Cariostatic effect of fluoride-containing restorative systems associated with dentifrices on root dentin

Objective. The aim of this in vitro study was to evaluate the interaction between two sources of fluoride (restorative systems and dentifrices) in inhibiting artificial root caries development. Methods. One hundred and eighty tooth segments were embedded in polyester resin, and sanded flat. Cylindrical cavities 1.0 mm-deep and 1.5 mm-diameter were prepared in root dentin and randomly restored by fluoride-containing restorative systems: Ketac-fil/Espe (Ke), Fuji II LC/GC Corp (Fj), F2000/3M (F2), Surefil/Dentsply (Su) or a control: Filtek Z250/3M (Z2). Ten experimental groups were made to test the association among the five restorative systems and two dentifrices: with F - (Sensodyne Baking Soda) or without F- (Sensodyne Original) (n = 18). After surface polishing, a 1 mm-wide margin around the restorations was demarcated and initial dentin surface Knoop microhardness values (KHNi) were obtained. The specimens were submitted to a pH-cycling model, and to applications of slurries of dentifrice. Afterwards the final dentin surface Knoop microhardness values (KHNf) were measured. Results. The differences between KHNi and KHNf, and the covariate KHNi were considered by the ANCOVA and Tukey's test (α = 0.05). The interaction between restorative system and dentifrice was statistically significant (p = 0.0026). All restorative systems provided some protection against artificial caries challenge when associated with the fluoride-containing dentifrice treatment. The means (standard deviation) of reductions in Knoop hardness values for systems associated with the fluoride-containing dentifrice were: Ke: 40.0(1.02)a, Fj: 41.9(1.02)b, F2: 43.3(1.04)c, Su: 43.5(1.00)c, Z2: 44.0(1.02)c; and with the non-fluoride-containing dentifrice were: Ke: 42.9(1.02)a, Fj: 44.7(1.01)b, F2: 45.2(1.09)bc, Su: 46.0(0.99)c, Z2: 46.6(0.99)c (statistical differences were expressed by different letters). Conclusion. The cariostatic effect shown by the fluoride-containing dentifrice could enhance that shown by Ketac-fil and Fuji II LC, and could mask that shown by F2000. © 2002 Elsevier Science Ltd. All rights reserved.

In vitro detection of secondary caries associated with composite restorations on approximal surfaces using laser fluorescence

This study evaluated the performance of the DIAGNOdent pen laser fluorescence device (LFpen) in comparison with visual examination (VE), bitewing radiographs (BW) and visual examination combined with bitewing radiographs (VEBW) in detecting secondary approximal caries associated with composite restorations. In total, 60 approximal surfaces from 43 permanent molars with composite restorations were assessed twice by two examiners using the LFpen, VE, BW and VEBW. After histological preparation and hardness measurements, the sample was assigned to either a crown or root caries group, depending on the location of the lesions as the gold standard. For crown caries at D1, the highest values of specificity and sensitivity were observed for the LFpen at a cutoff value of 18 (1.00) and for the VEBW (0.89). At D3 (cutoff of 30), the LFpen showed the highest values of sensitivity and specificity. For root caries, the LFpen and VEBW showed the highest values of specificity (0.54), sensitivity (0.81) and accuracy (0.69). The Spearman rank correlation coefficients for crown/root caries with histology were 0.54/0.37 (LFpen), 0.29/0.10 (BW), 0.29/0.18 (VE) and 0.23/0.37 (VEBW). For the LFpen, the ICC varied from 0.80 (interexaminer) to 0.97 (intraexaminer B); the kappa value was 0.19 for BW and 0.35 for VE (interexaminer). Intraexaminer kappa values for BW were 0.25 (A) and 0.29 (B), and those for VE were 0.31 (A) and 0.32 (B). The LFpen device exhibited a performance comparable to that of conventional methods but with higher interexaminer reproducibility. Therefore, the LFpen should be considered an auxiliary method for the detection of secondary approximal caries associated with composite restorations.

Efeito cariostático de restaurações adesivas em superfícies radiculares: estudo in vitro

Materiais restauradores que liberam íons flúor e/ou promovem adesão à estrutura dental têm sido relacionados com a inibição do desenvolvimento de lesões de cárie adjacentes às restaurações. A hipótese testada neste estudo foi a de que o uso de resina composta/sistema adesivo tem efeito cariostático semelhante a um material adesivo que libera íons flúor - cimento de ionômero de vidro - sobre a superfície radicular adjacente às restaurações. Foram utilizadas 20 raízes de terceiros molares humanos extraídos, embutidas em resina de poliestireno e planificadas. Cavidades padronizadas foram preparadas e restauradas aleatoriamente com (a) Chelon-Fil (Espe) ou (b) Z100/SingleBond (3M). Valores iniciais (KHNi) de microdureza superficial Knoop da dentina foram obtidos a 100, 200 e 300 mim da margem oclusal das restaurações. Uma área de 2,0 mm ao redor da restauração foi delimitada e submetida à indução de cárie artificial. Obtiveram-se, então, os valores finais (KHNf) de microdureza, nas mesmas condições e localizações da leitura inicial. As diferenças entre KHNi e KHNf foram consideradas para a análise estatística. As medianas de KHNi - KHNf nas distâncias de 100, 200 e 300 mim foram para (a): -3,8; -0,3; -1,0; e para (b): 3,3; 2,5; 1,7. O teste de Kruskal-Wallis não evidenciou diferença significativa entre as distâncias dentro de cada grupo. Às distâncias de 200 e 300 mim, não houve diferença significativa entre os materiais avaliados. À distância de 100 mim, (a) diferiu significativamente de (b) (p < 0,05). Sob as condições deste estudo, o cimento de ionômero de vidro apresentou maior potencial cariostático que a resina composta com sistema adesivo dentinário.

Conservative prosthetic-periodontal treatment for molar class iii furcation involvement: Case report

Purpose: The treatment for furcation involvement is a great challenge to the general dentists. Tunneling may be a treatment alternative for class II and III furcation involvements in mandibular molars with large angle separation and great divergence between the mesial and distal roots. This alternative is a conservative treatment that allows a great condition to oral hygiene maintenance by the patient. Thus, the aim of this case report was to describe a conservative and therapeutic treatment modality for the horizontal defect of periodontal tissues in the furcal area with buccal-lingual extension (class III furcation involvement). Case Report: A patient with class III furcation involvement in the first mandibular molar was submitted to root resection and periodontal surgery to expose the clinical crown for the full-coverage restoration with tunnel preparation. Results: The final result of the treatment with tunneled crown was favorable and predictable due to adequate hygiene condition to avoid plaque accumulation and occurrence of root caries. Clinical Significance: A multidisciplinary approach is essential to achieve a correct treatment plan including surgical-periodontal procedures integrated to the prosthetic rehabilitation. Besides, the recommendation for oral hygiene maintenance is essential for the treatment longevity with tunneled crown. © 2011 Nova Science Publishers, Inc.

Indicadores de saúde bucal e qualidade de vida

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Comparação de dois tipos de retalho para enxerto de tecido conjuntivo no tratamento de recessões gengivais: estudo clínico controlado randomizado

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

Lesões de cárie não cavitadas no esmalte

Tendo em conta os conceitos atuais da doença cárie dentária a necessidade de diagnóstico precoce das lesões de desmineralização que afetam o esmalte, pretendeu-se realizar uma revisão bibliográfica descritiva com os seguintes objetivos: descrever os principais conceitos acerca das lesões não cavitadas de cárie no esmalte, relacionadas com prevalência, gravidade, formas de deteção e registo; pretendeu-se ainda efetuar uma revisão da ação química dos agentes remineralizantes e infiltrantes, em lesões não cavitadas do esmalte, focando-se essencialmente na sua identificação, descrição, modos de apresentação, mecanismo de ação, modo de atuação clínica, principais evidências in vitro e in vivo sobre a ação dos remineralizantes e infiltrantes. Para tal, foi utilizada a metodologia PICO para a formulação das questões, avaliação e síntese da evidência empírica a incluir neste estudo. Os achados resultam da análise de 148 artigos, quer de perfil qualitativo, quer do perfil quantitativo, dos quais 104 são de revisões de literatura e 44 são empíricos, destes 44 artigos, 13 são relativos a infiltrantes e 31 são relativos a remineralizantes. Foram colocadas as palavras-chave: “enamel remineralization”, “ICDAS”, “white spot lesion”, “non-cavitated caries lesions”, “resin infiltration”, “infiltrants”, “dental caries detection”, “remineralizing agents”, “demineralization-remineralization” e “dental toothpaste”. Os critérios de inclusão foram: estudos observacionais, in vivo e in vitro, revisões narrativas, sistemáticas e meta-análises, escritas em nomenclatura Inglesa, sem período temporal definido, dando no entanto mais relevo clínico a publicações entre os anos de 2005 e 2016. Os critérios de exclusão foram todos os artigos que se referissem a lesões na dentina ou lesões cavitadas de esmalte, lesões odontopediátricas, lesões de cárie de raiz e materiais restauradores que não fossem infiltrantes. Foi possível concluir que ambas as técnicas (atuação por agentes remineralizantes e por infiltração resinosa) são eficazes na remineralização de lesões cariosas incipientes no esmalte. Os agentes remineralizantes apresentam uma vasta gama de formulações de acordo com as necessidades de cada paciente, enquanto os infiltrantes por serem uma técnica ainda recente apenas apresentam um composto disponível comercialmente para a sua aplicação em consultório dentário.

Considerações anatómicas sobre o envelhecimento do aparelho estomatognático

Introdução: com o crescente aumento da expectativa de vida, o conhecimento das alterações anatómicas e fisiológicas que ocorrem no aparelho estomatognático durante o envelhecimento é de suma importância para a correta avaliação do paciente idoso. Objetivos: descrição e abordagem das principais estruturas anatómicas do indivíduo, adulto e idoso. Estabelece-se uma anatomia comparativa e evolutiva durante o processo de envelhecimento. Pretende-se contribuir para o conhecimento e reflexão sobre o tema em questão e demonstrar a aplicabilidade deste conhecimento em contexto clínico. Métodos: realizou-se pesquisa bibliográfica, nas bases de dados Pubmed, b-on SciElo e Elsevier, no período entre 2006-2016. Resultados: Maxila - ocorre reabsorção óssea, alteração no contorno do arco da maxila, retrusão maxilar, rotação da maxila no sentido horário, diminuição gradual e constante do ângulo maxilar e redução vertical da altura maxilar. Mandíbula - aumento do ângulo da mandíbula, diminuição da densidade e volume ósseo. Articulação gonfose e Articulação Temporo-Mandibular - pode ocorrer tanto anquilose, como perda das estruturas de suporte. Observa-se degeneração e/ou perfuração do disco radicular e alteração do formato do côndilo. Dentes - cáries radiculares, fraturas dentárias e desgaste dentário. Ocorrem modificações histológicas no esmalte, dentina e polpa dentária. Periodonto: reabsorção do osso alveolar, gengiva atrófica com tendência a migração apical, deposição apical das camadas incrementais e desgaste de cemento exposto, ligamento periodontal fino, irregular e diminuição do espaço periodontal. Conclusões: as alterações anatómicas decorrentes do envelhecimento fisiológico são múltiplas. O Médico Dentista diante de um paciente idoso, deverá conhecer e distinguir entre uma alteração decorrente do envelhecimento fisiológico e uma alteração patológica, para o correto diagnóstico clínico e uma excelente decisão terapêutica. O Médico Dentista deverá contribuir para o envelhecimento saudável e para tal deve ser conhecedor em pleno da temática do presente trabalho.

Etiologia da recessão gengival

Introdução: A Periodontologia é um ramo da Medicina Dentária que tem como objetivo manter o periodonto saudável. A recessão gengival tem vindo a ser estudada, tanto em populações com pobre controlo de placa bacteriana, quanto naquelas com boa Higiene Oral. Os médicos dentistas desconhecem ainda muitos dos aspetos da etiologia da recessão gengival e como tal, este assunto foi objeto de muitas conjeturas, nomeadamente a causa da mesma, sendo ainda mais importante, o controle deste problema. Sendo assim, persiste a confusão levantada por várias opiniões e pontos de vista contraditórios, sendo alvo desta dissertação. Objetivos: Esta dissertação tem como objetivo analisar, e verificar a Etiologia da Recessão Gengival, mais precisamente, a sua origem e os fatores que predispõem a mesma. Tendo sido assim, realizada uma revisão bibliográfica, de modo a verificar: quais as causas desta patologia e as suas limitações. Materiais e Métodos: Para a obtenção da informação necessária na realização da presente dissertação, foi efetuada uma pesquisa bibliográfica nas bases de dados da Pubmed, Scielo, o livro Tratado de Peridontia Clinica e Implantologia Oral, o Jornal da Associação Dentária Americana, o livro Peridontia Clinica, o livro de Histologia Básica e o livro Anatomia, Embriologia e Histologia Oral. Para tal, foi realizada a investigação através das seguintes palavras-chaves: “Etiology”, Gingival Recession”, “Periodontitis”, “Dental plaque”, e “Prevalence”. Conclusão: No trabalho realizado, é possível concluir que a Etiologia da recessão é multifatorial e raramente leva à perda do elemento dentário, embora, cause muitos danos por provocar a sensibilidade dentária, devido a perda e retração da gengiva. Esta etiologia leva a uma maior incidência de cáries radiculares, sacrificando o aspecto estético do paciente, e consequentemente, leva a um desconforto psicológico. Subsequentemente a recessão gengival e as suas múltiplas causas, existem atualmente métodos e técnicas, que nos permitem a resolução de alguns dos danos provocados por esta, com o objetivo de criar uma maior probabilidade de eliminação dos fatores causais da mesma.

Fluoride plus CO2 laser against the progression of caries in root dentin

Purpose: To evaluate the effect of a 1.23% acidulated phosphate fluoride (APF) gel combined with CO2 laser in protecting carious root dentin against further cariogenic challenges. Methods: After a 7-day lead-in period, 12 volunteers wore an intraoral palatal device containing four carious root dentin slabs, treated with APF and APF+CO2 or placebo and placebo+CO2. After a 14-day wash-out period, volunteers were crossed-over to the other treatment arm. During both intraoral phases, specimens were submitted to cariogenic challenges and then evaluated for cross-sectional Knoop microhardness. Results: Two-way ANOVA demonstrated that there was significant effect for both main factors: CO2 laser irradiation (P< 0.0001) and gel treatment (P< 0.0001), and that there was no interaction between them (P= 0.4706). Protection of carious root dentin against further cariogenic challenges may be provided by APF fluoride gel and CO2 laser, but no additive benefit was found by combining such strategies. (Am J Dent 2012;25:114-117).

Formation of caries-like lesions in vitro on the root surfaces of human teeth in solutions simulating plaque fluid

Lesion formation on root surfaces of human posterior teeth was studied in acetate/lactate buffers with a background electrolyte composition based on plaque fluid analyses. Lesion depth after 28 days at 37 degrees C was measured in relation to: the presence or absence of cementum; the concentration of undissociated buffer; the presence or absence of magnesium ions at plaque fluid concentration. Each factor was evaluated at several values of -log(ion activity product for hydroxyapatite): pI(HA). Solutions were formulated to minimize variation in pH, which varied by < or =0.03 for a given comparison (individual pI(HA)) and by 0.42-0.82 over the range of pI(HA) within experiments. Lesions on surfaces from which cementum had been ground were significantly deeper than on intact surfaces, but this is considered to be due to subsurface mechanical damage and not to a solubility difference. Neither the concentration of undissociated buffer nor the presence of magnesium ions significantly affected lesion depth. Lesion depth was strongly influenced by the correlated variations in pI(HA) and pH. At pI(HA) 54 and 55, only extremely shallow lesions formed. From pI(HA) 56, lesion depth increased with increasing pI(HA). The results confirm that the solubility of the mineral of root tissues is higher than that of hydroxyapatite, but indicate that it is probably lower than suggested by Hoppenbrouwers et al. [Arch Oral Biol 1987;32:319-322]. For calcium concentrations of 3-12 mM, the critical pH for root tissue mineral was calculated as 5.22-5.66 assuming solubility equivalent to pI(HA) 54 and 5.08-5.51 assuming pI(HA) 55.

Effect of Two Restorative Materials on Root Dentine Erosion

This study sought to evaluate the microhardness of root dentine adjacent to glass-ionomer and composite resin restorations after erosive challenge. A crossover study was performed in two phases of 4 consecutive days each. One hundred twelve bovine root dentine slabs were obtained, and standardized box-shaped cavities were prepared at center of each specimen. The prepared cavities were randomly restored with glass-ionomer cement or composite resin. The slabs were randomly assigned among 14 volunteers, which wore intraoral palatal device containing four restored root dentin slabs. Starting on the second day, half of the palatal acrylic devices were immersed extraorally in a lemonade-like carbonated soft drink for 90 s, four times daily for 3 days. Alter 3-day wash-out, dentine slabs restored with the alternative material were placed into palatal appliance and the volunteers started the second phase of this study. After erosive challenges. microhardness measurements were performed. Regardless of the restorative material employed, eroded specimens demonstrated lower microhardness value (p < 0.0001). At eroded condition examined in this study, dentine restored with glass-ionomer cement showed higher microhardness values (p < 0.0001). It may be concluded that the glass-ionomer cement decreases the progression of root dentine erosion at restoration margin. (C) 2010 Wiley Periodicals, Inc J Biomed Mater Res Part B Appl Biomater 93B 304-305, 2010

Effects of copper vapor laser radiation on the root canal wall of human teeth: A scanning electron microscope study

Objective: The aim of this study is to analyze the effects of copper vapor laser radiation on the radicular wall of human teeth. Materials and Methods: Immediately after the crowns of 10 human uniradicular teeth were cut along the cement-enamel junction, a chemical-surgical preparation of the radicular canals was completed. Then the roots were longitudinally sectioned to allow for irradiation of the surfaces of the dentin walls of the root canals. The hemi-roots were separated into two groups: one (control) with five hemi-roots that were not irradiated, and another (experimental) with 15 hemi-roots divided into three subgroups that were submitted to the following exposure times: 0.02,0.05, and 0.1 s. A copper vapor laser (510.6 nm) with a total average power of 6.5 W in green emission, frequency of 16.000 Hz, and pulse duration of 30 ns was used. Results: The results obtained by scanning electron microscope analysis showed the appearance of a cavity in the region of laser beam impact, with melting, recrystallization, and cracking on the edges of the dentin of the cavity due to heat diffusion. Conclusions: We determined that the copper vapor laser produces significant morphologic changes in the radicular wall of human teeth when using the parameters in this study. However, further research should be done to establish parameters that are compatible with dental structure in order to eliminate thermal damages. © Mary Ann Liebert, Inc.

Feline caries in two cats from a 13th century archeological excavation

Mandibles of two cats containing carious lesions were discovered among the previously published findings of feline dental resorptive lesions from materials examined at an archaeological museum. These lesions were too small to be noted on radiographs, and consisted of two inconspicuous enamel lesions in a mandibular left first molar tooth (309), a clinically visible white spot area containing an enamel lesion in a mandibular left fourth premolar tooth (308), and a root surface caries in the 308 of a different specimen. Histologic examination using special stains and polarized light revealed both initial and early initial stage enamel caries, as well as root surface caries. Knoop hardness measurements confirmed these findings, considered the first documented cases of feline caries.

Clinical evaluation of root filled teeth restored with or without post-and-core systems in a specialist practice setting

AIM: To assess survival rates and complications of root-filled teeth restored with or without post-and-core systems over a mean observation period of >or=4 years. METHODOLOGY: A total of 325 single- and multirooted teeth in 183 subjects treated in a private practice were root filled and restored with either a cast post-and-core or with a prefabricated titanium post and composite core. Root-filled teeth without post-retained restorations served as controls. The restored teeth served as abutments for single unit metal-ceramic or composite crowns or fixed bridges. Teeth supporting cantilever bridges, overdentures or telescopic crowns were excluded. RESULTS: Seventeen teeth in 17 subjects were lost to follow-up (17/325: 5.2%). The mean observation period was 5.2 +/- 1.8 (SD) years for restorations with titanium posts, 6.2 +/- 2.0 (SD) years for cast post-and-cores and 4.4 +/- 1.7 (SD) years for teeth without posts. Overall, 54% of build-ups included the incorporation of a titanium post and 26.5% the cementation of a cast post-and-core. The remaining 19.5% of the teeth were restored without intraradicular retention. The adjusted 5-year tooth survival rate amounted to 92.5% for teeth restored with titanium posts, to 97.1% for teeth restored with cast post-and-cores and to 94.3% for teeth without post restorations, respectively. The most frequent complications included root fracture (6.2%), recurrent caries (1.9%), post-treatment periradicular disease (1.6%) and loss of retention (1.3%). CONCLUSION: Provided that high-quality root canal treatment and restorative protocols are implemented, high survival and low complication rates of single- and multirooted root-filled teeth used as abutments for fixed restorations can be expected after a mean observation period of >or=4 years.