Association of enamel microabrasion and dentinal bleaching in recovering an adolescent patient's smile: a case report

This article presents the enamel microabrasion protocol for removing intrinsic white stains of hard texture on the enamel surface, using a 37% phosphoric acid/pumice mixture associated with a carbamide peroxide-based bleaching agent in custom-made mouth trays. We observed that these clinical procedures were safe and effective, and solved our patient's esthetic problem. © 2010 Nova Science Publishers, Inc.

Analysis of the effects of thermal cycling on the microtensile shear bond strength of a self-etching and a conventional pit and fissure sealants to dental enamel

Objective: To analyze the effects of thermal cycling on the microtensile shear bond strength of a self-etching and a conventional pit and fissure sealants to dental enamel. Material and Method: Twenty-four healthy human molars extracted for orthodontic reasons, were sectioned in the mesio-distal direction and divided into two groups (n=24) according to the sealant to be applied: GI - conventional sealant Climpro (3M/ESPE) and GII - self-etching sealant Enamel Loc (Premier Dental). The sealants were applied on flattened enamel in matrixes 1 mm in diameter, in accordance with the manufacturers' recommendations. The specimens were stored in distilled water at 37°C for 24 hours. After this, half the samples of both groups were submitted to 500 thermal cycles in 30s baths at temperatures between 5 and 55°C. Forty-eight hours after the samples were made, the microtensile shear test was performed in an Instron 4411 test machine, with a stainless steel wire with a cylindrical cross section of 0.2mm in diameter at a constant speed of 0.5mm/s. The bond strength values were submitted to ANOVA for 2 factors and the fracture patterns were examined under an optical microscope at 65X magnification. Results: Thermal cycling did not influence the bond strength of the two sealants. The conventional sealant Climpro presented a statistically higher microtensile shear bond strength (11.72MPa, 11.34MPa with and without cycling, respectively) than the self-etching sealant Enamel Loc (5.92MPa, 5.02MPa with and without cycling, respectively). Fracture pattern analysis showed the occurrence of 100% of adhesive failures for Enamel Loc, while the conventional sealant Climpro presented 95% of adhesive failures and 5% of mixed failures. Conclusion: The conventional sealant presented higher microtensile shear bond strength to dental enamel in comparison with the self-etching sealant. Thermal cycling did not affect the bond strength of the sealants used in this study. © 2011 Nova Science Publishers, Inc.

Effects evaluation of remaining resin removal (three modes) on enamel surface after bracket debonding

Introduction: An appropriate selection of instruments is essential to perform a correct debonding technique, by properly removing orthodontic brackets and the remaining resin. Objective: The aim of this study was to evaluate three methods of remaining resin removal on enamel surface after bracket debonding, by means of Scanning Electron Microscopy (SEM). Methods: Eighteen bovine incisors were selected and divided into three groups (A, B and C) of six teeth each. Before bracket bonding, epoxy resin casts were obtained by impression of the teeth with addition silicon, in order to register baseline enamel characteristics and representing the control group. The methods for remaining resin removal were: Group A - gross and medium granulation Soflex discs; Group B - carbide bur in low-speed; Group C - carbide bur in high-speed. Soflex polishing system fine and ultrafine granulation discs were used for Group A, rubber tips for Groups B and C, and polishing paste for all groups. After polishing, impression of teeth were taken and casts were analyzed by means of SEM. The baseline enamel characteristics (Control Group) were compared to the final aspect of enamel to determine the method that generated less enamel abrasion. Results and Conclusion: The remaining resin removal by carbide bur in low-rotation, and enamel polished with rubber tips followed by polishing paste produced the smaller damage to the enamel.

Prevalence and microscopic features of enamel pearls from permanent human molars

Enamel pearls are ectopic structures observed mainly on the roots of permanent teeth and could be related to periodontal diseases. Aim: To evaluate the prevalence of enamel pearls in extracted human molars and characterize their structures using light and scanning electron microscopy. Methods: The study comprised 2,201 extracted human permanent molars. The teeth were analyzed and classified according to morphological features. The presence, location and shape of enamel pearls were investigated. Fifteen human molars with enamel pearls were embedded in acrylic resin and observed by light microscopy. Results: Seventy-one enamel pearls were identified on third molar root. Microscopically, most pearls were composed of prismatic irregular enamel and normal dentin. The dentinoenamel junction presented an irregular course. The number of dentinal tubules was normal and they presented curvature to continue within the root dentin of the carrier tooth. Dentinal tubules below the enamel pearls were closer to each other. Conclusions: Scanning electron microscopic analysis revealed that the enamel pearls were similar to coronal enamel.

Effect of bleaching on sound enamel and with early artificial caries lesions using confocal laser microscopy

The aim of this study was to evaluate effect of bleaching agents on sound enamel (SE) and enamel with early artificial caries lesions (CL) using confocal laser scanning microscopy (CLSM). Eighty blocks (4 × 5 × 5 mm) of bovine enamel were used and half of them were submitted to a pH cycling model to induce CL. Eight experimental groups were obtained from the treatments and mineralization level of the enamel (SE or CL) (n=10). SE groups: G1 - unbleached (control); G2 - 4% hydrogen peroxide (4 HP); G3 - 4 HP containing 0.05% Ca (Ca); G4 - 7.5% hydrogen peroxide (7.5 HP) containing amorphous calcium phosphate (ACP). CL groups: G5 - unbleached; G6 - 4 HP; G7 - 4 HP containing Ca; G8 - 7.5 HP ACP. G2, G3, G6, G7 were treated with the bleaching agents for 8 h/day during 14 days, while G4 and G8 were exposed to the bleaching agents for 30 min twice a day during 14 days. The enamel blocks were stained with 0.1 mM rhodamine B solution and the demineralization was quantified using fluorescence intensity detected by CLSM. Data were analyzed using ANOVA and Fisher's tests (α=0.05). For the SE groups, the bleaching treatments increased significantly the demineralization area when compared with the unbleached group. In the CL groups, no statistically significant difference was observed (p>0.05). The addition of ACP or Ca in the composition of the whitening products did not overcome the effects caused by bleaching treatments on SE and neither was able to promote remineralization of CL.

Optical characterization of one dental composite resin using bovine enamel as reinforcing filler

The use of composite resins for restorative procedure in anterior and posterior cavities is highly common in Dentistry due to its mechanical and aesthetic properties that are compatible with the remaining dental structure. Thus, the aim of this study was to evaluate the optical characterization of one dental composite resin using bovine enamel as reinforcing filler. The same organic matrix of the commercially available resins was used for this experimental resin. The reinforcing filler was obtained after the gridding of bovine enamel fragments and a superficial treatment was performed to allow the adhesion of the filler particles with the organic matrix. Different optical images as fluorescence and reflectance were performed to compare the experimental composite with the human teeth. The present experimental resin shows similar optical properties compared with human teeth. © 2012 SPIE.

Efficacy and cytotoxicity of a bleaching gel after short application times on dental enamel

Objectives: This study aimed to evaluate and correlate the efficacy and cytotoxicity of a 35 % hydrogen peroxide (HP) bleaching gel after different application times on dental enamel. Materials and methods: Enamel/dentin disks in artificial pulp chambers were placed in wells containing culture medium. The following groups were formed: G1, control (no bleaching); G2 and G3, three or one 15-min bleaching applications, respectively; and G4 and G5, three or one 5-min bleaching applications, respectively. Extracts (culture medium with bleaching gel components) were applied for 60 min on cultured odontoblast-like MDPC-23 cells. Cell metabolism (methyl tetrazolium assay) (Kruskal-Wallis/Mann-Whitney; α = 5 %) and cell morphology (scanning electron microscopy) were analyzed immediately after the bleaching procedures and the trans-enamel and trans-dentinal HP diffusion quantified (one-way analysis of variance/Tukey's test; α = 5 %). The alkaline phosphatase (ALP) activity was evaluated 24 h after the contact time of the extracts with the cells (Kruskal-Wallis/Mann-Whitney; α = 5 %). Tooth color was analyzed before and 24 h after bleaching using a spectrophotometer according to the Commission Internationale de l'Eclairage L*a*b* system (Kruskal-Wallis/Mann-Whitney; α = 0.05). Results: Significant difference (p < 0.05) in cell metabolism occurred only between G1 (control, 100 %) and G2 (60.6 %). A significant decrease (p < 0.05) in ALP activity was observed between G2, G3, and G4 in comparison with G1. Alterations on cell morphology were observed in all bleached groups. The highest values of HP diffusion and color alterations were observed for G2, with significant difference among all experimental groups (p < 0.05). G3 and G4 presented intermediate color change and HP diffusion values with no statistically significant differences between them (p > 0.05). The lowest amount of HP diffusion was observed in G5 (p < 0.05), which also exhibited no significant color alteration compared to the control group (p > 0.05). Conclusions: HP diffusion through dental tissues and its cytotoxic effects were proportional to the contact time of the bleaching gel with enamel. However, shorter bleaching times reduced bleaching efficacy. Clinical relevance: Shortening the in-office tooth bleaching time could be an alternative to minimize the cytotoxic effects of this clinical procedure to pulp tissue. However, the reduced time of bleaching agent application on enamel may not provide adequate esthetic outcome. © 2012 Springer-Verlag Berlin Heidelberg.

In vitro assessment of dentin erosion after immersion in acidic beverages: Surface profile analysis and energy-dispersive X-ray fluorescence spectrometry study

The aim of this study was to investigate the effects of some acidic drinks on dentin erosion, using methods of surface profile (SP) analysis and energy-dispersive X-ray fluorescence spectrometry (EDXRF). One hundred standardized dentin slabs obtained from bovine incisor roots were used. Dentin slabs measuring 5x5 mm were ground flat, polished and half of each specimen surface was protected with nail polish. For 60 min, the dentin surfaces were immersed in 50 mL of 5 different drinks (Gatorade®, Del Valle Mais orange juice®, Coca-Cola®, Red Bull® and white wine), 20 blocks in each drink. The pH of each beverage was measured. After the erosive challenge, the nail polish was removed and SP was analyzed. The mineral concentration of dentin surfaces was determined by means of EDXRF. Data were analyzed statistically by ANOVA and Tukey's test (α=0.05). SP analysis showed that Red-Bull had the highest erosive potential (p<0.05). EDXRF results exhibited a decrease in phosphate in the groups immersed in Red-Bull, orange juice and white wine (p<0.05), and no significant difference in calcium content between the reference surface and eroded surface. In conclusion, this study demonstrated that all studied beverages promoted erosion on root dentin and Red Bull had the highest erosive potential. There was no correlation between pH of beverages and their erosive potential and only the P content changed after erosive challenge.

In situ evaluation of a low fluoride concentration gel with sodium trimetaphosphate in enamel remineralization

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of fluoride-treated enamel on indirect cytotoxicity of a16% carbamide peroxide bleaching gel to pulp cells

The aim of this study was to evaluate the possibility of fluoride solutions applied to enamel to protect pulp cells against the trans-enamel and transdentinal cytotoxicity of a 16% carbamide peroxide (CP) bleaching gel. The CP gel was applied to enamel/ dentin discs adapted to artificial pulp chambers (8 h/day) during 1, 7 or 14 days, followed by fluoride (0.05% or 0.2%) application for 1 min. The extracts (culture medium in contact with dentin) were applied to MDPC-23 cells for 1 h, and cell metabolism (MTT assay), alkaline phosphatase (ALP) activity and cell membrane damage (flow cytometry) were analyzed. Knoop microhardness of enamel was also evaluated. Data were analyzed statistically by ANOVA and Kruskal-Wallis tests (a=0.05). For the MTT assay and ALP activity, significant reductions between the control and the bleached groups were observed (p<0.05). No statistically significant difference occurred among bleached groups (p>0.05), regardless of fluoride application or treatment days. Flow cytometry analysis demonstrated 30% of cell membrane damage in all bleached groups. After 14 days of treatment, the fluoride-treated enamel presented significantly higher microhardness values than the bleached-only group (p<0.05). It was concluded that, regardless of the increase in enamel hardness due to the application of fluoride solutions, the treated enamel surface did not prevent the toxic effects caused by the 16% CP gel to odontoblast-like cells.

Influence of air abrasion tips and operation modes on enamel-cutting characteristics

Objective: To assess the influence of air abrasion tips and system operation modes on enamel cutting. Methods: Forty bovine teeth were abraded with the air abrasion system Mach 4.1 for 10 and 15 seconds, employing conventional and sonic tips of 0.45-mm inner diameter and a 90° angle, and 27.5-μm aluminum oxide at 5.51 bar air pressure in continuous and pulsed modes. The width and depth of the resulting cuts were measured in SEM. Results: The multivariate analysis of variances revealed that, compared to the sonic tip, the conventional tip produced shallower cuts independent of the operation mode and the application period. Conclusions: The cutting patterns observed in this study suggest that the pulsed mode produced deeper cuts when both the conventional and sonic tips were used, and that the sonic tip cut more dental tissue than the conventional one.

Genes expressed in dental enamel development are associated with molar-incisor hypomineralization

Genetic disturbances during dental development influence variation of number and shape of the dentition. In this study, we tested if genetic variation in enamel formation genes is associated with molar-incisor hypomineralization (MIH), also taking into consideration caries experience. DNA samples from 163 cases with MIH and 82 unaffected controls from Turkey, and 71 cases with MIH and 89 unaffected controls from Brazil were studied. Eleven markers in five genes [ameloblastin (AMBN), amelogenin (AMELX), enamelin (ENAM), tuftelin (TUFT1), and tuftelin-interacting protein 11 (TFIP11)] were genotyped by the TaqMan method. Chi-square was used to compare allele and genotype frequencies between cases with MIH and controls. In the Brazilian data, distinct caries experience within the MIH group was also tested for association with genetic variation in enamel formation genes. The ENAM rs3796704 marker was associated with MIH in both populations (Brazil: p = 0.03; OR = 0.28; 95% C.I. = 0.06-1.0; Turkey: p = 1.22e-012; OR = 17.36; 95% C.I. = 5.98-56.78). Associations between TFIP11 (p = 0.02), ENAM (p = 0.00001), and AMELX (p = 0.01) could be seen with caries independent of having MIH or genomic DNA copies of Streptococcus mutans detected by real time PCR in the Brazilian sample. Several genes involved in enamel formation appear to contribute to MIH. © 2013.

Effect of low-fluoride dentifrices supplemented with calcium glycerophosphate on enamel demineralization in situ

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Prevalence of deciduous tooth erosion in childhood

Objectives: The objective of this study was to estimate the prevalence of deciduous tooth erosion and to identify possible associations with sex, age and toothbrushing frequency in children aged 4-6 years. Methods: The sample was drawn from attendants (n = 7058) of 57 public preschools in a Brazilian city. Tooth wear index was used to evaluate erosion. Descriptive statistical analysis consisted of the calculation of the prevalence of dental erosion; chi-squared and Fisher's exact tests were performed to verify the association between dental erosion and sex, age and toothbrushing frequency. Results: Two thousand and seven hundred and fifty-nine preschool students were examined. Deciduous tooth erosion was observed in 0.6% of children and its incidence did not differ between sexes. The highest prevalence was observed in children aged 6 years (58.3%) and the most affected sextants were the fourth (22.86%) and sixth (20.00%), indicating that lingual and occlusal tooth surfaces were most frequently involved. The degree of involvement was classified as incipient in 54.29% of children and moderate in 45.71%. The significance level was set at 5%. No association was found between erosion and sex, age or toothbrushing frequency. Conclusions: The prevalence of deciduous tooth erosion was low in Brazilian children, and this disorder is not considered a public health problem in this part of the population. © 2013 John Wiley & Sons A/S.