Development of toothpaste formulations containing mineral clays as abrasive agents and their effects on the physical properties of dental enamel.

To assess the physical properties and topographical aspect of dental enamel's surface microhardness (KHN), surface roughness (Ra), and color parameters CIELAB (∆Eab*), CIEDE 2000 (∆E00), and whiteness index for dentistry (∆WID) after toothbrushing with experimental toothpaste formulations with the following mineral clay types: kaolin, Sparclay SGY, and Tersil CGY used as abrasive component. Scanning electron microscopy (SEM) was performed for topographical analyses purposes. A total of 96 bovine incisors were used in the experiment. They were divided into eight experimental groups (n = 12), namely: NC-negative control (no treatment), CT12-Colgate Total 12®, CMP-Colgate® Máxima Proteção Anticáries, K-kaolin experimental toothpaste, SGY-Sparclay SGY experimental toothpaste; CGY-Tersil CGY experimental toothpaste, SD-SiO2 experimental toothpaste, and CC-CaCO3 experimental toothpaste. All samples were subjected to mechanical brushing protocol with 5000 cycles and kept in artificial saliva with daily exchanges. KHN was analyzed through the mixed linear model for repeated measures over time. Ra was analyzed through nonparametric Kruskal Wallis and Dunn tests to compare the groups. Paired Wilcoxon test was run to compare experimental times. ∆WID, ∆Eab*, and ∆E00 were analyzed through Kruskal Wallis and Dunn tests. All analyses were performed in R* software, at 5% significance level. EXP_SGY recorded higher KHN than EXP_SiO2 and EXP_CaCO3, whereas EXP_K showed increased Ra in comparison to CMP (p = 0.0229). ∆Eab and ∆E00 were significantly higher in the CT12, EXP_SiO2, and EXP_CaCO3 groups than in the NC and EXP_K (p < 0.0001). There were no significant changes in ∆WID (p = 0.0852). According to SEM results, toothbrushing with experimental toothpastes added with mineral clay types did not have significant impact on enamel's polishing and smoothness. CLINICAL RELEVANCE: Mineral clays have a broad application in the cosmetic industry, and recently, they have been used in the formulation of vegan toothpaste.

Maintenance of enamel properties after bleaching with high-concentrated hydrogen-peroxide gel containing calcium polyphosphate sub-microparticles.

OBJECTIVE: To assessed the physical and chemical properties of human-enamel after treatment with an experimental bleaching gel containing 35%-hydrogen peroxide (HP) and calcium polyphosphate sub-microparticles (CaPP). MATERIALS AND METHODS: Enamel/dentin specimens (4 × 4 × 3 mm) were obtained (n = 120) and allocated to different groups: control (saliva only); experimental (HP35%); commercial (whiteness-HP-Maxx); CaPP0.5% (HP35% + CaPP0.5wt%); CaPP1.5% (HP35% + CaPP1.5wt%). Three sessions were performed. The specimens' color was assessed using a spectrophotometer and the color (ΔE/ΔE00) and bleaching index (ΔWID) determined. The surface roughness and microhardness were assessed with a roughness tester and Knoop indenter. Raman spectroscopy was performed to obtain the ratios between the areas under the 431, 580, and 1070 cm-1 and the 960 cm-1 bands (430:960, 580:960, 1070:960). Kruskal-Wallis and Dunn compared the color, Ra, and SMH data. The Raman data was analyzed with Kruskal-Wallis and Dunn (α = 5%). RESULTS: The ΔE, ΔE00, and ΔWID were similar among the bleached groups (p > 0.05). The roughness was not different between the groups (p > 0.05). After the 3rd session, CaPP0.5% had higher microhardness than the experimental (p < 0.05). The 1070:960 was higher in the experimental than in the CaPP1.5% and control (p < 0.05). CONCLUSIONS: In human enamel, CaPP did not alter the bleaching effectiveness or roughness, and additionally, CaPP-containing gels increased the microhardness and preserved the mineral content when compared to the experimental without CaPP. CLINICAL RELEVANCE: Experimental bleaching gels containing calcium polyphosphate sub-microparticles as a mineral source reduce the mineral content alteration and superficial microhardness reduction, known potential side effects of the in-office bleaching treatments.

Effect of incorporation of calcium polyphosphate sub-microparticles in low-concentration bleaching gels on physical properties of dental enamel.

AIM: To evaluate the bleaching efficacy and effects on enamel properties of experimental gels with carbamide peroxide (CP; 10%) or hydrogen peroxide (HP; 6%) containing calcium polyphosphate sub-microparticles (CaPPs). METHODS: A total of 216 bovine tooth specimens were divided for microhardness and color analyses (n = 108) and block randomized into nine groups (n = 12): (G1) commercial CP (Whiteness Perfect, FGM; Brazil); (G2) experimental CP; (G3) CP-0.5%CaPPs; (G4) CP-1.5%CaPPs; (G5) commercial HP (Potenza Bianco, PHS; Brazil); (G6) experimental HP; (G7) HP-0.5%CaPPs; (G8) HP-1.5%CaPPs; (G9) artificial saliva. The gels' pH values were determined with a bench pH meter. Color (ΔE, ΔE00, ΔWID) and microhardness variation were evaluated before and after the therapy. Part of the specimens used for microhardness was submitted to the scanning electron microscopy (SEM) (n = 3) and energy-dispersive X-ray spectroscopy EDX (n = 3) analyses. Statistical analyses were performed in the R statistical software (α = 0.05). Linear mixed models for repeated measures in time were used to analyze microhardness and L* values. Generalized linear models were used to analyze the a*, b*, ΔE, ΔE00, and ΔWID, considering a group effect. The EDX data were analyzed using a one-way ANOVA with Tukey's test. RESULTS: The gels' pH remained over 6,0. All gels effectively bleached the specimens and did not differ significantly. When compared to the control group, the hardness was significantly lower in the G1, G2, G6, and G7 groups. The G3, G4, G5, and G8 groups did not differ significantly (p > 0.05). CONCLUSION: The incorporation of CaPPs in low-concentration whitening gels reduces its negative effects on microhardness without interfering with their bleaching efficacy.

In-office tooth bleaching with chitosan-enriched hydrogen peroxide gels: in vitro results.

OBJECTIVE: This study aimed to evaluate the effects of adding chitosan to 35% hydrogen peroxide gels (for in-office bleaching), with or without calcium gluconate, on tooth properties and bleaching efficacy. METHODS: Bovine enamel/dentin specimens (4 × 4 × 2.5 mm) were randomly allocated into groups (n = 10): negative control (unbleached), bleaching with 35% hydrogen peroxide gel (35% HP, commercial gel); 35% HP with 2% chitosan (% wt) (35% HP + chitosan), 35% HP and calcium (35% HP + Ca, commercial gel), and 35% HP + Ca + 2% chitosan. Variation of surface profile (ΔRa) and color analyses (ΔL*, Δa*, Δb*, ΔE*ab, ΔE00, and ΔWID) were performed comparing specimens at baseline (initial) and 24 h after of storage in artificial saliva (final). Surface microhardness (KHN) values and scanning electron microscopy (SEM) images were obtained on conclusion. The data were analyzed by ANOVA and Tukey's tests (KHN), generalized linear models (ΔL*, ΔEab, ΔE00, ΔWID, ΔRa), and Kruskal-Wallis and Dunn tests (Δa*, Δb*) (α = 0.05). RESULTS: Considering ΔL*, Δa*, Δb*, ΔE*ab, ΔE00, and ΔWID values, the bleached groups differed from negative control. For ΔRa, chitosan-based groups showed lower variation in surface roughness compared to 35% HP, without significant difference from negative control. For KHN, chitosan groups did not differ from negative control (unbleached control = chitosan groups > 35% HP + Ca > 35% HP). For SEM, slight surface changes were observed in all bleached groups, but the intensity varied according to gel used (35% HP > gels with Ca > gels with chitosan). CONCLUSION: Chitosan-enriched hydrogen peroxide gels can reduce negative impacts on tooth properties without affecting bleaching efficacy. CLINICAL RELEVANCE: Although commercial gels containing remineralizing agents such as calcium reduce the negative effects on the properties of teeth, the addition of chitosan appears to be a promising approach to preservation of dental properties without interfering in bleaching efficacy.

PEEK and fiberglass intra-radicular posts: influence of resin cement and mechanical cycling on push-out bond strength.

OBJECTIVES: To evaluate the bond strength of four types of posts (pre-fabricated fiberglass post, fiberglass post anatomized with composite resin, milled fiberglass post, and milled polyetheretherketone (PEEK) post), and two types of resin cements (conventional and self-adhesive) by assessing immediate bond strength and post-mechanical aging at each root third. MATERIALS AND METHODS: Bovine endodontically treated roots (16 groups, n = 8) were prepared and the posts were produced and luted; the specimens of aging groups were cycled (300,000 cycles under 50 N load at 1.2 Hz frequency); six slices of each root were obtained; push-out test was performed by using a universal testing machine (500 N load at 1 mm/min cross speed); fracture pattern was classified into five levels. The statistical analyses used were three-way ANOVA, Tukey's test (for bond strength), and Fisher's test (for fracture pattern) (α < 0.05). RESULTS: Differences were found between the cements for posts (conventional: p < 0.001; self-adhesive: p = 0.002), whereas no difference was found for root region (p = 0.941; p = 0.056, respectively); analysis of each root showed significant differences for cements (p < 0.001), posts (p < 0.001), and mechanical cycling (p = 0.001); in terms of double interaction, differences were found for posts and mechanical cycling (p = 0.005); no other interactions were observed (double or triple); the fracture pattern showed difference between the groups for both cements. CONCLUSIONS: Milled PEEK posts seem to be a good clinical option, but they require improvement of CAD-CAM technology and advances towards their adhesion. CLINICAL RELEVANCE: Milled posts are promising and can reduce clinical time for rehabilitation of extensively destroyed teeth.

Effect of accelerated stability on the physical, chemical, and mechanical properties of experimental bleaching gels containing different bioadhesive polymers.

OBJECTIVE: To evaluate the physical-chemical (weight, pH, quantification of hydrogen peroxide) and mechanical (texture profile and rheology tests) properties of the experimental bleaching gel based on the bioadhesive polymer Aristoflex® AVC, after accelerated stability testing. MATERIALS AND METHODS: A total of 300 syringes of bleaching gels were divided into 5 groups (n = 60): Whiteness Perfect® 10%-FGM (WP); carbamide peroxide 10% with aristoflex (CPa); carbamide peroxide 10% with Carbopol (CPc); aristoflex thickener (A); and Carbopol thickener (C). According to the following requirements and time, the accelerated stability test was performed: in an incubator at 40 °C and 75% humidity per 1, 3, and 6 months, and baseline (refrigerator at 5 °C and 25% humidity). The variables were analyzed following the statistical tests: Two-way ANOVA and Tukey's test were applied to pH; weight data were analyzed using a mixed model for repeated measurements over time and the Tukey-Kramer test; one-way ANOVA and Tukey's test analyzed the rheology test; generalized linear models were used to quantify the peroxide amount and texture profile data. A significance level of 5% was considered. RESULTS: The experimental bleaches CPa and CPc had the highest pH values when compared to the others in 6 months. Thickeners A and C did not change the pH, weight, and active content over the accelerated stability times (p > 0.05). Furthermore, there was weight loss after 3 months of storage for CPa and CPc (p < 0.05). In the quantification of hydrogen peroxide, the WP group showed the highest values over time (p < 0.0001), only showing a significant loss after the 3rd month. Meanwhile, CPa and CPc showed a reduction in quantification from the 1st month. CONCLUSIONS: Temperature and humidity directly influenced the active content and properties of bleaching gels. In addition, the presence of components regardless of thickeners, such as stabilizers, in the commercial gel allowed for greater stability over time. CLINICAL RELEVANCE: The development of experimental bleaching gels for clinical use requires careful testing. Therefore, accelerated stability testing represents a valuable tool in the development and evaluation of cosmetic formulations.

Altered physical-chemical properties of home bleaching gels after an accelerated stability study and their effects on tooth enamel.

OBJECTIVES: To investigate the physical-chemical properties of home bleaching gels based on Carbamide Peroxide (CP) and Hydrogen Peroxide (HP) after accelerated stability (AS) and its effects on enamel. MATERIALS AND METHODS: A total of 360 bovine teeth blocks were divided (n = 12): Control, CP10%-Whiteness Perfect, CP10%-Pola Night, HP7.5%-Pola Day, and HP7.5%-White Class Calcium. Microhardness (KHN), roughness (Ra), color (ΔE and ΔE00), hardness, compressibility, elasticity, cohesiveness, adhesiveness, weight, pH, and calcium (Ca) quantification in enamel were analyzed without storage of the bleaching gels and after AS at 1 and 3 months. Data of Ca, KHN, and Ra were analyzed through mixed models for repeated measurements and the Tukey-Kramer test. Values of weight, hardness, compressibility, and elasticity were analyzed with two-way ANOVA and Tukey's test. ΔE/ΔE00 data, cohesiveness, and adhesiveness were analyzed with Kruskal-Wallis and Dunn tests (α = 0.05). RESULTS: Groups subject to AS had lower ΔE and ΔE00 compared to those without storage. Lower KHN and higher Ra values were found after bleaching treatment in all groups compared to controls. Higher amounts of Ca were found on the first day of evaluation in the gels subject to AS for 3 months, regardless of the bleaching agent used. CONCLUSIONS: Incorrectly stored bleaching gel accentuates adverse effects on enamel. Temperature and humidity interfere directly with the chemical stability of bleaching agents, reducing their properties. CLINICAL RELEVANCE: HP is an unstable oxidizing agent when stored at high temperatures. Therefore, pH becomes more acidic and potentiates the demineralizing effect on enamel.

Effect of at-home bleaching gels with different thickeners on the physical properties of a composite resin without bisphenol A.

OBJECTIVE: To investigate, in vitro, the influence of at-home bleaching with 16% carbamide peroxide (CP) gels containing different thickeners on the color, gloss, roughness, and microhardness of a composite resin with bisphenol A (BPA) and without bisphenol A (BPA-free). MATERIAL AND METHODS: Cylindrical samples (7 × 2 mm) of a composite resin with BPA (Filtek Z350 XT®; 3M/ESPE) and composite resin BPA-free (Vittra APS®; FGM) were subdivided into six subgroups (n = 12), according to the bleaching gel used: no bleaching (control), commercial gel with 16% CP and carbopol, experimental gel with 16% CP and carbopol, experimental gel with 16% CP and natrosol, experimental gel with carbopol and experimental gel with natrosol. At the end of the experimental phase, the specimens were analyzed for color (ΔE*ab and ΔE00 ), surface roughness (Ra), gloss (GU), and surface microhardness (SMH). The data for all analyzes were submitted to Levene's test, Shapiro-Wilk's test and ANOVA. RESULTS: For ΔE*ab and ΔE00 no statistically significant differences were found between all groups evaluated. Bleaching with experimental 16% CP gel with carbopol resulted in the lowest GU values for both composite resins evaluated. 16% CP experimental gel with natrosol resulted in higher Ra for the BPA composite resin and the bleaching with natrosol resulted in higher Ra for BPA-free. About 16% CP experimental gel with carbopol and 16% CP experimental gel with natrosol resulted in the lowest final SMH for composite resin with BPA. For the BPA-free composite resin, no differences were found between the groups in SMH for the same resin, however they presented the lowest values compared with all others groups. CONCLUSION: The effects on physical properties are dependent on the composition of the composite resin and the thickener/bleaching gel used. The BPA-free composite resin showed less changes after exposure to bleaching agent, although its initial physical properties were worse compared to a bleached BPA. CLINICAL RELEVANCE: The hydrogen peroxide and thickener of the at-home bleaching gel does impact the properties of composites with BPA or BPA-free such as gloss, roughness and surface microhardness, extremely important factors for maintaining an aesthetically and physically satisfactory restoration. BPA-free composite resins have inferior properties after at-home bleaching with different thickeners.

Nano-hydroxyapatite-induced remineralization of artificial white spot lesions after bleaching treatment with 10% carbamide peroxide.

OBJECTIVE: To assessed in vitro the effect of nanohydroxyapatite (n-HA) to improve the aesthetic appearance and microhardness of white spot lesions (WSL) when associated with a low-concentration bleaching agent (carbamide peroxide-CP10%). MATERIAL AND METHODS: Enamel/dentin specimens (n = 60) of 5 × 5 × 2.2 mm were prepared, of these, 48 were submitted to pH-cycling to create artificial WSL. Subsequently, these were allocated into five groups (n = 12): n-HA; n-HA + CP10%; CP10%; WSL control (WSLC ); sound control (Sound). The color was assessed at baseline, pre-treatment, and post-treatment using a spectrophotometer, and the color (ΔE/ΔE00 ) and whiteness index (ΔWID) alterations were determined. The enamel cross-sectional microhardness (CSMH) was evaluated (post-treatment) with a Knoop indenter, 25gf/5 s, 20-200 µm. The data was analyzed through generalized linear models (α = 5%). RESULTS: ΔE and ΔE00 were significantly higher for the bleached groups (n-HA + CP10% and CP10%), and the n-HA was higher than the WSLC group (p < 0.05). ΔWID was significantly higher for the bleached groups (p < 0.05). The CSMH values were significantly higher in the sound group than in the n-HA, CP10%, and WSLC groups (p < 0.05). The WSLC had lower microhardness than the n-HA + CP10% and sound groups (p < 0.05). CONCLUSION: n-HA is suitable to remineralize and recover the color of the WSL. However, its association with CP10% maintains the esthetical outcome while increasing its in-depth remineralizing effect. CLINICAL SIGNIFICANCE: Considering the aesthetic and functional repercussions of the WSL persistence, treatments that tend to improve its physical appearance and reinforce its weakened substructure in a non-invasive way are ideal. For this associating low-concentration, bleaching agents to the remineralizing treatments is promising to treat this type of lesions.

Effect of tooth bleaching and application of different dentifrices on enamel properties under normal and hyposalivation conditions: an in situ study.

OBJECTIVE: The purpose of this in situ study was to evaluate different dentifrices on enamel after bleaching under normal and hyposalivatory conditions. MATERIALS AND METHODS: Twenty-four participants were assigned of which 12 had normal and 12 had low salivary flow. The study was conducted in 6 in situ experimental phases of 24 h duration: placebo, NaF, SnF2, F/Sn/Chitosan, F/Arginine, and F/Bioactive Glass. The specimens were previously bleached in vitro. Microhardness (SMH), roughness (Ra), and color analyses (CIELAB and ΔE00) were performed at baseline (T1), after bleaching (T2) and after in situ phase (T3). Scanning electron microscopy (SEM) and the elemental levels (wt%) of Ca, P, and Na and the proportion between Ca and P were determined using an energy-dispersive X-ray spectrometer (EDS) in T3. The SMH and Ra were analyzed by mixed models for repeated measures and Tukey Kramer. The color and Na% were analyzed by split-plot ANOVA and Tukey test. The EDS were analyzed by Mann's Whitney nonparametric, Friedman, and Nemenyi tests (p<0.05). RESULTS: The dentifrices placebo and NaF in the low flow presented lower SMH and higher Ra in T3 and lower Ca% compared to the same dentifrices in normal flow. For normal flow, SnF2 resulted in greater SMH. For low flow, SnF2, F/Sn/Chitosan, and F/Bioactive Glass resulted in higher SMH in T3 and did not differ from T1. F/Bioactive Glass showed lower Ra among the dentifrices evaluated for both salivary flows, whereas SnF2 showed the highest. F/Bioactive Glass showed a statistically significant difference from placebo for Ca%, P%, Na%. For ΔE*ab and ΔE00 (T1×T3), no differences were found for the dentifrices and salivary flows. CONCLUSION: The low salivary flow had less capacity for remineralization of bleached enamel compared to normal flow. Overall, the dentifrice with bioactive glass had the best performance in bleached enamel under low and normal salivary flow condition. CLINICAL RELEVANCE: It is recommended to use a bioactive glass-based dentifrice after bleaching to promote tooth enamel recovery for patients with or without impaired salivary flow.

COMPLIANCE OF RANDOMIZED CLINICAL TRIALS ON DENTAL CARIES PREVENTION METHODS WITH THE CONSORT STATEMENT: A SYSTEMATIC REVIEW.

OBJECTIVE: Reporting of randomized controlled trials (RCTs) in dentistry remains suboptimal. Considering the positive impact of the Consolidated Standards of Reporting Trials (CONSORT) guidelines on the quality of evidence in RCTs, the main objective of this systematic review was to determine whether RCTs on dental caries prevention conform to these guidelines. The secondary objective was to assess the association between CONSORT adherence and the year and impact factor of the journal in which the study was published. METHODS: A systematic search was conducted in different databases using appropriate terms to retrieve RCTs that assessed the caries-preventive effect of at least 2 of the following materials-fluoride varnish, resin-based fissure sealants, and ionomer-based fissure sealants-on the occlusal surfaces of permanent molars. Since the first CONSORT statement was published in 1996, a time frame from 1997 to 2020 was established for the identification of studies. Selected articles were assessed according to their adherence to the CONSORT statement, risk of bias (Cochrane risk of bias tool, RoB 2.0), and journal impact factor based on the InCites Journal Citation Reports. The year of publication and other relevant data were also recorded. SPSS (SPSS Statistics 25.0, IBM©) was used to perform the linear correlation analyses to determine the relationship between the article CONSORT score (previously determined) and the year of publication and journal impact factor. A significance level of 5% was established for all analyses. RESULTS: Of 3196 references retrieved, 30 articles were selected and evaluated. Using RoB 2.0, 8 studies were classified as having a high risk of bias, 16 as having some concerns about the risk of bias assessment, and 6 as having a low risk of bias. Concerning CONSORT adherence, 77% of the studies adequately reported the intervention domain, since the methodology for the application of fluoride varnish or sealant materials was thoroughly described. However, the participants' setting and location, random sequence generation, randomization, and the flowchart description of the losses/exclusions domains were poorly reported. Meanwhile, the allocation concealment process was not reported in 83% of the articles. Correlation analyses indicated a positive relationship between CONSORT adherence and the year of publication, as well as the journal impact factor. CONCLUSION: When assessing clinical trials on the prevention of occlusal caries, most RCTs examined followed the CONSORT statement. However, some methodological domains remain poorly reported, demonstrating the need to improve CONSORT compliance in these RCTs.

Effect of ammonium acryloyldimethyltaurate copolymer on the physical and chemical properties of bleached dental enamel.

OBJECTIVE: To analyze the effect of bioadhesive polymer, Aristoflex® AVC, on enamel physical and chemical properties. MATERIALS AND METHODS: Bovine enamel blocks were divided into CP 10% with carbopol-Whiteness Perfect® (WP-FGM), CP 10% with Aristoflex (A + CP 10%), CP 10% with carbopol (C + CP 10%), Aristoflex (A), carbopol (C), carbamide peroxide 10% (CP 10%) and control (no treatment). The treatment was performed for 4 h during 14 days. The colour (ΔE, ΔL*, Δa* and Δb*), profilometry (Ra) and surface microhardness (KHN) were performed before and after the bleaching treatment. The concentrations of Ca and P were performed on the 1st, 3rd, 7th and 14th days by inductively coupled plasma optical emission spectrometry for the groups WP, A + CP 10%, C + CP 10%, A, C and CP 10% (control without thickener) and the morphology by scanning electron microscopy. RESULTS: All groups with CP 10%, regardless of polymer, differing statistically to ΔE, ΔL*, Δa* and Δb* compared to control group. The group A + CP 10% maintained low values of roughness and microhardness after bleaching. Higher concentration of Ca and P was found in the 1st day of treatment for the WP group compared to the groups A + CP 10% and C + CP 10%. CONCLUSION: The 10% CP associated with the bioadhesive polymer Aristoflex® AVC was effective on the bleaching treatment without changing the physical properties of the dental enamel. Also, this experimental gel caused less mineral loss than the group CP 10% with carbopol (WP-FGM). CLINICAL RELEVANCE: Because the change of Carbopol by Aristoflex, a bioadhesive polymer, does not interfere with the effectiveness of bleaching treatment, it is a promising agent associated to carbamide to maintain the physical properties of enamel after bleaching.

Influence of different thickeners in at-home tooth bleaching: a randomized clinical trial study.

OBJECTIVES: To evaluate the effects of 10% carbamide peroxide (CP) with two different thickeners, carbopol (CPc) and natrosol (CPn), on color variation (CV), tooth sensitivity (TS), and cytotoxicity (CC). METHODS: Seventy subjects were distributed into the CPc or CPn groups (n = 35), in a parallel group, randomized, controlled, single-blind clinical trial. Bleaching gels were used by volunteers for 4 h daily for 2 weeks. Color evaluation was performed using a reflectance spectrophotometer, before bleaching treatment (BT), immediately after the first and second weeks of BT, and 1 week and 1 month after BT ended. TS was evaluated using two pain scales, before, during, and after BT. CC was evaluated using MTT after exposure of MDPC-23 cells to the bleaching gels for 4 h. Epoxy replicas of the subjects teeth were made before and after BT and analyzed using a scanning electronic microscope. The data was analyzed using statistical methods. RESULTS: CV and TS showed similar variation between both bleaching gels (p ≤ 0.05). None of the protocols affected cellular metabolism or the surface morphology of enamel. CONCLUSIONS: Bleaching gels with carbopol and natrosol as thickening agents produced similarly effective tooth bleaching and TS, but did not cause cytotoxicity. CLINICAL RELEVANCE: Natrosol could be an alternative as a thickener used in bleaching gels due to its similar bleaching effect and TS when compared with Carbopol.

Chewing in adolescents with overweight and obesity: An exploratory study with behavioral approach.

Physiological and behavioral aspects of masticatory function may have an impact on nutritional status, which has been little studied. The aim was to perform a comprehensive evaluation of objective, subjective and behavioral aspects of masticatory function in 231 adolescents, aged 14-17 years and compare these parameters between normal-weight (n = 115) and adolescents with overweight/obesity (n = 116). Objective aspects were examined by the Oro-facial Myofunctional Evaluation-expanded protocol (OMES-e), determining the masticatory type, chewing time/frequency, abnormal movements, and other; masticatory performance (color changeable chewing gum) and bite force were also explored. The subjective and behavioral evaluations were assessed using the Quality of Mastication Function Questionnaire, which explores the masticatory behavior and frequency/intensity of difficulty in chewing different types of foods. Results were submitted to normality tests, Chi-square, unpaired t-test and Mann-Whitney. A multiple linear regression model was used to evaluate which of the variables under study contributed to the variation in Percent Body Fat (α = 0.05). The results showed that OMES-e total score differed significantly between groups, that is, individuals with overweight showed more changes in oro-facial myofunctional aspects than normal-weight ones. Unilateral mastication was more frequent among females with overweight/obesity. They also showed greater difficulty on Habits and Fruit domains, reporting the need of adding sauce to the meal to facilitate swallowing and peeling and cutting fruit (apples) in small pieces in order to better chew them. OMES-e total score also showed a significant relationship with Percent Body Fat. Masticatory performance evaluated by chewing gum and bite force did not differ between groups. This study showed that adolescents with excess weight presented changes in masticatory behavior and greater difficulty in performing the masticatory function comparing to normal-weight ones.

Effect of 7.5% hydrogen peroxide containing remineralizing agents on hardness, color change, roughness and micromorphology of human enamel.

PURPOSE: To determine the microhardness, color change, surface roughness, and micromorphology of tooth enamel submitted to bleaching treatment with 7.5% hydrogen peroxide (HP) with added calcium, amorphous calcium phosphate, sodium fluoride (NaF), and hydroxyapatite (HA). METHODS: 80 enamel slabs were used (n = 10). Three commercial agents [Pola Day 7.5%, Day White ACP 7.5% (DW-ACP), and White Class Calcium 7.5% (WC-Calcium)], three experimental (7.5% HP+NaF, 7.5% HP+HA, and 7.5% PH+NaF+HA), a positive control (with HP), and a negative control (without HP) groups were assessed. The commercial products were applied according to manufacturers' recommendations and the experimental ones were applied for 1.5 hours daily. During and after treatment, specimens were stored in artificial saliva. Tests were performed at baseline, 7, 14, 21, 28, and 35 days. Data were analyzed by ANOVA and Tukey's test (α = 0.05). RESULTS: DW-ACP presented lower microhardness and HP+HA presents the highest values (P < 0.05); only the experimental group presented color change similar to the commercial agents (P > 0.05). Overall, roughness increased with time (P < 0.05) and porosities, and deposition of crystalline structures in groups HP+HA and HP+NaF+HA were noted. The HP+HA agent was capable of reducing the loss of enamel microhardness due to bleaching and also present color change similar to the commercial products.

Influence of successive light-activation on degree of conversion and Knoop hardness of the first layered composite increment.

PURPOSE: To evaluate the influence of light-activation of second, third and fourth increments on degree of conversion (DC) and microhardness (KHN) of the top (T) and bottom (B) surface of the first increment. MATERIALS AND METHODS: Forty samples (n = 5) were prepared. In groups 1-4, after each increment light-activation (multiple irradiation), T and B of the first increment were measured in DC and KHN. In groups 5-8, only the first increment was made (single irradiation) and measurements of DC and KHN were taken at 15 min intervals. The light-activation modes were (XL) 500 mW/cm(2) × 38 s (G1/G5); (S) 1000 mW/cm(2) × 19 s (G2/G6), (HP) 1400 mW/cm(2) × 14 s (G3/G7); (PE) 3200 mW/cm(2) × 6 s (G4/G8). Data for DC and KHN were analyzed separately by using PROC MIXED for repeated measures and Tukey-Kramer test (α = 0.05). RESULTS: For KHN, B showed lower values than T. PE resulted in lower values of KHN in B surface. For single and multiple irradiations, T and B of first measurement showed the lowest KHN and the fourth measurement showed the highest, with significant difference between them. For single irradiation, first and second increments presented similar KHN, different from the third and fourth increment, which did not differ between them. For multiple irradiations, the second light-activation resulted in KHN similar to first, third and fourth increments. For DC, except QTH, T presented higher DC than B. CONCLUSION: The light-activation of successive increments was not able to influence the KHN and DC of the first increment.

In vitro effects of hydrogen peroxide combined with different activators for the in-office bleaching technique on enamel.

OBJECTIVE: The aim of this study was to evaluate the alteration of human enamel bleached with high concentrations of hydrogen peroxide associated with different activators. MATERIALS AND METHODS: Fifty enamel/dentin blocks (4 × 4 mm) were obtained from human third molars and randomized divided according to the bleaching procedure (n = 10): G1 = 35% hydrogen peroxide (HP - Whiteness HP Maxx); G2 = HP + Halogen lamp (HL); G3 = HP + 7% sodium bicarbonate (SB); G4 = HP + 20% sodium hydroxide (SH); and G5 = 38% hydrogen peroxide (OXB - Opalescence Xtra Boost). The bleaching treatments were performed in three sessions with a 7-day interval between them. The enamel content, before (baseline) and after bleaching, was determined using an FT-Raman spectrometer and was based on the concentration of phosphate, carbonate, and organic matrix. Statistical analysis was performed using two-way ANOVA for repeated measures and Tukey's test. RESULTS: The results showed no significant differences between time of analysis (p = 0.5175) for most treatments and peak areas analyzed; and among bleaching treatments (p = 0.4184). The comparisons during and after bleaching revealed a significant difference in the HP group for the peak areas of carbonate and organic matrix, and for the organic matrix in OXB and HP+SH groups. Tukey's analysis determined that the difference, peak areas, and the interaction among treatment, time and peak was statistically significant (p < 0.05). CONCLUSION: The association of activators with hydrogen peroxide was effective in the alteration of enamel, mainly with regards to the organic matrix.

Effect of light polymerization time, mode, and thermal and mechanical load cycling on microleakage in resin composite restorations.

This study evaluated the effect of polymerization mode and time and thermal and mechanical loading cycling (TMC) on microleakage in composite resin restorations. One hundred and eighty cavities were prepared and randomly divided according to the light curing time (20, 40, or 60 s), modes (quartz-tungsten-halogen (QTH)-420 mW/cm(2), LED 2 (2nd degree generation)-1,100 mW/cm(2), or LED 3 (3rd degree generation)-700 mW/cm(2)), and TMC. Following standard restorative procedures, the samples were prepared for analysis in an absorbance spectrophotometer. All results were statistically analyzed using the three-way ANOVA and Tukey test (p ≤ 0.05). The results revealed that the groups QTH and LED 3 submitted to TMC showed higher microleakage than those that were not submitted to TMC. Only for LED 3, 60 s showed higher microleakage than 20 s. For LED 2 and QTH, there were no differences between the times. QTH showed lower microleakage means than LED 2, when photoactivated for 20 s, without TMC. When photoactivated for 60 s, QTH showed lower microleakage means than LED 3, for the groups with or without TMC. It was concluded that TMC, the increase in polymerization time, and the irradiance were factors that may increase the marginal microleakage of class II cavities.

Effect of different monomer-based composites and acid etching pre-treatment of enamel on the microleakage using self-etch adhesives systems.

OBJECTIVE: To evaluate quantitatively the marginal microleakage of restorations carried out with self-etching adhesives with or without prior phosphoric enamel acid etching of silorane or methacrylate resin-based composite restorations subjected to thermal cycling. MATERIALS AND METHODS: Forty cavities were prepared at the proximal surface of bovine incisors and randomly divided according to the etching of the enamel and restorative system used. The groups were restored with methacrylate [Adper SE Plus adhesive (3M ESPE) + Filtek Z250 (3M ESPE)] or silorane [Filtek LS adhesive (3M ESPE) + Filtek LS composite (3M ESPE)] restorative systems, light-cured using a LED unit (Bluephase 16i, Vivadent). After restorative procedure and thermocycling (1000 cycles), the specimens were immersed in methylene blue for 2 h. The specimens were triturated and the powder was used for analysis in an absorbance spectrophotometer. Data were statistically analyzed by 2-way ANOVA (alpha = 0.05). RESULTS: No statistical difference between the restorative materials tested with or without previous acid etching of enamel in Class II marginal microleakage was observed (p > 0.05). CONCLUSIONS: The use of acid etching prior to self-etching adhesives did not interfere on the microleakage of methacrylate- or silorane-based restorations.

Effect of light curing protocol on degree of conversion of composites.

OBJECTIVE: To evaluate the degree of conversion (DC) of two light-cured composites with different protocols of light curing. MATERIALS AND METHODS: One hundred and ninety two specimens (n = 8) were prepared (5 mm × 2 mm) according to experimental groups: two composite resins (Filtek Supreme and four seasons); three light curing protocols [20 s with the tip of the light curing unit (LCU) device touching composite surface (C); 20 s with the tip of the LCU at 8 mm distant from composite surface (D); and tip of the LCU at 8 mm distant from composite surface and polymerization time required to obtain a radiant exposure of 16 J/cm(2) (DS)]. Four LCUs (Bluephase 16i, Ultralume LED 5, XL 3000 and Optilux 501C) were used. DC of the bottom and top surface of specimens were measured using a FTIR spectrometer. Data were statistically analyzed by 3-way split splot ANOVA and Tukey's test (alpha = 0.05). RESULTS: The results showed that DC of the top surface was higher than the bottom at all experimental conditions (p < 0.0001). Overall, the curing at 8 mm of distance did not affect conversion rate on the top surface (p > 0.05), but bottom surfaces showed DC reduction (p < 0.05). The highest monomer conversion values were observed for C and DS situations. CONCLUSION: The distance between the LCU and material surface and radiant exposure can affect the DC. Polymerization at distance should be performed with curing units with higher light power and/or extended exposure time.