Use of infrared photobiomodulation with low-level laser therapy for reduction of bleaching-induced tooth sensitivity after in-office bleaching: a double-blind, randomized controlled trial.

The purpose of this study is to evaluate the use of infrared photobiomodulation with low-level laser therapy (PBM) to reduce bleaching-induced tooth sensitivity (TS) after in-office bleaching. Eighty-three participants were randomized in blocks into two groups. In the experimental group, the patients received an application after each session of in-office bleaching (35% hydrogen peroxide, 1 × 50 min; 2 sessions with 1-week interval), while the laser application was simulated in the control group. The PBM system was operated in continuous mode, using 3 J of energy. A dose of 100 J/cm2 was applied for 30 s with 808 nm (100 mW of power) in the middle third of the crown. The risk and intensity of TS were recorded immediately after bleaching, 1 h, 24 h, and 48 h after each bleaching session, with a visual scale analog (0-10) and a five-point numerical scale (0-4). The color was recorded at the beginning, weekly, and 1 month after the end of the bleaching (VITA Classical, VITA Bleachedguide, and digital spectrophotometer). The risk of TS was 98% (95% CI 88 to 99%) for the laser group and 95% (95% CI 83 to 99%) for the control (RR = 1.03; 95% CI 0.94 to 1.12; p = 1.0). Similarly, no difference in the intensity of TS was detected for both pain scales (p > 0.65). Improvement in color change, regardless of the group, was observed (p > 0.15). The application of an PBM did not reduce the risk and intensity of TS when applied after the procedure using the parameters recommended by the manufacturer.Trial registration number and date of registration: RBR-4HCVSG-04/06/2019.

Intrapocket topical anesthetic versus injected anesthetic for pain control during scaling and root planing in adult patients: Systematic review and meta-analysis.

BACKGROUND: In this systematic review and meta-analysis, the authors evaluated the pain during scaling and root planing with use of topical anesthetic versus that with the use of injected anesthetic in adult patients. TYPES OF STUDIES REVIEWED: The authors searched 6 databases for randomized clinical trials in which the investigators compared the clinical effectiveness of intrapocket and injectable anesthetics. The primary outcome was the risk of developing pain or intensity of pain. Quality assessment followed the guidelines from the Cochrane Collaboration's risk-of-bias tool. The authors performed meta-analyses on studies considered at low and unclear risk of bias. RESULTS: From 976 articles identified, 6 remained in the qualitative synthesis (4 at low and 2 at unclear risk of bias). Injected anesthetic produced lower pain intensity than did anesthetic gel (P = .03) and required less rescue anesthetic than did topical anesthetic (P < .0001). There was no difference in patient preference (P = .09). CONCLUSIONS AND PRACTICAL IMPLICATIONS: Injected anesthetic decreased the intensity of pain and the need for rescue anesthetic during scaling and root planing, but the risk of developing pain yielded similar results for injected and topical anesthetics.

Potential of desensitizing toothpastes to reduce the hydrogen peroxide diffusion in teeth with cervical lesions.

PURPOSE: To evaluate the occlusive potential of four toothpastes by atomic force microscopy (AFM) before and after bleaching and quantify the hydrogen peroxide (HP) diffusion into the pulp chamber after application of desensitizing toothpastes in teeth with cervical lesions. METHODS: In 52 human extracted premolars, 2-mm deep artificial cervical lesions (ACL) were prepared and rinsed with EDTA for 10 seconds. Then teeth were adapted in a brushing machine and brushed with one of the following toothpastes [Regular toothpaste with no occlusive compounds Colgate Cavity Protection (CP), Oral-B Pro Health (OB), Colgate ProRelief (PR) and Sensodyne Rapid Relief (RR)] under constant loading (250 g; 4.5 cycles/seconds; 3 minutes). In 13 teeth (control group), no artificial cervical lesion was prepared. After that, the teeth were bleached with 35% HP with three 15-minute applications. The HP diffusion was measured spectrophotometrically as a stable red product based on HP reaction with 4-aminoanthipyrine and phenol in presence of peroxidase, at a wavelength of 510 nm and the dentin surfaces of ACL were evaluated before and after bleaching by AFM. Data was statistically analyzed by one-way ANOVA and Tukey's test (alpha = 0.05). RESULTS: In the AFM images, some modifications of the dentin surface were observed after application of OB and RR. However, only for RR the formation of a surface deposit was produced, which occluded the majority of the dentin tubules. Also, only for RR, this deposit was not modified/removed by bleaching. Despite this, all groups with ACL showed higher HP penetration than sound teeth, regardless of the toothpaste used (P < 0.001).

Effect of EDTA conditioning on cervical restorations bonded with a self-etch adhesive: A randomized double-blind clinical trial.

OBJECTIVE: To compare the 18-month retention rates of composite restorations in non-carious cervical lesions [NCCLs] bonded with a self-etch adhesive with and without preliminary conditioning with EDTA. METHODS: Forty-eight patients with two similar-sized NCCL were selected and randomly allocated to one of two groups. Two calibrated operators placed 96 restorations with a one-step self-etch adhesive (Adper Easy One, 3M ESPE). Half of the restorations were placed according to the manufacturer's instructions while, for the other half, the surfaces of the lesions were conditioned with 17% EDTA for 2 min prior to adhesive application. Two blinded and independent examiners evaluated the restorations at baseline, 6, 12, and 18 months, according to the FDI criteria. The comparison between groups in each period was conducted with the Fisher's exact test, and the performance of each group at the different periods was evaluated by McNemar's test (α=0.05). RESULTS: After 18 months, significantly higher retention rates (95% CI) were observed for the EDTA group (95.5 [84.9-98.7]) than the control group (79.6% [65.5-88.9]) (p=0.02). Significant deterioration of the marginal adaptation and marginal discoloration were observed for both groups over the 18-month evaluation. CONCLUSIONS: The preliminary conditioning with EDTA before application of a one-step self-etch adhesive significantly improved the retention rates of composite restorations in cervical lesions. CLINICAL SIGNIFICANCE: Conditioning with EDTA is an alternative that improves the 18-month retention rate of cervical restorations bonded with a self-etch adhesive.

Arthroscopy for temporomandibular disorders.

BACKGROUND: Temporomandibular disorders (TMDs) are considered a collection of disorders involving many organic, psychological and psychosocial factors. They can involve the masticatory muscles or the temporomandibular joint (TMJ) and associated structures, or both. It is estimated that 40% to 75% of the population displays at least one sign of the disease and 33% of the population reports at least one symptom. Arthroscopy has been used to reduce signs and symptoms of patients with TMD but the effectiveness has still not been totally explained. OBJECTIVES: To assess the effectiveness of arthroscopy for the management of signs and symptoms in patients with TMDs. SEARCH STRATEGY: The Cochrane Oral Health Group Trials Register (to 23 December 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2010), MEDLINE via OVID (1950 to 23 December 2010), EMBASE via OVID (1980 to 23 December 2010), LILACS via BIREME Virtual Health Library (1982 to 23 December 2010), Allied and Complementary Medicine Database (AMED) via OVID (1985 to 23 December 2010), CINAHL via EBSCO (1980 to 23 December 2010). There were no restrictions regarding the language or date of publication. SELECTION CRITERIA: Randomized controlled clinical trials of arthroscopy for treating TMDs were included. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data, and three review authors independently assessed the risk of bias of included trials. The authors of the selected articles were contacted for additional information. MAIN RESULTS: Seven randomized controlled trials (n = 349) met the inclusion criteria. All studies were either at high or unclear risk of bias. The outcome pain was evaluated after 6 months in two studies. No statistically significant differences were found between the arthroscopy versus nonsurgical groups (standardized mean difference (SMD) = 0.004; 95% confidence interval (CI) -0.46 to 0.55, P = 0.81). Two studies, analyzed pain 12 months after surgery (arthroscopy and arthrocentesis) in 81 patients. No statistically significant differences were found (mean difference (MD) = 0.10; 95% CI -1.46 to 1.66, P = 0.90). Three studies analyzed the same outcome in patients who had been submitted to arthroscopic surgery or to open surgery and a statistically significant difference was found after 12 months (SMD = 0.45; 95% CI 0.01 to 0.89, P = 0.05) in favor of open surgery. The two studies compared the maximum interincisal opening in six different clinical outcomes (interincisal opening over 35 mm; maximum protrusion over 5 mm; click; crepitation; tenderness on palpation in the TMJ and the jaw muscles 12 months after arthroscopy and open surgery). The outcome measures did not present statistically significant differences (odds ratio (OR) = 1.00; 95% CI 0.45 to 2.21, P = 1.00). Two studies compared the maximum interincisal opening after 12 months of postsurgical follow-up. A statistically significant difference in favor of the arthroscopy group was observed (MD = 5.28; 95% CI 3.46 to 7.10, P < 0.0001). The two studies compared the mandibular function after 12 months of follow-up with 40 patients evaluated. The outcome measure was mandibular functionality (MFIQ). This difference was not statistically significant (MD = 1.58; 95% CI -0.78 to 3.94, P = 0.19).   AUTHORS' CONCLUSIONS: Both arthroscopy and nonsurgical treatments reduced pain after 6 months. When compared with arthroscopy, open surgery was more effective at reducing pain after 12 months. Nevertheless, there were no differences in mandibular functionality or in other outcomes in clinical evaluations. Arthroscopy led to greater improvement in maximum interincisal opening after 12 months than arthrocentesis; however, there was no difference in pain.

Microtensile bond strength of prehybridized dentin: storage time and surface treatment effects.

PURPOSE: This study evaluated the effect of surface treatments of the prepolymerized adhesive layer in the immediate dentin sealing technique (IDS) on the microtensile bond strength of two-step etch-and-rinse adhesive systems. MATERIALS AND METHODS: The occlusal dentin surfaces of 60 human third molars were exposed and Adper Single Bond 2 (SB) or Prime & Bond NT (PB) adhesive systems were applied (control groups). Immediately afterwards, the temporary cement RelyXTemp NE was applied on the bonded dentin surface, and the teeth were stored in artificial saliva for 48 h or 4 months. After the storage time, the temporary cement layer was removed and the following surface treatments were applied: aluminum oxide (AO), 37% phosphoric acid (PA), or AO+PA. Next, a second adhesive layer was applied for each adhesive system, and a composite resin block restoration (Z250) was built. The specimens were cut and submitted to microtensile strength (microTBS) testing. The adhesive layer thickness (ALT) was evaluated in other specimens from all groups by SEM. The fracture pattern was evaluated in all sticks tested by SEM. microTBS and ALT values were analyzed with two-way ANOVA and Tukey's test (alpha = 0.05). RESULTS: The highest microTBS, similar to the control, was obtained with aluminum oxide and phosphoric acid (AO+PA) for both adhesives systems. The use of aluminum oxide alone (AO) or associated with phosphoric acid (AO+PA) showed values close to those of the control groups in relation to the ALT. The failure pattern was the same for control groups and AO +PA groups. CONCLUSION: Dentin prehybridization can improve the adhesive bond strength if the bonded surface is treated with airborne aluminum oxide particle abrasion associated with 37% phosphoric acid, followed by application of a second adhesive layer.