Responses of dental pulp cells to a less invasive bleaching technique applied to adhesive restored teeth

To assess the cytotoxicity of 35% hydrogen peroxide (HP) bleaching gel applied for 15 min to sound or restored teeth with two-step self-etching adhesive systems and composite resin. Materials and Methods: Sound and restored enamel/dentin disks were stored in water for 24 h or 6 months + thermocycling. The disks were adapted to artificial pulp chambers and placed in compartments containing culture medium. Immediately after bleaching, the culture medium in contact with dentin was applied for 1 h to previously cultured odontoblast-like MDPC-23 cells. Thereafter, cell viability (MTT assay) and morphology (SEM) were assessed. Data were analyzed by two-way ANOVA and Tukey's test (a = 5%). Results: In comparison to the negative control group (no treatment), no significant cell viability reduction occurred in those groups in which sound teeth were bleached. However, a significant decrease in cell viability was observed in the adhesive-restored bleached groups compared to negative control. No significant difference among bleached groups was observed with respect to the presence of restoration and storage time. Conclusion: The application of 35% HP bleaching gel to sound teeth for 15 min does not cause toxic effects in pulp cells. When this bleaching protocol was performed in adhesive-restored teeth, a significant toxic effect occurred.

Microbiological analysis of dental casts stored long-term

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efecto del blanqueamiento dental con peroxido de hidrógeno al 35% en la resistencia de unión de dientes restaurados con resina compuesta

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

Effect of different bleaching protocols on dental enamel and composite resin

To evaluate changes in microhardness, roughness and surface morphology of dental enamel and composite resin after different tooth bleaching techniques. Material and Methods: Dental fragments from bovine incisors with composite resin restorations were submitted to different bleaching protocols: G1 – daily 8 hours application of a 10% carbamide peroxide (CP) gel during 21 days; G2: 3 applications of 15 minutes of a 38% hydrogen peroxide (H2O2) gel; G3: 38% H2O2 gel associated to irradiation with LED (470nm) during 6 minutes. The Knoop micro hardness of enamel and composite resin were evaluated at 1, 7, 14 and 21 days for G1, and after 1, 2 and 3 sessions for G2 and G3. The roughness and superficial morphology (atomic force microscopy) were evaluated before and at the end of the bleaching treatment. The data were analyzed by Mann-Whitney and Wilcoxon tests (=5%). Results: Significant reduction on enamel hardness was observed after 2 and 3 sessions for G2 and G3. For composite, the reduction occurred after 21 days for G1, and after 3 sessions for G2 and G3 (p<0.05). Significant reduction on roughness and superficial morphology were observed only for enamel of G1 group (p<0.05). Conclusion: The 10% CP gel promoted only superficial alterations on dental enamel, while the 38% H2O2 gel promoted mineral reduction of this dental tissue. All the bleaching protocols promoted reduction on hardness of composite resin.

Effect of hydrogen-peroxide-mediated oxidative stress on human dental pulp cells

To evaluate the effect of the oxidative stress on human dental pulp cells (HDPCs) promoted by toxic concentrations of hydrogen peroxide (H2O2) on its odontoblastic differentiation capability through time. Methods HDPCs were exposed to two different concentrations of H2O2 (0.1 and 0.3 μg/ml) for 30 min. Thereafter, cell viability (MTT assay) and oxidative stress generation (H2DCFDA fluorescence assay) were immediately evaluated. Data were compared with those for alkaline phosphatase (ALP) activity (thymolphthalein assay) and mineralized nodule deposition (alizarin red) by HDPCs cultured for 7 days in osteogenic medium. Results A significant reduction in cell viability and oxidative stress generation occurred in the H2O2-treated cells when compared with negative controls (no treatment), in a concentration-dependent fashion. Seven days after H2O2 treatment, the cells showed significant reduction in ALP activity compared with negative control and no mineralized nodule deposition. Conclusion Both concentrations of H2O2 were toxic to the cells, causing intense cellular oxidative stress, which interfered with the odontogenic differentiation capability of the HDPCs. Clinical significance The intense oxidative stress on HDPCs mediated by H2O2 at toxic concentrations promotes intense reduction on odontoblastic differentiation capability in a 7-day evaluation period, which may alter the initial pulp healing capability in the in vivo situation.

Bone-implant contact around crestal and subcrestal dental implants submitted to immediate and conventional loading

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Bone apposition and surface treatment in dental implants: histomorphometric pilot evaluation in rabbits

The surface of dental implants is an important factor for osseointegration process and different methods of surface treatment have been described. Objective: To investigate the bone apposition in implant surface treated with sandblasting and acid-etching. Material and methods: Ten rabbits were selected and received one implant treated with method I in the left tibia and one implant treated with method II in the right tibia. Then, twenty implants were divided in two groups, according to methods of sandblasting and acid-etching (method I and method II). After 7, 14, 30, 45 and 60 days, tibias were retrieved and submitted to histotechnical procedures. The percentages of bone–implant contact (BIC) and bone area between threads (BABT) were determined throughout histomorphometric analysis and bone apposition was detected in implants of both groups. Results: In BABT measurements, an increase was observed after 45 and 60 days in the method II, compared to method I and no differences were found after 7, 14 and 30 days. In BIC measurements, an increase was detected with method II at 45 days when compared to method I. No differences between groups in BIC values were observed after 7, 14, 30 and 60 days. Conclusion: Our data demonstrated that implants treated with the method II presented increase in the contact between bone and implant after 45 days compared to method I. Moreover, with concern to bone area between threads, it was observed an increased in the method II after 45 and 60 days. However, both groups can be successfully used as a therapeutic strategy to rehabilitation of edentulous patients. Then, further experiments are needed to evaluate, in depth, the putative differential role of each surface treatment.

Micro-arc oxidation as a tool to develop multifunctional calcium-rich surfaces for dental implant applications

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

Efeitos de diferentes sistemas de clareamento dental sobre a rugosidade e morfologia superficial do esmalte e de uma resina composta restauradora

The aim of this study was to evaluate and compare the roughness and superficial morphology of enamel and a composite restorative resin after different bleaching techniques application. Material and Methods: Bovine incisors were selected and standardized cavities were prepared on the buccal surface, which were restored with composite resin. The teeth were distributed according to the following treatments: G1- bleaching with 10% carbamide peroxide (CP); G2 - bleaching with 38% hydrogen peroxide (HP); and G3 - bleaching with 38% of HP associated to light irradiation. For G1, the bleaching gel was applied for 8 hours daily during 21 days. For G2 and G3, 3 sessions were performed, consisting of 3 applications of 15 minutes each, with 7 days of intervals between the sessions. For G3, the LED (470nm) light was used to activate the bleaching agent for 6 minutes. The surface of enamel and composite resin were evaluated before and after the bleaching procedures using a roughness tester and an atomic force microscope. Results: The results showed significant differences in surface roughness of enamel after bleaching only for G1 (Wilcoxon, p<0.05). For composite resin, neither group showed a statistical difference compared to control (Mann-Whitney, p>0.05). Conclusion: It was concluded that the increase in the roughness of enamel occurred only after bleaching therapy using a gel with 10% of CP. The bleaching procedures evaluated in this investigation did not increase the roughness or cause changes in the superficial morphology of the composite resin.

Predictability of short dental implants: a literature review

Introduction: In clinical situations where severe bone resorption has occurred following tooth loss, implant treatment options may comprise either a previous bone reconstruction or only the use of short implants. Objective: This non-systematic review summarizes and discusses some aspects of the use of short implants, such as: biomechanical aspects, success rate, longevity and surgical-prosthetic planning. Literature review: Current and relevant references were selected in order to compare short dental implants to conventional ones. Several studies have highlighted the great importance of wide-diameter implants. Dental short implants have shown high predictability and success rates when some biomechanical aspects are taken into consideration. Conclusion: Placement of short dental implants is a viable treatment method for patients with decreased bone height.

Microstructural, physical, and fluid dynamic assessment of spinel-based and phosphate-bonded investments for dental applications

This work reports the experimental evaluation of physical and gas permeation parameters of four spinel-based investments developed with or without inclusion of sacrificial fillers. Data were compared with those of three commercial formulations. Airflow tests were conducted from 27 to 546°C, and permeability coefficients were fitted from Forchheimer's equation. Skeletal densities found for spinel- (ρs = 3635 ± 165 kg/m3) and phosphate-bonded (ρs = 2686 ± 11 kg/m3) samples were in agreement with the literature. The developed investments were more porous and less permeable than commercial brands, and the differences were ascribed to the different pore morphologies and hydraulic pore sizes of ceramic matrices. The inclusion of both fibers and microbeads resulted in increases of total porosity (42.6–56.6%) and of Darcian permeability coefficient k1 (0.76 × 10−14–7.03 × 10−14 m2). Air permeation was hindered by increasing flow temperatures, and the effect was related to the influence of gas viscosity on ΔP, in accordance with Darcy's law. Casting quality with molten titanium (CP Ti) was directly proportional to the permeability level of the spinel-based investments. However, the high reactivity of the silica-based investment RP and the formation of α-case during casting hindered the benefits of the highest permeability level of this commercial brand.

A survey of the management of patients with temporomandibular disorders by general dental practitioners in southern Brazil

Purpose: Temporomandibular disorders (TMD) are recognized as one of the mostcontroversial topics in dentistry, despite the fact that both basic science and clinicalresearchers have currently reached some degree of consensus. This study aimed toconduct a questionnaire-based survey about the management of TMD patients bygeneral dental practitioners (GDPs).Materials and Methods: One hundred fifty-one GDPs with a private practice in a cityof southern Brazil were included, independent of school of origin, gender, graduationyear, and curriculum content. All participants were administered a questionnaire aboutthe management of patients with TMD, and the responses were analyzed by binomialand chi-square tests (α = 0.05).Results: Of the GDPs, 88.7% received TMD patients, who were primarily diagnosedon the basis of medical history (36.6%) or physical examination (30.4%). Of these,65.4% referred the patients elsewhere, primarily to specialists in occlusion (36.1%) ororthodontics (29.7%). Occlusal splinting was the most commonly used managementmodality (20.8%), followed by occlusal adjustment (18.1%) and pharmacotherapy(16.6%). Splints were fabricated in maximum habitual intercuspation or centric re-lation depending on individual patient (54.8%). The hard stabilization form was themost common type of appliance used (35.0%). Moreover, 73.8% of the GDPs didnot employ semi-adjustable articulators, and 69.5% adjusted the appliances at thetime of fixing. The duration of splint use and the frequency of follow-up were con-sidered patient dependent by 62.1% and 72.8%, respectively. GDPs considered thetwo major TMD etiologic categories as multifactorial (20.8%) and occlusion (19.9%).Multidisciplinary medical and dental treatment was considered necessary by 97.9%.Conclusions: The evaluated general dental practitioners manage TMD patients ac-cording to international guidelines.

Instrumentation of dental implants: a literature review

The aim of this study was to review the literature on the systems used to decontaminate the implant's surface. Different instruments have been proposed, but there is no agreement in the literature about which methods would be more efficient with no damage to the implant surface. It was reported the use of plastic, carbon fiber, stainless-steel and titanium curettes and also the use of other systems such as ultrasonic points with different tips, rubber cups and air abrasion. Literature review: In most of the studies, the injury caused on the titanium surface at the time of instrumentation was examined. In others, the cell adhesion on the titanium dental implants following instrumentation of the implant surface was observed. Moreover, to enhance cleaning around implants, ultrasonic systems were recently tested. Conclusion: Metal instruments can lead to major damage to implant surface, therefore, they are not indicated for decontamination of dental implants surfaces. Furthermore, non-metallic instruments, such as plastic curettes, rubber cups, air abrasion and some ultrasonic systems seem to be better choices to remove calculus and plaque of the sub- and supra-gingival peri-implant area. It is noteworthy that more studies evaluating the effects of these systems are required to establish best practices to be used in the treatment of patients with dental implants.