Changes on degree of conversion of dual-cure luting light-cured with blue LED

The indirect adhesive procedures constitute recently a substantial portion of contemporary esthetic restorative treatments. The resin cements have been used to bond tooth substrate and restorative materials. Due to recently introduction of the self-bonding resin luting cement based on a new monomer, filler and initiation technology has become important to study the degree of conversion of these new materials. In the present work the polymerization reaction and the filler content of dual-cured dental resin cements were studied by means of infra-red spectroscopy (FT-IR) and thermogravimetry (TG). Twenty specimens were made in a metallic mold (8 mm diameter x 1 mm thick) from each of 2 cements, PanaviaA (R) F2.0 (Kuraray) and RelyX (TM) Unicem Applicap (3M/ESPE). Each specimen was cured with blue LED with power density of 500 mW/cm(2) for 30 s. Immediately after curing, 24 and 48 h, and 7 days DC was determined. For each time interval 5 specimens were pulverized, pressed with KBr and analyzed with FT-IR. The TG measurements were performed in Netzsch TG 209 under oxygen atmosphere and heating rate of 10A degrees C/min from 25 to 700A degrees C. A two-way ANOVA showed DC (%) mean values statistically significance differences between two cements (p < 0.05). The Tukey`s test showed no significant difference only for the 24 and 48 h after light irradiation for both resin cements (p > 0.05). The Relx-Y (TM) Unicem mean values were significantly higher than PanaviaA (R) F 2.0. The degree of conversion means values increasing with the storage time and the filler content showed similar for both resin cements.

Dentin hypersensitivity clinical study comparing LILT and LEDT keeping the same irradiation parameters

Dentin hypersensitivity is a common condition associated with high dental pain. A new LED-based (light emitting diode) light source has been used as an experimental tool in some studies. Purpose: The main objective was to compare these two light sources emitting in the same spectral band (red from 625 to 660 nm) to promote pain relief. Material and methods: A total of 6 sessions were accomplished, being three irradiation sessions and three follow-up sessions. This single-blind study compared a control group (Placebo) and two other groups with different equipments: low laser intensity treatment (LILT) and a light emitting diode system treatment (LEDT). Results: The results showed that there is no statistical difference between LILT and LEDT groups, however, both were better than control group (p=0.01) in terms of treatment efficiency; there is no difference between the second and the third sessions for both treatment, it means that the third session was not necessary; finally, the improvement at the end of the entire research (follow up care of 30 days) was very expressive in comparison to pre-treatment situation for all teeth (p=0.01). Conclusion: LILT and LEDT were equally effective to treat dentine hypersensitivity, a 3rd treatment session was not necessary/two sessions are enough.

Chondrichthyans from the base of the Irati Formation (Early Permian, Parana Basin), Sao Paulo, Brazil

Three species of chondrichthyans are reported from conglomeratic sandstone at the base of the Lower Permian (Artinskian) Irati Formation (Parana Basin) near Rio Claro, Sao Paulo State, Brazil. The fossils include: 1) dispersed teeth of the petalodont ltapyrodus punctatus Silva Santos 1990, first described from the Permian (Artinskian) Pedra do Fogo Formation, Parnaiba Basin, Northeast Brazil; 2) a new species of tooth of the Order Orodontiformes; and 3) a new species of finspine of the Order Ctenacanthiformes. These fossils occur in an allochthonous assemblage of vertebrate remains including other Chondrichthyes, Xenacanthiformes and cladodonts, paleonisciform bony fish, and tetrapods. This discovery is a significant contribution to the sparse record of South American Chondrichthyes from the Early Permian and raises questions regarding the paleoenvironmental adaptations among these fish within Paleozoic basins of Brazil at this time. (C) 2010 International Association for Gondwana Research. Published by Elsevier B.V. All rights reserved.

Placas maxilo-dentárias em Rincossauros Hyperodapedon Huxley, 1859. Histologia e morfogênese maxilo-dental: nova abordagem.

O estudo das estruturas da placas maxilo-dentárias dos rincossauros Hyperodapedon Huxley, 1859, do Triássico da Formação Santa Maria, em nova abordagem histológica e ontogênica resultou na identificação da natureza do esmalte aprismático verdadeiro, de variados elementos histológicos dentinários e osteológicos, e de um centro de ossificação periosteal primário. Também foram encontradas evidências histológicas dos mecanismos de fusionamento maxilo-dentinário e amelo-maxilar. Com estes elementos, inferimos os modelos de organogênese dental, da ontogênese maxilar e dos mecanismos de fusionamento maxilodental. Encontrou-se uma singular e raríssima coroa dental, imatura e ainda não erupcionada, na região posterior da placa dental e assim evidenciou-se a correta posição da margem odontogenicamente ativa. Adicionalmente inferiu-se a localização da posição da lâmina dentária embrionária. Constatou-se a não formação de alvéolos dentários, de cemento radicular e do espaço necessário à formação do ligamento periodontal e, assim, se deduziu a não formação do folículo dental embriônico. As presenças de especiais elementos anatômicos e histológicos nos tecidos ósseos periapicais evidenciam o crescimento radicular contínuo, enquanto a forma e o fusionamento radicular imediato depõe a favor de uma função dentária fisiológica diferenciada para as baterias dentárias maxilares dos Rincossauros do gênero Hyperodapedon. Os mecanismos que possibilitaram o controle embriônico para a deposição das lamelas de tecido ósseo coronal e seu preciso fusionamento sobre o esmalte dentário, declinam por modificações nas funções tardias do órgão reduzido do esmalte e pela presença de uma membrana oral com funções osteogênicas e também protetivas, situada nas porções posteriores da placa maxilo-dentária em desenvolvimento. Mudanças heterocrônicas no tempo de diferenciação das células da crista neural embriônica e em seus derivados, como a lâmina dentária e órgãos dentários embrionários ou correlacionadas com a organogênese das placas maxilo-dentárias e seus anexos periodontais, todos como condições plesiomórficas para Diápsidas Triássicos, poderiam ser as causas responsáveis pela origem e evolução deste estranho aparelho estomatognático nos clados de Hyperodapedon sp..

Análise da dentina de dentes decíduos submetidos ao capeamento pulpar indireto

O objetivo do estudo foi avaliar as características da dentina cariada remanescente de molares decíduos quanto à coloração, consistência e microdureza, após um período médio de 3 anos e 8 meses da realização do capeamento pulpar indireto. O estudo clínico constou de 27 dentes que apresentavam lesões cariosas ativas com expressão radiográfica em metade interna de dentina. Aleatoriamente, foi realizado o capeamento pulpar indireto e utilizado como material capeador o hidróxido de cálcio (HC) e o cimento de ionômero de vidro resinoso modificado (CIVRM). As crianças foram acompanhadas através de exames clínicos e radiográficos, e ao longo de um período médio de 3 anos e 8 meses, observou-se um índice de sucesso de 89% para o grupo do HC e de 93% para o CIVRM, não havendo diferença estatisticamente significante entre os dois grupos (p=0,62). Os dentes considerados como sucesso no estudo clínico foram agrupados em um único grupo (grupo teste), que constou de 13 dentes que sofreram esfoliação natural ou exodontia por motivos ortodônticos. Além disso, foram selecionados 15 molares decíduos hígidos (grupo controle positivo) e 15, portadores de lesões cariosas ativas em metade interna de dentina (grupo controle negativo). As amostras do grupo teste tiveram suas respectivas restaurações removidas, a profundidade medida e a dentina remanescente avaliada por um operador calibrado, seguindo critérios descritivos, quanto à consistência e a coloração. Nos dentes do grupo controle positivo, foram realizados preparos cavitários oclusais em até 4 mm de profundidade, enquanto que, no grupo controle negativo, o mesmo operador do estudo clínico realizou a remoção parcial de tecido cariado in vitro. A partir daí, todos os dentes foram preparados para análise de microdureza, que foi realizada por um examinador calibrado, que empregou o princípio de cegamento. Na análise da consistência, todos os dentes do grupo teste (n=13) apresentaram-se endurecidos, enquanto que 9, apresentaram coloração amarela-clara (8 do CIVRM e 1 do HC) e 4, castanho-escura (1 do CIVRM e 3 do HC). Para o teste de microdureza no grupo teste, obteve-se uma média KHN de 40,81 (±16,28) MPa, enquanto que nos grupos controles positivo e negativo, foram alcançados valores médios de 62,73 (±11,24) MPa e 19,15 (±6,99) MPa, respectivamente. A análise estatística mediante o teste ANOVA indicou que houve diferença significativa entre os 3 grupos. Foi constatada a remineralização da dentina de dentes decíduos em que foi realizada a técnica do capeamento pulpar indireto após um período médio de 3 anos e 8 meses, através de critérios clínico (consistência) e laboratorial (análise da microdureza).

Avaliação da saúde bucal e anomalias dentárias em pacientes tratados com leucemia na infância e adolescência

Objetivo: o objetivo deste estudo foi avaliar as condições de saúde bucal e a ocorrência de anomalias dentárias em crianças tratadas para leucemia linfoblástica aguda (LLA) no Serviço de Oncologia Pediátrica (SOP) do Hospital de Clínicas de Porto Alegre (HCPA), comparadas com um grupo crianças saudáveis. Amostra: foram selecionadas 56 crianças com diagnóstico de LLA e analisadas as presenças de anomalias dentárias e os índices CPO-D (cariado, perdido, obturado-dente), IPV (índice de placa visível), ISG (índice de sangramento gengival) e fluxo salivar. As crianças tratadas apresentaram uma média de idade, na época do diagnóstico da LLA, de 5,3 ± 2,6, e 11,8 ± 4,2 na avaliação, sendo 32 masculinos e 24 femininos. Os pacientes tratados para LLA foram divididos em três grupos: crianças tratadas somente com quimioterapia, com quimio e radioterapia, e com quimio, radio e transplante de medula óssea. Resultados: os resultados revelaram 80,4% de anomalias dentárias nas crianças tratadas, ou seja, 45 destas apresentaram pelo menos uma alteração, e o grupo de pacientes tratados com quimio, radio e submetidos ao transplante de medula óssea foi o que revelou a maior média de anormalidades dentárias por indivíduo (15,37 ± 15,03), não ocorrendo diferença estatística entre os gêneros. As crianças tratadas para LLA obtiveram CPO-D de 1,9 ± 4,0, ISG de 26,5%, IPV de 72,0%, e índice de fluxo salivar médio de 0,19 mL/min criança. Já o grupo de crianças sadias apresentou CPO-D de 1,52 ± 3,5, ISG de 11,1%, IPV de 53,8% e índice de fluxo salivar médio de 0,27 mL/min. Conclusão: o tratamento para a cura da LLA provoca um aumento significativo no número de anomalias dentárias, sendo mais freqüente nos pacientes menores de cinco anos de idade, principalmente nos pacientes submetidos a quimio e radioterapia associadas ao transplante de medula óssea, o que requer, por parte do cirurgião-dentista, intervenções clínicas diferenciadas e cuidadosas nestes pacientes, tendo-se em vista também os índices aumentados de ISG e IPV. As alterações sofridas pelas glândulas salivares durante o tratamento não são permanentes sob o aspecto do fluxo salivar, que retorna à normalidade. A orientação e o acompanhamento adequados destes pacientes por parte da equipe de saúde bucal podem mantê-los com o índice de CPO-D dentro dos padrões preconizados pela Organização Mundial de Saúde.

Periodontal diseases in a representative urban population in south Brazil

Background and Aims: There is little information about the epidemiology and risk factors of periodontal diseases in Latin America in general, and Brazil in particular. The principal aims of this study were to: 1) describe the prevalence and severity of periodontal attachment loss and gingival recession, and to assess the contribution of demographic, behavioral, and environmental exposures to the occurrence of periodontal disease outcomes in a sample representative of the urban population in the state of Rio Grande do Sul in south Brazil; and 2) report the epidemiology and risk indicators of aggressive periodontitis in this population. Methods: A representative sample consisting of 1,586 subjects 14-103 years of age (mean 38 y) and comprising 45.3% males and 54.7% females was selected using a multi-stage, probability, cluster sampling strategy. The subjects were interviewed using a structured questionnaire and underwent a full-mouth, six sites per tooth clinical examination in a mobile examination center. Results: Moderate and severe clinical attachment loss and gingival recession were widespread among adults in this population. The prevalence and extent of attachment loss ³5 and ³7 mm were 79% and 52% subjects, and 36% and 16% teeth; and for gingival recession ³3 mm and ³5 mm were 52% and 22% subjects, and 17% and 6% teeth, respectively. Aggressive periodontitis was diagnosed in 5.5% of subjects, which is significantly higher than the reported prevalence in most other populations. Among the main risk indicators for chronic as well as aggressive destructive periodontal diseases were: older age, low socioeconomic status, dental calculus, and smoking. Cigarette smoking accounted for an important part of periodontal disease burden, particularly in adults, and should be considered an important target in any prevention strategy aimed at reducing the burden of periodontal diseases. Partial recording methods consistently underestimated the prevalence of attachment loss in the population, and the extent of underestimation was dependent on the type of system used and the threshold of attachment loss. Conclusions: Destructive periodontal diseases are prevalent in this Brazilian population. Suitable disease prevention and health promotion programs should be established to improve the periodontal health in this population.

Technologies that motivates healthy toothbrushing: practices through social translucence

Fifty percent of the European Union’s population suffers from an oral disease. Studies have repeatedly shown that while acquiring healthy toothbrushing practices early on in one’s life is of significance, children and adults often fail to adhere to those. In this thesis we attempt to design and prototype interactive technologies that motivate healthy tooth brushing habits on individuals. Rather than focusing on the technologies’ persuasive power over individuals, we tap on the social mechanisms employed by families. In this sense, we think of these technologies as social translucent rather than persuasive, whose goal is to raise awareness within the family on each other’s habits and that aim at leveraging families’ existing social mechanisms for behavior change, rather than replacing them. More specifically, we aim to gain insights with respect to the following questions: a) What are the drivers and barriers towards adhering to healthy tooth brushing behaviors? b) Can we effectively measure toothbrushing behaviors? c) How can technologies leverage family communication practices in motivating proper toothbrushing behaviors? First, we present two studies about children and adults’ tooth brushing behaviors and how these are influenced by social interactions within the family. Secondly, we present the design and prototyping of two systems that sense toothbrushing practices and provide feedback, using the Social Translucence Framework as a design lens. We conclude with an overview of lessons learnt from the prototyping of these systems supported by an analysis of the strengths and pitfalls of the developed technologies.

Incidência de cárie dentária em adolescentes em município do Nordeste brasileiro, 2006

NORO, Luiz Roberto Augusto et al. Incidência de cárie dentária em adolescentes em município do Nordeste brasileiro, 2006, Cadernos de Saúde Pública, Rio de Janeiro, v. 25, n. 4, p. 783-790, abr. 2009.

Estudo de sistemas vítreos para infiltração em alumina

The system in-Ceram Alumina, produced by VITA, consists in a technique of prepare of a substructure of ceramics to dental crowns. First burning is made in the alumina decanted by slip casting process under a stone die that reproduces the tooth prepared to receive a crown. In a second burning, alumina is infiltrated by vitreous system, giving to this set a high mechanic resistance. In this work, it s made a study of the composition of a new infiltrating material more used nowadays, giving to alumina desirable mechanics proprieties to its using like substructure of support to ceramic s crown used in the market today. The addition of Lanthanum oxide (frit A) and calcium oxide (frit B) was made in attempt to increase the viscosity of LZSA and to reduce fusion temperature. The frits were put over samples of alumina and took to the tubular oven to 1400ºC under vacuum for two groups (groups 1 and 2). For another two groups (groups 3 and 4) it was made a second infiltration, following the same parameters of the first. A fifth group was utilized like group of control where the samples of pure alumina were not submitted to any infiltrating process. Glasses manifested efficient both in quality and results of analysis of mechanic resistance, being perfectly compatible with oral environment in this technical requisite. The groups that made a second infiltration had he best results of fracture toughness, qualify the use in the oral cavity in this technical question. The average of results achieved for mechanic resistance to groups 1, 2, 3, 4 and 5 were respectively 98 MPa, 90 MPa, 144 MPa, 236 MPa and 23 MPa

Caracterização Microestrutural e Tribocorrosiva de Sistemas Metalocerâmicos Odontológicos do Tipo Ni-Cr/Porcelana E Ni-Cr/Ti/Porcelana

The partial fixed prosthodontics restoration is used to rehabilitate form and function of partial or total compromised teeth, having to remain permanently joined to remainder tooth. The most useful material on prosthodontics is the feldspar porcelain, commercialized as aluminosilicate powders. Dental porcelains are presented with limited mechanical properties to rehabilitate extensive spaces. The association with Ni-Cr metallic systems (metal-ceramic system) allows that the metallic substructure compensates the fragile porcelain nature, preserving the thermal insulation and aesthetics desirable, as well as reducing the possibility of cracking during matication efforts. Cohesive flaws by low mechanical strength connect the metallic substructure to the oral environment, characterized by a electrolytic solution (saliva), by aggressive temperature, pH cyclic changes and mechanical requests. This process results on ionic liberation that could promote allergic or inflammatory responses, and/or clinical degradation of ceramometal system. The aim of this study was to evaluate the presence of an intermediate titanium layer on the microscopic fracture behavior of porcelains on ceramometal systems. Plasma deposition of titanium films result in regular passivating oxide layers which act as barriers to protect the metallic substrate against the hazardous effects of corrosive saliva. Tribocorrosion tests were performed to simulate the oral environment and mechanical stress, making it possible the early detection of crack formation and growth on metal-ceramic systems, which estimate the adherence between the compounds of this system. Plain samples consisting of dental feldspar porcelain deposited either onto metallic substrates or titanium films were fired and characterized by scanning electron microscopy. The result showed that the titanium film improved the adherence of the system compared to conventional metal-ceramic interfaces, thus holding crack propagation

Associação entre as narrativas em saúde bucal e condições socioeconômico-culturais: a dentição como reflexo da desigualdade social

This anthropological study investigates the lived-experience of oral diseases in the context of poverty in Northeast Brazil. During six months in 2004???, ethnographic interviews, narratives and participant-observation with 31 residents of the low-income community, Dendê, located in Fortaleza, Ceará were conducted and analyzed utilizing a hermeneutic-dialetic method. It is revealed that precarious life conditions make prioritizing caretaking a difficult task. Despite suffering tooth pain, seeking a dentist's care is perceived as "a luxury" not a citzens' right. Difficulties in accessing services and poor quality restorations, favor tooth extractions as the most effective intervention. The deterioration of one's oral health is lamented by community members who seek help from popular clinics, politicians and traditional healers. The experience of dental disease differs according to social class, leaves oral scars of inequity, harms self-esteem and inhibits social inclusion. In this context, "treating" the Teeth of Inequity demands that we deepen our comprehension of the social determinants of health, reduce injustice in the access to quality care, remove demoralizing stigmas and empower the community to confront structural forces which affect its life

Acesso aos serviços odontológicos e incidência de cárie em adolescentes e fatores de risco em município do Nordeste Brasileiro, 2006

The aims of this study were to analyze the access of dental services by child population, to determine the prevalence of dental caries, gingivitis and malocclusion in resident children from the municipal district of Sobral Ceará and to evaluate the incidence of the dental decay in adolescents associated with the factors related to socioeconomic condition, access to health services and self-perception. This study had as main factor the multidisciplinary represented by the participation of health professional (doctors, dentists, nurses) in the development of the survey's initial reference; student from Human Sciences area to apply the structured questionnaire in domiciliary visits; statistics professionals in the orientation of the analysis to be held and family health team (community health agents, dentists and dental clinic assistants) in the scheduling of domiciliary visits and the accomplishment of oral exam. The sample was determined from the domicile record that included children born between 1990 and 1994 to develop the research Children health conditions in the municipal district of Sobral Ceará . The first sample comprised 3425 parents of children from 5 to 9 years old, living in the urban area at the municipal district of Sobral Ceará, aiming at identifying the most important factors associated to the access to dental service. From this sample, 1021 children were selected in a systematic way, for the accomplishment to the epidemiological study of decay, gingivitis and malocclusion. In the study's third phase, in order to arrange the group to be followed, 688 adolescents were examined and interviewed, by means of the active search from the 1021 individuals that had been previously examined. It was observed that 50.9% of the children had access to dental service at least once in a lifetime. Of this total, 65.3% accomplished it during the last year, and 85.4% of these did in public services, what allows to identify the importance of this sector in the access to dental services. It was observed that the factors that most affected the access to dental 129 services were related to socioeconomic condition, such as the access to health plan, the possession of toothbrush, garbage collecting, mother s schooling, sewerage treatment and malnutrition. In relation to oral diseases, an increase in the DMF-T index according the age was observed, from 0.10 in five years old to 1.66 in the nine years old, while with the dmf-t index, the inverse happened, since the index decreased from 3.59 in five years old to 2.69 in nine years old. In relation to gingivitis, an average 32.7% of the children presented gum bleeding. In what concerns malocclusion, it was observed that 60.3% of the children didn't present any problem, 30.17% had light malocclusion and 9.5% severe malocclusion. The average incidence of dental caries was 1.86 teeth per youngster. Among the studied variables, tooth pain in the last six months, mother's income and school snack, adjusted by the perception about the need of treatment, the mother's schooling and the dentist's appointment at least once in a lifetime, were the variables that presented positive relationship with the high incidence of dental caries on this population by logistic regression. Variables of socioeconomic nature, related to the access to health services and behavior and biological variables presented a relationship with the high caries incidence. The study point out to the need of developing health actions in a humanized way, by an oral health team effectively bound to the population's interest, with the great objective to provide, with the public health services managers, adequate conditions to improve oral health

Prevalência de oclusopatias e caracteríticas cefalométricas e dentais de escolares cearense da cidade de Fortaleza

The people of Ceará state are descended from miscegenation between the Portuguese colonizers and the native population, resulting in a different facial pattern from other populations. It is important that this pattern be thoroughly understood, along with its minimum and maximum values so that they can be assessed and respected, allowing professionals who deal with the craniofacial complex to work more efficiently and scientifically. Aim: To characterize the morphological pattern of individuals from Ceará state, whose father and grandfather are also native from Ceará, in the 10-12 year age group, not submitted to previous orthodontic treatment, in order to determine: 1) the prevalence of occlusal pattern; 2) the prevalence of dental anomalies (DA) and, 3) the skeletal and dental cephalometric characteristics of individuals that present with normal occlusion and harmonious facial pattern. Methodology: A list of 10-12 year-olds was obtained from 515 schools containing 162,713 students (Education Secretariat of Ceará State), from which 234 individuals were examined (107 boys and 157 girls). The assessment criteria adopted were: 1) Angle s Classification System to determine occlusal pattern. The occlusal characteristics were measured through overbite, overjet, crowding and interincisal diastema. 2) DA are anomalies of number, shape, size, eruption and structure and, 3) in the group that presented with normal occlusion, we used cephalometric analysis measures proposed by Downs, Steiner, Tweed, Holdaway, Jacobson and McNamara. Results: 1) 25.8% of the schoolchildren had normal occlusion, 47.5% class I malocclusion, 22.3% class II malocclusion and 4.2% class III malocclusion. No statistically significant difference was found between the age group studied and sex. Thirty percent of the individuals had normal overbite, while 36.7% and 19.7% had increased and reduced overbite, respectively. Normal overjet was found in 33.7% of the individuals, increased overjet in 50% and reduced in 16.3%. Dental crowding was observed in 62.5% of the individuals and the presence of interincisal diastema in 14.8%. 2) The prevalence of DA was 56.1%, 6.8% in the number, 10.8% in shape, 4.1% in size, 34.5% in eruption, 26.4% in structure and 17.4% had more than one DA. No association was found between DA and sex, but DA was significantly associated to malocclusion (p<0.05); 3) there was no association between sex or facial type between the measures of nasal-labial angle, position and effective maxillary length, effective mandibular length and the sagittal relationship between the molars, overjet and overbite, position of upper incisors, lower incisors and between the incisors themselves. There was a difference between sex, on the VERT index and in lower anterior facial height, upper incisor inclination and line-H, between facial types for the occlusal plane angles, mandibular plane, facial axis, lower incisor inclination, mandibular position, upper incisor position, lower anterior facial height, ANB and line-H. It was concluded that: 1) the most prevalent occlusal type was class I malocclusion, with no distinction for sex or age group, and the assessment of occlusal characteristics showed that excessive overbite and overjet were the most predominant findings, along with a high occurrence of tooth crowding; 2) a high prevalence of DA was found, particularly eruption anomalies, not influenced by sex but significantly associated to malocclusion and 3) individuals from Ceará are predominantly brachyfacial, exhibiting a number of similarities inherent to their facial pattern, such as a convex profile, retracted jaw, reduced lower third and protruded lower incisors. This study was multidisciplinary, involving researchers from the areas of epidemiology, radiology and dentistry, thereby meeting the multidisciplinarity requirements of the Postgraduate Program in Health Sciences

Efetividade do clareamento dentário com peróxido de carbamida a 10% e avaliação dos efeitos adversos sobre o esmalte dentário

The aim of the present study was to assess the effectiveness and adverse effects on dental enamel caused by nightguard vital bleaching with 10% carbamide peroxide. This was accomplished through the interaction of researchers from different areas such as dentistry, materials engineering and physics. Fifty volunteers took part in the doubleblind randomized controlled clinical trial. They were allocated to an experimental group that used Opalescence PF 10% (OPA) and a control group that used a placebo gel (PLA). Fragments of human dental enamel from the vestibular surface of healthy premolars, extracted for orthodontic reasons, were fixed to the vestibular surface of the first upper molars of the volunteers for in situ observation. Bleaching was performed at night for 21 days. The observation periods included Baseline (BL), T0 (21 days), T30 (30 days after treatment) and T180 (180 days after treatment, only for the OPA group). Tooth color was assessed by comparing it with the Vita® scale and by the degree of satisfaction expressed by the volunteer. We also assessed adverse clinical effects, dental sensitivity and gingival bleeding. The study of adverse effects on enamel was conducted in vivo and in situ, using the DIAGNOdent® laser fluorescence device to detect mineral loss. Scanning electron microscopy (SEM) was used to check for superficial morphological alterations, energy dispersive spectrophotometry (EDS) to semiquantitatively assess chemical composition using the Ca/P ratio, and the x-ray diffraction (XRD) technique to observe alterations in enamel microstructure. The results showed that nightguard vital bleaching with 10% carbamide peroxide was effective in 96% of the cases, versus 8% for the PLA group. Dental sensitivity was present in 36% (9/25) of the cases. There was no significant association between gingival bleeding and the type of gel used (p = 1.00). In vivo laser fluorescence analysis showed no difference in values for the control group, whereas in the OPA group there was a statistically significant difference between baseline values in relation to the subsequent periods (p<0.01), with lower mean values for post-bleaching times. There was a significant difference between the groups for times T0 and T30. Micrographic analysis showed no enamel surface alterations related to the treatment performed. No significant alteration in Ca/P ratio was observed in the OPA group (p = 0.624) or in the PLA group (p = 0.462) for each of the observation periods, nor between the groups studied (p=0.102). The XRD pattern for both groups showed the presence of three-phase Hydroxyapatite according to JCPDS files (9-0432[Ca5(PO4)3(OH)], 18-0303[Ca3(PO4)2.xH2O] and 25-0166[Ca5(PO4)3(OH, Cl, F)]). No other peak associated to other phases was found, independent of the group analyzed, which reveals there was no disappearance, nucleation or phase transformation. Neither was there any alteration in peak pattern location. With the methodology and protocol used in this study, nightguard vital bleaching with 10% carbamide peroxide proved to be an effective and safe procedure for dental enamel