Estudo clínico comparativo entre diferentes sistemas de clareamento de uso em consultório / Comparative clinical trial between different in-office bleaching systems

Objetivos: Estudos clínicos longitudinais que acompanham os pacientes por longos períodos não são muito comuns na literatura, ainda mais quando associados a grandes amostras (veio do fim do resumo). Por isso, o objetivo do trabalho foi determinar a eficiência, estabilidade de cor e sensibilidade dental, trans e pós operatória, dentro de um período de 365 dias, de quatro protocolos de clareamento em consultório. Material e Métodos: Foi realizado um estudo clínico randomizado, cego (para os pacientes), composto por 120 sujeitos (n=30). A amostra foi formada por pacientes adultos, sem distinção de gênero e etnia, e idade superior a 18 anos que foram selecionados por meio de avaliação clínica na qual foi verificada a cor dos dentes, a condição de higiene oral e a presença de restaurações e/ou próteses nas regiões em que os procedimentos seriam realizados. Todos os sujeitos foram submetidos a uma sessão de clareamento de acordo com as instruções do fabricante e obedecendo a aplicação ou não da luz, para os clareadores baseados no sistema Foto-Fenton (havia faltado citar nos métodos do resumo), e qual o seu tipo: Zoom Advanced Power, peróxido de hidrogênio (PH) 25% - Zoom! + luz UVA (Phillips Oral Healthcare); Zoom Whitespeed, PH 25% - Zoom! + luz Whitespeed (Phillips Oral Healthcare); Zoom sem luz, PH 25% - Zoom! (Phillips Oral Healthcare). Boost, PH 38% - Opalescence Xtra Boost (Ultradent). As alterações de cor foram avaliadas utilizando as escalas Vita Classical e Vita Bleachedguide 3D Master e o Espectrofotômetro Vita-Easyshade. As medições foram feitas em incisivos centrais e caninos uperiores antes, imediatamente e 7, 14, 30, 180 e 365 dias após o tratamento. Os dados foram analisados estatisticamente por meio do software Statistica 8.0 (StatSoft - Tulsa, OK) através da análise de variância (ANOVA) para medidas repetidas na avaliação das médias e as comparações foram realizadas através de contrastes (Tukey). Resultados:

Para a escala Vita Classical, Zoom AP e WS foram semelhantes entre si porém diferentes de Opalescence e Zoom sem luz, exceto para a avaliação de 30 dias (caninos) e 365 dias (incisivos) onde o Zoom WS demonstrou dados semelhantes ao Opalescence e Zoom sem luz Já para a escala Vita Bleached, Zoom AP e WS foram semelhantes entre si, porém diferentes de Opalescence e Zoom sem luz, exceto para as avaliações de 30 e 180 dias onde o Zoom WS demonstrou dados semelhantes ao Opalescence e Zoom sem luz (caninos). Para dentes incisivos, os achados foram semelhantes, exceto que houve diferença entre o Zoom AP e WS e as semelhanças entre Zoom WS, Opalescence e Zoom sem luz foram encontradas nas avaliações de 180 e 365 dias. Na avalição com o espectrofotômetro Vita Easyshade Zoom AP e WS foram semelhantes entre si e diferentes do Opalescence que, por sua vez, foi diferente do Zoom sem luz, exceto para as avaliações de 7, 14 e 30 dias (caninos). Para incisivos, Zoom AP e WS foram semelhantes entre si e diferentes de Opalescence e Zoom sem luz, exceto para a avaliação de 14 dias onde o Zoom AP foi diferente do Zoom WS. Por fim, a sensibilidade apresentou um aumento nos seus valores na avaliação imediatamente após o clareamento, com uma redução na avalição de 7 dias, para todos os grupos que ainda apresentaram valores de sensibilidade semelhantes em todos os períodos de avaliação. Conclusão: O acompanhamento até 365 dias demonstrou a eficiência dos protocolos de clareamento analisados uma vez que nenhum deles recidivou para os tons iniciais, demonstrando a durabilidade dos procedimentos. Os dois grupos com os clareadores Foto-Fenton obtiveram maior efeito clareador (substituiu desempenho, tinha ficado vago), exceto nas seguintes avaliações: Vita Classical, 30 dias (caninos) e 365 dias (incisivos) e Vita Bleached, 30 e 180 dias (caninos) e 180 e 365 dias (incisivos). Observou-se uma estabilização da cor após sete dias em todos os grupos. A sensibilidade...

Objectives: Longitudinal clinical studies that follow patients for long periods are not very common in the literature, especially when associated with large samples. The objective of this study was to determinate the efficacy, color stability and sensitivity within a 365 day period of four in-office bleaching protocols. Methods: A randomized clinical trial, blinded (for patients), composed of 120 subjects (n=30) was conducted. The sample consisted of adult patients, without gender and ethnic distinction, with age superior than 18 years old that were selected through clinical evaluation in which was verified the color of teeth, the condition of oral hygiene and the presence of restorations and/or prostheses in the areas where the procedures would be carried out. All subjects were submitted to a session of bleaching according to the manufacturer's instructions: Zoom Advanced Power, 25% hydrogen peroxide (HP) - Zoom! + UVA light (Phillips Oral Healthcare); Zoom Whitespeed, 25% HP - Zoom! + Whitespeed light (Phillips Oral Healthcare); Zoom without light, 25% HP - Zoom! (Phillips Oral Healthcare). Boost, 38% HP - Opalescence Xtra Boost (Ultradent). Color changes were evaluated using Vita Classical and Vita Bleachedguide 3D Master shade guides and Vita-Easyshade spectrophotometer. Measurements were made on the superior central incisive and canines before, immediately and 7, 14, 30, 180 and 365 days after the treatment. Statistical analysis of the data were made with the software Statistica 8.0 (StatSoft - Tulsa, OK) through the analysis of variance (ANOVA) for repeated measures in the mean evaluation and comparisons were made by using contrasts (Tukey). Results:

For the Vita Classical shade guide, Zoom AP and WS were similar but different from Opalescence and Zoom without light except for the 30 day (canines) and 365 days evaluations (incisives) where the Zoom WS showed similar data to Opalescence and Zoom without light...

Estudo clínico comparativo entre diferentes sistemas de clareamento de uso em consultório / Comparative clinical trial between different in-office bleaching systems

Objetivos: Estudos clínicos longitudinais que acompanham os pacientes por longos períodos não são muito comuns na literatura, ainda mais quando associados a grandes amostras (veio do fim do resumo). Por isso, o objetivo do trabalho foi determinar a eficiência, estabilidade de cor e sensibilidade dental, trans e pós operatória, dentro de um período de 365 dias, de quatro protocolos de clareamento em consultório. Material e Métodos: Foi realizado um estudo clínico randomizado, cego (para os pacientes), composto por 120 sujeitos (n=30). A amostra foi formada por pacientes adultos, sem distinção de gênero e etnia, e idade superior a 18 anos que foram selecionados por meio de avaliação clínica na qual foi verificada a cor dos dentes, a condição de higiene oral e a presença de restaurações e/ou próteses nas regiões em que os procedimentos seriam realizados. Todos os sujeitos foram submetidos a uma sessão de clareamento de acordo com as instruções do fabricante e obedecendo a aplicação ou não da luz, para os clareadores baseados no sistema Foto-Fenton (havia faltado citar nos métodos do resumo), e qual o seu tipo: Zoom Advanced Power, peróxido de hidrogênio (PH) 25% - Zoom! + luz UVA (Phillips Oral Healthcare); Zoom Whitespeed, PH 25% - Zoom! + luz Whitespeed (Phillips Oral Healthcare); Zoom sem luz, PH 25% - Zoom! (Phillips Oral Healthcare). Boost, PH 38% - Opalescence Xtra Boost (Ultradent). As alterações de cor foram avaliadas utilizando as escalas Vita Classical e Vita Bleachedguide 3D Master e o Espectrofotômetro Vita-Easyshade. As medições foram feitas em incisivos centrais e caninos uperiores antes, imediatamente e 7, 14, 30, 180 e 365 dias após o tratamento. Os dados foram analisados estatisticamente por meio do software Statistica 8.0 (StatSoft - Tulsa, OK) através da análise de variância (ANOVA) para medidas repetidas na avaliação das médias e as comparações foram realizadas através de contrastes (Tukey). Resultados: Para a escala Vita Classical, Zoom AP e WS foram semelhantes entre si porém diferentes de Opalescence e Zoom sem luz, exceto para a avaliação de 30 dias (caninos) e 365 dias (incisivos) onde o Zoom WS demonstrou dados semelhantes ao Opalescence e Zoom sem luz Já para a escala Vita Bleached, Zoom AP e WS foram semelhantes entre si, porém diferentes de Opalescence e Zoom sem luz, exceto para as avaliações de 30 e 180 dias onde o Zoom WS demonstrou dados semelhantes ao Opalescence e Zoom sem luz (caninos). Para dentes incisivos, os achados foram semelhantes, exceto que houve diferença entre o Zoom AP e WS e as semelhanças entre Zoom WS, Opalescence e Zoom sem luz foram encontradas nas avaliações de 180 e 365 dias. Na avalição com o espectrofotômetro Vita Easyshade Zoom AP e WS foram semelhantes entre si e diferentes do Opalescence que, por sua vez, foi diferente do Zoom sem luz, exceto para as avaliações de 7, 14 e 30 dias (caninos). Para incisivos, Zoom AP e WS foram semelhantes entre si e diferentes de Opalescence e Zoom sem luz, exceto para a avaliação de 14 dias onde o Zoom AP foi diferente do Zoom WS. Por fim, a sensibilidade apresentou um aumento nos seus valores na avaliação imediatamente após o clareamento, com uma redução na avalição de 7 dias, para todos os grupos que ainda apresentaram valores de sensibilidade semelhantes em todos os períodos de avaliação. Conclusão: O acompanhamento até 365 dias demonstrou a eficiência dos protocolos de clareamento analisados uma vez que nenhum deles recidivou para os tons iniciais, demonstrando a durabilidade dos procedimentos. Os dois grupos com os clareadores Foto-Fenton obtiveram maior efeito clareador (substituiu desempenho, tinha ficado vago), exceto nas seguintes avaliações: Vita Classical, 30 dias (caninos) e 365 dias (incisivos) e Vita Bleached, 30 e 180 dias (caninos) e 180 e 365 dias (incisivos). Observou-se uma estabilização da cor após sete dias em todos os grupos. A sensibilidade...

Objectives: Longitudinal clinical studies that follow patients for long periods are not very common in the literature, especially when associated with large samples. The objective of this study was to determinate the efficacy, color stability and sensitivity within a 365 day period of four in-office bleaching protocols. Methods: A randomized clinical trial, blinded (for patients), composed of 120 subjects (n=30) was conducted. The sample consisted of adult patients, without gender and ethnic distinction, with age superior than 18 years old that were selected through clinical evaluation in which was verified the color of teeth, the condition of oral hygiene and the presence of restorations and/or prostheses in the areas where the procedures would be carried out. All subjects were submitted to a session of bleaching according to the manufacturer's instructions: Zoom Advanced Power, 25% hydrogen peroxide (HP) - Zoom! + UVA light (Phillips Oral Healthcare); Zoom Whitespeed, 25% HP - Zoom! + Whitespeed light (Phillips Oral Healthcare); Zoom without light, 25% HP - Zoom! (Phillips Oral Healthcare). Boost, 38% HP - Opalescence Xtra Boost (Ultradent). Color changes were evaluated using Vita Classical and Vita Bleachedguide 3D Master shade guides and Vita-Easyshade spectrophotometer. Measurements were made on the superior central incisive and canines before, immediately and 7, 14, 30, 180 and 365 days after the treatment. Statistical analysis of the data were made with the software Statistica 8.0 (StatSoft - Tulsa, OK) through the analysis of variance (ANOVA) for repeated measures in the mean evaluation and comparisons were made by using contrasts (Tukey). Results: For the Vita Classical shade guide, Zoom AP and WS were similar but different from Opalescence and Zoom without light except for the 30 day (canines) and 365 days evaluations (incisives) where the Zoom WS showed similar data to Opalescence and Zoom without light...

A new universal simplified adhesive: 6-month clinical evaluation.

STATEMENT OF THE PROBLEM: Multimode adhesives, which can be used as etch-and-rinse or as self-etch adhesives, have been recently introduced without clinical data to back their use. PURPOSE OF THE STUDY: To evaluate the 6-month clinical performance of Scotchbond Universal Adhesive (SU; 3M ESPE, St. Paul, MN, USA) in noncarious cervical lesions (NCCLs) using two evaluation criteria. METHODS/MATERIALS: Thirty-nine patients participated in this study. Two hundred restorations were assigned to four groups: SU-TEm: etch-and-rinse + moist dentin; SU-TEd: etch-and-rinse + dry dentin; SU-SEet: selective enamel etching; and SU-SE: self-etch. The composite resin Filtek Supreme Ultra (3M ESPE) was placed incrementally. The restorations were evaluated at baseline and after 6 months using both the World Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. Statistical analyses were performed with Friedman repeated measures analysis of variance by rank and McNemar test for significance in each pair (α = 0.05). RESULTS: Only four restorations (SU-SE: 3 and SU-TEm: 1) were lost after 6 months (p > 0.05 for either criteria). Marginal discoloration occurred in one restoration in the SU-SE group (p > 0.05 for either criteria). Only 2/200 restorations were scored as bravo for marginal adaptation using the USPHS criteria (one for SU-SE and one for SU-SEet, p > 0.05). However, when using the FDI criteria, the percentage of bravo scores for marginal adaptation at 6 months were 32%, 36%, 42%, and 46% for groups SU-TEm, SU-TEd, SU-SEet, and SU-SE, respectively (p > 0.05). CONCLUSIONS: The clinical behavior of the multimode adhesive does not depend on the bonding strategy at 6 months. The FDI evaluation criteria are more sensitive than the USPHS criteria. CLINICAL SIGNIFICANCE: At 6 months, the clinical behavior of the new multimode adhesive Scotchbond Universal was found to be reliable when used in noncarious cervical lesions and may not depend on the bonding strategy employed.

Efficacy of and effect on tooth sensitivity of in-office bleaching gel concentrations: a randomized clinical trial.

With the aim of reducing the side effects of in-office bleaching agents, less-concentrated hydrogen peroxide (HP) gels have been released by manufacturers. We evaluated the tooth sensitivity (TS) and bleaching efficacy (BE) of two HP concentrations in this study. Gels containing 35% and 20% HP (HP35 and HP20, respectively) were applied on teeth of 60 caries-free patients. Color was recorded at baseline and one week after the first and second bleaching sessions using the Vita Classical shade guide. TS was recorded on a 0-4 scale. BE at each weekly recall was evaluated by Kruskall-Wallis and Mann-Whitney tests (α=0.05). Absolute risk of TS and its intensity was evaluated by Fisher exact and Mann-Whitney tests, respectively (α=0.05). After two bleaching sessions, color change of approximately eight tabs was obtained with HP35; whereas, with HP20 it was six tabs (p<0.05). Only 26.7% (HP35) and 16.7% (HP20) of the participants reported TS, and no statistical differences were detected among them. Both in-office bleaching gels showed similar TS intensity, but the 35% HP agent produced faster bleaching.

Effect of surgical defect coverage on cervical dentin hypersensitivity and quality of life.

BACKGROUND: Root exposure due to gingival recession (GR) can cause cervical dentin hypersensitivity (CDH), which is characterized by tooth pain. The aim of this study is to evaluate the effect of surgical defect coverage on CDH and quality of life in patients with GR. METHODS: Twenty-five GRs in maxillary canines and premolars were treated with coronally positioned flap plus connective tissue graft. GR dimensions, amount of keratinized gingiva, and clinical attachment level were evaluated. CDH was assessed by thermal and evaporative stimuli. Quality of life was assessed by use of the Oral Health Impact Profile-14 (OHIP-14) questionnaire. All parameters were evaluated at baseline and after 3 months. RESULTS: Statistically significant reduction in CDH (P <0.001), significant reduction in impact of oral health on quality of life (P <0.001), and significant changes in periodontal parameters were observed after 3 months. Mean defect coverage of 67.90% was achieved, with full coverage in 11 cases. Percentage defect coverage showed no correlation with air blast-stimulated CDH (P = 0.256) or cold stimulus (P = 0.563). The OHIP-14 physical disability dimension was correlated with the amount of keratinized tissue (P = 0.010) and also with defect coverage (P = 0.035). CONCLUSIONS: Surgical defect coverage may reduce CDH and improve patient quality of life, by keratinized gingiva augmentation and impact on physical disability, irrespective of amount of defect coverage.

Repair of dimethacrylate-based composite restorations by a silorane-based composite: a one-year randomized clinical trial.

PURPOSE: To investigate clinical performance of a low-shrinkage silorane-based composite resin when used for repairing conventional dimethacrylate-based composite restorations. BACKGROUND: Despite the continued development of resin-based materials, polymerization shrinkage and shrinkage stress still require improvement. A silorane-based monomer system was recently made available for dental restorations. This report refers to the use of this material for making repairs and evaluates the clinical performance of this alternative treatment. MATERIALS AND METHODS: One operator repaired the defective dimethacrylate-based composite resin restorations that were randomly assigned to one of two treatment groups: control (n=50) repair with Adper SE Plus (3M/ESPE) and Filtek P60 Posterior Restorative (3M/ESPE), and test (n=50) repair with P90 System Adhesive Self-Etch Primer and Bond (3M/ESPE) and Filtek P90 Low Shrink Posterior Restorative (3M/ESPE). After one week, restorations were finished and polished. Two calibrated examiners (Kw≥0.78) evaluated all repaired restorations, blindly and independently, at baseline and one year. The parameters examined were marginal adaptation, anatomic form, surface roughness, marginal discoloration, postoperative sensitivity, and secondary caries. The restorations were classified as Alpha, Bravo, or Charlie, according to modified US Public Health Service criteria. Mann-Whitney and Wilcoxon tests were used to compare the groups. RESULTS: Of the 100 restorations repaired in this study, 93 were reexamined at baseline. Dropout from baseline to one-year recall was 11%. No statistically significant differences were found between the materials for all clinical criteria, at baseline or at one-year recall (p>0.05). No statistically significant differences were registered (p>0.05) for each material when compared for all clinical criteria at baseline and at one-year recall. CONCLUSIONS: The hypothesis tested in this randomized controlled clinical trial was accepted. After the one-year evaluations, the silorane-based composite exhibited a similar performance compared with dimethacrylate-based composite when used to make repairs.

One-year clinical evaluation of composite restorations in posterior teeth: effect of adhesive systems.

This clinical study assessed the performance of posterior composite resins applied with the Adper™ Single Bond Plus (SB) and Adper™ Scotchbond SE (SE) adhesive systems and Filtek™ Supreme Plus composite resin, using modified US Public Health Service criteria. A total of 97 restorations were placed in posterior teeth by two calibrated operators. Application of the materials followed manufacturers' instructions. The restorations were evaluated by two examiners at baseline and after one year. Statistical analyses were conducted using the proportion test at a significance level of 5% (p<0.05). All the restorations evaluated (ie, 100%) received an alpha rating for the criteria of marginal discoloration and marginal integrity at baseline. At one year, for marginal discoloration, 64.6% of SB and 61.2% of SE received an alpha rating. For marginal integrity, 72.9% of SB and 77.6% of SE received an alpha rating. The other restorations received bravo ratings for both criteria. None of the teeth that received the restorative systems presented caries lesions around the restorations. A total of eight teeth presented postoperative sensitivity one week after baseline, five with SB and three with SE; the symptom had disappeared one year later. One year later, composite resin restorations using either adhesive system showed satisfactory clinical performance.

Oxalic acid under adhesive restorations as a means to reduce dentin sensitivity: a four-month clinical trial.

The aim of this double-blind randomized controlled clinical trial was to evaluate the reduction of dentin sensitivity using an oxalate-based compound, placed under adhesive restorations, during a four-month period. One hundred three preoperatively sensitive teeth, on 36 patients aged 25-66 years (mean, 40.3±7), were included in the study. Group A (experimental) was treated with oxalic acid (BisBlock) before resin-based composite (RBC) restorations (n=52), and group B (control) was treated with distilled water before RBC restorations (n=51). The first tooth in each patient was randomly assigned to group A, and the second tooth received group B. Clinical evaluation as made by a thermal/evaporation test with an air syringe and measurement by visual analog scale (VAS) at baseline and four months after treatment. The results showed sensitivity reduction during the evaluation period (expressed in VAS values): group A, 7.6 to 0.8; group B, 7.3 to 2.6. We concluded from this study that both treatments reduced dentin sensitivity during the evaluation period, with group A showing significantly less dentin sensitivity after four months (p<0.05).

Avaliaçäo clínica de pacientes portadores de lesöes dentárias cervicais näo cariosas, relacionadas com alguns aspectos físicos, químicos e mecânicos da cavidade bucal / Clinical evaluation of patients with non carious cervical dental lesions and the oral cavity conditions

Avaliaram-se clinicamente pacientes portadores de lesöes dentárias cervicais näo cariosas, relacionando-se com alguns aspectos físicos, químicos e mecânicos da cavidade bucal. Foram relacionados 100 pacientes de ambos os sexos e da faixa etária entre 18 a 75 anos, portadores de lesöes dentárias näo cariosas, localizadas na regiäo cervical dos dentes. Os pacientes relacionados responderam a um questionário envolvendo identificaçäo, registro dos hábitos de higiene bucal, alimentos e condiçäo de saúde. Era feito exame clínico, com classificaçäo da lesäo e sensibilidade dentinária, seguido de identificaçäo dos contatos oclusais do paciente em MIH, em lateralidade e protrusäo. Fazia-se o mapeamento oclusal com registro das características oclusais do paciente, documentaçäo radiográfica, fotográfica e confecçäo dos modelos de estudo. Os dados obtidos foram avaliados e concluiu-se que: 1) Pacientes do sexo masculino apresentaram maior prevalência de lesäo cervical näo cariosa; 2) Observou-se maior ocorrência de lesöes cervicais com hipersensibilidade em pacientes do sexo masculino; 3) Os pré-molares mostraram maior prevalência de lesöes cervicais seguidos dos molares, caninos e incisivos respectivamente; o mesmo foi encontrado com relaçäo a hipersensibilidade; 4) As lesöes cervicais e hipersensibilidade dentinária ocorreram mais frequentemente nos dentes superiores...

Estudo da distribuiçäo das tensöes internas, em um dente natural e em dente restaurado com coroa metalocerâmica e retentor intrarradicular fundido, sob carga axial: método do elemento finito / Study of the internal stress distribution in a natural tooth and in a ceramic-metal crown restored tooth with a cast post and core restoration, subjected to axial load: finite element method

Estudo comparativo da distribuiçäo das tensöes internas em um dente natural e em dente endodonticamente tratado, pelo método do elemento finito em modelo bidimensional de segundo pré-molar inferior, sob carga axial de 30 kgf em três pontos (contato primário e estabilizante) e, processados pelo programa SAP90. Os resultados indicaram maior acúmulo de tensöes, na metade vestibular, no dente natural e no dente restaurado. As tensöes foram mais intensas sob o ponto de aplicaçäo de cargas, nos dois modelos. As tensöes foram maiores no dente restaurado, por causa do maior módulo de elasticidade dos materiais restauradores, demonstrando que existem diferenças na distribuiçäo das tensöes no dente e na base óssea nos dois modelos