Adhesión a dentina parte I: características del sustrato y sistemas adhesivos / Dentin bonding part I: substrate characteristics and bonding systems

La Odontología Restauradora contemporánea no puede concebirse sin la adhesión de los materiales restauradores a las estructuras dentarias. En mu-chos procedimientos restauradores, no sólo el esmal-te sino también la dentina se encuentra involucrada, por lo tanto, la adhesión a esta última juega un rol cla-ve en el éxito clínico. No obstante, todavía supone un gran desafío lograr una adhesión estable y predeci-ble en el tiempo. El propósito del presente artículo es analizar las características principales de la dentina como sustrato adhesivo y describir los sistemas ad-hesivos actuales y sus mecanismos de acción (AU)

Contemporary Restorative Dentistry cannot be conceived without the adhesion of restorative materials to dental structures. In many restorative procedures not only the enamel, but also the dentin is involved, therefore dentin bonding plays a key role in their success. However, it is still a great challenge to achieve stable and predictable dentin bonding over time. The aim of this article is to analyze the main characteristics of dentin as an adhesive substrate and to describe current adhesive systems and their bonding mechanisms (AU)

Molecular diagnosis of hypophosphatasia and differential diagnosis by targeted Next Generation Sequencing.

Hypophosphatasia (HPP) is a rare inherited skeletal dysplasia due to loss of function mutations in the ALPL gene. The disease is subject to an extremely high clinical heterogeneity ranging from a perinatal lethal form to odontohypophosphatasia affecting only teeth. Up to now genetic diagnosis of HPP is performed by sequencing the ALPL gene by Sanger methodology. Osteogenesis imperfecta (OI) and campomelic dysplasia (CD) are the main differential diagnoses of severe HPP, so that in case of negative result for ALPL mutations, OI and CD genes had often to be analyzed, lengthening the time before diagnosis. We report here our 18-month experience in testing 46 patients for HPP and differential diagnosis by targeted NGS and show that this strategy is efficient and useful. We used an array including ALPL gene, genes of differential diagnosis COL1A1 and COL1A2 that represent 90% of OI cases, SOX9, responsible for CD, and 8 potentially modifier genes of HPP. Seventeen patients were found to carry a mutation in one of these genes. Among them, only 10 out of 15 cases referred for HPP carried a mutation in ALPL and 5 carried a mutation in COL1A1 or COL1A2. Interestingly, three of these patients were adults with fractures and/or low BMD. Our results indicate that HPP and OI may be easily misdiagnosed in the prenatal stage but also in adults with mild symptoms for these diseases.

In vitro remineralizing effect of fluoride varnishes containing sodium trimetaphosphate.

This study analyzed the effects of fluoride varnishes supplemented with sodium trimetaphosphate (TMP) on the remineralization of caries-like lesions in vitro. Bovine enamel discs were selected through surface hardness (SH) and caries-like lesions were induced. SH was again determined and the blocks were divided into 7 experimental groups (n = 24/group): placebo (no fluoride or TMP), 5% TMP, 2.5% NaF, 2.5% NaF/5% TMP, 5% NaF, 5% NaF/5% TMP and commercial formulation (Duraphat™, 5% NaF), following a blind protocol. Discs were treated with the varnishes and kept in a remineralizing solution for 4 h and a demineralizing solution for 2 h. Varnishes were then removed and half of the discs were used for analysis of loosely (CaF2) and firmly bound fluoride. The remaining discs were submitted to a pH-cycling regimen for 6 days. The percentage of surface hardness recovery (%SHR), cross-sectional hardness (ΔKHN) and enamel CaF2 and fluoride were determined. Data were analyzed by ANOVA and by Student-Newman-Keuls' test (p < 0.05). A dose-response relationship was observed between fluoride concentrations in the varnishes and %SHR. The 5% TMP varnish led to %SHR similar to that obtained for the placebo. When TMP was used in association with fluoride, however, significantly higher %SHR were observed in comparison with their counterparts without TMP. Moreover, ΔKHN obtained for the 5% NaF/5% TMP was significantly lower among all groups tested. Higher concentrations of CaF2 and fluoride were observed for Duraphat and 5% NaF, followed by 5% NaF/5% TMP, 2.5% NaF and 2.5% NaF/5% TMP (p < 0.05). It was concluded that the supplementation of fluoride varnishes with TMP leads to enhanced remineralizing effect of artificial caries lesions in vitro.

MMPs activity and bond strength in deciduous dentine-resin bonded interfaces.

OBJECTIVES: To determine effect of ageing on deciduous dentine-resin interfaces bond strength and the metalloproteinases (MMPs) activity at the hybrid layer compared to permanent dentine. METHODS: Microtensile bond strength (MTBS) tests were performed in human deciduous and permanent dentine after 24h, 3 and 6 months using an etch and rinse adhesive. C-terminal telopeptide concentrations (ICTP) were calculated, in order to determine MMPs mediated collagen degradation at the hybrid layer. RESULTS: The highest MMPs-mediated collagen degradation values occurred in phosphoric acid demineralized dentine, ICTP values were similar for deciduous and permanent dentine after 1 week. Resin infiltration decreased collagen degradation in both dentins and ICTP values were similar to those attained by for untreated dentine. In resin infiltrated and untreated dentine specimens collagen degradation was always higher for deciduous dentine. At 24h, MTBS was higher in permanent dentine. After ageing MTBS decreased and performed similarly in both dentins. CONCLUSIONS: Higher collagenollytic activity is found in deciduous than in permanent dentine. At 24h, collagen cleavage by MMPs at the hybrid layer is higher in deciduous dentine leading to a lower MTBS. CLINICAL SIGNIFICANCE: The presence of resin monomers reduced collagen degradation when applied on demineralized dentine, but exerted protection was lower in deciduous dentine.

Effect of resin composites with sodium trimetaphosphate with or without fluoride on hardness, ion release and enamel demineralization.

PURPOSE: To evaluate the effect of the addition of sodium trimetaphosphate (TMP) with or without fluoride on enamel demineralization, and the hardness and release of fluoride and TMP of resin composites. METHODS: Bovine enamel slabs (4 x 3 x 3 mm) were prepared and selected based on initial surface hardness (n = 96). Eight experimental resin composites were formulated, according to the combination of TMP and sodium fluoride (NaF): TMP/NaF-free (control), 1.6% sodium fluoride (NaF), and 1.5%, 14.1% and 36.8% TMP with and without 1.6% NaF. Resin composite specimens (n = 24) were attached to the enamel slabs with wax and the sets were subjected to pH cycling. Next, surface and cross-sectional hardness and fluoride content of enamel as well as fluoride and TMP release and hardness of the materials were evaluated. Data were statistically analyzed using ANOVA (P < 0.05). RESULTS: The presence of fluoride in enamel was similar in fluoridated resin composites (P > 0.05), but higher than in the other materials (P < 0.05). The combination of 14.1% TMP and fluoride resulted in less demineralization, especially on lesion surface (P < 0.05). The presence of TMP increased fluoride release from the materials and reduced their hardness.

Evaluation of different fluoride concentrations supplemented with trimetaphosphate on enamel de- and remineralization in vitro.

Trimetaphosphate (TMP) effects on demineralized bovine enamel were studied after 15 days of pH cycling. Treatments included 30 wt% (weight percent) dilutions of 0, 500, 1,500 or 3,000 µg F/g aqueous NaF solutions with or without 3% TMP. Treated specimens were assessed by transverse microradiography. With the exception of the 3,000 µg F/g case, 3% TMP addition provided significant additional overall remineralization compared with F alone. Mineral content profiles differed significantly between corresponding F and F + TMP groups. Fluoride alone resulted in more remineralization in the original demineralized zone, whereas F + TMP caused less demineralization in the underlying, originally sound enamel.

pH-cycling models for in vitro evaluation of the efficacy of fluoridated dentifrices for caries control: strengths and limitations

Despite a plethora of in situ studies and clinical trials evaluating the efficacy of fluoridated dentifrices on caries control, in vitro pH cycling models are still broadly used because they mimic the dynamics of mineral loss and gain involved in caries formation. This paper critically reviews the current literature on existing pH-cycling models for the in vitro evaluation of the efficacy of fluoridated dentifrices for caries control, focusing on their strengths and limitations. A search was undertaken in the MEDLINE electronic journal database using the keywords "pH-cycling", "demineralization", "remineralization", "in vitro", "fluoride", "dentifrice". The primary outcome was the decrease of demineralization or the increase of remineralization as measured by different methods (e.g.: transverse microradiography) or tooth fluoride uptake. Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were solved by discussion and consensus or by a third party. One hundred and sixteen studies were included, of which 42 addressed specifically the comparison of dentifrices using different pH-cycling models. The other studies included meta-analysis or reviews, data about the effect of different fluoride sources on de-remineralization, different methods for analysis de-remineralization and chemical variables and characteristics of dental hard tissues that might have influence on de-remineralization processes. Generally, the studies presented ability to detect known results established by clinical trials, to demonstrate dose-related responses in the fluoride content of the dentifrices, and to provide repeatability and reproducibility between tests. In order to accomplish these features satisfactorily, it is mandatory to take into account the type of substrate and baseline artificial lesion, as well as the adequate response variables and statistical approaches to be used. This critical review of literature showed that the currently available pH-cycling models are appropriate to detect dose-response and pH-response of fluoride dentifrices, and to evaluate the impact of new active principles on the effect of fluoridated dentifrices, as well as their association with other anti-caries treatments.

Enamel remineralization by fluoride-releasing materials: proposal of a pH-cycling model

This study proposes a pH-cycling model for verifying the dose-response relationship in fluoride-releasing materials on remineralization in vitro. Sixty bovine enamel blocks were selected for the surface microhardness test (SMH1). Artificial caries lesions were induced and surface microhardness test (SMH2) was performed. Forty-eight specimens were prepared with Z 100, Fluroshield, Vitremer and Vitremer » diluted - powder/liquid, and subjected to a pH-cycling model to promote remineralization. After pH-cycling, final surface microhardness (SMH3) was assessed to calculate percent recovery of surface microhardness ( percentSMHR). Fluoride present in enamel (μg F/mm3) and in the pH-cycling solutions (μg F) was measured. Cross-sectional microhardness was used to calculate mineral content (∆Z). There was no significant difference between Z 100 and control groups on analysis performed on - percentSMHR, ∆Z, μg F and mg F/mm3 (p>0.05). Results showed a positive correlation between percentSMHR and μg F/mm3 (r=0.9770; p=0.004), percentSMHR and μg F (r=0.9939; p=0.0000001), ∆ and μg F/mm3 (r=0.9853; p=0.0002), ∆ and μg F (r=0.9975; p=0.0000001) and between μg F/mm3 and μg F (r=0.9819; p=0.001). The pH-cycling model proposed was able to verify in vitro dose-response relationship of fluoride-releasing materials on remineralization.

Este trabalho propôs um modelo de ciclagem de pH verificando a relação dose-resposta de materiais que liberam flúor na remineralização in vitro. Foram selecionados 60 blocos de esmalte bovino pelo teste de microdureza de superfície (SMH1). Realizou-se indução de cárie e microdureza de superfície pós-cárie (SMH2). Corpos-de-prova (n=48) dos grupos Z 100, Fluroshield, Vitremer e Vitremer diluído » foram fabricados e submetidos à ciclagem de pH para promover a remineralização. Após, avaliou-se a microdureza de superfície final (SMH3) para cálculo da porcentagem de recuperação da microdureza de superfície ( por centoSMHR). Determinou-se o flúor presente no esmalte (μg F/mm3) e nas soluções de ciclagem (μg F). O teste de microdureza em secção longitudinal foi realizado para cálculo do conteúdo mineral (∆Z). Entre os grupos controle e Z100 não houve diferença significativa nas análises realizadas - por centoSMHR, ∆Z, μg F e μg F/mm3 (p>0,05). Houve correlação positiva entre a por centoSMHR e μg F/mm3 (r=0,9770; p=0,004), por centoSMHR e μg F (r=0,9939; p=0,0000001), ∆Z e μg F/mm3 (r=0,9853; p=0,0002), ∆Z e μg F (r=0,9975; p=0,0000001) e também entre μg F/mm3 e μg F (r=0,9819; p=0,001). O modelo de ciclagem de pH proposto foi adequado para verificar relação dose-resposta in vitro de materiais que liberam flúor na remineralização.

Visual evaluation of in vitro cariostatic effect of restorative materials associated with dentifrices

O objetivo deste trabalho foi avaliar, in vitro, o efeito cariostático de 6 materiais restauradores contendo ou não flúor (Fuji II LC, F-2000, Degufil Mineral, Sure Fil and Z-250) associados à aplicação de dentifrícios (fluoretado e não-fluoretado; Sensodyne Fórmula Original and Sensodyne Sodium Bicarbonate) em esmalte dental humano. Cavidades classe V foram preparadas no esmalte de 240 fragmentos dentais, aleatoriamente divididos em 12 grupos (6 materiais e 2 dentifrícios). Após serem restauradas as cavidades, os fragmentos foram submetidos a ciclos térmicos e de desmineralização e remineralização, simulando um alto desafio cariogênico. Sobre os fragmentos restaurados, ainda, foram aplicados dentifrícios contendo ou não flúor, 5 min por dia. As diferenças no desenvolvimento de lesões experimentais de cárie adjacente às restaurações foram avaliadas por 5 examinadores calibrados, através de inspeção visual, atribuindo-se escores de 0 a 3. Os resultados foram avaliados pelo teste de Kruskal-Wallis seguido pelo teste de comparações múltiplas (a=0,05). Quando associados ao dentifrício fluoretado, os materiais restauradores não diferiram entre si em relação ao potencial cariostático (p>0,05). Quando os materiais foram utilizados em associação com o dentifrício não-fluoretado o Ketac-Fil apresentou o maior potencial cariostático, seguido pelo Fuji II LC e pelos demais materiais. O Ketac-Fil foi o único material que não diferiu significativamente quando associado com o dentifrício com ou sem flúor. Sob as condições experimentais do estudo, a associação dos materiais restauradores ao dentifrício fluoretado resultou em uma maior ação cariostática, exceto para o cimento de ionômero de vidro convencional, que não diferiu com a aplicação dos dentifrícios.

Influence of olive oil emulsions on dentin demineralization in vitro.

The effect of two different concentrations of olive oil emulsions on development of artificial caries-like dentin lesions under severe demineralizing conditions was investigated. Bovine dentin samples (n = 180) were ground flat, polished, divided into four groups, and subjected to three demineralization cycles per day. Samples were stored in one of the following solutions for 5 min prior to demineralization in a buffer solution (pH 5): Group 1: 50% oil emulsion (olive oil and distilled water); group 2: 5% oil emulsion; group 3: distilled water; and group 4: 1,500 ppm sodium fluoride. Daily up to 9 days, lesion depth (ld) and mineral loss (deltaZ) were determined by means of microradiography and analyzed by ANOVA and Tukey's studentized range test (p < or = 0.05). Lesion depth increased with time for all groups. Mineral loss increased in groups 1-3. A small but significant decrease in mineral loss was observed following treatment with lipid emulsions as compared to treatment with distilled water, but fluoride treatment was considerably more effective. Mean mineral loss (means +/- SD in vol% x microm) averaged over the study period was 4,368 +/- 1,599, 4,536 +/- 1,823, 4,849 +/- 1,798, and 789 +/- 177 for group 1, 2, 3, and 4, respectively. Ratio (deltaZ/ld) remained constant around 30 vol% for groups 1-3, but decreased for group 4. In conclusion, externally provided lipids have the potential to reduce dentin demineralization in vitro.

Cervical tooth wear and sensitivity: erosion, softening and rehardening of dentine; effects of pH, time and ultrasonication.

BACKGROUND: Cervical dentine wear is commonly observed and may be associated with dentine hypersensitivity. Erosion is thought to play a part in both conditions but compared to enamel has been little studied in dentine. AIM: The aims of these studies in vitro were to: (i) determine the effects of citric acid on dentine at different pH values and over time; (ii) measure the depth of dentine demineralisation or softening using ultrasonication; (iii) determine whether softened dentine can be remineralised or rehardened using artificial saliva. METHODS: Groups of flat dentine specimens prepared from unerupted human third molar teeth were: (a) exposed to citric acid at pH 3.2 for periods up to 4 h with mineral water as control; (b) exposed to citric acid at pH 2.54, 3.2, 4.5, 5.5 and 6.0 for 2 h and then subjected to ultrasonication stepwise up to 480 s; (c) exposed to citric acid at pH 2.54, 3.2, and 4.5, placed into artificial saliva for 24 h and then subjected to ultrasonication as in (b). Loss of dentine was measured by profilometry, after, each phase of erosion, ultrasonication and immersion in artificial saliva. RESULTS: Depth of erosion significantly increased non-linearly with time and significantly decreased with increasing pH. Ultrasonication had minimal albeit significant effects on control specimens. Removal of softened dentine increased with ultrasonication time. Depth of softening significantly increased with increasing erosion time to 2 h, plateauing at 2 microm. Depth of softening increased to 2 microm from pH 2.54 to pH 3.2 and decreased at higher pH values thereafter. 24 h in artificial saliva provided no protection to the soften zone against ultrasonicaion. Citric acid at all pH values and exposure times removed the dentine smear layer to expose tubules. Ultrasonication did not remove the smear layer on control specimens but removed all deposits formed after exposure to artificial saliva. CONCLUSION: It is concluded that dentine is susceptible to erosion even at relatively high pH, the tubule system is readily exposed and dentine, unlike enamel, shows little propensity to remineralise.

Caries prevention by CO2 laser treatment: dependency on the number of pulses used.

The aim of this study was to assess the caries-preventive potential of various carbon dioxide laser conditions and to explore the effect of the number of laser pulses used. The authors irradiated unerupted human molars at two wavelengths--10.6 or 9.6 micrometers--and at 1, 5, 25 or 100 pulses. All teeth were then subjected to pH cycling simulating the conditions for caries progression. Pulsed CO2 laser-preventive treatment inhibited caries-like lesion progression by up to 87 percent. This effect was dependent on the number of pulses used, but there was no correlation between caries resistance and enamel surface morphological changes.

Esmalte aprismático yuxtadentinario y caries, en dientes permanentes / Yuxta-dentinal aprismatic enamel and caries in permanent teeth

Se describen las características del esmalte aprismático yuxtadentinario, empleando microscopía de transparencia, incidencia y polarización. Su presencia es constante, su espesor uniforme y por setores esfumado, adoptando una configuración estructural particular identificada por la microscopía de polarización y es travesado por laminillas, penachos y husos adamantinos. Su comportamiento ante la progresión de la caries, es similar a una barrera natural, ofreciendo resistencia a la desmineralización cariogénica

Práctica preventiva en la lesión de caries / Preventive practice in the carious lesion

Para comprender el proceso de desmineralización-remineralización debemos partir de la base que la superficie del esmalte no es una superficie estática, sino que actúa como una membrana de actividad selectiva que permite la entrada de ciertos iones. La maduración del esmalte es consecuencia de un intercambio contínuo entre película-placa, superficie de esmalte y fluído bucal. Cuando los cristales de hidroxiapatita pierden su capa de iones absorbidos, produciendo la salida de iones CO y PO4, se tiene en consecuencia la desmineralización. Por el contrario, cuando los cristales puden absorber iones aumentan de tamaño y cierran las porosidades favoreciendo la remineralización. Nosotros contamos con la valiosa ayuda del flúor en sus distintas formas que facilitan la absorción de iones a través de la fase fluída produciendo la recristalización de la superficie del esmalte

Procesos de desmineralización y remineralización del esmalte dental / Process of demineralization and remineralization in dental enamel

Se describen los aspectos más importantes del complejo mecanismo físico-químico de de-remineralización del esmalte dental. Como fuera demostrado en modelos in vitro e in vivo, la OH-Ap y sus formas posibles, actúan como un sistema dinámico, donde se reconocen como principales factores: la influencia inhibitoria de las proteínas salivales y del fluoruro, las variaciones anatómicas de los elementos dentarios, el comportamiento químico de los fosfatos, la importancia de la carga y los coeficientes de difusión sobre el gradiente. Si las condiciones del medio lo permiten, la OH-Ap, principal componente de la fase sólida, se convierte en diferentes tipos de fosfatos, correspondiendo al fosfato dicálcico dihidratado (BSH), el octacálcico y el amorfo las formas más estudiadas. La estabilidad-inestabilidad del sistema dependen de pH del medio, de la concentración de fluoruros y de la fuerza iónica. Tanto in vitro como in vivo, la persistencia de la acidez favorece la disolución, mientras que la reducción del tiempo de exposición estimula la remineralización

Esmalte aprismático en surcos de dientes permanentes y caries incipientes / Prismless enamel in grooves from permanent teeth and incipient caries

En 50 dientes permanentes extraídos por diferentes razones, se demuestra la presencia de esmalte aprismático en un 60 por ciento de los mismos, en las vertientes que configuran fosas y surcos oclusales. En un 22 por ciento guardan relación con las estrías de Retzius de los surcos, en forma imbricada, y en un 78 por ciento, la forma laminar. La metodología empleada: microscopía de polarización y microscopía electrónica de barrido (M.E.B.), permiten determinar su aspecto irregular cuando esta zona es afectada por la caries incipiente. Los procesos de pérdida de sales minerales y remineralización se dan principalmente en esta zona

Effects of aluminum (III) and fluoride on the demineralization of bovine enamel: a longitudinal microradiographic study.

Longitudinal microradiography has been used to determine inhibiting effects of aluminum (III), Al, and fluoride on mineral loss from slices of bovine enamel exposed to a demineralizing solution 4 h daily for 35 days. Inhibitor treatment was 5 min four times daily. For the remaining time, the samples were immersed in a neutral calcium phosphate solution which allowed neither remineralization nor demineralization. This study indicates that a 1-mM (27 ppm) solution of Al in a 0.1-M lactate solution, pH 5, has an inhibitory effect on the in vitro demineralization of bovine enamel. Application of this solution alternating with 20 mM (380 ppm) fluoride gave the same total inhibition as treatment with 20 mM fluoride alone.