A simple method to increase the bleaching effectiveness of high-concentrated carbamide peroxide used for in-office bleaching.

This in vitro study aimed to evaluate the effect of two alternative clinical protocols on the tooth bleaching effectiveness of 37% carbamide peroxide. Thirty enamel-dentin blocks from bovine incisors were stained with a coffee solution for 1 week. After color measurement at baseline with a portable spectrophotometer, the blocks were bleached during two 45-min applications of 37% carbamide peroxide with a 2-day interval between bleaching procedures, according to one of the following protocols: 1) Control: placement of bleaching agent over dried enamel; 2) Moist enamel: placement of bleaching agent over enamel previously humidified with a damp gauze for 1 min; 3) Moist cotton pellet: covering the bleaching agent with a moist cotton pellet during the entire bleaching procedure. The tooth color was assessed 2 days after each bleaching procedure. The data of ΔL, Δa, Δb, and ΔE were individually analyzed using ANOVA and Tukey's test (α = 0.05). In general, applying the bleaching agent to the moist enamel resulted in lower Δa and Δb values, and higher ΔL and ΔE values than the control. No difference was observed between the control and the protocol of covering the bleaching agent with a moist cotton pellet. Regardless of the protocol, the second bleaching procedure resulted in a further increase in ΔL and ΔE, and a reduction in Δa. A further decrease in Δb was observed only for the moist enamel protocol. In conclusion, humidifying the enamel with a damp gauze prior to the placement of 37% carbamide peroxide improved the effectiveness of the bleaching.

High-concentration carbamide peroxide can reduce the sensitivity caused by in-office tooth bleaching: a single-blinded randomized controlled trial.

Objectives A single-blinded, randomized, parallel clinical trial evaluated the use of 37% carbamide peroxide (CP) on bleaching effectiveness and tooth sensitivity reported by patients undergoing in-office tooth bleaching, in comparison with the results of using 35% hydrogen peroxide. Material and Methods Forty patients were allocated to receive two sessions of in-office tooth bleaching using either 35% hydrogen peroxide (HP) or 37% CP. Each patient's sensitivity level was evaluated during and up to 24 h after bleaching. The effectiveness of the bleaching procedures was evaluated with a spectrophotometer one week after each session and 30 days after the last session. The impact of tooth bleaching on the patients' perceptions regarding smile changes, in addition to the bleaching procedures and their results, were also recorded. Absolute and relative sensitivity risks were calculated. Data on sensitivity level were analyzed using the Mann-Whitney or T-test, and data from the color evaluation were subjected to 2-way repeated measures ANOVA. Results The use of CP reduced the risk and level of tooth sensitivity to values close to zero, whereas the difference between the bleaching agents disappeared after 24 h. An increased bleaching effect was observed for HP, mainly due to an improved reduction of redness and yellowness. Participants perceived improved tooth bleaching for HP and reduced sensitivity for CP, but no differences regarding the comfort of the techniques were noted. Conclusions In our study, 37% CP resulted in reduced tooth sensitivity but decreased the tooth bleaching effectiveness. However, both bleaching agents resulted in high levels of patient satisfaction.

Color restoration and stability in two treatments for white spot lesions.

This study evaluated the effectiveness of resin infiltration or enamel microabrasion for restoring color changes caused by incipient carious lesions as well as the color stability achieved by these treatments. Enamel specimens were subjected to cariogenic challenge to produce white spot lesions (WSLs) using a microcosm biofilm model. These lesions were treated with resin infiltration or enamel microabrasion (n = 8), and color changes were measured with a spectrophotometer at baseline and after the treatments. Untreated specimens were used as a control. The treated specimens were then immersed in coffee for 1 week, and tooth color was measured again. Data for ΔL*, Δa*, Δb*, and ΔE were analyzed by two-way repeated measures ANOVA and Tukey's test (α = 0.05). Caries induction resulted in significant color changes, mainly decreased lightness. Neither resin infiltration nor enamel microabrasion were able to restore tooth color. The specimens subjected to resin infiltration and the control specimens were more susceptible to color changes following immersion in coffee. In conclusion, enamel microabrasion and resin infiltration were unable to restore the initial tooth color observed prior to WSL induction. Moreover, resin-infiltrated enamel seems more susceptible to staining solutions than enamel subjected to microabrasion.

Effect of topical application of dipyrone on dental sensitivity reduction after in-office dental bleaching: A randomized, triple-blind multicenter clinical trial.

BACKGROUND: Tooth sensitivity commonly occurs during and immediately after dental bleaching. The authors conducted a trial to compare tooth sensitivity after in-office bleaching after the use of either a topical dipyrone or placebo gel. METHODS: A split-mouth, triple-blind, randomized, multicenter clinical trial was conducted among 120 healthy adults having teeth that were shade A2 or darker. The facial tooth surfaces of the right or left sides of the maxillary arch of each patient were randomly assigned to receive either topical dipyrone or placebo gel before 2 in-office bleaching sessions (35% hydrogen peroxide) separated by 2 weeks. Visual analog and numerical rating scales were used to record tooth sensitivity during and up to 48 hours after bleaching. Tooth color change from baseline to 1 month after bleaching was measured with shade guide and spectrophotometer measures. The primary outcome variable was absolute risk of tooth sensitivity. An intention-to-treat analysis was used to analyze data from all patients who were randomly assigned to receive the dipyrone and placebo gels. RESULTS: No statically significant difference was found in the absolute risk of tooth sensitivity between the dipyrone and placebo gels (83% and 90%, respectively, P = .09; relative risk, 0.92; 95% confidence interval, 0.8 to 1.0). A whitening effect was observed in both groups with no statistically significant difference (P > .05) between them. No adverse effects were observed. CONCLUSION: Topical use of dipyrone gel before tooth bleaching, at the levels used in this study, did not reduce the risk or intensity of bleaching-induced tooth sensitivity. PRACTICAL IMPLICATIONS: Topical application of dipyrone gel does not reduce bleaching-induced tooth sensitivity.

Changes in dental esthetic perceptions of patients subjected to inoffice tooth bleaching / Mudanças nas percepções estéticas odontológicas de pacientes submetidos a clareamento dental de consultório

Objective: This study evaluated changes in the esthetic perceptions of patients subjected to inoffice tooth bleaching. Material and Methods: Fifty participants included in a clinical trial evaluating the in-office tooth bleaching answered two questionnaires about their dental esthetic perceptions. The participants answered the Orofacial Esthetic Scale (OES) questionnaire and the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) before and after treatment. The average scores observed at baseline were compared with those recorded after tooth bleaching using the paired t-test or the Wilcoxon signed rank test (α = 0.05). Results: Improvement in tooth color (reduction of 5.1 shade guide units) had a positive impact on patients' perceptions. According to PIDAQ, tooth bleaching significantly increased the psychological impact and dental selfconfidence; and reduced esthetic concerns. The OES demonstrated improvements in participants' satisfaction for all questions, except for the one on "facial appearance". However, higher effect size was observed for the question related to tooth color, as expected. Conclusion: Tooth bleaching was associated with an overall improvement in dental esthetic perception, even when only tooth color was affected. (AU)

Objetivo: Este estudo avaliou mudanças nas percepções estéticas de pacientes submetidos a clareamento dental de consultório. Material e Métodos: Cinquenta pacientes incluídos em um ensaio clínico avaliando clareamento dental de consultório responderam a dois questionários sobre suas percepções estética odontológicas. Os participantes responderam ao questionário de escala estética orofacial (EEO) e o questionário de impacto psicossocial da estética orofacial (PIDAQ) antes e após o tratamento. As médias dos escores no início do tratamento foram comparados com aqueles mensurados após o clareamento usando o teste-T pareado ou de Wilcoxon (α = 0,05). Resultados: Melhora na cor dental (redução de 5,1 unidades da escala de cor) teve um impacto positivo nas percepções dos pacientes. De acordo com PIDAQ, o clareamento dental significativamente aumentou o impacto psicossocial e autoconfiança dental, e reduziu as preocupações estéticas. O EEO demonstrou melhora na satisfação dos participantes para todas as questões, exceto para a de "aparência facial". Entretanto, maior efeito foi observado para a questão relacionada à cor dos dentes, como esperado. Conclusão: O clareamento dental foi associado com um aumento geral na percepção estética odontológica, mesmo que apenas a cor dos dentes foi afetada. (AU)

High-concentration carbamide peroxide can reduce the sensitivity caused by in-office tooth bleaching: a single-blinded randomized controlled trial

Abstract Objectives A single-blinded, randomized, parallel clinical trial evaluated the use of 37% carbamide peroxide (CP) on bleaching effectiveness and tooth sensitivity reported by patients undergoing in-office tooth bleaching, in comparison with the results of using 35% hydrogen peroxide. Material and Methods Forty patients were allocated to receive two sessions of in-office tooth bleaching using either 35% hydrogen peroxide (HP) or 37% CP. Each patient's sensitivity level was evaluated during and up to 24 h after bleaching. The effectiveness of the bleaching procedures was evaluated with a spectrophotometer one week after each session and 30 days after the last session. The impact of tooth bleaching on the patients' perceptions regarding smile changes, in addition to the bleaching procedures and their results, were also recorded. Absolute and relative sensitivity risks were calculated. Data on sensitivity level were analyzed using the Mann-Whitney or T-test, and data from the color evaluation were subjected to 2-way repeated measures ANOVA. Results The use of CP reduced the risk and level of tooth sensitivity to values close to zero, whereas the difference between the bleaching agents disappeared after 24 h. An increased bleaching effect was observed for HP, mainly due to an improved reduction of redness and yellowness. Participants perceived improved tooth bleaching for HP and reduced sensitivity for CP, but no differences regarding the comfort of the techniques were noted. Conclusions In our study, 37% CP resulted in reduced tooth sensitivity but decreased the tooth bleaching effectiveness. However, both bleaching agents resulted in high levels of patient satisfaction.

Immediate and delayed photoactivation of self-adhesive resin cements and retention of glass-fiber posts.

The aim of this study was to evaluate the effect of immediate and delayed photoactivation of self-adhesive resin cements (SARCs) on the retention of glass-fiber posts luted into root canals. Bovine incisors were endodontically treated, and post holes of 9 mm in depth were prepared. Fiber posts were luted using one of two SARCs, BisCem (Bisco Inc., Schaumburg, USA) or RelyX Unicem clicker (3M ESPE, Saint Paul, USA), or a regular (etch-and-rinse) resin cement (AllCem; FGM, Joinvile, Brazil). Photoactivation was performed immediately, or at 5 or 10 min after cementation. Root/post specimens were transversely sectioned 7 days after luting into 1-mm-thick slices, which were submitted to push-out testing in a mechanical testing machine. Bond strength data were analyzed by two-way ANOVA and Student-Newman-Keuls' method (α = 0.05). Immediate photoactivation resulted in the highest bond strength for Unicem. BisCem demonstrated higher bond strength values when photoactivated after a 10-min delay. Immediate photoactivation yielded the lowest bond strengths for AllCem, although no differences in bond strength were observed between photoactivation delayed by 5 and 10 min. In conclusion, the moment of resin cement photoactivation may affect the intraradicular retention of fiber posts, depending upon the resin cement used for luting.

Transplante dentário: Atualização da literatura e relato de caso / Dental Transplantation: Literature Update and Case Report

Apesar dos grandes avanços da odontologia, com consequente diminuição das indicações de exodontia por doença periodontal e cárie, a prática da remoção de dentes que podem ser tratados de forma conservadora ainda é rotineira em locais onde a condição sócio-econômica é desfavorável. As terapêuticas possíveis frente a um dente perdido são geralmente por reabilitação protética, implantes e ortodontia, todavia são tratamentos que geralmente dependem de condição financeira. Desse modo, o transplante dental surge como uma opção de tratamento a todas as camadas sociais, sendo denominado por alguns pesquisadores de "prótese biológica". As principais indicações para a transferência de um dente natural do seu alvéolo para outro sítio estão relacionadas a cáries extensas, reabsorção radicular, doença periodontal, fratura coronorradicular, agenesia e aplasia de dentes, dentes inclusos. A técnica cirúrgica deve ser minimamente traumática para melhor prognóstico do dente a ser transplantado, uma vez que o ligamento periodontal não deve ser manipulado, por ser necessário à reparação dos tecidos periodontais.

Despite major advances in dentistry, with consequent reduction of the indications for extraction for periodontal disease and tooth decay, the practice of removing teeth may be treated conservatively is still routinely used in places where the socio-economic status is unfavorable. The therapeutic potential against a missing tooth are usually for prosthetic rehabilitation, implants and orthodontics, however, are treatments that often depend on financial condition. Thus, the dental transplant comes as a treatment option to all social strata, being called by some researchers "bioprosthetic". The main indications for the transfer of a natural tooth in its socket to another site is related to extensive caries, root resorption, periodontal disease, fractured coronorradicular, agenesis and aplasia of teeth, impacted teeth. The surgical procedure should be minimally traumatic to better prognosis of the tooth to be transplanted, since the periodontal ligament should not be manipulated by the need of periodontal tissue repair.

Immunohistochemical analysis of human homologue of drosophila patched (PTCH) in dental follicles of impacted third molars / Análisis imunohistoquímico del homólogo humano del gen parcheado de drosofila (PTCH) en folículos dentales de terceros molares retenidos

This study investigated the immunodetection of PTCH in epithelial components of dental follicles associated with impacted third molars without radiographic signs of pathosis. One hundred and five specimens of dental follicles associated with impacted third molars with incomplete rhizogenesis (between Nolla's stage 6 and 9) were surgically removed from 56 patients. Epithelial cell proliferation was determined by using immunohistochemical labeling. Statistical analysis was performed using Fisher exact test and a level of significance of 5 percent. Of the 105 dental follicles collected, 3 were PTCH-positive. The specimens with squamous metaplasia and epithelial hyperplasia had higher rates of positivity for PTCH, as well as those with active remnants of odontogenic epithelium. This study suggests that the odontogenic cells of the dental follicle might be proliferating during the rhizogenesis, while the squamous metaplasia and hyperplasia of the epithelial lining and proliferative odontogenic epithelial rests show the differentiation potential of dental follicles.

Se investigó la inmunodetección de PTCH en los componentes epiteliales de los folículos dentales asociados a terceros molares retenidos sin signos radiográficos y morfológicos de patología. Fueron quirúrgicamente extraídos de 56 pacientes 105 muestras de folículos dentales asociadas a terceros molares retenidos con rizogénesis incompleta (entre el estadio de Nolla 6 y 9). La proliferación de células epiteliales se deteminó mediante inmunohistoquímica. El análisis estadístico se realizó mediante la prueba exacta de Fisher. De los 105 folículos dentales recogidos, 3 fueron PTCH-positivos. Las muestras con metaplasia escamosa e hiperplasia epitelial tuvieron mayores tasas de positividad para PTCH, así como aquellos con los restos de proliferación del epitélio odontogénico. En conclusión, este estudio sugiere que las células odontogénicas del folículo dental podrían estar proliferando durante la rizogénesis, mientras que la metaplasia escamosa e hiperplasia del epitelio y de restos epiteliales odontogénicos en proliferación muestran el potencial de diferenciación de los folículos dentales.

Percepção dos Cirurgiões-Dentistas em Relação ao Sistema Único de Saúde/Programa de Saúde da Família (SUS/PSF) no Município de Nossa Senhora do Socorro - SE / Perception of Dentists in Relation to the Single Health System/Family Health (SUS/PSF) Program in the City of Nossa Senhora do Socorro-SE

O presente estudo objetivou conhecer a percepção dos cirurgiões-dentistas em relação ao Sistema Único de Saúde e ao Programa Saúde da Família no município de Nossa Senhora do Socorro, Sergipe. Foram aplicados 41 questionários contendo perguntas objetivas e subjetivas, com análise dos resultados desenvolvida por meio da abordagem qualiquantitativa. Os resultados demonstraram que a maioria dos cirurgiões-dentistas enfatiza a importância da capacitação de recursos humanos como forma de integração e efetividade da Equipe de Saúde Bucal no Sistema Único de Saúde e no Programa Saúde da Família. Concluiu-se que os profissionais, os gestores e as entidades públicas devem buscar promover a interação entre avanço do conhecimento, progresso tecnológico, mercado de trabalho, estrutura de serviços, políticas públicas, agenda social e perfil das demandas, contribuindo, dessa maneira, na resolução do paradoxo entre formação profissional, com ênfase no domínio cognitivo/instrumental e mudanças nas tendências atuais das políticas de saúde.

This study examines perceptions of dentists in relation to the Health System and the Family Health Program in the city of Nossa Senhora do Socorro, Sergipe. Questionnaires containing 41 questions with objective and subjective questions were utilized and the analysis of the results were developed through the qualitativequantitative approach. The results showed that most dentists emphasizes the importance of training human resources as a means of integration and effectiveness of the Oral Health Team in the National Health System and the Family Health Program. It was concluded that professionals, managers and public authorities should seek to promote the interaction between scientific knowledge, technological progress, labor market structure, services, public policy, social agenda and profile of demand, contributing, in this way, with the resolution of paradox between training with emphasis on the cognitive / instrumental and changes in current trends of health policies.

Bilateral bifid mandibular condyle: a case report / Proceso condilar bífido bilateral: reporte de caso

The bifid mandibular condyle is an exceedingly rare anomaly, frequently diagnosed as an incidental finding in a panoramic radiograph. Its etiology and pathogenesis are unknown, though the most acceptable theory suggests that trauma is at the origin of the condition. This article reports a new case of bilateral bifid condyle in a 21-year-old female with history of trauma in childhood.

El proceso condilar bífido es una anomalía muy rara. Se diagnostica como un hallazgo accidental en una radiografía panorámica. Su etiología y patogenia son desconocidas, aunque la teoría más aceptada sugiere que el trauma está en el origen de esta condición. Este artículo presenta un nuevo caso de proceso condilar bífido bilateral en una mujer de 21 años de edad con antecedentes de trauma en la infancia.