The use of mouthwash containing trimetaphosphate as an adjunct therapy to fluoridated toothpaste reduces enamel demineralization.

INTRODUCTION: The decline in dental caries has been attributed to the widespread use of fluoride (F). Two forms of presentation are fluoridated toothpaste (FT) and mouthwash (MW), widely used by the population. MATERIALS AND METHODS: This study aimed to evaluate in vitro the effects of combining FT and MW, whether supplemented with sodium trimetaphosphate (TMP) or not, on dental enamel demineralization. Bovine enamel blocks (n = 60) were selected based on initial surface hardness (SHi) and divided into 5 experimental groups (n = 12 each): I) Placebo Toothpaste (without F/TMP); II) 1100 ppm F Toothpaste (FT); III) 1100F associated with a MW at 100 ppm F (FT + MW 100F); IV) 1100F associated with a MW at 225 ppm F (FT + MW 250F); and V) 1100F associated with a MW at 100 ppm F supplemented with 0.4 % TMP (FT + MW 100F-TMP). The blocks were treated twice a day, undergoing 5 pH cycles over 7 days. Thus, the percentage change in surface hardness (%SH), integrated subsurface hardness loss (ΔKHN), and the concentration of F, phosphorus (P), and calcium (Ca) in the enamel were determined. The data were submitted to ANOVA and Student-Newman-Keuls test (p < 0.001). RESULTS: The 1100F group was statistically inferior to the groups associated with MW for %SH, ΔKHN, and the concentration of P and Ca in the enamel (p < 0.001). Blocks treated with FT + MW 225F and FT + MW 100F-TMP showed significantly lower %SH compared to the other groups (p < 0.001). The FT + MW 100F - TMP group exhibited the lowest depth mineral loss (ΔKHN), and higher concentration de P in enamel (p < 0.001). CONCLUSION: The adjunct use of MW with FT produces a greater protective effect in inhibiting enamel demineralization, and the supplementation of TMP to the MW with 100F provides a superior effect compared to MW with 225F. CLINICAL SIGNIFICANCE: This combination of treatments could be regarded as one of several alternative fluoride supplements for subjects at elevated risk of caries.

A systematic review and meta-analysis on the effects of phototherapy on postoperative pain in conventional endodontic reintervention.

OBJECTIVES: This systematic review and meta-analysis (SRM) aimed to evaluate the efficacy of laser phototherapy (LPT) on the reduction in postoperative pain (PP) of endodontic origin after conventional/non-surgical reintervention of root canals. METHODS: This SRM was registered with PROSPERO (CRD42021243500) and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Meta-analysis was conducted using R software with the "META" package, the mean difference (MD) measure of effect was calculated, and the fixed effect model was applied with a 95% confidence interval (CI). The Cochrane collaboration scale was used to assess the risk of bias and the GRADE tool to assess the quality of evidence. RESULTS: Initially, 1028 articles were found, and five articles were included. Most studies were classified as "low" risk of bias. Of the five clinical studies, four showed a significant decrease in PP after endodontic reintervention in the LPT groups compared to the control group, especially in the first four days after the intervention. In symptomatic teeth with multiple roots, LPT led to less PP at 24 h (MD -0.52 [-1.03; -0.02] p = .04). However, no significant difference between the groups was found at 48 and 72 h (p > .05). The certainty of the evidence was classified as low. CONCLUSION: Despite the limitations of this SRM, LPT was shown to be a promising alternative for reducing and controlling PP in conventional endodontic reintervention. CLINICAL SIGNIFICANCE: The use of LPT in endodontic reintervention may be a safe and promising alternative to clinically efficacious agent for use in the management of PP in this procedure.

Biomineralization and remineralizing potential of toothpastes containing nanosized ß-calcium glycerophosphate: an in vitro study.

To evaluate the effect of 1100 ppm F toothpastes supplemented with micrometric or nanosized ß-CaGP (ß-CaGPm/ß-CaGPn) on artificial enamel remineralization, using a pH cycling model. Enamel blocks with artificial caries were randomly allocated into ten groups (n = 10), according to the toothpastes: without fluoride/ß-CaGPm/ß-CaGPn (negative control); 1100 ppm F (1100F); 1100F plus 0.125%, 0.25%, 0.5%, and 1.0% of ß-CaGPm or ß-CaGPn. The blocks were treated 2×/day with slurries of toothpastes. After pH cycling, the percentage of surface hardness recovery (%SHR); integrated loss of subsurface hardness (ΔKHN); integrated mineral loss (ΔIMR); fluoride (F), calcium (Ca), and phosphorus (P) concentrations in the enamel; polydispersity index (PdI); and zeta potential (Zp) were determined. The data were analyzed by ANOVA (p < 0.001). For Zp/PdI, no significance was observed when comparing the means (p > 0.001). The treatment with 1100F-0.25%ß-CaGPn led to %SHR ∼57 higher when compared to the 1100F group (p < 0.001). The lowest ΔKHN was observed for the 1100F-0.25%ß-CaGPn group (p < 0.001). The ΔIMR was lower (∼201%) for the 1100F-0.25%ß-CaGPn when compared to 1100F (p < 0.001). The association of ß-CaGPm and ß-CaGPn to 1100F did not influence its F concentration (p > 0.001). The highest increase in Ca and P was observed for 1100F-0.25%ß-CaGPn (p < 0.001). The addition of 0.25%ß-CaGPn to 1100F toothpaste was able to promote an additional remineralizing effect of artificial caries lesions.

Análise in vitro da capacidade de soluções contendo fluoreto e/ou trimetafosfato na remineralização da dentina e na inibição da atividade de metaloproteinases da matriz dentinária / In vitro analysis of the capacity of solutions containing fluoride and/or trimetaphosphate in the remineralization of dentin and in the inhibition of the activity of dentin matrix metalloproteinases

Objetivo: O objetivo deste estudo foi investigar o potencial anti-proteolítico contra MMP-2 e MMP-9 e a capacidade de induzir a remineralização da dentina, através de soluções contendo diferentes concentrações de TMP (na sua forma cíclica), diferentes concentrações de F e associação TMP/F. Métodos: Blocos de dentina radicular (6mmx4mmx2mm, n = 130) foram selecionados e divididos aleatoriamente em 13 grupos/soluções experimentais (n = 10): 1) Placebo (sem F/TMP); 2) 0,3% TMP hidrolisado; 3) 1% TMP hidrolisado; 4) 3% TMP hidrolisado; 5) 0,3% TMP; 6) 1% TMP; 7) 3% TMP; 8) 250 ppm F; 9 500 ppm F; 10) 1100 ppm F; 11) 250 ppm F associado a 0,3% TMP; 12) 500 ppm F associado a 1% TMP e 13) 1100 ppm F associado a 3% TMP. A avaliação do potencial anti-proteolítico das soluções experimentais contra as metaloproteinases da matriz dentinária (- 2 e -9) foi realizado por meio da análise zimográfica. Para as análises mecânicas, três áreas foram determinadas para cada espécime: 1- controle (sem tratamento); 2- desmineralizado (cárie artificial); 3- tratado (desmineralizado e submetido a ciclagem de pH por 7 dias, e tratado por 1 min com as soluções experimentais). Os espécimes de dentina foram analisados quanto à porcentagem de recuperação de dureza superficial (%SHR), em dureza transversal (%CSHR) e por microtomografia computadorizada (IMC). Para os dados de dureza e Micro-CT, os resultados foram analisados por ANOVA de medidas repetidas seguida do teste de Student-Newman-Keuls (p <0,05). Resultados: A análise zimográfica mostrou que 1100 ppm F + 3% de TMP promoveu inibição completa da atividade gelatinolítica (MMP-2; MMP-9). Os grupos com TMP não hidrolisados apresentaram efeito remineralizador (% SHR e % CSHR) superior aos grupos hidrolisados. O grupo 1100F + TMP promoveu a maior %SHR e %CSHR entre todos os grupos (p <0,001), sendo respectivamente 15,4 e 10,5%, superior ao grupo 1100F. Os grupos contendo 1100F e 1100F + 3%TMP apresentaram maior concentração mineral. Conclusão: Com base nos resultados, 3% TMP atua como um agente antiproteolítico contra metaloproteinases da matriz dentinária. Além disso, quando suplementado com 1100F, 3% TMP potencializa a remineralização, aumentando significativamente as propriedades mecânicas da dentina tratada. Os tratamentos com TMP não hidrolisado e associado ao F maior que as soluções fluoretadas sem o TMP. Significância clínica: Dessa forma, uma potencial estratégia preventiva e terapêutica pode ser considerada na clínica odontológica, principalmente na terapia da cárie radicular, como também para método preventivo de lesões iniciais de cárie dentinária ou no pré-tratamento da dentina, utilizando-os como agentes cross-linker em procedimentos restauradores(AU)

Objective: The aim of this study was to investigate the anti-proteolytic potential against MMP-2 and MMP-9 and the ability to induce dentin remineralization, through solutions containing different concentrations of TMP (in its cyclic form), different concentrations of F and TMP / F association. Methods: Root dentin blocks (6mmx4mmx2mm, n = 130) were selected and randomly divided into 13 groups / experimental solutions (n = 10): 1) Placebo (without F / TMP); 2) 0.3% hydrolyzed TMP; 3) 1% hydrolyzed TMP; 4) 3% hydrolyzed TMP; 5) 0.3% TMP; 6) 1% TMP; 7) 3% TMP; 8) 250 ppm F; 9,500 ppm F; 10) 1100 ppm F; 11) 250 ppm F associated with 0.3% TMP; 12) 500 ppm F associated with 1% TMP and 13) 1100 ppm F associated with 3% TMP. The evaluation of the antiproteolytic potential of experimental solutions against dentin matrix metalloproteinases (- 2 and -9) was carried out by means of zymographic analysis. For mechanical analysis, three areas were determined for each specimen: 1- control (without treatment); 2- demineralized (artificial caries); 3- treated (demineralized and subjected to pH cycling for 7 days, and treated for 1 min with the experimental solutions). The dentin specimens were analyzed for the percentage of recovery of superficial hardness (% SHR), in crosssectional hardness (% CSHR) and by computed microtomography (∆IMC). For the hardness and Micro-CT data, the results were analyzed by repeated measures ANOVA followed by the Student-Newman-Keuls test (p <0.05). Results: The zymographic analysis showed that 1100 ppm F + 3% TMP promoted complete inhibition of gelatinolytic activity (MMP-2; MMP-9). The groups with non-hydrolyzed TMP showed a remineralizing effect (% SHR and % CSHR) superior to the hydrolyzed groups. The 1100F + TMP group promoted the highest % SHR and % CSHR among all groups (p <0.001), being 15.4 and 10.5%, respectively, higher than the 1100F group. The groups containing 1100F and 1100F + 3% TMP showed higher mineral concentration. Conclusion: Based on the results, 3% TMP acts as an antiproteolytic agent against dentinal matrix metalloproteinases. In addition, when supplemented with 1100F, 3% TMP enhances remineralization, significantly increasing the mechanical properties of the treated dentin. Treatments with non-hydrolyzed TMP and associated with F greater than fluoridated solutions without TMP. Clinical significance: Thus, a potential preventive and therapeutic strategy can be considered in the dental clinic, mainly in the treatment of root caries, as well as for the preventive method of initial lesions of dental caries or in the pretreatment of dentin, using them as agents cross-linker in restorative procedures(AU)

In situ effect of fluoride toothpaste supplemented with nano-sized sodium trimetaphosphate on enamel demineralization prevention and biofilm composition.

OBJECTIVE: To evaluate the effect of a fluoride toothpaste containing nano-sized sodium trimetaphosphate (TMPnano) on enamel demineralization in situ and composition of the biofilm. DESIGN: This crossover double-blind study consisted of four phases (seven days each) and 12 volunteers who wore oral appliances containing four enamel bovine blocks. The cariogenic challenge was performed by 30% sucrose solution (6x/day). The toothpaste treatments (3x/day) were as follows: no F/TMP/TMPnano (Placebo), 1100 ppm F (1100F), 1100F plus 3% micrometric or nano-sized TMP (1100F/TMP; 1100F/TMPnano). Percentage of surface hardness loss (%SH), and integrated loss of subsurface hardness (ΔKHN), as well as enamel calcium (Ca), phosphorus (P), and fluoride (F) were determined. Moreover, biofilm formed on the blocks were analyzed for F, Ca, P, and insoluble extracellular polysaccharide (EPS) concentrations. Data were analyzed using one-way ANOVA, repeated measures followed by Fisher LSD test (p < 0.001). RESULTS: 1100F/TMPnano promoted the lowest %SH and ΔKHN among all groups (p < 0.001). Regarding the F concentrations in the enamel and in the biofilm, there were no significant differences between 1100 F and 1100 F/TMPnano, but significantly increased enamel Ca concentrations (p < 0.001). 1100F/TMPnano showed lower values of EPS concentration when compared with 1100F (∼80%) (p < 0.001). CONCLUSION: 1100F/TMPnano promoted a greater protective effect against enamel demineralization and significantly affected the composition of biofilm formed in situ when compared to 1100F toothpaste.

Remineralizing effect of a fluoridated gel containing sodium hexametaphosphate: An in vitro study.

OBJECTIVES: To evaluate in vitro the effect of neutral pH topical gels with reduced fluoride concentration (F), supplemented or not with sodium hexametaphosphate (HMP) on the remineralization of dental enamel, using a pH-cycling model. Materials and methods Bovine enamel blocks with caries-like lesions were randomly treated with five gels (n = 24/group): without F/HMP (Placebo); 4500 ppm F (4500F), 4500F plus 9% HMP (4500F + HMP); 9000 ppm F (9000F); and 12,300 ppm F (Acid gel). After pH-cycling, the percentage of surface hardness recovery (%SHR), integrated loss of subsurface hardness (ΔKHN), and concentrations of loosely- (CaF2) and firmly-bound (FA) fluoride formed and retained in/on enamel were determined. The results were analyzed by ANOVA followed by the Student-Newman-Keuls test (p < 0.001). RESULTS: The 4500F + HMP gel promoted the highest %SHR among all groups; the lowest ΔKHN was achieved by 4500F + HMP and Acid gel, without significant differences between these. The Acid gel group presented the highest CaF2 and FA formed and retained on/in enamel (p < 0.001). CONCLUSION: Based on the present results, the addition of 9% sodium hexametaphosphate to a gel with reduced fluoride concentration (4500F) was able to significantly enhance the remineralization of artificial carious lesions in vitro when compared to 4500F, reaching protective levels similar to an acidic formulation with ∼3-fold higher fluoride concentration.