Effect of gel replacement during in-office dental bleaching: a case report.

In-office dental bleaching allows the dentist to have greater control of the procedure and prevents patients from ingesting chemicals. To obtain optimum results, in-office bleaching usually requires a longer period of application as well as changes of the bleaching agent applied to the tooth surfaces at each appointment. The objective of this case report was to assess, by means of a split-mouth design in a single patient, the final tooth color and tooth sensitivity resulting from 2 different bleaching protocols: 1 application of 35% hydrogen peroxide for 45 minutes and 3 applications of 35% hydrogen peroxide for 15 minutes each. Neither the patient nor 5 individuals who were blinded to the techniques noted a difference in the final esthetic results of the 2 protocols immediately after the procedure. In addition, the patient reported that no tooth sensitivity was associated with either protocol. The results of dental bleaching on both sides were maintained after 15 days. The results shown in the present case report suggest that there may be no need to renew the gel during in-office dental bleaching.

The association between Nd:YAG laser and desensitizing dentifrices for the treatment of dentin hypersensitivity.

This study aims to evaluate the association between Nd:YAG laser (with and without a photoabsorber) and two desensitizing dentifrices containing 15% NovaMin or 8% arginine, as potential treatments for dentin hypersensitivity (DH). DH was simulated by EDTA application for 2 min. Specimens were then analyzed with an environmental scanning electron microscope (ESEM) to ensure open dentin tubules (ODT), counted by using ImageJ software. Specimens were randomized into eight groups (n = 10): Laser (L), Laser+Photoabsorber (LP), Arginine (A), Arginine+Laser (AL), Arginine+Laser+Photoabsorber (ALP), NovaMin (N), NovaMin+Laser (NL), and NovaMin+Laser+Photoabsorber (NLP). Laser irradiation was performed with 1 W, 100 mJ, 10 Hz, ≅85 J/cm2; 4 irradiations of 10 s each, with 10 s intervals between them. After treatment, specimens were again analyzed by ESEM and submitted to erosive/abrasive cycling for 5 days. A final ESEM analysis was performed. Data were analyzed with two-way repeated measure ANOVA and Tukey tests (α = 0.05). After treatment, groups N, NL, and NLP presented the lower number of ODT, but they did not different from LP, ALP, and AL. Group A presented the highest number of ODT and it did not differ from group L. Groups L, AL, ALP, and LP presented intermediate results, without differing from each other. After cycling, group A presented the highest number of ODT and did not differ significantly from the other groups, except NLP. None of the associations tested presented better tubule occlusion than NovaMin by itself. Arginine was the only treatment that presented improved tubule occlusion when associated with Nd:YAG laser.

Effects of Different Radiation Doses on the Bond Strengths of Two Different Adhesive Systems to Enamel and Dentin.

PURPOSE: To evaluate the effects of three different radiation doses on the bond strengths of two different adhesive systems to enamel and dentin. MATERIALS AND METHODS: Eighty human third molars were randomly divided into four groups (n = 20) according to the radiation dose (control/no radiation, 20 Gy, 40 Gy, and 70 Gy). The teeth were sagittally sectioned into three slices: one mesial and one distal section containing enamel and one middle section containing dentin. The sections were then placed in the enamel and dentin groups, which were further divided into two subgroups (n = 10) according to the adhesive used. Three restorations were performed in each tooth (one per section) using Adper Single Bond 2 (3M ESPE) or Universal Single Bond (3M ESPE) adhesive system and Filtek Z350 XT (3M ESPE) resin composite and subjected to the microshear bond test. Data were analyzed using a two-way ANOVA followed by Tukey's test. Failure modes were examined under a stereoscopic loupe. RESULTS: Radiotherapy did not affect the bond strengths of the adhesives to either enamel or dentin. In dentin, the Universal Single Bond adhesive system showed higher bond strength values when compared with the Adper Single Bond adhesive system. More adhesive failures were observed in the enamel for all radiation doses and adhesives. CONCLUSION: Radiotherapy did not influence the bond strength to enamel or dentin, irrespective of the adhesive or radiation dose used.

The Effects of Ionizing Radiation on the Oral Cavity.

AIM: The aim of this study is to present a literature review on the effects of the ionizing radiation from radiotherapy treatment on dental tissues. BACKGROUND: Among the effects of increasing global life expectancy and longevity of the teeth in the oral cavity, increasing rates of neoplastic diseases have been observed. One of the important treatment modalities for head and neck neoplastic diseases is radiotherapy, which uses ionizing radiation as the main mechanism of action. Therefore, it is essential for dentists to be aware of the changes in oral and dental tissues caused by ionizing radiation, and to develop treatment and prevention strategies. RESULTS: In general, there is still controversy about the effects of ionizing radiation on dental structures. However, qualitative and quantitative changes in saliva and oral microbiota, presence of oral mucositis and radiation-related caries are expected, as they represent the well-known side effects of treatment with ionizing radiation. Points that still remain unclear are the effects of radiotherapy on enamel and dentin, and on their mechanisms of bonding to contemporary adhesive materials. CONCLUSION: Ionizing radiation has shown important interaction with organic tissues, since more deleterious effects have been shown on the oral mucosa, salivary glands and dentin, than on enamel. CLINICAL SIGNIFICANCE: With the increasing number of patients with cancer seeking dental treatment before and after head and neck radiotherapy, it is important for dentists to be aware of the effects of ionizing radiation on the oral cavity.

Effectiveness of Violet LED alone or in association with bleaching gel during dental photobleaching: A Systematic Review.

AIMS: To conduct a systematic review to determine the efficacy of violet led in promoting dental bleaching by itself or accelerating dental bleaching when associated with peroxides. METHODS: Clinical and in vitro studies were identified by a search on November 27th 2020 in the PubMed and Scopus databases. Inclusion criteria were: 1) studies related to bleaching; 2) studies related to violet LED Light (405-410nm); and 3) studies that analyzed efficacy. The authors assessed the studies for risk of bias independently. Authors extracted outcomes including color change evaluation and pain assessment independently. RESULTS: During the search process, 895 articles were found in the previously cited databases. After the first screening consisting of title and abstract evaluations, 18 articles were selected. Finally, 13 articles met the eligibility criteria and were included in this review, being 5 clinical trial/case series and 8 in vitro studies. In vitro studies showed a high risk of bias and interventional studies showed a low risk of bias. CONCLUSION: The violet Led seems to have the potential to bleach teeth without peroxides, with a clinical perceptible color alteration. However, the effect is small in comparison to bleaching using peroxides. When Violet Led is used in association with peroxides, it seems to potentialize the bleaching result. However, due to the high heterogeneity between studies, a small number of clinical studies, and the high risk of bias of the in vitro included studies, the results are not definitive, and further well-designed studies are needed to reach safe evidence.

Influence of 35% hydrogen peroxide gel renewal on color change during in-office dental photobleaching with violet LED: A split-mouth randomized controlled clinical trial.

BACKGROUND: To clinically evaluate the effect of 35% hydrogen peroxide gel renewal in association with violet LED (405-410nm) through a split-mouth randomized controlled clinical trial. METHODS: The treatment consisted in 3 bleaching sessions of 15 min each, with an interval of 7 days between them, using 35% hydrogen peroxide combined to violet LED irradiation. Selected patients had two experimental segments for the split-mouth design: No change of the bleaching gel during each session (NBGR) and 3 changes of the bleaching gel every 5 min for each session (BGR). During the 3 bleaching sessions, the selected quadrant received the same treatment. Patients had their upper canines and central incisors teeth color measured with a subjective (color scale - VITA Classical) and an objective (spectrophotometer - VITA Easyshade) method and their teeth sensitivity measured using a Visual Analog Scale (VAS) before, immediately after each bleaching session, and 14 days and 2 months (60 days) after the end of the treatment. RESULTS: The protocol adopted in the present study reached satisfactory results regarding color change. No statistical difference between groups was observed immediately after the end of the treatment and in the follow-up analysis for both subjective and objective color evaluation. No difference in tooth sensitivity between segments was observed. CONCLUSION: There is no need for bleaching gel renewal when following the clinical protocol of 3 sessions of 15 min in a bleaching protocol of 35% hydrogen peroxide combined with violet LED.

In vivo and in vitro radiotherapy increased dentin enzymatic activity.

OBJECTIVES: The present study investigated the effects of in vitro and in-vivo radiotherapy on endogenous enzymatic activity in dentin using gelatin zymography and in-situ zymography. METHODS: Gelatin zymographic assays were performed on protein extracts obtained from dentin powder of sound non-irradiated (NRT), in vitro irradiated (VTRT) and in vivo irradiated (VIRT) human teeth. Their proteolytic activities were quantified using band densitometric evaluation. For in-situ zymography, dentin specimens from NRT, VIRT and VTRT were covered with fluorescein-conjugated gelatin and examined with confocal laser-scanning microscopy. Fluorescence intensity emitted by the hydrolyzed fluorescein-conjugated gelatin was quantified and statistically analyzed. In-situ zymography data were statistically analyzed using Kruskal-Wallis ANOVA and Dunn's multiple comparison procedures (α = 0.05). RESULTS: No difference between in vitro and in vivo radiotherapy treatment was found. Both VTRT and VIRT groups showed increase in MMP-9 expression when compared to NRT group. Significant increases (p < 0.05) in gelatinolytic activity (26 % for VTRT; 55 % for VIRT) were observed when compared to the NRT group. CONCLUSION: Radiotherapy increase endogenous enzymatic activity in non-restored dentin.

Chlorhexidine preserves the hybrid layer in vitro after 10-years aging.

OBJECTIVE: The present study investigated the ability of a chlorhexidine (CHX)-containing primer (0.2% aqueous solution) to inhibit dentinal enzymes, preserve the hybrid layer (HL) and remain within the HL, after 10 years of aging in artificial saliva at 37°C. METHODS: Non-carious extracted molars were assigned to two groups, cut into slabs exposing middle/deep dentin, etched and bonded with Adper Scotchbond 1XT (SB1XT) with or without 0.2% CHX aqueous solution pretreatment. Composite build-ups were made, and the specimens were cut in 1-mm thick bonded sticks. In situ zymography was performed on freshly prepared specimens (T0) and specimens aged for 10 years (T10-yr) at 37°C in artificial saliva, to investigate endogenous gelatinolytic activity within the HL. At T10-yr, specimens were also decalcified and embedded in epoxy resin for TEM analysis. Micro-Raman spectroscopy was performed at T0 and T10-yr to evaluate the chemical profiles in intertubular dentin and the HL. RESULTS: In situ zymography showed less pronounced enzymatic activity in the CHX-pretreated group (p<0.05) regardless of aging, maintaining a similar level of fluorescence at T0 and T10-yr (p>0.05). TEM results showed that 98% of the HL had been degraded in the control group, while 95% of the HL was intact in the experimental group. Moreover, all the Raman spectra peaks assigned to CHX could be identified only in the CHX-pretreated group (T0 and T10-yr). SIGNIFICANCE: In vitro, CHX remains in the HL after 10 years with its inhibitory effect preserved. This may be the underlying factor for HL preservation after this long aging period.

Long-term bond strength and endogenous enzymatic activity of a chlorhexidine-containing commercially available adhesive.

OBJECTIVES: The aim of this study was to investigate, by the means of microtensile bond strength (µTBS) test, gelatin and in situ zymography, the influence of 0.2% CHX contained within a commercially available adhesive on long-term bond strength and endogenous enzymatic activity. METHODS: Non-carious teeth were subjected to µTBS test (N = 15 for each group) and stressed until failure. µTBS was evaluated immediately and after 12-month storage in artificial saliva at 37 °C. Dentin powder was obtained from additional teeth (N = 7) for gelatin zymography, while for in situ zymography, 3 teeth for each group were selected. Gelatin and in situ zymography were performed in dentin powder and slices of dentin, respectively, to assess the ability of 0.2% CHX blended within the adhesive to inhibit endogenous enzymatic activity. RESULTS: µTBS bond strength was higher in the CHX-containing groups, immediately as well as after aging. The bond strength significantly decreased after 12-month aging. The activation of endogenous MMPs was found to be related to the presence of CHX within the adhesive system and the bonding strategy employed. CONCLUSIONS: Under this perspective 0.2% CHX blended within Peak Universal adhesive monomer seems to increase immediate bond strength, to preserve bond strength over time and to efficiently inhibit endogenous enzymatic activity in dentin. Hence, blending the CHX in low concentrations within the adhesive could be recommended as a feasible technique in every-day clinical practice. CLINICAL SIGNIFICANCE: Using CHX-containing adhesives could be recommended due to several benefits: it seems to increase the longevity of the hybrid layer; the inhibitor appears to be efficiently delivered to the dentinal substrate and to inhibit endogenous enzymatic activity, without prolonging chair time.

Dentin bonding systems: From dentin collagen structure to bond preservation and clinical applications.

OBJECTIVES: Efforts towards achieving durable resin-dentin bonds have been made for decades, including the understanding of the mechanisms underlying hybrid layer (HL) degradation, manufacturing of improved adhesive systems, as well as developing strategies for the preservation of the HL. METHODS: This study critically discusses the available peer-reviewed research concerning the formation and preservation of the HL, the mechanisms that lead to the degradation of the HL as well as the strategies to prevent it. RESULTS: The degradation of the HL occurs through two main mechanisms: the enzymatic degradation of its collagen fibrils, and the leaching of the resin from the HL. They are enabled by residual unbound water between the denuded collagen fibrils, trapped at the bottom of the HL. Consequently, endogenous dentinal enzymes, such as the matrix metalloproteinases (MMPs) and cysteine cathepsins are activated and can degrade the denuded collagen matrix. Strategies for the preservation of the HL over time have been developed, and they entail the removal of the unbound water from the gaps between the collagen fibrils as well as different modes of silencing endogenous enzymatic activity. SIGNIFICANCE: Although there are many more hurdles to be crossed in the field of adhesive dentistry, impressive progress has been achieved so far, and the vast amount of available research on the topic is an indicator of the importance of this matter and of the great efforts of researchers and dental material companies to reach a new level in the quality and longevity of resin-dentin bonds.

Experimental use of an acrolein-based primer as collagen cross-linker for dentine bonding.

OBJECTIVES: The objective of the present study was to investigate the long-term effect of 0.01% acrolein (ACR) aqueous solution, employed as an additional primer, on the mechanical durability and enzymatic activity of resin-dentine interfaces created with a simplified etch-and-rinse adhesive. METHODS: Dentine surfaces were etched with 35% phosphoric acid for 15s, rinsed and blot-dried. Specimens were then assigned to: Group 1: dentine pre-treated with 0.01% ACR aqueous solution for 1min and bonded with Adper Scotchbond 1 XT (SB1XT), a 2-step etch-and-rinse adhesive; Group 2: SB1XT was applied on untreated acid-etched dentine (control). Resin composite build-ups were made using Filtek Z250. Microtensile bond strength was tested by stressing sectioned specimens to failure immediately or after 1year of storage in artificial saliva at 37°C. Zymography and in-situ zymography assays were performed for examining dentine matrix metalloproteinase (MMP) activities. RESULTS: The use of 0.01% ACR as conditioning primer appeared to have contributed better to preservation of bond strength over time without affecting immediate bond strength. Zymography and in-situ zymography showed reduction in MMP activities after the application of ACR. CONCLUSION: Dentine collagen cross-linking produced by an ACR-based primer increases the longevity of resin-dentine bonds by reinforcement of the adhesive interface and reduction of dentine MMP activities. Further studies are required to evaluate the potential in vivo and in vivo cytotoxicity of ACR. CLINICAL SIGNIFICANCE: The acrolein-based primer is a potentially useful clinical bonding tool because it demonstrates good collagen cross-linking ability within a clinically-acceptable working time. Although a low ACR concentration was employed in the present study, the cytotoxicity of ACR should be tested prior to clinical use.

Photobiomodulation in the Prevention of Tooth Sensitivity Caused by In-Office Dental Bleaching. A Randomized Placebo Preliminary Study.

OBJECTIVE: Analyze the effect of photobiomodulation in the prevention of tooth sensitivity after in-office dental bleaching. BACKGROUND DATA: Tooth sensitivity is a common clinical consequence of dental bleaching. Therapies for prevention of sensitivity have been investigated in literature. MATERIALS AND METHODS: This study was developed as a randomized, placebo blind clinical trial. Fifty patients were selected (n = 10) and randomly divided into five groups: (1) control, (2) placebo, (3) laser before bleaching, (4) laser after bleaching, and (5) laser before and after bleaching. Irradiation was performed perpendicularly, in contact, on each tooth during 10 sec per point in two points. The first point was positioned in the middle of the tooth crown and the second in the periapical region. Photobiomodulation was applied using the following parameters: 780 nm, 40 mW, 10 J/cm2, 0.4 J per point. Pain was analyzed before, immediately after, and seven subsequent days after bleaching. Patients were instructed to report pain using the scale: 0 = no tooth sensitivity, 1 = gentle sensitivity, 2 = moderate sensitivity, 3 = severe sensitivity. RESULTS: There were no statistical differences between groups at any time (p > 0.05). More studies, with others parameters and different methods of tooth sensitivity analysis, should be performed to complement the results found. CONCLUSIONS: Within the limitation of the present study, the laser parameters of photobiomodulation tested in the present study were not efficient in preventing tooth sensitivity after in-office bleaching.

In vitro evaluation of methylene blue removal from root canal after Photodynamic Therapy.

In Endodontics, photosensitizers' such as methylene blue and toluidine blue have been used in Photodynamic Therapy due to their positive results. However, they can stain the dentin from the root canal after Photodynamic Therapy (PDT). The present in vitro study aimed to evaluate different stain removal protocols from root canal after PDT using methylene blue (MB) dye. After mechanical preparation of the root canal of 40 uni-radicular human teeth, PDT was performed using 0,01% MB with parameters of 3min of pre-irradiation and a diode laser irradiation emitting at 660nm, 40mW, 4min, 9.6J. After PDT, different protocols of MB removal were performed: Group 1 - control (0.9% saline solution); Group 2 - sodium hypochlorite (2.5% NaOCl); Group 3-17% ethylenediamine tetraacetic acid (EDTA); Group 4 - passive ultrasonic irrigation (PUI); The color of the dentin of the root canal was measured, before, immediately after the PDT and immediately after the cleaning using a spectrophotometer. The ΔE values found were statistically compared using the ANOVA and Tukey's tests (α=0.05). All the treatments lead to some cleaning of root canal after PDT, however, none of the treatments tested completely removed all staining caused by MB photosensitizer of the root canal. Among the treatments tested, PUI and Hypochlorite 2.5% promoted greater cleaning, with no statistically significant difference between them. In conclusion, within the protocols tested in the present study, no treatments were able to completely remove MB staining of the root canal after PDT.

Effects of different radiation doses on the microhardness, superficial morphology, and mineral components of human enamel.

OBJECTIVE: To evaluate the effects of three different radiotherapy doses (20, 40, and 70Gy) on the microhardness, superficial morphology, and mineral content (based on Ca and P values) of three different depths of human enamel (cervical, middle, and occlusal). DESIGN: Thirty-four third molars were cut, separated, and prepared. Microhardness samples (n=30) were embedded in acrylic resin and then polished, and depths were delimited. Microhardness tests were performed on cervical, middle, and occlusal enamel pre- and post-radiotherapy with a load of 50g for 30s. For the scanning electron microscopy (SEM) analysis (n=4) and energy dispersive X-ray spectroscopy (EDS) (n=12), samples were fixed in a 3% glutaraldehyde solution, washed in 0.1M cacodylate solution, and dehydrated in crescent concentrations of ethanol. Microhardness data were tested for significant differences using a two-way analysis of variance (ANOVA) and Tukey's test (p<0.05), while SEM and EDS were evaluated qualitatively. RESULTS: The results showed a decrease in microhardness values only in the cervical enamel, regardless of the radiation dose used; no morphological or mineral change was observed. CONCLUSION: Radiotherapy can affect the microhardness values of only cervical enamel without compromising the morphological or mineral (Ca and P) content at any depth.

Surgery Combined with LPRF in Denosumab Osteonecrosis of the Jaw: Case Report.

This paper describes two cases in which the use of leucocyte-rich and platelet-rich fibrin (LPRF) combined with bone resection did not result in complete tissue response in the treatment of medication-related osteonecrosis of the jaw (MRONJ). It has been recently described in patients receiving subcutaneous administration of RANK-inhibitors, such as Denosumab, and anti-angiogenic drugs, such as Bevacizumab, as observed in our cases. Due to promising results in recent studies, more patients will receive these medications in order to avoid skeletal complications due to metastatic bone disease and, therefore, this scenario has a potential to become a comparable challenge to the bisphosphonate- induced jaw necrosis in the area of Oral and Maxillofacial Surgery. No convincing surgical technique has been described to overcome the non-healing mucosal lesions with exposed bone due to RANK-inhibitor therapy. Based on the findings in the literature and in both cases described herein can be concluded that the use of LPRF should be considered in the treatment of patients with DRONJ.

Dental Adhesion to Erbium-Lased Tooth Structure: A Review of the Literature.

OBJECTIVE: The aim of the present study was to conduct a review of the literature about adhesion on erbium laser prepared cavities, related to the specific conditions of the irradiated dentin substrate and the effects on bond strength values. BACKGROUND DATA: Advances in adhesive restorative techniques significantly influenced modern restorative dentistry. The concept of "minimally invasive dentistry" aims to perform more conservative treatment of cavities in which the removal of sound dentin is no longer necessary. This approach, which relies on the concept of adhesion of restorative materials to the mineralized dental tissues, is considered to be a contemporary outcome in dentistry. Similarly, laser technology in restorative dentistry opened new possibilities and strategies as alternatives to conventional treatment. Considering the clinical aspects of the use of erbium lasers for caries removal, cavity preparations, and substrate conditioning, treatment with lasers can be considered to be an efficient technique with wide acceptance by patients. METHODS: Computerized and manual searches were conducted for studies through 2015 that addressed the topic. RESULTS: According to the literature, there is no defined standard protocol concerning the information that articles must provide, making a definitive protocol very difficult to establish. Data varied from the type of adhesive and resin composite used, substrate, and parameters (power, energy density, pulse duration, irradiation time, distance, cooling system) to the bond strength test methodology used. CONCLUSIONS: Further studies are necessary in order to define a standard protocol with positive results and higher bond strength values when using erbium lasers. Detailed information concerning laser parameters should be implemented. Also, longitudinal clinical studies should be developed in the search for new parameters that behave favorably in the irradiated substrate.

Surgery Combined with LPRF in Denosumab Osteonecrosis of the Jaw: Case Report

Abstract This paper describes two cases in which the use of leucocyte-rich and platelet-rich fibrin (LPRF) combined with bone resection did not result in complete tissue response in the treatment of medication-related osteonecrosis of the jaw (MRONJ). It has been recently described in patients receiving subcutaneous administration of RANK-inhibitors, such as Denosumab, and anti-angiogenic drugs, such as Bevacizumab, as observed in our cases. Due to promising results in recent studies, more patients will receive these medications in order to avoid skeletal complications due to metastatic bone disease and, therefore, this scenario has a potential to become a comparable challenge to the bisphosphonate- induced jaw necrosis in the area of Oral and Maxillofacial Surgery. No convincing surgical technique has been described to overcome the non-healing mucosal lesions with exposed bone due to RANK-inhibitor therapy. Based on the findings in the literature and in both cases described herein can be concluded that the use of LPRF should be considered in the treatment of patients with DRONJ.

Resumo Este artigo descreve dois casos onde a ressecção óssea associada à fibrina rica em plaquetas e leucócitos (LPRF) não resultou em resposta completa no tratamento da osteonecrose dos maxilares relacionados à medicações (MRONJ). Como observado nos casos aqui relatados, MRONJ foi recentemente descrito na literatura em pacientes que recebem a administração subcutânea de inibidores-RANK, como Denosumab ou drogas anti-angiogenicas, como Bevacizumab. Estudos recentes com resultados promissores indicam que mais pacientes serão tratados com estas terapias para evitar complicações esqueléticas devido às metástases ósseas. Portanto, este cenário pode tornar-se um desafio clínico comparável às osteonecroses dos maxilares relacionados aos bisfosfonatos na área de Cirurgia Bucomaxilofacial. Até o momento, nenhuma técnica cirúrgica foi descrita com eficiência para superar as lesões da mucosa com exposição óssea e que não cicatrizam devido a terapia com inibidores de RANK. Com base na literatura e nos achados dos casos reportados, podemos concluir que o uso do LPRF pode ser considerado no tratamento de pacientes com osteonecrose dos maxilares relacionados ao Denosumab.

Os efeitos da radiação ionizante nas proteínas endógenas da dentina / The effects of ionizing radiation on dentin endogenous proteases

A radioterapia é um dos principais tratamentos para pacientes com câncer de cabeça e pescoço e a cárie relacionada à radioterapia é um de seus efeitos colaterais, apresentando-se com alta taxa de ocorrência. Além disso, falhas precoces em restaurações realizadas em dentes de pacientes irradiados em cabeça e pescoço também são observadas. Como a degradação enzimática do colágeno ocorre principalmente através da atividade das metaloproteinases de matriz e das cisteínacatepsinas, o objetivo deste estudo foi avaliar a atividade enzimática da dentina hígida e restaurada de dentes submetidos à radioterapia in vivo e in vitro. Os dentes irradiados in vivo foram extraídos de pacientes submetidos à radioterapia com uma dose cumulativa que variou de 40 a 70 Gy. As extrações foram feitas de 3 a 12 meses após a RT devido a doenças periodontais. Para os dentes irradiados in vitro, as amostras foram submersas em água destilada com uma irradiação total e única de 70 Gy. O estudo foi dividido em 2 fases independentes: Fase 1: Dentina Não-Restaurada (avaliação de amostras não irradiadas, dentes submetidos à radioterapia in vitro e in situ). Fase 2: Dentina Restaurada (avaliação de amostras não irradiadas e dentes submetidos à radioterapia in vitro) com 3 adesivos. Para o ensaio de zimografia (fase 1), os grupos irradiados in vitro, in vivo e não irradiados foram divididos em dois subgrupos: 1) mineralizado; 2) desmineralizado com ácido fosfórico10%. As proteínas dentinárias foram extraídas e submetidas à análise zimográfica de acordo com Mazzoni et al., 2007. Para a zimografia in situ (fase 2), os espécimes foram divididos em 6 grupos, de acordo com a forma de irradiação (não irradiada e irradiada in vitro) e o sistema adesivo testado (Adper Single Bond, 3M ESPE, ClearFil SE Bond, Kuraray ou Scotchbond Universal, 3M ESPE). Uma gelatina conjugada com fluoresceína autoextinguível foi usada como substrato para as proteases endógenas. A atividade enzimática gelatinolítica foi observada em microscópio confocal (Zeiss LSM 780-NLO, Carl Zeiss Microscopy GmbH). Para a análise da microscopia eletrônica de varredura, amostras restauradas e hígidas foram submetidas a técnica de pré-imunomarcação usando anticorpo monoclonal primário anti-CT-K e anti-CT-B, e anticorpo secundário conjugado com nano-partículas de ouro de 15nm. Um aumento na atividade gelatinolítica pós radioterapia para ambos os substratos (dentina restaurada e hígida) pôde ser observada. Houve uma maior expressão das formas ativas das MMP-2 e MMP-9 pós radioterapia para ambas as formas de radioterapia em dentina não restaurada. Nenhuma diferença na imuno-marcação para CT-K e CT-B entre os grupos irradiados e não irradiados foi observada. Adesivos autocondicionantes apresentaram uma imuno-marcação mais fraca para CT-K quando comparado ao adesivo de condicionamento total. Com isso, pode-se concluir que a radiação ionizante foi capaz de influenciar a atividade enzimática das proteínas endógenas da dentina restaurada e não restaurada. Palavras-chave: Radioterapia, metaloproteinases de matriz, MMP, cisteinocatepsinas, CT, Cárie relacionada à radiação.

Efeito de três diferentes doses de radiação com raios-X na microdureza, morfologia superficial, espectrometria de energia dispersiva de radios-X (EDS) e resistência de união ao esmalte e dentina com dois diferentes sistemas adesivos / The effect of three different doses of radiation with x-rays in the microhardness, superficial morfology, energy dispersive X-ray spectroscopy (EDS) and bond strength of enamel and dentin with two adhesive systems

Este estudo teve como objetivo analisar dentina e esmalte irradiados com diferentes doses de radiação ionizante com raios-x (20, 40 e 70Gy), através da microdureza, morfologia superficial, conteúdo mineral e resistência de união com adesivo de condicionamento total de 2 etapas (Adper Single Bond 2) e um novo sistema adesivo, universal, com a técnica auto-condicionante (Universal Single Bond). Oitenta e quatro terceiros molares humanos foram cortados, separados e preparados para cada ensaio. Para os ensaios de microdureza e microcisalhamento as amostras foram incluídas em resina acrílica e polidas. Para a microscopia eletrônica de varredura (MEV) e espectrometria de energia dispersiva de raios-x (EDS), as amostras foram fixadas em solução de glutaraldeído 3%, lavadas em solução de cacodilato 0,1M e desidratadas em álcool etílico crescente. A microdureza (n=30) foi realizada pré e pós-radioterapia, com força de 50gf em esmalte cervical, médio e oclusal e 25gf em dentina profunda, média e rasa, por 30s. As amostras para o microcisalhamento foram divididas em 4 grupos (n=20) e 2 subgrupos (n=10) conforme o sistema adesivo. Foram construídos 3 corpos de prova cilíndricos com 1mm de diâmetro e altura em cada amostra. O teste de microcisalhamento foi realizado em máquina de ensaio universal com velocidade de 1mm/min.

Os resultados indicam perda de propriedade de microdureza apenas em esmalte cervical em todas as três doses (20Gy pré-radioterapia: 298,04±11,80 e pós-radioterapia: 294,36±16,68; 40Gy pré-radioterapia: 285±19,45 e pósradioterapia: 275,3±36; 70Gy pré-radioterapia: 291,98±16,51 e pós-radioterapia: 283,68 ± 21,64) e em dentina em todas as profundidades (profunda: 20Gy préradioterapia: 57,79±1,96; pós-radioterapia: 55,37±1,30; 40Gy pré-radioterapia: 57,31±1,76; pós-radioterapia: 55,83±1,63; 70Gy não apresentou alterações; média: 20Gy pré-radioterapia: 58,05±1,79; pós-radioterapia: 55,36±1,20; 40Gy préradioterapia: 57,87± 2,04; pós-radioterapia: 55,65 ± 2,48; 70Gy não apresentou alterações; rasa: 20Gy pré-radioterapia: 56,60±12,17; pós-radioterapia: 55,18±2,57; 40Gy pré-radioterapia: 57,36±2,78; pós-radioterapia: 55,18± 2,57; 70Gy préradioterapia: 55,08±1,94; pós-radioterapia: 54,72±2,57). O teste de microcisalhamento não apresentou diferença significativa entre grupo controle e as 3 doses, tanto para esmalte (p=0,325) como para dentina (p=0,719), apresentando o adesivo Universal Single Bond, em dentina, a resistência de união mais satisfatória. A análise de padrão de fratura para dentina, indicou um maior número de rupturas coesivas em dentina na dose 70Gy quando comparada ao grupo controle. Em esmalte prevaleceram as fraturas do tipo adesivas. As eletromicrografias apresentaram alterações apenas em esmalte na dose 70Gy, com prismas de esmalte mais curtos e arredondados. O EDS mostrou que o conteúdo mineral permaneceu intacto em ambos substratos. Dentro das limitações de um estudo in vitro, conclui-se que a radiação ionizante apresenta maior interação preferencialmente em dentina, no entanto, o EDS mostra não haver modificação no conteúdo mineral em ambos substratos

The aim of this study was to evaluate the effects of different doses (20Gy, 40Gy and 70Gy) of ionizing radiation with x-rays in the microhardness, superficial morphology, mineral content and bonding effectiveness with a 2 steps all-etch adhesive (Adper Single Bond 2) and the new generation of adhesive, the universal adhesive system, (Universal Single Bond), using the self-etch technique. Eighty-four third molars were cutted, separed and prepared for each assay. For the microshear-bond and microhardness the samples were included in acrylic resin and then polished. For the scanning electron miscroscopy (SEM) and energy dispersive x-ray spectroscopy (EDS), the samples were fixated in a 3% glutaraldehyde solution, washed in 0,1M cacodylate solution and dehydrated in increscent concentrations of ethyl alcohol. The microhardness (n=30) was held pre and post radiotherapy with 50gf on cervical, middle and occlusal enamel and 25kg on superficial, middle and deep dentin, both cases with 30s. The microshear-bond was divided in 4 groups (n=20) and 2 subgroups (n=10) according to the adhesive system. Three cylinders were built with 1mm in diameter and heigh in every sample

The assay were accomplished at an universal testing machine with 1mm/min. Results indicate loss of microhardness properties only in cervical enamel at all 3 doses (20Gy pre-radiotheraphy: 298,04 ± 11,80 and post-radiotherapy: 294,36 ± 16,68; 40Gy pre-radiotherapy: 285 ± 19,45 and post-radiotherapy: 275,3 ± 36; 70Gy pre-radiotherapy: 291,98 ± 16,51 and post-radiotherapy: 283,68 ± 21,64) and in all dentin depths (deep: 20Gy preradiotherapy: 57,79 ± 1,96; post-radiotherapy: 55,37 ± 1,30; 40Gy pre-radiotherapy: 57,31 ± 1,76; post-radiotherapy: 55,83 ± 1,63; 70Gy showed no alteration; Middle: 20Gy pre-radiotherapy: 58,05 ± 1,79; post-radiotherapy: 55,36 ± 1,20; 40Gy preradiotherapy: 57,87 ± 2,04; post-radiothetrapy: 55,65 ± 2,48; 70Gy showed no alteration; Superficial: 20Gy pre-radioterapia: 56,60 ± 12,17; post-radiotrapia: 55,18 ± 2,57; 40Gy pre-radiotherapy: 57,36 ± 2,78; post-radiotherapy: 55,18 ± 2,57; 70Gy pre-radiotherapy: 55,08 ± 1,94; post-radiotherapy: 54,72 ± 2,57). The microshearbond test did not show significant difference between the control group and the 3 doses, both enamel (p=0.325) and dentin (p=0.719), showing better bonding with Universal Single Bond adhesive in dentin