Adílis Kalina Alexandria

Characterization of a new TiF4 and β-cyclodextrin inclusion complex and its in vitro evaluation on inhibiting enamel demineralization

Titanium tetrafluoride (TiF(4)) is an effective but instable caries preventive agent. As the stability problems could be minimized through the use of drug carriers this study aimed to prepare and characterize a new TiF(4) nanoinclusion complex and to evaluate its potential in inhibiting enamel demineralization under pH cycling conditions. The TiF(4) nanosystems were prepared using β-cyclodextrin (βCD) and sodium montmorillonite (MMTNa). Bovine enamel blocks (n=48) with known surface microhardness (SMH), were randomly assigned to 4 groups (n=12) and submitted to one of the following treatments: distilled deionized water (as negative control) and solutions containing 1% βCD, 1% TiF(4) and TiF(4):βCD. The solutions were blinded applied once on the blocks with a microbrush(®) on the surface for 1min before pH-cycling. After that, samples were reavaluated by SMH, %SMH loss, cross-sectional microhardness (CSMH), scanning electron microscope (SEM) and energy dispersive spectrometry (EDX). The inclusion complex of TiF(4):βCD offered better protection against demineralization in the subsurface. The SEM analysis showed that TiF(4) and TiF(4):βCD samples presented the most intact enamel than the control. The EDX analysis identified titanium in TiF(4) and TiF(4):βCD groups. TiF(4):βCD has higher potential on inhibiting demineralization in the inner enamel. TiF(4):βCD is a new alternative to TiF(4) stabilization in order to reduce enamel subsurface demineralization.

Does trauma in the primary dentition cause sequelae in permanent successors? A systematic review.

This systematic review sought scientific evidence (in the literature) that trauma in the primary incisors cause sequelae in permanent successors. Also this work verified whether there was a relation between the presence and type of sequelae in permanent teeth with the childs age at the time of injury and type of trauma. Electronic databases, including the PubMed, Scopus, The Cochrane Library, LILACS, and Web of Science were used to search for original articles up to June 2013. Prospective and retrospective studies that assessed the association of trauma in deciduous incisors and developmental disturbances in permanent successors were selected. Two authors independently reviewed and extracted the data from the included studies. A methodological quality assessment evaluation of the selected studies was performed. The search retrieved 258 citations. Initially, 19 studies fulfilled the selection criteria; however, one (1) was excluded, leaving 18 for the final selection. Despite some limitations in the study designs were observed, especially the lack of a control group in most studies, the evidence found suggests that individuals with trauma in their primary incisors have more developmental disorders in the permanent successors than individuals without a previous trauma. Furthermore, the younger the child is at the time of injury, the more frequent and more severe are the sequelae to the permanent successor incisors. More severe traumas such as intrusion and avulsion are associated to more serious developmental disorders. These results should be analyzed carefully because very few studies evaluated had a control group.

In Situ Effect of Titanium Tetrafluoride and Sodium Fluoride on Artificially Decayed Human Enamel

This study compared in situ the application of 4% titanium tetrafluoride (TiF4) solution and 2% sodium fluoride (NaF) gel on artificial white-spot lesions in human enamel. A crossover, double-blind study using in situ caries models was carried out. Eleven volunteers used an intraoral appliance containing five demineralized human enamel blocks. The blocks (n=170) were randomly divided according to treatment into the following groups: TiF4 (n=55), NaF (n=55), positive control (n=55). A negative control group was composed of demineralized specimens (n=5). The microhardness test was performed using a Knoop penetrator. Energy dispersive spectrometer (EDS) was used to analyze the concentration of titanium, calcium, phosphate and oxygen. The enamel microhardness at different depths for TiF4, NaF and positive control samples was not statistically different (p>0.05). The samples from these three groups had statistically higher microhardness values than the negative control samples (p<0.05). EDS analysis did not provide conclusive results about the penetration of titanium in the TiF4 samples. While in some fragments it had substantial penetration, in other fragments it only had superficial penetration. It was possible to conclude that, under in situ conditions, 4% TiF4 solution and 2% NaF gel were able to remineralize artificial white-spot lesions in human enamel. However, the magnitude of the remineralization did not differ between groups.

In vitro enamel erosion and abrasion-inhibiting effect of different fluoride varnishes

OBJECTIVE To investigate the erosion and abrasion inhibiting effect of CPP-ACP/NaF and xylitol/NaF varnishes. METHODS Bovine enamel samples (n=40) were exposed to the following treatments (n=10): NaF varnish (Duraphat®, positive control); CPP-ACP/NaF varnish (MI varnishTM); xylitol/NaF (Profluorid®) or distilled and deionized water (MilliQ®, negative control). The samples were submitted for 3days to 4 cycles/day of erosion (5min in Sprite Zero) and 2 cycles of abrasion/day after the first and last erosive challenge, with a toothbrush machine and slurries of a placebo toothpaste for 15s (50 strokes/s). Among the cycles and after the last daily cycle, the specimens remained in artificial saliva. The change in the enamel surface was evaluated by using 3D non-contact optical profilometry with surface roughness (Ra and Sa values) and tooth structure loss (TSL) measurements. Scanning electron microscopy (SEM) assessed the enamel topographic characteristics. Differences in the Ra, Sa and TSL among treatments were tested using one-way ANOVA followed by the Tukey test. RESULTS All varnishes promoted better results for Ra and Sa values than the negative control (p=0.0001), without difference among them (p>0.05). However, CPP-ACP/NaF varnish stimulated fewer TSL (7.09±0.70μm) compared to NaF varnish (10.33±1.36μm, p=0.002), xylitol/NaF varnish (9.96±0.41μm, p=0.007) and the negative control (18.38±3.32μm, p=0.0001). CONCLUSION A single-application of fluoride topical varnishes was effective in reducing enamel wear. The CPP-ACP/NaF varnish had the best effect against enamel loss from an erosion-abrasion challenge.

Do pediatric medicines induce topographic changes in dental enamel

The purpose of the present study was to evaluate the effect of common pediatric liquid medicines on surface roughness and tooth structure loss and to evaluate the pH values of these medicines at room and cold temperatures in vitro. Eighty-four bovine enamel blocks were divided into seven groups (n = 12): G1-Alivium®, G2-Novalgina®, G3-Betamox®, G4-Clavulin®, G5-Claritin®, G6-Polaramine® and G7-Milli-Q water (negative control). The pH was determined and the samples were immersed in each treatment 3x/day for 5 min. 3D non-contact profilometry was used to determine surface roughness (linear Ra, volumetric Sa) and the Gap formed between treated and control areas in each block. Scanning electron microscopy (SEM) and energy dispersive spectrometry (EDS) were also performed. The majority of liquid medicines had pH ≤ 5.50. G1, G4, and G5 showed alterations in Ra when compared with G7 (p < 0.05). According to Sa and Gap results, only G5 was different from G7 (p < 0.05). Alteration in surface was more evident in G5 SEM images. EDS revealed high concentrations of carbon, oxygen, phosphorus, and calcium in all tested groups. Despite the low pH values of all evaluated medicines, only Alivium®, Clavulin®, and Claritin® increased linear surface roughness, and only Claritin® demonstrated the in vitro capacity to produce significant tooth structure loss.

Does flavoured dentifrice increase fluoride intake compared with regular toothpaste in children? A systematic review and meta-analysis

BACKGROUND Toothpaste manufacturers encourage through aggressive marketing strategies the overconsumption of fluoridated dentifrices. There are conflicting results regarding fluoride intake from toothpastes in children. AIM The aim of this systematic review and meta-analysis was to determine whether dentifrice flavour increases fluoride ingestion by children. DESIGN We included clinical trials on children that evaluated the use of flavoured dentifrice - FD vs regular dentifrice - RD to identify the fluoride intake. An electronic search was performed in PubMed, Web of Science, Scopus, The Cochrane Library, LILACS/BBO, and grey literature followed by manual search. The methodological quality of the studies was assessed using the Cochrane Collaboration common scheme for bias and ROBINS-I tool. Data were analysed in subgroups such as low (G1) and ordinary (G2) fluoride concentrations of dentifrices. We carried out heterogeneity and sensitive analyses. RESULTS For G1, the fluoride intake from RD was significantly higher than from FD [standardised mean difference = -2.57 (-3.26, -1.89), P < 0.00001]. For G2, the fluoride ingestion from RD was significantly higher than from FD [mean difference = -0.00 (-0.00, -0.00), P = 0.02]. CONCLUSIONS There is evidence to support the null hypothesis that flavouring from dentifrice does not increase fluoride intake in young children.

Cytotoxicity of novel fluoride solutions and their influence on mineral loss from enamel exposed to a Streptococcus mutans biofilm

OBJECTIVE This study evaluated the cytotoxicity, antimicrobial activity and in vitro influence of new fluoridated nanocomplexes on dental demineralization. DESIGN The nanocomplexes hydroxypropyl-β-cyclodextrin with 1% titanium tetrafluoride (TiF4) and γ-cyclodextrin with TiF4 were compared to a positive control (TiF4), a blank control (without treatment) and negative controls (hydroxypropyl-β-cyclodextrin, γ-cyclodextrin, deionized water), following 12- and 72-hour complexation periods. The cytotoxicity was assessed using the neutral red dye uptake assay at T1-15 min, T2-30 min and T3-24 h. A minimum bactericidal concentration (MBC) against Streptococcus mutans (ATCC 25175) was performed. Enamel blocks were exposed to an S. mutans biofilm, and the percentage of surface microhardness loss was obtained. Biocompatibility and microhardness data were analysed using ANOVA/Tukey tests (p < 0.05). RESULTS At T1, the cell viability results of the nanocomplexes were similar to that of the blank control. At T2 and T3, the 72 h nanocomplexes demonstrated cell viability results similar to that of the blank, while the 12 h solutions showed results different from that of the blank (p < 0.05). All fluoridated nanocompounds inhibited S. mutans (MBC = 0.25%), while the MBC of TiF4 alone was 0.13%. All fluoridated compounds presented a percentage of surface microhardness loss lower than that of deionized water (p < 0.05). CONCLUSIONS The new fluoridated nanocomplexes did not induce critical cytotoxic effects during the experimental periods, whilst they did show bactericidal potential against S. mutans and inhibited enamel mineral loss.

Effect of the inclusion nanocomplex formed of titanium tetrafluoride and β-Cyclodextrin on enamel remineralization

Objective: Titanium tetrafluoride (TiF4) is a topical agent used in the control of dental caries; however, it is highly acidic. To minimize this effect, cyclodextrins (CDs) are used. This study evaluated the in vitro potential of TiF4and β-CD on remineralization. Methods: Forty bovine enamel blocks were selected by microhardness and randomly assigned to four groups (n = 10 per group): control (distilled and deionized water), 1% β-CD solution, 1% TiF4solution, and TiF4: β-CD solution. The blocks were subjected to a pH cycling regimen for 8 days. After that, samples were evaluated by cross-sectional microhardness (CSMH), scanning electron microscopy (SEM), and energy dispersive spectrometry (EDS). Data were assessed for normality and analyzed using ANOVA and Tukeys tests (α = 0.05). Results: Regarding CSMH, TiF4: β-CD was statistically superior to the control (P = 0.033), β-CD (P = 0.022), and TiF4(P = 0.006). SEM photomicrography revealed the titanium dioxide coating on slabs treated with TiF4and TiF4: β-CD. EDS assessment demonstrated the presence of titanium on the surface of slabs treated with TiF4and TiF4: β-CD. Conclusion: The solution containing the inclusion nanocomplex formed of TiF4and β-CD was able to reharden the enamel subsurface.

Histological and Ultrastructure Analysis of Dentin Dysplasia Type I in Primary Teeth: A Case Report

Abstract Dentin dysplasia type I (DD-I) is a rare human dentin disorder that may affect both the primary and permanent dentitions. The teeth present crowns with normal morphology but short or absent roots. Pulp chamber obliteration and early exfoliation of primary teeth are also observed. We describe herein the typical and atypical features of DD-I presented by a 6-year-old patient, the diagnostic rationale and assessment emphasizing the histological and scanning electron microscopic analysis and the therapeutic approach. The DD-I diagnosis in patients in the mixed dentition period is challenging, especially when only some teeth are affected.

In Situ analysis of CO2 laser irradiation on controlling progression of erosive lesions on dental enamel.

The present study aimed to evaluate in situ the effect of CO2 laser irradiation to control the progression of enamel erosive lesions. Fifty‐six slabs of bovine incisors enamel (5 × 3 × 2.5 mm3) were divided in four distinct areas: (1) sound (reference area), (2) initial erosion, (3) treatment (irradiated or nonirradiated with CO2 laser), (4) final erosion (after in situ phase). The initial erosive challenge was performed with 1% citric acid (pH = 2.3), for 5 min, 2×/day, for 2 days. The slabs were divided in two groups according to surface treatment: irradiated with CO2 laser (λ = 10.6 µm; 0.5 W) and nonirradiate. After a 2‐day lead‐in period, 14 volunteers wore an intraoral palatal appliance containing two slabs (irradiated and nonirradiated), in two intraoral phases of 5 days each. Following a cross‐over design during the first intraoral phase, half of the volunteers immersed the appliance in 100 mL of citric acid for 5 min, 3×/day, while other half of the volunteers used deionized water (control). The volunteers were crossed over in the second phase. Enamel wear was determined by an optical 3D profilometer. Three‐way ANOVA for repeated measures revealed that there was no significant interaction between erosive challenge and CO2 laser irradiation (P = 0.419). Erosive challenge significantly increased enamel wear (P = 0.001), regardless whether or not CO2 laser irradiation was performed. There was no difference in enamel wear between specimens CO2‐laser irradiated and non‐irradiated (P = 0.513). Under intraoral conditions, CO2 laser irradiation did not control the progression of erosive lesions in enamel caused by citric acid. Microsc. Res. Tech. 77:586–593, 2014.