Lourdes Santos-Pinto

Control of White Spot Lesion Adjacent to Orthodontic Bracket with Use of Fluoride Varnish or Chlorhexidine Gel

The aims of this study were to compare the effectiveness of fluoride varnish and chlorhexidine gel in controlling white spot lesions (WSLs) adjacent to orthodontic brackets and to compare the ability of Quantitative Light-Induced Fluorescence (QLF) to measure mineral uptake with that of transverse microradiography (TMR). Thirty premolars with artificially induced WSLs were randomly assigned to three groups: (1) two applications of 5% NaF-varnish (F), with one-week interval, (2) two applications of 2% chlorhexidine gel (CHX), with one-week interval, and (3) control (CO), no treatment. QLF was used to measure changes in fluorescence before and after caries induction, 1 week after each application and 1, 2, and 3 months after the last application of F or CHX. TMR was performed to quantify lesion depth and mineral content after caries induction to evaluate the effects of F, CHX, and CO 3 months after the last application of agents. The data were analyzed by repeated measures ANOVA and Tukeys test. All treatments increased the mineral content during the experimental period; however, F induced faster remineralization than CHX. The correlation between QLF and TMR was significantly moderate. Two applications of fluoride varnish or 2% chlorhexidine gel at one-week intervals were effective in controlling WSLs.

Therapeutic Effects of Low-Level Laser Therapy After Premolar Extraction in Adolescents: A Randomized Double-Blind Clinical Trial

OBJECTIVE The purpose of this study was to evaluate the effect of low-level laser therapy (LLLT) on wound healing process and pain levels after premolar extraction in adolescents. BACKGROUND DATA The advantage of using LLLT in oral surgeries is the reduction of inflammation and postoperative discomfort; however, the optimal dosing parameters and treatment effects in surgical procedures are inconclusive. METHODS A double-blind, randomized, controlled clinical trial was conducted with 14 patients who were to undergo surgical removal of premolars. Patients were randomly allocated to the LLLT (test) group and placebo (control) group. Patients in the test group received 5.1 J (60 J/cm(2)) of energy density of a gallium-aluminum-arsenide (GaAlAs) diode laser (wavelength, 830 nm; output power, 0.1 W) at three different points intraorally, 1 cm from the target tissue immediately and at 48 and 72 h after the surgical procedure. For patients in the placebo group, the laser device was applied to the same points without activating the hand piece. The wound healing process was evaluated by an independent examiner by visual inspection with the support of digital photographs at baseline and 2, 7, and 15 days postoperatively. Patients recorded the degree of pain using the visual analogue scale (VAS). RESULTS Compared with the placebo group, the test group showed a lower intensity of pain, but this difference was not statistically significant at any time point. The wound healing process was similar in both groups. CONCLUSIONS Within the limitations of this study, the LLLT parameters used neither increased the wound healing process nor significantly decreased pain intensity after premolar extraction in adolescents.

Effect of photoinitiator concentration on marginal and internal adaptation of experimental composite blends photocured by modulated methods.

Objective: The aim of this study was to evaluate the influence of photoinitiator concentration on marginal and internal adaptation of composites photocured by modulated methods. Materials and Methods: Composites based on BisGMA/triethylene glycol dimethacrylate and 65 wt% of filler were prepared with different concentrations of camphorquinone/amine (C1-0.5%, C2-1%, C3-1.5%). Cavities were prepared (3 mm × 3 mm × 2 mm) on the buccal surface of 120 bovine incisors and the adhesive system Adper Single Bond 2 was applied following manufactures instruction. Specimens were then distributed according to type of composite (C1, C2, C3) and photoactivation method (high-intensity – 750 mW/cm2 for 40 s; low intensity – 150 mW/cm2 for 200 s; soft-start – 150 mW/cm2 for 10 s + 750 mW/cm2 for 38 s; pulse-delay – 150 mW/cm2 for 10 s + 3 min dark + 750 mW/cm2 for 38 s). Superficial and internal margins were analyzed by scanning electron microscopy, using the epoxy replica technique. The length of gaps was expressed as a percentage of the total length of the margins. Data were submitted to two-way analysis of variance and Tukeys test (α =0.05). Results: Modulated curing methods did not influence gap formation regarding both superficial and internal adaptation. The composite with the lower initiator concentration (C1) presented higher gap formation when compared with those with higher concentrations (C2 and C3). Conclusion: Modulated photoactivation methods did not reduce gap formation for the experimental composite restorations evaluated. However, higher photoinitiator concentrations promote better marginal seal.

Family-Based Genetic Association for Molar-Incisor Hypomineralization.

Despite some evidence of genetic and environmental factors on molar-incisor hypomineralization (MIH), its aetiology remains unclear. This family-based genetic association study aimed more comprehensively to investigate the genetic carriage potentially involved in MIH development. DNA was obtained from buccal cells of 391 individuals who were birth family members of 101 Brazilian nuclear families. Sixty-three single nucleotide polymorphisms (SNPs) were investigated in 21 candidate genes related to amelogenesis using the TaqMan™ OpenArray™ Genotyping platform. All SNPs were genotyped in 165 birth family members unaffected by MIH, 96 with unknown MIH status and 130 affected individuals (50.7% with severe MIH). Association analysis was performed by the transmission/disequilibrium test (TDT), and statistical results were corrected using the false discovery rate. Significant results were obtained for SNPs rs7821494 (FAM83H gene, OR = 3.7; 95% CI = 1.75-7.78), rs34367704 (AMBN gene, OR = 2.7; 95% CI = 1.16-6.58), rs3789334 (BMP2 gene, OR = 2.9; 95% CI = 1.34-6.35), rs6099486 (BMP7 gene, OR = 2.2; 95% CI = 1.14-4.38), rs762642 (BMP4 gene, OR = 2.3; 95% CI = 1.38-3.65), rs7664896 (ENAM gene, OR = 2.1; 95% CI = 1.19-3.51), rs1711399 (MMP20 gene, OR = 0.4; 95% CI = 0.20-0.72), rs1711423 (MMP20 gene, OR = 2.1; 95% CI = 1.18-3.61), rs2278163 (DLX3 gene, OR = 2.8; 95% CI = 1.26-6.41), rs6996321 (FGFR1 gene, OR = 2.7; 95% CI = 1.20-5.88), and rs5979395 (AMELX gene, OR = 11.7; 95% CI = 1.63-84.74). Through this family-based association study, we concluded that variations in genes related to amelogenesis were associated with the susceptibility to develop MIH. This result is in agreement with the multifactorial idea of the MIH aetiology, but further studies are necessary to investigate more thoroughly the factors that could influence MIH.

Longitudinal Evaluation of the Structural Integrity of Teeth Affected by Molar Incisor Hypomineralisation

The aim of this prospective cohort study was to evaluate the risk of posteruptive breakdown and the development of caries lesions in teeth with molar incisor hypomineralisation (MIH). A total of 367 permanent incisors and first molars, affected and not affected by MIH lesions, of 45 children with MIH from Araraquara, São Paulo, Brazil, were evaluated at intervals from 6 to 12 months by assessing the severity of MIH, the presence of tooth caries lesions and the treatment needed. During the study period, all patients received preventive care. The data were analysed using Fishers exact test and actuarial method survival analysis. Significant associations were also found in teeth between the presence of MIH and a DMFT index >0 in all periods and also between the need for treatment and the presence of MIH. The teeth affected by MIH opacities were healthy in 99% of incisors and 93% of molars at the end of the 12-month period. Due to the high likelihood of maintaining the tooth structure in opacities, the complete or premature removal of the affected area is not justified.

Comparison of space analysis performed on plaster vs. digital dental casts applying Tanaka and Johnston's equation

OBJECTIVE The purpose of this study was to compare dental size measurements, their reproducibility and the application of Tanaka and Johnston regression equation in predicting the size of canines and premolars on plaster and digital dental casts. METHODS Thirty plaster casts were scanned and digitized. Mesiodistal measurements of the teeth were then performed with a digital caliper on the plaster and digital casts using O3d software system (Widialabs©).The sum of the sizes of the lower incisors was used to obtain predictive values of the sizes of the premolars and canines using the regression equation, and these values were compared with the actual sizes of the teeth. The data were statistically analyzed by applying to the results Pearsons correlation test, Dahlbergs formula, paired t-test and analysis of variance (p < 0.05). RESULTS Excellent intraexaminer agreement was observed in the measurements performed on both dental casts. No random error was present in the measurements obtained with the caliper and systematic error (bias) was more frequent in the digital casts. Space prediction obtained by applying the regression equation was greater than the sum of the canines and premolars on the plaster and digital casts. CONCLUSIONS Despite an adequate reproducibility of the measurements performed on both casts, most measurements on the digital casts were higher than those on the plaster casts. The predicted space was overestimated in both models and significantly higher in the digital casts.

Control of White Spot Lesions with Use of Fluoride Varnish or Chlorhexidine Gel During Orthodontic Treatment A Randomized Clinical Trial

OBJECTIVE To compare the effectiveness of fluoride varnish and 2% chlorhexidine gel for controlling active white spot lesions (WSLs) adjacent to orthodontic brackets. STUDY DESIGN Thirty-five orthodontic patients (17.2 ± 2.3 years old) presenting 60 WSLs adjacent to orthodontic brackets were enrolled in this randomized, blind, 3-armed and controlled clinical trial. The patients were randomly allocated to 1 of 3 arms: (1) two applications of 5% NaF varnish- F, with one-week interval, (2) two applications of 2% chlorhexidine gel-CHX, with one-week interval and (3) usual home care-control (CO). The WSLs were scored by using a DIAGNOdent pen. An independent examiner scored the surfaces using Nyvad criteria for caries assessment. RESULTS A total of thirty patients presenting 51 lesions completed the study. All treatments reduced the fluorescence values during the experimental period; however, F induced faster remineralization than CHX. After 3 months, 70.58 % were inactive considering all groups. DIAGNOdent pen and Nyvad presented a significant correlation. CONCLUSION After 3 months of treatment, F, CHX and CO were capable of controlling the WSLs adjacent to the orthodontic brackets. However, the treatment with F was capable of controlling the progression of the WSLs in a shorter period of time.

Photodynamic antimicrobial chemotherapy for prevention and treatment of dental caries: a critical review

Introduction Photodynamic antimicrobial chemotherapy studies regarding dental caries have been present more frequently in the literature. However, photodynamic antimicrobial chemotherapy depends on the adjustment of variables such as the type of light source and, photosensitisers target microorganism; this makes it difficult to draw meaningful comparisons. The purpose of this paper was to provide a critical review related to this coadjuvant approach in the prevention and treatment of dental caries. Materials and Methods A database search was made via Medline/PubMed (keywords: photodynamic therapy and dental caries) and 33 articles were found. Results Twelve articles were included after using the filter tool, being excluded reviews and manuscripts reporting works not related to the studied area. Conclusion The manuscripts showed that photodynamic therapy presents optimal results against dental caries, even though better understanding of photodynamic antimicrobial chemotherapy and its components are necessary before the clinical application of this alternative modality in the dental practice. Photodynamic antimicrobial chemotherapy for prevention and treatment of dental caries: a critical review MA Paschoal1, S Duarte2*, L Santos-Pinto1* Introduction The human oral cavity is heavily colonised by a complex, relatively specific and highly interrelated range of microorganisms (as many as 1000 different species have been detected) collectively known as normal oral microflora1. A peculiarity of this environment is that most of the bacteria found here are present in complex aggregates (known as biofilms)2. Microbial biofilms are composed of microorganisms adhered both to each other and to dental surfaces (or interfaces) and embedded in an extracellular polymeric matrix, which includes water and nutrient channels3. A change in a key environmental factor will trigger a shift in the balance of the resident microflora, which will promote the emergence of acidogenic/aciduric bacteria. The constant accumulation of these kind of bacteria change the equilibrium towards dental demineralisation (dental caries lesions)4. The constituents of diet present an important role in the development of dental caries. Sucrose is considered the most cariogenic dietary carbohydrate, because it is fermentable and serves as a substrate for the synthesis of extracellular polysaccharides (EPS) and intracellular polysaccharides in cariogenic dental plaque4. In addition, the presence of EPS (mainly insoluble glucan) promote bacterial adherence to the tooth surface and contribute to the structural integrity of dental biofilms. Yet, there is a clear evidence showing that sucrose exposure and insoluble EPS lead to a more cariogenic biofilm5. Dental caries is among the most significant human chronicle infectious diseases and results in the progressive dissolution of enamel. With the disease progression, it can lead the underlying dentine compromising the vitality of the element and its fixation in the maxillomandibular complex6. Prevention of dental caries can be achieved by controlling the accumulation of dental plaque by mechanical removal7. In cases of insufficient biofilm disorganisation, the association with antimicrobial chemical agents, such as chlorhexidine may help in the decreasing of pathogenic bacteria levels7. Unfortunately, this preventive approach does not reach the population as a whole, allowing dental cavity formation. Treatment of the carious lesion involves the removal of infected dentine with posterior restoration of the affected tooth with any of the variety of materials, for example mercury amalgam, resin composite and glass ionomer cements8. Due to emergence of antibiotic resistant strains, alteration in taste, burning sensation, increase of calculus formation and staining of the teeth and restorative materials stimulated a search for alternative treatments9. Recently, approaches that might offer the possibility of efficient intraoral bacterial count reduction with minimum damage to systemic health (preventive approach) and avoid secondary caries development reducing the chance of material substitution and pulp inflammation as well (curative approach) are necessary. For these circumstances, photodynamic antimicrobial chemotherapy (PACT) offers the possibility of a novel modality to reduce pathogenic bacteria, and consequently, prevent against (new) dental caries lesions10. * Corresponding authors Emails: marcobpaschoal@hotmail.com; lspinto@foar.unesp.br; sd84@nyu.edu 1 Department of Pediatric Dentistry, Araraquara School of Dentistry, Univ Estadual Paulista (UNESP), Araraquara, SP, Brazil 2 Department of Basic Science and Craniofacial Biology, College of Dentistry, New York University (NYU), New York, NY, USA

Effect of Fluoride Varnish on Enamel Remineralization in Anterior Teeth with Molar Incisor Hypomineralization.

OBJECTIVE The objective of this study was to investigate the effect of fluoride varnish on remineralization of anterior teeth affected by Molar-Incisor Hypomineralization (MIH) by means of Quantitative Light-Induced Fluorescence- QLF. STUDY DESIGN Fifty-one healthy 9 - 12- year-old children were selected according to different clinically diagnosed levels of MIH, proposed by the European Academy of Pediatric Dentistry (2003) (considering the most severe lesion per patient, n= 51 lesions), and randomly divided into two groups: (1) four applications of 5% NaF varnish, with one-week interval, and (2) usual home care- control. At each visit, the mean change in fluorescence and area of lesion were measured by QLF. The data were analyzed by repeated measures ANOVA and Tukeys test. RESULTS All patients showed enamel alterations in first permanent molars and incisors, frequently with two molars affected by MIH (41.1%). There was no statically significant difference in the mean of fluorescence and area of lesion between groups over the studied time. CONCLUSION We observed no favorable effect on the remineralization of MIH lesions in anterior teeth after four applications of fluoride varnish.

Digital Radiography for Determination of Primary Tooth Length: In Vivo and Ex Vivo Studies

Background. Methods for determining the root canal length of the primary tooth should yield accurate and reproducible results. In vitro studies show some limitations, which do not allow their findings to be directly transferred to a clinical situation. Aim. To compare the accuracy of radiographic tooth length obtained from in vivo digital radiograph with that obtained from ex vivo digital radiograph. Method. Direct digital radiographs of 20 upper primary incisors were performed in teeth (2/3 radicular resorption) that were radiographed by an intraoral sensor, according to the long-cone technique. Teeth were extracted, measured, and mounted in a resin block, and then radiographic template was used to standardise the sensor-target distance (30 cm). The apparent tooth length (APTL) was obtained from the computer screen by means of an electronic ruler accompanying the digital radiography software (CDR 2.0), whereas the actual tooth length (ACTL) was obtained by means of a digital calliper following extraction. Data were compared to the ACTL by variance analysis and Pearsons correlation test. Results. The values for APTL obtained from in vivo radiography were slightly underestimated, whereas those values obtained from ex vivo were slightly overestimated. No significance was observed (P ≤ 0.48) between APTL and ACTL. Conclusion. The length of primary teeth estimated by in vivo and ex vivo comparisons using digital radiography was found to be similar to the actual tooth length.