (48.9%). Lower percentages agreed being well educated about treating DH (40.9%/37.3%). The majority self-educated themselves about DH after dental school by attending continuing education courses in person or online (60.6%/36.8%), reading articles (64.1%), or consulting with colleagues (59.6%). The majority knew that patients with DH describe their pain as stimulated (91.4%) and that recessed gingiva (89.6%), abrasion lesions (72.3%), tooth whitening (63.1%), erosion lesions (58.6%), and abfraction lesions (51.4%) are risk factors for DH. The majority diagnosed DH with patient self-reporting, confirmed by exams (81.8%), applying air blasts (53.7%), or cold-water (52.3%). They treated patients with DH often/very often with over-the-counter desensitizing agents (90%), and prescribing fluoride formulations toothpaste (82.8%) and/or potassium nitrate toothpastes (60.9%). In their offices, the majority (73.2%) educated their patients often/very often about DH and used fluoride dental varnish for treating DH (71.8%). The more recently respondents had graduated from dental school, the more positively they described their dental school education (r = 0.14; p < 0.05), the more ways to diagnose DH they used (r = 0.16; p < 0.05) and the more often they used fluoride dental varnish in their offices (r = 0.23; p < 0.001). The more dentists had educated themselves, the more methods for diagnosing DH they used (r = 0.23; p < 0.001) and the more often they used potassium oxalate products (r = 0.19; p < 0.01), Arginine/calcium products (r = 0.19; p < 0.01) and dentin bonding (r = 0.22; p < 0.001). CONCLUSIONS: More recently graduating from dental school correlates with more positive evaluations of DH-related dental school education. The finding that most dentists engage in self-education about DH after dental school should motivate dental educators to increase education about this topic not only in dental school, but also in continuing education courses.

The Effectiveness of Calcium Phosphates in the Treatment of Dentinal Hypersensitivity: A Systematic Review.

Dentin hypersensitivity (DH) pain is a persistent clinical problem, which is a common condition known to affect patients' quality of life (QoL), but no treatment has ever been agreed upon. Calcium phosphates, available in different forms, have properties that allow sealing the dentinal tubules, which may relieve dentin hypersensitivity. The aim of this systematic review is to evaluate the ability of different formulations of calcium phosphate to reduce dentin hypersensitivity pain level in clinical studies. The inclusion criterion was as follows: clinical randomized controlled studies using calcium phosphates in treating dentin hypersensitivity. In December 2022, three electronic databases (Pubmed, Cochrane and Embase) were searched. The search strategy was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The bias assessment risks results were carried out using the Cochrane Collaboration tool. A total of 20 articles were included and analyzed in this systematic review. The results show that calcium phosphates have properties that reduce DH-associated pain. Data compilation showed a statistically significant difference in DH pain level between T0 and 4 weeks. This VAS level reduction is estimated at about -2.5 compared to the initial level. The biomimetic and non-toxic characteristics of these materials make them a major asset in treating dentin hypersensitivity.

The effect of combination treatment of CO2-laser irradiation and tetracalcium phosphate/dicalcium phosphate anhydrate on dentinal tubules blockage: an in vitro study.

The aim of this study was the evaluation of the in vitro efficacy of a carbon dioxide (CO2) laser, a tetracalcium phosphate/dicalcium phosphate anhydrate (TP/DP) desensitizer and the combination of the desensitizer and additional CO2 laser irradiation as a treatment modality for cervical dentin hypersensitivity. A total of 48 dental specimens, prepared from extracted human premolars and molars, were divided into four groups: a control group, a TP/DP desensitizer paste group, a CO2 laser (10.600-nm wavelength) group, and a paste and laser group. The specimens were coated with nail varnish except in the marked area and were then immersed in 2% methylene blue dye for 1 h. The specimens were then washed, dried, and cut longitudinally. Thereafter, photos of 40 dentin specimens were taken and evaluated. The area of penetration was assessed and reported as percentage of the dentin surface area. Additionally eight dental specimens were examined with the aid of a scanning electron microscope and evaluated. Significant differences in the penetration depth were found for all experimental groups compared to the control group. The lowest penetration area was detected in the paste-laser group (16.5%), followed by the laser (23.7%), the paste (48.5%), and the control group (86.2%). The combined treatment of the CO2 laser and a TP/DP desensitizer was efficient in sealing the dentinal surface and could be a treatment option for cervical dentin hypersensitivity.

Assessment of Patients' Experience and Perception Toward Dentinal Hypersensitivity for Its Diagnosis and Management: A Cross-Sectional Study.

Background Dentinal hypersensitivity (DH) is a common clinical finding that varies greatly in prevalence. An appropriate impulse that detonates noxious stimuli in the pulp/dentin boundary causes the typical DH pain, which is sudden, short, sharp, and of rapid onset. The objective of this research was to ascertain the incidence of DH in Keralites and evaluate some contributory factors, along with other initiating stimuli. Methodology Over three months, from June 2022 to August 2022, a cluster sampling technique was employed to conduct the study in 14 districts of Kerala. Patients from five clinics from each district who reported having DH and were aged 25 to 65 years were chosen at random. Using Google Survey forms, a 20-question, closed-ended survey was mailed to patients. The data were collected, evaluated, and analyzed using SPSS Version 23.0 (IBM Corp., Armonk, NY, USA). The statistical difference in the distribution of DH and the patient's age was determined using analysis of variance (ANOVA). A chi-square test was carried out to test the association between dentinal hypersensitivity, gender, and other parameters; P < 0.05 was considered to be statistically significant. Results Among the 2,520 persons to whom questionnaires were mailed, 2,321 responded, with an unresponsive rate of 7.89%. The study revealed a sensitivity predilection among females (54%), although statistically insignificant. Respondents aged 25 to 35 years (41.01%) were commonly reported to have DH, the age distribution of which was found to be highly significant statistically (P < 0.01). Teeth whitening resulted in 82.98% of the sensitivity, whereas 47.99% accepted poor oral hygiene as an additional contributory factor. DH was reported in 52.01% of the patients with gastritis and 63.03% of the patients with gingival recession. Further, blame for poor dental treatment (88.88%) and climate change (82.92%) were also found relevant. The quality of life was claimed to be afflicted in 90.99% of the patients. Desensitizing agents were used by 68.97% of the patients, with which 68.03% reported satisfaction. Of the subjects who underwent professional treatment, 87.03% reported being satisfied. Oral prophylaxis-induced sensitivity was reported in 57.99%, indicating enhanced oral health awareness among Kerala residents. There was a statistically highly significant difference in the patient distribution based on the exposure to DH, and their perception of the causes and factors affecting DH (P < 0.01). Conclusions DH is a frequently and widely prevalent dental malady. Respondents demonstrated that they were conversant with DH. The quality of life and enjoyment of daily activities are both impacted by dentin hypersensitivity, and many patients are unaware that it is a treatable illness. Various desensitizing substances are also available and can be applied quickly to sensitive areas. Patients prefer this procedure as it is simpler to apply these agents and the effects are pleasant and beneficial.

Use of calcium-containing bioactive desensitizers in dental bleaching: A systematic review and meta-analysis.

BACKGROUND: Topical application of calcium-containing bioactive desensitizers (CBs) has been used to minimize bleaching-induced tooth sensitivity (TS). This study answered the research question "Is the risk of TS lower when CBs are used with dental bleaching in adults compared with bleaching without desensitizers?" TYPES OF STUDIES REVIEWED: The authors included randomized clinical trials comparing topical CB application with a placebo or no intervention during bleaching. Searches for eligible articles were performed in MEDLINE via PubMed, Cochrane Library, Brazilian Library in Dentistry, Latin American and Caribbean Health Sciences Literature, Scopus, Web of Science, Embase, and gray literature without language and date restrictions and updated in September 2022. The risk of bias was evaluated using Risk of Bias Version 2.0. The authors conducted meta-analyses with the random-effects model. The authors assessed heterogeneity with the Cochrane Q test, I2 statistics, and prediction interval. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty of the evidence. RESULTS: After database screening, 22 studies remained, with most at high risk of bias. No difference in the risk of TS was detected (risk ratio, 0.95; 95% CI, 0.90 to 1.01; P = .08, low certainty). In a visual analog scale, the intensity of TS (mean difference, -0.98; 95% CI, -1.36 to -0.60; P < .0001, very low certainty) was lower for the CB group. The color change was unaffected (P > .08). PRACTICAL IMPLICATIONS: Although topical CB dental bleaching did not reduce the risk of TS and color change, these agents slightly reduced the TS intensity, but the certainty of the evidence is very low.

Effect of an experimental desensitizing gel on bleaching-induced tooth sensitivity after in-office bleaching-a double-blind, randomized controlled trial.

OBJECTIVES: To evaluate the risk and intensity of tooth sensitivity (TS), and the efficacy of in-office bleaching after applying an experimental desensitizing gel composed of 10% calcium gluconate, 0.1% dexamethasone acetate, 10% potassium nitrate, and 5% glutaraldehyde. MATERIAL AND METHODS: In a split-mouth, double-blind, placebo-controlled study, 50 participants had their upper hemiarches randomized into experimental and placebo groups. Desensitizing and placebo gels were applied for 10 min before in-office bleaching (35% hydrogen peroxide, 1 × 50 min; two bleaching sessions; 1-week interval). TS was recorded immediately after bleaching, 1, 24, and 48 h after each session, with a 0-10 visual analogue scale (VAS) and a five-point numerical rating scale (NRS). The color was recorded in all groups at baseline, 1 week after each session, and 1 month after the end of bleaching using shade guide units (ΔSGUs) and a spectrophotometer (ΔEab, ΔE00, and ΔWID). RESULTS: Most participants (96%) felt some discomfort during treatment regardless of the study group. The odds ratio for pain was 0.65 (95% CI 0.1 to 4.1; p = 1.0). The intensity of TS did not differ between groups (p > 0.31), and it was only 0.34 VAS units lower in the experimental group. A significant color change occurred in both groups regardless of the group. CONCLUSIONS: The desensitizing experimental gel applied before in-office bleaching did not reduce the risk and the intensity of TS and did not affect color change. CLINICAL RELEVANCE: Although the experimental desensitizing agent with varying mechanisms of action did not jeopardize the color change, it did not reduce the risk or intensity of in-office bleaching. CLINICAL TRIAL REGISTRATION NUMBER: RBR-7T7D4D.

Ensaios clínicos randomizados sobre tratamentos de hipersensibilidade dentinária ­ conformidade com as diretrizes do CONSORT e mapeamento das características dos estudos: uma revisão sistemática / Randomized clinical trials of dentin hypersensitivity treatments ­ compliance with CONSORT guidelines and mapping of trials features: a systematic review

A hipersensibilidade dentinária (HD) é definida como uma dor aguda, de curta duração, que ocorre em resposta à estímulos externos direcionados a áreas de dentina exposta. Esta revisão sistemática objetivou avaliar a literatura disponível quanto à conformidade dos ensaios clínicos randomizados (ECRs) sobre tratamentos de HD com a Declaração CONSORT, além de realizar um mapeamento de suas características (tipo de intervenção, métodos de avaliação de sensibilidade, escalas utilizadas, modo de aplicação etc.), e analisar o risco de viés destes mesmos estudos. Apenas ECRs entraram nesta revisão. Foi traçada uma estratégia de busca específica para cada bases de dados: MEDLINE via PubMed, Scopus, Web of Science, LILACS, Biblioteca Brasileira em Odontologia (BBO) e EMBASE, além das buscas manuais. A análise e coleta de dados foram realizadas por dois revisores independentes que selecionaram os estudos em potencial primeiro pelo título e resumo e, após, pela leitura completa dos selecionados. Os artigos foram avaliados quanto à conformidade ao CONSORT em uma escala: 0 = sem descrição, 1 = descrição deficiente e 2 = descrição adequada, para cada item. Análise do risco de viés dos artigos foi realizada através da plataforma The Risk Of Bias Tool 2.0. Análises descritivas também foram realizadas. Dos 3078 artigos analisados, 2867 foram excluídos por não atenderem aos critérios de inclusão, não apresentarem comparação entre tratamentos ou não serem ECRs. Após as exclusões, 211 ECRs permaneceram para avaliação. Os periódicos que mais contribuíram foram o American Journal of Dentistry (13,7%) e Journal of Dentistry (8,5%). Os países com mais publicações foram a Índia (24,6%), seguido pelo Brasil (17,5%). Quanto à pontuação dos artigos para cada item CONSORT analisado, 92,42% dos artigos obtiveram pontuação máxima em "Elegibilidade", demonstrando haver uma descrição clara dos critérios de elegibilidade para participantes na maioria dos estudos. O item com menor quantidade de artigos com pontuação máxima foi "Tamanho do efeito estimado" (25,6%), demonstrando uma certa dificuldade dos autores em descrever adequadamente o tamanho do efeito estimado do(s) desfecho(s) e sua precisão com um intervalo de confiança de 95%. A maioria dos artigos apresentou risco "incerto" de viés. Com as análises feitas, concluiu-se que a adesão dos ECRs ao CONSORT requer mais atenção, uma vez que seguir suas diretrizes pode, a longo prazo, resultar em uma melhoria significativa dos relatos de ECRs, o que acarretará inúmeros benefícios tanto para a ciência acerca do tema, quanto para a posterior aplicação clínica (AU)

Dentin hypersensitivity (DH) is defined as an acute, short-term pain that occurs in response to external stimuli directed at areas of exposed dentin. This systematic review aimed to assess the available literature regarding the compliance of randomized clinical trials (RCTs) on DH treatments with the CONSORT statement, in addition to mapping their characteristics (type of intervention, sensitivity assessment methods, scales used, application mode, etc.), and to analyze the risk of bias of these same studies. Only RCTs were included in this review. A specific search strategy was designed for each of the following databases: MEDLINE via PubMed, Scopus, Web of Science, LILACS, Brazilian Dental Library (BBO) and EMBASE, in addition to manual searches. Data analysis and collection were performed by two independent reviewers who selected the potential studies at first by title and abstract, then by complete reading of the selected ones. Articles were evaluated for compliance with the CONSORT statement on a scale: 0 = no description, 1 = deficient description and 2 = adequate description, for each item. Analysis of the risk of bias was performed using The Risk Of Bias Tool 2.0. Descriptive analyzes were also performed. Among the 3078 articles analyzed, 2867 were excluded because they did not meet the inclusion criteria, did not present a comparison between treatments, or were not RCTs. After deletions, 211 RCTs remained for evaluation. The journals that most contributed were the American Journal of Dentistry (13.7%), Journal of Dentistry (8.5%%) and the Journal of Clinical Dentistry (7.1%). India (24.6%) and Brazil (17.5%) were the countries with the most publications. As for the score received by the articles for each CONSORT item analyzed, 92.42% of the articles obtained the maximum score in "Eligibility", demonstrating that there is a clear description of the eligibility criteria for participants in most studies. The item with the lowest number of articles with the maximum score was "Estimated effect size" (25.6%), demonstrating a particular difficulty for authors to adequately describe the estimated effect size of the outcomes and its precision with a confidence interval of 95%. Most articles presented an "uncertain" risk of bias. After these analyses, it was concluded that the adherence of RCTs to CONSORT requires more attention, since following its guidelines can, in the long term, result in a significant improvement in RCT reports, which may bring numerous benefits both to the science on the subject, as well as for the clinical application of what is being studied. (AU)

Effect of Iontophoresis on the Effectiveness of Nano-Hydroxyapatite and Pro-argin in In-Office Treatment of Dentin Hypersensitivity: A Split-Mouth Randomized Clinical Trial.

Background and objectives Dentin hypersensitivity (DH) treatment is one of the main challenges dentists face in their daily clinical practice. Current therapies provide only temporary relief and require multiple applications to exhibit results, and there is a lack of evidence related to the long-term effects of these agents. Nano-hydroxyapatite (n-HA) and pro-argin (8.0% arginine-calcium carbonate) have recently been used for dentin desensitization with a one-time in-office application, but the effects are interim. However, a standard treatment protocol demands definitive or enduring results. Since iontophoresis amplifies the transport of neutral and ionized drugs across a membrane, the use of these desensitizing agents with iontophoresis may be beneficial to accomplish satisfactory results. This study was conducted to evaluate whether iontophoresis could enable better penetration of nano-hydroxyapatite and pro-argin into the dentin, enhancing and prolonging their therapeutic effect. Materials and methods Forty-five participants with dentin hypersensitivity in the age group of 20 to 60 years were included. In each individual, four teeth with cervical lesions (one from each quadrant) were selected and divided randomly into four groups: group I: desensitizing paste containing nano-hydroxyapatite, group II: desensitizing paste containing nano-hydroxyapatite with iontophoresis, group III: desensitizing paste containing pro-argin, and group IV: desensitizing paste containing pro-argin with iontophoresis; followed by one-time application of the agents. Sensitivity was assessed by tactile, air blast, and cold-graded thermal tests (CGTTs) before and immediately after application, after one week, and at the end of the first, third, and sixth months. Statistical analysis Statistical analysis was done by repeated measures ANOVA for within-group comparison. Intergroup comparison was done using one-way ANOVA and Tukey's post-hoc test. Results All the groups showed a statistically significant reduction in dentin hypersensitivity (p<0.001). The reduction in hypersensitivity in various groups can be graded as group II (3.578/1.800/1.556) > group IV (3.367/1.755/1.555) > group I (2.3781/1.022/0.822) > group III (2.222/0.911/0.778) as evaluated by tactile, air blast, and cold-graded thermal tests, respectively. Group II and group IV presented a significant reduction in sensitivity levels consistent for up to six months. Conclusion Nano-hydroxyapatite and pro-argin can be used effectively for reducing dentin hypersensitivity. Iontophoresis can be a valuable adjunct for their improved delivery, enhancing and prolonging their effectiveness.

Comparative clinical evaluation of two different formulated in-office newer desensitizing agents (Clinpro XT and Tokuyama Shield Force Plus) in reducing dentin hypersensitivity - A randomized clinical trial.

Aim: The aim of this study was to assess the effectiveness of two various in-office newer desensitizing agents in reducing dentinal hypersensitivity in patients with mild-to-moderate sensitivity for a 1-month follow-up. Materials and Methods: Forty subjects with cervical dentin hypersensitivity (otherwise healthy patients) were included. A split-mouth, randomized clinical trial was conducted. A Visual Analog Scale (VAS) was used to record the initial sensitivity levels at the baseline visit. Each individual has been exposed to thermal (ethyl chloride spray) and evaporative (air blast) stimuli to elicit sensitivity. A single application of two different in-office desensitizing agents, Clinpro XT Varnish (3M ESPE, Minnesota, USA) and Shield Force Plus (Tokuyama Dental, Tokyo, Japan), was done. The sensitivity scores were recorded after the application of the desensitizing agent immediately, after 1 week, and after 1 month using both air and cold stimuli in the same manner as initially. Results: Mean VAS scores represent teeth that were more sensitive to cold stimuli compared to air blasts in both groups. For both stimuli at all-time intervals except baseline, there is a significant difference between CXT and SFP, with low mean VAS scores for CXT. Post hoc analysis revealed that in the CXT group, there is a significant difference in mean VAS score between pre-and postintervention at all-time intervals except between immediate and 1-week time intervals (P < 0.001) but only at immediate and 1-week time intervals in SFP. Conclusion: Clinpro XT Varnish is more efficient compared to Shield Force Plus at all-time points irrespective of the stimuli after a 1-month follow-up.

The 100 Most-Cited Papers in Dentin Hypersensitivity: A Bibliometric Analysis

ABSTRACT Objective: To identify the 100 most-cited articles in DH and analyze their characteristics. Material and Methods: A search was performed on the Web of Science (WoS) and the 100 most-cited articles were selected. The following data were extracted: citations, year of publication, authorship, institution, country, journal, language, study design, topic of interest, conflict of interest (COI), and sponsorship. The VOSviewer software was used to visualize bibliometric networks. Poisson regression analysis was performed to measure associations between several citations and the characteristics of the studies. Results: The number of citations ranged from 346 to 48. The most-cited article was published in 1997 by Holland in the Journal of Clinical Periodontology. This journal published the most papers, followed by the Journal of Oral Rehabilitation and Journal of Dentistry. Laboratory research, review, and clinical trial were the study designs most prevalent. Reviews (p<0.05; PR= 1.853) and method development studies (p<0.05; PR= 1.853) had a more chance to present more citations. The main topics of interest were the clinical effectiveness of desensitizers and in vitro analysis of dentin morphology. Sponsorship and COI were underreported. England and USA presented the greatest number of citations and connections in the coauthorship network map. Conclusion: Most of the articles were original research, and their topics of interest were mainly the clinical effectiveness of desensitizing agents and dentin morphology.

Effect of different toothpastes on permeability and roughness of eroded dentin / Efeito de diferentes cremes dentais na permeabilidade e rugosidade da dentina erodida

ABSTRACT Dentin hypersensitivity (DH) is characterized by rapid, acute pain arising from exposed dental tubules. Aim: the aim of this study was to evaluate the roughness, tubule occlusion, and permeability of eroded dentin brushed with different toothpastes. Materials and Method: ninety bovine teeth were cut into blocks. Thirty hemifaces were protected with varnish and the other sixty were submitted to permeability tests. Specimens were divided into groups according to the dentifrices: without fluoride (WF), sodium fluoride (NaF), and stannous fluoride (SnF2). The blocks were subjected to a 5-day erosive-abrasive protocol. Surface roughness and dentinal tubule occlusion (n=10) were assessed for both control and test hemifaces of the same sample along with permeability analysis (n=20). Two-way RM ANOVA and Tukey's post-hoc test were performed (p≤0.05). Results: NaF and SnF2 presented higher roughness than WF. The number of open tubules was higher in WF. Permeability was higher in SnF2, but there was no significant difference between WF and NaF. Conclusions: both fluoride toothpastes occluded dentinal tubules and increased roughness. NaF toothpaste promoted greater decrease in dentin permeability.

RESUMO A hipersensibilidade dentinária (HD) é caracterizada por dor rápida e aguda decorrente de túbulos dentais expostos. Objetivo: este estudo teve como objetivo avaliar a rugosidade, oclusão tubular e permeabilidade da dentina erodida escovada com diferentes dentifrícios. Materiais e Método: noventa dentes bovinos foram seccionados em blocos. Trinta hemifaces foram protegidas com verniz e outras sessenta foram submetidas à permeabilidade. Os espécimes foram divididos em grupos de acordo com os dentifrícios: sem flúor (SF), fluoreto de sódio (NaF) e fluoreto estanoso (SnF2). Em seguida, os blocos foram submetidos a um protocolo erosivo-abrasivo de 5 dias. A rugosidade da superfície e a oclusão do túbulo dentinário (n = 10) foram avaliadas para ambas as hemifaces de controle e teste da mesma amostra, também realizou-se a análise de permeabilidade (n = 20). Two-way RM ANOVA e pós-teste de Tukey foram realizados (p≤0,05). Resultados: NaF e SnF2 apresentaram rugosidade superior ao SF. O número de túbulos abertos foi maior em SF. Não encontramos diferenças significativas entre SF e NaF em relação à permeabilidade; entretanto, SnF2 apresentou maior permeabilidade. Conclusão: ambos os dentifrícios fluoretados foram capazes de ocluir os túbulos dentinários e aumentar a rugosidade. No entanto, o dentifrício NaF promoveu uma maior diminuição da permeabilidade dentinária.

Assessment of the Efficacy of Different Desensitizing Agents on Dentinal Tubules Occlusion- An In vitro Study.

Aim: The aim of the current research was to evaluate the effectiveness of three desensitizing agents on the occlusion of dentinal tubules. Materials and Methods: Eighty human maxillary and mandibular permanent premolar teeth that were subjected to extraction in the course of orthodontic treatment were utilized in this study. The teeth were subjected to sectioning by employing a double-sided diamond disk. A block was procured from every even cervical dentinal surface with dimensions of 4 mm × 4 mm × 3 mm (L × B × H) by sectioning the tooth transversely. Further, 35% phosphoric acid was utilized for 30 s to cause dentinal etching, thereby exposing the dentinal tubules. The blocks of dentin were assigned at random to one of the following four groups (n = 20): group I: control, group II: bioactive glass containing desensitizing agent, group III: 1% nano-hydroxyapatite containing desensitizing agent, group IV: tri-calcium phosphate-containing desensitizing agent. The exterior of the specimens was scanned and evaluated using a scanning electron microscope. Results: 1% nano-hydroxyapatite-containing desensitizing agent (2.04 ± 0.08) exhibited higher mean dentinal tubular blockage, followed by the bioactive class-containing desensitizing substance (2.26 ± 0.19), tri-calcium phosphate desensitizing agent (2.84 ± 0.10), and the control group (4.18 ± 0.12) in that order. Amid the experimental groups employing the various desensitizing substances, there were significant differences statistically with P < 0.001. Conclusion: The current research concluded that each of the three desensitizing agents was efficient in dentinal tubular occlusion regardless of their different chemical constitution. However, it was noted that 1% nano-hydroxyapatite-containing desensitizing agent was marginally superior to the bioactive glass- and tri-calcium phosphate-containing desensitizing agents.

Effectiveness and cytotoxicity of two desensitizing agents: a dentin permeability measurement and dentin barrier testing in vitro study.

BACKGROUND: When evaluating the efficacy and safety of various desensitizing products in vitro, their mechanism of action and clinical utility should be considered during test model selection. This study aimed to evaluate the effects of two desensitizers, an in-office use material and an at-home use material, on dentin specimen permeability, and their dentin barrier cytotoxicity with appropriate test models. METHODS: Two materials, GLUMA desensitizer (GLU) containing glutaraldehyde and remineralizing and desensitizing gel (RD) containing sodium fluoride and fumed silica, were selected. Human dentin specimens were divided into three groups (n = 6): in groups 1 and 2, GLU was applied, and in group 3, RD was applied and immersed in artificial saliva (AS) for 24 h. Dentin specimen permeability before and after each treatment/post-treatment was measured using a hydraulic device under a pressure of 20 cm H2O. The perfusion fluid was deionized water, except in group 2 where 2% bovine serum albumin (BSA) was used. The representative specimens before and after treatment from each group were investigated using scanning electron microscopy. To measure cytotoxicity, test materials were applied to the occlusal surfaces of human dentin disks under which three-dimensional cell scaffolds were placed. After 24-h contact within the test device, cell viability was measured via 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays. RESULTS: GLU significantly reduced the dentin permeability and occluded the dentinal tubules when 2% BSA was used as perfusion fluid. RD significantly reduced dentin permeability and occluded the tubules, but permeability rebounded after AS immersion. GLU significantly decreased cell viability, but RD was non-cytotoxic. CONCLUSIONS: In vitro GLU application induced effective dentinal tubule occlusion only following the introduction of simulated dentinal fluid. RD provided effective tubule occlusion, but its full remineralization potential was not realized after a short period of immersion in AS. GLU may harm the pulp, whereas RD is sufficiently biocompatible.

Resin-based materials to control human dentin permeability under erosive conditions in vitro: A hydraulic conductance, confocal microscopy and FTIR study.

OBJECTIVES: To characterize the behavior of three different polymeric agents before and after an erosive challenge on dentin permeability, to analyze their degradation in both conditions, and to analyze their degree of conversion (DC). METHODS: The permeability of human dentin disks (1.0 ± 0.2 mm) was measured with smear layer, after its removal, after treatment (LpTreat) with Gluma Desensitizer, PRG Barrier Coat (PBC) or Icon infiltrant (n = 11/group) and after exposure to citric acid (LpEro) (6%, pH 2.1, 1 min). The specimens were analyzed under a Laser Scanning Confocal Microscope (n = 2/group) and the products' DC were calculated. Data were subjected to 2-way repeated measures ANOVA and post-hoc Bonferroni (permeability analysis), to paired t-test (for specimens treated with Icon) and to t-test (DC analysis) (α < 0.05). RESULTS: Icon showed the lowest LpTreat and LpEro values, while PBC and Gluma did not differ from each other under these conditions. Icon and PBC showed LpEro similar to a dentin with smear layer. Under the Laser Scanning Confocal Microscope, more deposits were noticeable on dentin after treating with PBC. Gluma presented the deepest penetration in dentin. The DC of PBC was the highest. SIGNIFICANCE: Icon caused the highest reduction on permeability values, followed by PBC and Gluma. PBC generated more deposits covering dentin and seemed to be more efficient after an erosive challenge. The association of a polymeric resin with inorganic ion-releasing fillers seem to be a great strategy to manage dentin hypersensitivity under erosive conditions.