Hipersensibilidade Dentinária Cervical: fatores de risco e protocolos de tratamento neural - estudo in vitro e clinico / Cervical Dentin Hypersensitivity: risk factors and neural treatment protocols - in vitro and clinical study

A lesão cervical não cariosa (LCNC) é uma doença caracterizada pela perda mineral do tecido dentário na região cervical. A sua progressão pode levar a hipersensibilidade dentinaria cervical (HDC). Apresenta etiologia multifatorial através de mecanismos de: fricção como a escovação (frequência, força, direção e creme dental abrasivo); tensão com sobrecarga oclusal (bruxismo e má-oclusão) e, principalmente, o mecanismo de corrosão através de doenças gástricas, transtornos alimentares e hábitos dietéticos (ingestão de ácido). Nos últimos anos é notório observamos a mudança de estilo de vida da população, e com isso um aumento da prevalência de HDC. É uma condição clínica comum caracterizada por uma dor aguda e transitória que surge devido a túbulos expostos em resposta a estímulos. Impacta negativamente a saúde bucal e a qualidade de vida dos pacientes. Para facilitar o entendimento, essa tese apresenta um compilado em três capítulos. Capitulo 1: O objetivo foi avaliar o pH de bebidas esportivas, energéticas, fitness/funcionais e suplementos, e a capacidade de neutralizar o ácido pela adição de saliva artificial, em um estudo experimental; capitulo 2: Avaliar o pH de bebidas, alimentos e medicamentos disponíveis no mercado brasileiro e a capacidade de neutralizar o ácido pela adição de saliva artificial; e capitulo 3: Através de um estudo clínico longitudinal randomizado, avaliar diferentes protocolos de tratamento da HDC com laser de baixa potência, agente dessensibilizante, e sua associação. Após as análises dos resultados ressalta-se que bebidas esportivas são comumente recomendadas por outros profissionais com o objetivo principal de atingir as metas de cada atleta, seja amador ou profissional. No entanto, como podem ter impacto na saúde bucal e um trabalho multidisciplinar é necessário, além de orientações para os pacientes esportivos. A maioria dos alimentos e bebidas consumidas por brasileiros são ácidas, e os resultados fornecem a dentistas e pacientes informações relevantes sobre as características do potencial corrosivo das bebidas comercialmente disponíveis no Brasil, sendo necessário orientações dietéticas específicas para prevenir ou minimizar o desgaste precoce dos dentes. E por último, encontrou-se que protocolo dessensibilizante de três sessões foi eficaz na redução da HDC após 3 meses, independentemente do mecanismo de dessensibilização utilizado.

Photobiomodulation therapy and 3% potassium nitrate gel as treatment of cervical dentin hypersensitivity: a randomized clinical trial.

OBJECTIVES: This randomized controlled trial aimed to evaluate different protocols for dentin hypersensitivity treatment with low-power lasers and desensitizing agents, and the association between low-power lasers and desensitizing agents. MATERIALS AND METHODS: Fifty-four patients (303 teeth) were randomly allocated to three groups: G1, 3% nitrate potassium gel, UltraEZ (n = 17); G2, photobiomodulation therapy (PBM) with a low-level infrared laser (n = 17), 100 mW, spot size of 0.028 cm2, and dose of 1 J per point; and G3, nitrate potassium + PBM (n = 20). Treatments were applied to the buccal cervical region at intervals of 72 h, and all protocols were performed in three sessions. The patients' response to evaporative stimuli was rated using the visual analog scale (VAS). Re-evaluations were performed immediately after each application and 1 week, 1 month, and 3 months after treatment. A two-way repeated measures test and Tukey's post hoc test were used for multiple comparisons (α = 5%). RESULTS: There was a reduction in pain levels at the end of treatment in all groups. There were no significant differences in VAS score changes between the groups immediately after treatment and after the third month, compared to the baseline (p > 0.05). CONCLUSION: Under the limitations of this in vivo study, the proposed three-session protocol was effective in reducing dentin hypersensitivity after 3 months, regardless of the desensitization mechanism used. Conservative and long-term protocols are interesting for the control of pain caused by dentin hypersensitivity. CLINICAL RELEVANCE: The increase in cervical dentin hypersensitivity prevalence warrants easy-to-apply and long-lasting desensitizing protocols for pain control.

Sports dentistry: a perspective for the future

Sports Dentistry (SD) acts in the prevention, maintenance and treatment of oral and facial injuries, as well as the collection and dissemination of information on dental trauma, beyond stimulus to research. Establishes as a duty for the dentist detect problems related to the athlete's stomatognathic system. This essay is based on the provided data from the literature related to SD, including definition, practice areas and research fields. To discuss the data, six areas were categorized: shares in sports dentistry; oral health of athlete; sports-related dental implications; dental-facial trauma; face shields; and mouthguards. The analyzed data show that the SD is still an underexplored field of action by dentists, but it is expanding, despite not being recognized specialty by the Federal Council of Dentistry, but the Brazilian Academy of Sports Dentistry has been created with a mission to show the real importance of Dentistry in sport. The dentist should be part of the group of professionals associated with the athlete to perform periodic checks in order to ensure oral health which may contribute to athletes´performance. When impact occurs, however, it would be possible reduce the severity of the impact related to injuries, by using helmets, masks, goggles, face shields and mouthguard. Additionally, it is imperative that dentists, sports coaching, athletes, and professional who work with athletes be aware of the benefits of incorporating SD as an important academic and professional subject.

Análise do desgaste de pontas diamantadas 1014 por meio de MEV / Wear analysis of espherical diamond burs 1014 under SEM

Pontas diamantadas são instrumentos rotatórios abrasivos utilizados rotineiramente na odontologia restauradora. Objetivou-se analisar e comparar a qualidade da impregnação dos grânulos de diamante e o desgaste sofrido pelas pontas, por meio de MEV. Utilizaram-se 60 pontas diamantadas do modelo 1014, de seis marcas comerciais nacionais: KG Sorensen, Microdont, Fava, Vortex, Option e Zeep. Após MEV prévia ao desgaste, as pontas diamantadas foram submetidas a três testes sequenciais de três minutos em bloco de reina composta (n=5) e em cerâmica à base de dissilicato de lítio (N=5), ao término de cada etapa foi realizada MEV. Houve perda e variação na forma dos grânulos de diamante para todas as marcas comerciais, o que ressalta a importância da substituição de instrumentos rotatórios na atividade clínica.

Diamond burs are abrasive rotary instruments routinely used in restorative dentistry. The aim of this study was to analyze and compare the quality of the diamond granules impregnation and the wear under SEM. Sixty diamond burs were used (#1014) from 6 brazilian manufacturers: KG Sorensen, Microdont, Fava, Vortex, Option and Zeep. After initial SEM assessment, the diamond burs were subjected to three sequential tests of 3 minutes in composite resin blocks (n=5) and lithium disilicate-based ceramics (N=5). The burs were evaluated for wear under SEM after each step. Loss and variation of the shape of diamond granules were observed for all trademarks, highlighting the importance of replacement of rotary instruments in clinical procedures.

Esthetic rehabilitation with laminated ceramic veneers reinforced by lithium disilicate.

Because of their predictable results and conservation of tooth structure, ceramic veneers are indicated for the esthetic treatment of anterior teeth with anomalous positions or appearance. The objective of this case report is to highlight the steps in dental rehabilitation using ceramic veneers reinforced by lithium disilicate. In this case the patient had diastemas between the mandibular incisors. After preliminary procedures, diagnostic models, waxing, and mock-up were completed, an impression was made with addition silicone, and the veneers were fabricated and cemented with light-cure cement. As a result, the esthetics and function expected by the patient were achieved. The use of ceramic veneers enabled a conservative and esthetically successful rehabilitation treatment.