Stem Cells from Human Exfoliated Deciduous Teeth: A Growing Literature.

Adult stem cells research has been considered the most advanced sort of medical-scientific research, particularly stem cells from human exfoliated deciduous teeth (SHED), which represent an immature stem cell population. The purpose of this review is to describe the current knowledge concerning SHED from full-text scientific publications from 2003 to 2015, available in English language and based on the keyword and/or abbreviations 'stem cells from human exfoliated deciduous teeth (SHED)', and individually presented as to the properties of SHED, immunomodulatory properties of SHED and stem cell banking. In summary, these cell populations are easily accessible by noninvasive procedures and can be isolated, cultured and expanded in vitro, successfully differentiated in vitro and in vivo into odontoblasts, osteoblasts, chondrocytes, adipocytes and neural cells, and present low immune reactions or rejection following SHED transplantation. Furthermore, SHED are able to remain undifferentiated and stable after long-term cryopreservation. In conclusion, the high proliferative capacity, easy access, multilineage differentiation capacity, noninvasiveness and few ethical concerns make stem cells from human exfoliated deciduous teeth the most valuable source of stem cells for tissue engineering and cell-based regenerative medicine therapies.

Effect of 7.5% hydrogen peroxide containing remineralizing agents on hardness, color change, roughness and micromorphology of human enamel.

PURPOSE: To determine the microhardness, color change, surface roughness, and micromorphology of tooth enamel submitted to bleaching treatment with 7.5% hydrogen peroxide (HP) with added calcium, amorphous calcium phosphate, sodium fluoride (NaF), and hydroxyapatite (HA). METHODS: 80 enamel slabs were used (n = 10). Three commercial agents [Pola Day 7.5%, Day White ACP 7.5% (DW-ACP), and White Class Calcium 7.5% (WC-Calcium)], three experimental (7.5% HP+NaF, 7.5% HP+HA, and 7.5% PH+NaF+HA), a positive control (with HP), and a negative control (without HP) groups were assessed. The commercial products were applied according to manufacturers' recommendations and the experimental ones were applied for 1.5 hours daily. During and after treatment, specimens were stored in artificial saliva. Tests were performed at baseline, 7, 14, 21, 28, and 35 days. Data were analyzed by ANOVA and Tukey's test (α = 0.05). RESULTS: DW-ACP presented lower microhardness and HP+HA presents the highest values (P < 0.05); only the experimental group presented color change similar to the commercial agents (P > 0.05). Overall, roughness increased with time (P < 0.05) and porosities, and deposition of crystalline structures in groups HP+HA and HP+NaF+HA were noted. The HP+HA agent was capable of reducing the loss of enamel microhardness due to bleaching and also present color change similar to the commercial products.

Effect of the application of a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste and adhesive systems on bond durability of a fissure sealant.

This study aimed to evaluate the effect of the previous application of a casein phosphopeptide-amorphous calcium phosphate paste (MI Paste, MI) and adhesive systems on the bond durability of a fissure sealant. Ninety-eight enamel blocks were obtained from proximal surfaces of erupted third molars. Specimens were divided into 14 groups (n = 7) according to the previous application of MI (with and without) and the adhesive systems used (no adhesive system; hydrophobic resin of a three-step etch-and-rinse adhesive system; etch-and-rinse single-bottle adhesive system; all-in-one adhesive system; two-step self-etching adhesive system; additional phosphoric acid conditioning and all-in-one adhesive system; additional phosphoric acid conditioning and two-step self-etching adhesive system). A fissure sealant (Fluroshield) was applied and photoactivated for 20 s. Beams (~0.7 mm(2)) were prepared for the microtensile bond strength test, which was executed after 24 h or 6 months of water storage. Fractured specimens were analyzed by scanning electronic microscopy. Data were analyzed by two-way ANOVA with repeated measures/Tukey's test (P < 0.05). Groups that received MI application and adhesive systems presented higher means than those groups where MI was not applied. Higher frequency of cohesive failures was observed for groups with MI. Applying a CPP-ACP containing paste on enamel before adhesive systems was an effective method to increase bond durability of the sealant tested.

Effect of home-use and in-office bleaching agents containing hydrogen peroxide associated with amorphous calcium phosphate on enamel microhardness and surface roughness.

STATEMENT OF THE PROBLEM: The effects of amorphous calcium phosphate (ACP)-containing bleaching agents on enamel surface have not been clarified yet. PURPOSE: The study aims to evaluate the effects of different bleaching agents, either associated with ACP, or not, on enamel Knoop microhardness (KHN) and surface roughness (SR). MATERIALS AND METHODS: The home-use hydrogen peroxide (HP) bleaching agents PolaDay 7.5% (HP7.5; SDI Limited, Bayswater, Victoria, Australia), PolaDay 9.5% (HP9.5; SDI Limited); DayWhite ACP-7.5% (ACP7.5; Discus Dental, Culver City, CA, USA) and DayWhite ACP 9.5% (ACP9.5; Discus Dental), and the in-office agents PolaOffice 35% (HP35; SDI Limited) and Opalescence XtraBoost 38% (HP38; Ultradent Products, South Jordan, UT, USA) were applied to polished enamel slabs (N = 10) for 30 minutes/day for 21 consecutive days (home-use) or in one session a week, for 3 weeks (in-office). KHN and SR were tested before (baseline), during (7, 14, 21 days), and after (7 and 14 days in artificial saliva) the bleaching treatment. RESULTS: KHN evaluation revealed no significant difference among bleaching agents (p > 0.05); however, there was a significant decrease during bleaching treatment (p < 0.0001). KHN values attained in the post-treatment phase were statistically similar to baseline values (p > 0.05). SR was not altered during and after treatment, with the exception of PH38, which showed an increase in SR during bleaching treatment and a recovery after treatment. The ACP7.5 showed a trend to decreasing SR values during the bleaching treatment, but this decrease was only significant when associated with 14 days of immersion in artificial saliva, when the enamel was less rough than at baseline. CONCLUSIONS: Bleaching agents caused a decrease in enamel KHN, but values were recovered after treatment, showing the importance of saliva in recovering mineral content. SR was altered during or after treatment, depending on HP concentration/association with ACP. The beneficial effects of adding ACP to bleaching formulas on SR may be restricted to lower HP concentrations in association with the remineralizing effect of saliva. CLINICAL SIGNIFICANCE: No beneficial effects of adding ACP to bleaching formulas on enamel microhardness were observed, but these observations may be attributable to the lower hydrogen peroxide concentrations in association with the remineralizing effect of saliva, when considering the enamel roughness.

Effect of 10% sodium ascorbate and 10% alpha-tocopherol in different formulations on the shear bond strength of enamel and dentin submitted to a home-use bleaching treatment.

This in vitro study assessed the shear bond strength of human enamel and dentin submitted to a bleaching treatment with 10% carbamide peroxide and treatment with antioxidant agents containing 10% alpha-tocopherol and 10% sodium ascorbate formulated in solution and gel. Sixty human dental enamel slabs (E) and 60 human dental dentin slabs (D) were randomly divided into six groups (n = 10). Groups E1 and D1 were negative control groups and the bleaching agent was not applied. The bleaching agent was applied daily for two-hours on the dental slabs of all the other groups and, during the remaining 22 hours, the specimens were stored in an artificial saliva solution for a total of 14 days. Groups E2 and D2 were positive control groups and they only received application of the bleaching agents. Antioxidant agents were applied in Groups E3 and D3 (10% sodium ascorbate solution), E4 and D4 (10% alpha-tocopherol solution), E5 and D5 (10% sodium ascorbate gel) and E6 and D6 (10% alpha-tocopherol gel) for two hours. Cylinders were made with microhybrid resin composite and a total-etch adhesive system for shear bond strength tests. These tests were performed in a universal testing machine at a speed of 0.5 mm/minute to obtain the values in MPa. ANOVA (p > 0.05) showed no significant differences among groups E4, E5, E6 and E1. However, groups E3, E5 and E6 presented statistically similar values to group E2. The Kruskal-Wallis test showed no significant differences among D1 and all the other experimental groups; the same values occurred with D2, which did not differ from the experimental groups. Antioxidant treatment with 10% alpha-tocopherol solution was the only effective agent to revert the oxidizing effects of the bleaching treatment on enamel.

Influence of in situ post-bleaching times on resin composite shear bond strength to enamel and dentin.

PURPOSE: To evaluate in situ the influence of time after treatment with a 16% carbamide peroxide home-use bleaching agent on the shear bond strength of resin-based composite to human enamel and dentin. METHODS: 80 enamel slabs (E) and 80 dentin slabs (D) were obtained, embedded, flattened, sterilized and randomly fixed on the buccal surface of teeth in 20 volunteers. These specimens were submitted to treatment with a 16% carbamide peroxide bleaching agent (Pola Night) for 2 hours a day, for 3 weeks. The control group (C) consisted of slabs that were fixed on buccal tooth faces that did not receive any bleaching treatment. For the experimental groups, three slabs of E and three slabs of D were fixed to teeth of the same volunteers, and after bleaching treatment, the slabs were removed at different times: EI--immediate removal; E7--removal 7 days after treatment ended; E14--removal 14 days after treatment ended. After removal, the slabs were again embedded and microhybrid composite resin cylinders (Filtek Z250) were constructed and bonded using a one-bottle adhesive system (Single Bond) for shear bond strength tests. These tests were performed in a universal testing machine, with a speed of 0.5 mm/minute, with the data returned in MPa. The results were submitted to the ANOVA test. RESULTS: There were no significant differences with regards to the timespan for the E and D groups (P > 0.05). For the fracture mode analysis, there was a predominance of adhesive failures for Groups C, EI and E14 in enamel, with the same adhesive failures occurred for all groups in dentin. It was concluded that restorative procedures may be performed immediately after the end of the bleaching treatment.

Rat Facial Nerve Regeneration with Human Immature Dental Pulp Stem Cells.

Facial paralysis can result in severe implications for the patients. However, stem cell biology has become an important field in regenerative medicine since the discovery and characterization of mesenchymal stem cells. Our aim was to evaluate the regeneration after facial nerve crush injury and application of human immature dental pulp stem cells (iDPSC). For this study 70 Wistar rats underwent a unilateral facial nerve crush injury and were divided into two groups: Group I (GI): Crushed; Group II (GII): Crushed and iDPSC, and distributed into study periods of 3, 7, 14, 21, and 42 postoperative days. Facial nerve regeneration was analyzed via functional recovery of whisker movement, histomorphometric analysis, and immunoblotting assay. The results show that GII had complete functional recovery at 14 days, while GI recovered after 42 days. Also, regarding the facial nerve trunk, GII presented histological improvement, evidencing better axonal and structural organization of the myelin sheath, and exhibited statistically higher values for the outer and inner perimeters and g-ratio. Nevertheless, GI exhibited statistically higher values for the thickness of myelin sheath. In the buccal branch, no differences were observed for all parameters between groups. At 42 days, both groups GI and GII were close to the levels observed for the control group. Concerning nerve growth factor expression, GII exhibited statistically greater values (p < 0.05) compared with the control group at 7 days. In summary, a single injection of human iDPSC promoted a positive effect on regeneration of the facial nerve trunk after 14 days and provided an alternative to support regeneration following peripheral nerve injury.

Influence of time on bond strength after bleaching with 35% hydrogen peroxide.

AIM: The aim of this in vitro study was to evaluate the influence of time after treatment with a 35% hydrogen peroxide bleaching agent on the shear bond strength between composite resin and sound enamel and dentin. METHODS AND MATERIALS: Eighty dental slabs - 40 enamel (E) slabs and 40 dentin (D) slabs - were embedded, flatted, and divided into four groups (n=10). In G1 the E and D slabs were kept in artificial saliva for 14 days. For the G2, G3, and G4 groups the E and D slabs were submitted to bleaching treatment with a 35% hydrogen peroxide bleaching agent. At different times after bleaching treatments (G2=immediate; G3=seven days; G4= fourteen days), composite resin cylinders were made using an adhesive system. Tests were performed in a universal testing machine at a speed of 0.5 mm/min to obtain the values in MPa. RESULTS: For enamel, the Kruskal-Wallis test and Dunn Method showed G1 differed significantly from G2 (G1=13.40 a; G2=6.64 b; G3=16.76 a; G4=11.64 ab). For dentin, the analysis of variance (ANOVA) and Tukey tests showed that G1 differed significantly from G2 and G3 (G1=12.11 a; G2=4.97 b; G3=8.67 c; G4=11.86 ac). CONCLUSION: It is recommended adhesive restorative procedures in enamel be delayed for seven days post-bleaching treatment with 35% hydrogen peroxide, while restorations in dentin should be delayed for 14 days following bleaching treatment.

Enamel microhardness and shear bond strength after treatment with an 18% carbamide peroxide bleaching varnish.

PURPOSE: To evaluate the microhardness and shear bond strength of human enamel treated with an 18% carbamide peroxide bleaching varnish. METHODS: 40 dental enamel slabs were embedded and ground flat, dividing them into four groups (n=10) which received the varnish application for 14 consecutive days: (G1) one daily varnish application; (G2) two daily varnish applications with an interval of 15 minutes; (G3) two daily varnish applications with an interval of 5 hours. After varnish application, the slabs were immersed in artificial saliva changed daily. The control group (G4) consisted of slabs (n=10) that did not receive any varnish treatment and were maintained in artificial saliva for 14 days. Microhardness tests were performed with Knoop indentation with a load of 25 grams for 5 seconds at the beginning of the treatment (baseline values) and after 7 and 14 days. Cylinders were made with microhybrid resin composite and one-bottle adhesive system for shear bond strength tests. Using a universal testing machine with a speed of 0.5 mm/minute to obtain the values in MPa. RESULTS: The Kruskal-Wallis test showed no changes in microhardness values among groups after 7-day varnish application, although there was a decrease in microhardness values when using an 18% carbamide peroxide varnish twice a day with a time-interval of 5 hours between applications (P < 0.05). For enamel shear bond strength, ANOVA test (P > 0.05) did not show significant differences among the groups (G1=15.8; G2=15.2; G3=19.0; G4=15.1).

The effects of home-use and in-office bleaching treatments on calcium and phosphorus concentrations in tooth enamel: an in vivo study.

BACKGROUND: Because the effects of dental bleaching on enamel needs to be clarified in vivo, the authors conducted a study to determine calcium and phosphorus concentrations in enamel after the application of different bleaching treatments. METHODS: The authors applied four agents (10 percent and 20 percent carbamide peroxide [both recommended for home use], 38 percent and 35 percent hydrogen peroxide [both applied in the dental office]) to the enamel of 80 participants, who were divided into four groups of 20. The authors collected enamel microbiopsy specimens from incisors before (baseline), during (seven, 14 and 21 days) and after (seven and 14 days) the bleaching treatments. They analyzed calcium and phosphorus concentrations by using a spectrophotometer. RESULTS: The authors analyzed data by using the Friedman test and the Kruskal-Wallis test, followed by the Dunn test (α= .05). There were no statistical differences between the evaluation results, regardless of which bleaching gel was used, for determining the concentration of either calcium or phosphorus. CONCLUSIONS: Home-use and in-office bleaching gels did not alter the concentrations of calcium and phosphorus concentrations on the enamel surface in vivo. CLINICAL IMPLICATIONS: In vivo, different dental bleaching techniques did not alter the inorganic composition of enamel.

Effect of enamel pretreatment on shear bond strength of brackets bonded with resin-modified glass-ionomer cement.

AIM: To evaluate the shear bond strength of brackets bonded with resin-modified glass-ionomer cement (RMGIC) using various methods of enamel conditioning. METHODS: Forty-five human premolars were randomly divided into five groups. The roots of these teeth were fixed in acrylic resin cylinders, and brackets were bonded to the teeth's crowns using the following material combinations: RMGIC only; RMGIC and corresponding primer; RMGIC, acid etching, and Scotchbond Multipurpose; RMGIC and two-step self-etching primer; and RMGIC and one-step primer. All specimens were submitted to pH cycling for 14 days before shear bond strength was assessed in a universal test machine. RESULTS: The medians and standard deviations (in MPa) were RMGIC only = 8.34 ± 1.11; RMGIC and corresponding primer = 7.05 ± 2.24; RMGIC, acid etching, and Scotchbond Multipurpose = 7.00 ± 4.79; RMGIC and two-step self-etching primer = 0.54 ± 0.30; and RMGIC and one-step primer = 10.61 ± 4.58. The value for RMGIC and two-step self-etching primer was significantly lower than all other values. CONCLUSION: It can be concluded that the tested RMGIC is suitable for bonding orthodontic brackets, even when used by itself. Different enamel preparations do not improve its performance. However, they can worsen its bonding capacity as the combination with the two-step primer system clearly shows.

Micromorphology and microhardness of enamel after treatment with home-use bleaching agents containing 10% carbamide peroxide and 7.5% hydrogen peroxide.

OBJECTIVE: The purpose of this study was to assess the effect of home-use bleaching agents containing 10% carbamide peroxide and 7.5% hydrogen peroxide on enamel microhardness and surface micromorphology. MATERIAL AND METHODS: Enamel slabs (n=10) received the bleaching agents for 1 h/day and remained in artificial saliva solution for 23 h/day, during a total period of 21 days. Control group was composed of enamel slabs that were not subjected to treatment with the agents and were maintained in artificial saliva solution. Microhardness tests were performed before treatment application, 21 days of treatment and 14 days after the end of treatment. Scanning electron microscopy analyses were performed after 14 days after the end of bleaching treatment by 3 calibrated observers who attributed scores. RESULTS: The Tukey's test (alpha=0.05) showed no significant differences in microhardness values among bleaching agents, at 21 days of treatment and a significant increase in microhardness for different agents after 14 days from the end of treatment. Fisher's exact test showed differences in micromorphology of enamel between control and experimental groups (p=0.0342). CONCLUSIONS: Bleaching agents containing 10% carbamide peroxide and 7.5% hydrogen peroxide may change surface micromorphology of enamel, although no changes in microhardness were observed.

Microhardness of nanofilled composite resin light-cured by LED or QTH units with different times

Aim: To evaluate the influence of light-curing units and light-curing time on the microhardness of a nanofilled composite resin. Methods: Forty-five composite resin (Z350 - 3M) specimens were randomly prepared using Teflon ring molds (4.0 mm internal diameter and 2 mm depth) and divided into nine experimental groups (n=5): three polymerization units (conventional - 450 mW/ cm2; 2nd generation LED - 1100 mW/cm2; and 3rd generation LED - 700 mW/cm2) and three lightcuring times (20 s, 40 s, and 60 s). All specimens were polymerized with the light-curing tip positioned 8 mm far from the top surface of the specimen. After 24 h, Knoop microhardness measurements were made on the top and bottom surfaces of the specimen, with a load of 10 g for 10 s. Five indentations were made on each surface. All results were analyzed statistically by subdivided parcel ANOVA (Split-Plot) and Tukey's tests (p<0.05). Results: There were no statistically significant differences for the polymerization unit and light-curing time factors in either top or bottom surface. For all experimental conditions, the top surfaces showed greater hardness than the bottom surfaces (p<0.0001). Conclusions: The mode of polymerization and the lightcuring time did not affect the hardness of the nanofilled composite resin, and increasing the lightcuring time did not improve the hardness of the bottom surface of the composite resin.

Micromorphology and microhardness of enamel after treatment with home-use bleaching agents containing 10 percent carbamide peroxide and 7.5 percent hydrogen peroxide

OBJECTIVE: The purpose of this study was to assess the effect of home-use bleaching agents containing 10 percent carbamide peroxide and 7.5 percent hydrogen peroxide on enamel microhardness and surface micromorphology. MATERIAL AND METHODS: Enamel slabs (n=10) received the bleaching agents for 1 h/day and remained in artificial saliva solution for 23 h/day, during a total period of 21 days. Control group was composed of enamel slabs that were not subjected to treatment with the agents and were maintained in artificial saliva solution. Microhardness tests were performed before treatment application, 21 days of treatment and 14 days after the end of treatment. Scanning electron microscopy analyses were performed after 14 days after the end of bleaching treatment by 3 calibrated observers who attributed scores. RESULTS: The Tukey's test (á=0.05) showed no significant differences in microhardness values among bleaching agents, at 21 days of treatment and a significant increase in microhardness for different agents after 14 days from the end of treatment. Fisher's exact test showed differences in micromorphology of enamel between control and experimental groups (p=0.0342). CONCLUSIONS: Bleaching agents containing 10 percent carbamide peroxide and 7.5 percent hydrogen peroxide may change surface micromorphology of enamel, although no changes in microhardness were observed.

O uso de bifosfonatos e sua relação com a osteonecrose / The use of bisphosphonates and its relation to osteonecrosis

O uso dos bifosfonatos vem sendo amplamente indicado no tratamento da osteoporose, em alguns tipos de câncer e de metástases tumorais em tecidos ósseos. O bifosfonato inibe a formação de osteoclastos, interferindo no processo de reabsorção óssea, no entanto, o uso destas drogas vem sendo relacionado a casos de osteonecrose em maxila e mandíbula de pacientes que se submeteram a exodontia ou procedimentos cirúrgicos que tenham tido o tecido ósseo exposto ou manipulado. Procedimentos invasivos como exodontias ou cirurgias que manipulem o tecido ósseo devem ser submetidos a uma avaliação criteriosa em pacientes que estejam sob tratamento com bifosfonatos. Diante disso, este estudo tem como objetivo alertar o cirurgião-dentista em relação aos cuidados no manejo de pacientes que estejam sob tratamento com bifosfonatos, por meio de uma revisão na literatura e descrições de casos clínicos relatados.

The use of bisphosphonates has been widely used in the treatment of osteoporosis, in some cancer types and in metastases to bone. Bisphosphonates inhibit osteoclast formation, interfering in the process of bone reabsorption. However, the use of these drugs has been found to be related to osteonecrosis of maxillary and mandibular bones of patients which underwent to tooth extraction or surgical procedures with manipulation or exposure of bone tissue. Patients under treatment with bisphosphonates should be carefully assessed prior to undergoing invasive procedures such as tooth extraction or surgery that involves bone tissue. Therefore, the goal of this paper is to alert the dentist about the care of patients which are under treatment with bisphosphonates through a literature review that includes scientific papers and clinical cases.

Verificação glicêmica casual de pacientes odontológicos / Casual glicemia of dental patients

O objetivo deste trabalho foi verificar o perfil glicêmico de pacientes odontológicos e propor um método para medir a glicemia destes indivíduos na consulta de rotina. Procurou-se também ressaltar a importância deste exame para o atendimento odontológico, prevenindo complicações. Após anamnese, 300 pacientes de ambos os gêneros, de 18 a 65 anos foram submetidos à medida rápida da glicemia capilar. Os voluntários eram pacientes de consulta odontológica de rotina em Campinas, SP e foram encaminhados ao serviço médico caso sua glicemia estivesse alterada. A glicemia mostrou-se alterada em 7% dos pacientes, dentre os quais apenas 2% sabiam ser portadores de diabete melito, porém julgavam estar com a glicemia controlada. Do total, 37% nunca haviam realizado teste glicemico. O método por análise imediata de glicemia durante atendimento odontológico pode ser empregado por ser útil como método de pré-diagnóstico de alterações metabólicas e como prevenção de complicações durante o atendimento odontológico.

Alterações bucais em pacientes com Síndrome de Sjõgren / Oral alterations in patients with Sjõgren's Syndrome

A Síndrome de Sjõgren (SS) é uma afecção auto-imune na qual o sistema imune compromete as glândulas exócrinas, envolvendo principalmente as glândulas salivares e lacrimais, determinando os quadros clínicos de xerostomia e ceratoconjuntivite seca. Entre os sintomas orais mais evidentes está a xerostomia, acarretando secura nos lábios, língua, faringe e conseqüente desconforto ao falar, mastigar e deglutir alimentos secos. A proposta deste trabalho foi apresentar um caso clínico de SS, enfatizando a sua importância clínica e a necessidade de um diagnóstico precoce, visando melhorar a qualidade de vida dos pacientes acometidos.