[Mineral composition of mixed saliva in patients with dental fluorosis]. / Mineral'nyi sostav smeshannoi sliuny u patsientov s fliuorozom zubov.

The aim of the study was to assess the mineral composition of mixed saliva in dental fluorosis patients undergoing treatment with microabrasion and bleaching. The study included 60 patients aged 18-35 years with various forms of dental fluorosis. Group 1 included 40 patients in which enamel microabrasion was performed, group 2 - 20 patients with microabrasion and bleaching. Mixed saliva composition was analyzed with Olimpus automatic analyzing device. Dental fluorosis treatment in both groups resulted in saliva mineral composition changed associated with enamel demineralization which proves the necessity for calcium and phosphate containing compositions in these treatment groups.

Infiltrante resinoso vs Microabrasão no manejo de lesões de mancha branca: relato de caso / Resin infiltration vs microabrasion in white-spot lesions treatment: case report

Objetivo: Apresentar caso clínico de tratamento estético das lesões de mancha branca após tratamento ortodôntico nos dentes superiores anteriores através de duas técnicas minimamente invasivas usando o sistema de infiltração de resina e microabrasão. Relato de caso: Paciente com 18 anos de idade apresentava lesões de manchas brancas inativas nos dentes 11, 12, 13, 21, 22, 23. O sistema de infiltrante de resina Icon (DMG, Hamburgo, Alemanha) foi utilizado nos dentes 11, 12, 13, enquanto os dentes 21, 22, 23 foram submetidos à microabrasão com Whiteness RM (FGM, Joinville, Santa Catarina, Brasil).Ambos os protocolos foram utilizados de acordo com as recomendações do fabricante.Nos dentes 21 e 22, o produto para microabrasão foi aplicado com espátula que acompanha o kit, enquanto que no dente 23 utilizou-se o mesmo produto aplicado com taça de borracha em baixa rotação, todos os procedimentos executados por um único operador. A microabrasão com taça de borracha proporcionou uma superfície mais lisa e homogênea.Ambos os produtos tiveram resultados satisfatórios na resolução estética das lesões de mancha branca após um ano de acompanhamento. Conclusão: Os dois produtos apresentam bom desempenho e resolutividade para os problemas estéticos de lesões de manchas brancas inativas, entretanto deve-se levar em conta o tempo clínico, toxicidade, a atividade da lesão e a possibilidade de desgaste da estrutura dentária.

Objective: To present a case report of aesthetic treatment of post orthodontic white--spot lesions in the anterior superior teeth through two minimally invasive technique susing resin infiltration system or microabrasion. Case report: Patient 17 years of age had inactive white-spots lesions on teeth 11, 12, 13, 21, 22, 23. The teeth 11, 12, 13 received the resin infiltrating system Icon (DMG, Hamburg, Germany) while the teeth 21, 22, 23were submitted to microabrasion with Whiteness RM (FGM, Joinville, Santa Catarina, Brazil). Both protocols were used according to manufacturer’s recommendations. In the teeth 21 and 22, the product of the microabrasion was applied with a spatula that accompanied the kit, while the tooth 23 received the same product applied with a rubbercup at low speed turbine, all by a single operator. The microabrasion with rubber cupoccasioned a more smooth and homogeneous surface. Both products had satisfactory results in aesthetic resolution of the white-spots lesions, for a 1-year follow-up. Conclusion:Although both products are able to resolve aesthetic problems of inactive white-spots lesions, it should be taken into account the clinical time, toxicity, the activity ofthe lesion and the possibility of wear of the tooth structure.

Unusual extrinsic staining following microabrasion in a girl with amelogenesis imperfecta.

BACKGROUND: Developmental defects of enamel (DDE), such as amelogenesis imperfecta (AI), may present with tooth discolouration that is of aesthetic concern to the affected individual. Children and young people with DDE may therefore seek dental interventions to improve their dental appearance. The most commonly employed approaches include microabrasion, bleaching and/or placement of composite resin veneers. CASE REPORT: A 13-year-old girl with hypomature AI requested treatment for the 'marks' on her teeth which were having a negative impact on her social interactions. Clinical examination revealed generalised dense white opacities, and a microabrasion approach was performed on 11, 12 and 13 using a commercial preparation of 6.6 % hydrochloric acid. Concerningly, the girl's father phoned the next day reporting that his daughter's teeth had turned 'orange'. An urgent review revealed that the treated teeth had indeed become an orange colour. Further enquiry found that the patient had eaten a tomato pizza immediately after her dental treatment and this was believed to have caused the severe extrinsic staining. The patient was provided with a 16 % carbamide peroxide preparation for night-time use in a laboratory-made tray. A 2-week review revealed complete resolution of the staining. FOLLOW-UP: Direct composite resin restorations were subsequently provided for the girl's maxillary anterior teeth to achieve an optimal cosmetic result and she has remained pleased with her dental appearance. CONCLUSION: Clinicians should be aware of the potential for extrinsic staining following microabrasion or tooth bleaching. Patients should be advised against consuming coloured food and drink for at least 48 h after their treatment.

The Ethics of Interproximal Reduction.

Interproximal reduction (IPR) has become particularly popular with the use of removable aligners. Clinical and ethical factors concerning the use of interproximal reduction to facilitate orthodontic alignment are discussed. CPD/Clinical Relevance: An understanding of the aetiological factors of a malocclusion is essential to enable full discussion of the risks and benefits, or the alternatives to IPR.

Interproximal enamel reduction as a part of orthodontic treatment.

OBJECTIVE: Interproximal enamel reduction is a part of orthodontic treatment for gaining a modest amount of space in the treatment of crowding. Today interproximal enamel reduction has become a viable alternative to the extraction of permanent teeth, and helps to adjust the Bolton Index discrepancy. The aim of the study is to evaluate various interproximal enamel reduction techniques, its indications, contraindications and complications presented in recent scientific studies. MATERIAL AND METHODS: Papers published in English language between 2003 and 2012 were searched in PubMed, ScienceDirect and The Cochrane Library databases, as well as the Web search Google Scholar. Initial searches were made to find peer-reviewed systematic reviews, meta-analyses, literature reviews, clinical trials, which analysed at least one interproximal enamel reduction method. 31 published data fulfilled the inclusion criteria. RESULTS: According to the study, abrasive metal strips, diamond-coated stripping disks, and air-rotor stripping are the main interproximal enamel reduction techniques. Indications for use are mild or moderate crowding in dental arches, Bolton Index discrepancy, changes in tooth shape and dental esthetics within the enamel, enhancement of retention and stability after orthodontic treatment, normalization of gingival contour, elimination of black gingival triangles, and correction of the Curve of Spee. Complications of interproximal enamel reduction are hypersensitivity, irreversible damage of dental pulp, increased formation of plaque, the risk of caries in the stripped enamel areas and periodontal diseases. CONCLUSION: Interproximal enamel reduction is an important part of orthodontic treatment for gaining space in the dental arch, and for the correction of the Bolton index discrepancy.

Enamel roughness and incidence of caries after interproximal enamel reduction: a systematic review.

The aim of this study was to investigate the effect of interproximal enamel reduction (IER) on tooth surfaces regarding the level of enamel roughness after applying different IER methods and the caries risk of treated teeth. Seven electronic databases were systematically searched. Two independent reviewers rated the articles at every step according to predetermined eligibility criteria. Data on enamel roughness were pooled if the same IER method was used and arithmetic values were available. Data on occurrence of caries were suitable for the analysis if the same units for caries development were used. From 2396 citations initially identified, 18 articles met the inclusion criteria and were further considered (14 studying enamel roughness and four studying the risk of caries after IER). A meta-analysis of quantitative data regarding enamel roughness was not possible due to statistical heterogeneity; instead, the enamel roughness findings are only described. The meta-analysis of studies focusing on the incidence of caries revealed no statistical difference between treated and untreated enamel surfaces (p = NS) from 1 to 7 years after IER. Drawing reliable conclusions on enamel roughness after IER is difficult owing to the diversity of the available studies. Statistically, the occurrence of caries on surfaces previously treated with IER was the same as that on intact surfaces, indicating that IER does not increase the risk of caries on treated teeth.

Effects of microabrasion on substance loss, surface roughness, and colorimetric changes on enamel in vitro.

OBJECTIVES: To determine in vitro the effects of 2 commercially available microabrasion compounds (Prema [Premiere Dental Products] and Opalustre [Ultradent]) on human enamel under standardized conditions after treatment periods of 10, 20, 30, and 40 seconds. Nonacidified pumice served as an abrasive control compound. METHOD AND MATERIALS: Mean substance loss was determined by measuring dissolved Ca2+ using atomic absorption spectrophotometry. Differences in the mean surface roughness were profilometrically assessed. These findings were completed with micromorphologic observations using SEM. In addition, color changes after microabrasion were evaluated using the CIE L*a*b* system. RESULTS: Opalustre caused the highest tooth substance loss, followed by the Prema compound and pumice, which showed a lesser substance-removal capacity. These findings were in concordance with the mean surface roughness difference measurements and micromorphologic analyses. Microabrasion did not cause any significant colorimetric changes. CONCLUSION: Microabrasion should be considered a microinvasive method, and clinical application should be used with caution to avoid excessive substance removal. Subsequent polishing appears crucial to maintain optimal esthetics and avoid surface alterations.

Effect of different splint removal techniques on the surface roughness of human enamel: a three-dimensional optical profilometry analysis.

Because there is no standard protocol for the removal of resin-based materials that retain semi-rigid trauma splints on teeth, iatrogenic enamel damage caused by various splint removal techniques has remained unknown. The purpose of this study was to evaluate the effect of five different resin removal techniques (H6/H7 scaler, ultrafine diamond bur, ultrasonic scaler, 16-blade tungsten carbide bur, and Sof-Lex disks) on the surface roughness of human enamel. Three-dimensional white-light interferometry, a non-contact profilometry technique, was used to obtain qualitative and quantitative measurements of surface roughness both at baseline and after finishing procedures. Statistical analysis using Friedman test and Wilcoxon signed ranks test showed that the roughest enamel surface was obtained after splint removal with the hand scaler (P < 0.05). Overall, the smoothest enamel surface was obtained after removal of resin with Sof-Lex disks and the 16-blade tungsten carbide bur (P < 0.05).

Effect of different bleaching techniques on enamel surface microhardness.

UNLABELLED: Conservative techniques for treatment of discolored human enamel include in-office bleaching with heat-activated 35% hydrogen peroxide, Nightguard vital bleaching with 10% carbamide peroxide, and enamel microabrasion with 18% hydrochloric acid. OBJECTIVES: In this study, these bleaching techniques were performed on 30 extracted teeth to evaluate their effects on microhardness of enamel surfaces. METHODS: The enamel surface microhardness measurements were performed 0, 24, 48, and 72 hours and 1 week after treatment. Paired t tests were performed in the statistical analyses. RESULTS: No changes were found on specimens treated with carbamide peroxide. There was a significant decrease in the surface microhardness of enamel after 0 and 24 hours when the specimens were treated with 18% hydrochloric acid (softening 85.7 and rehardening 99.4) or with 35% hydrogen peroxide (softening 85.7). However, after 72 hours, significant rehardening was observed in these groups (P <.001). CONCLUSION: According to the results, except Nightguard vital bleaching, all other techniques softened the enamel surface.

Severe enamel abrasion due to misuse of an air polishing device.

OBJECTIVES: In this case report, a 28-year-old male patient who severely injured the enamel tissue of his upper incisors due to excessive self-performed air polishing has been presented. Air polishing devices are frequently used in initial or supportive periodontal therapy to remove supragingival plaque and dental stains. Enamel tissue is minimally affected by air polishing when appropriately performed by a professional. However, excessive air polishing may have detrimental effects even on the intact enamel. The aim of this case report is to present a patient who severely injured the enamel surfaces of his upper incisors due to excessive self-performed air polishing. METHODS: A case of severe enamel abrasions in a 28-year-old male patient who injured the enamel surfaces of his upper incisors following several self-performed air polishing sessions has been presented. RESULTS: Severely abraded enamel surfaces of the upper incisors were present and during the course of therapy restored by composite restorations to establish a satisfactory clinical appearance. CONCLUSIONS: In clinical practice, air polishing can be performed rather safely on intact enamel and is a beneficial procedure in initial and supportive periodontal therapy when performed by a professional under recommended operating conditions. However, review of the literature reveals that air polishing may be harmful on tooth and surrounding structures unless carried out cautiously. Furthermore, excessive use of air polishing devices, especially by unauthorized personnel may be damaging and lead to severe abrasion of enamel tissue.

Effect of air-polishing devices on the gingiva: histologic study in the canine.

OBJECTIVES: The aim of this study was to evaluate histologically the immediate effect of two types of air-polishing devices (APDs) on the gingiva. MATERIAL AND METHODS: The buccal gingiva in four mongrel dogs was exposed to 5, 10 and 20 s of instrumentation, applying a hand-piece type of APD (HP-APD) PROPHYflex and a stand-alone type of APD (SA-APD) Jetpolisher in a split-mouth design. Immediately after treatment, the exposed gingiva was excised by sharp dissection and fixed in 10% buffered formalin. For each specimen, 15 sections, 20 microm apart, corresponding to the central part of the treated and control untreated gingiva were cut and stained with haematoxylin and eosin. Stained sections were examined histomorphometrically for keratin width and epithelial cell layer (ECL) (prickle and basal cell layers) width. Extent of erosion was expressed as loss of keratin and ECL compared with control. RESULTS: Microscopic examination presented changes in keratin and ECL, including keratin detachment and disruption of the normal ECL architecture. The erosive changes in the gingiva caused by both APD, positively correlated with instrumentation time (p<0.001) and type of instrument (p=0.008). Keratin loss was significantly higher for SA APD than for the HP APD in each time interval (p=0.019). Following exposure for 5 s, both APD caused a 25% loss of the ECL. Exposure for 10 and 20 s revealed a significantly greater ECL loss caused by the SA-APD than the HP-APD (p=0.018). Exposure for 20 s was the only time interval that presented the area of total epithelium erosion with SA-APD causing significantly more (p=0.002) areas of total epithelial erosion than the HP-APD. CONCLUSION: Gingiva exposure to air-polishing slurry delivered by APD caused localized trauma because of epithelial erosive changes with severity, positively correlated with instrumentation time and design principles of the applied APD. The clinician should be aware of the potential insult of the gingiva when applying the APD and careful precautions should be taken.

Pulpal response to different pulp capping methods after pulp exposure by air abrasion.

Air abrasion is regaining popularity especially in the area of pediatric dentistry due to its ease of use and its advantages. Due to the lost of tactile information, while using this technique, there is an increased risk for pulpal exposure. On the other hand, Ca(OH)2 medicament has been proven to induce dentin bridge formation, but an adequate sealing seems to be even more important that the capping material used. The purpose of this study was two fold: to assess the pulpal response after pulpal exposure by air abrasion and to evaluate the healing potential after using Ca(OH)2 medicament or Liner Bond II as a capping agent. Two hundred sixteen teeth from mixed-bred dogs were used in this study. The teeth were divided into three groups, A) pulpal exposure by air-abrasion followed by sealing of the cavity with Liner Bond II, B) pulpal exposure by air-abrasion and Ca(OH)2 pulp capping and C) pulpal exposure by high-speed followed by air-abrasion and Ca(OH)2 pulp capping as a control group. The animals were sacrificed after 7, 14, 30 and 60 days and a histopathological evaluation was undertaken. After applying Analysis of Variance to compare the groups, it was observed that at earlier observation periods, the inflammatory criteria near the exposure site were different among the groups. As time elapsed, the inflammation was resolved in the pulp tissue, however, the odontoblastic layer and the dentin bridge formation had a highly statistically significant difference (p<0.001) among the various groups at all observation periods. In addition, a positive correlation was observed between the organization of the odontoblastic layer and the dentin bridge formation mainly after 30 days. It could be concluded that dentin bridge formation could be achieved with the use of Ca(OH) or Liner Bond II as capping agent with an adequate sealing. However, the formation is delayed especially when Liner Bond II is used as capping agent.