Effectiveness of Cyanoacrylate in the Treatment of Dentin Hypersensitivity: A Systematic Review.

Objective: To compare the effectiveness of cyanoacrylate to other treatments or placebo in the management of dentin hypersensitivity (DH). Materials and Methods: The present review was organized based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. The search aimed to answer the following question: is cyanoacrylate effective in the treatment of DH when compared to other treatments or placebo? The following databases were used: PubMed/MEDLINE, Scopus, BVS, Web of Science, Cochrane, Clinicaltrials.gov, Portal Periódicos Capes, Google Scholar, and manual search. The evaluation process started with the information collected from the selected articles according to the Consolidated Standards of Reporting Trials (CONSORT). Results: Two randomized and five nonrandomized clinical trials were analyzed in the qualitative synthesis. The studies presented different cyanoacrylate formulations, different scales for evaluating pain, and different methods for provoking a painful stimulus. Cyanoacrylate-based products reduce DH in shorter follow-up periods and this reduction persisted throughout the study. The results varied according to the methods used to stimulate the pain. Only two articles showed a low risk of bias and a high level of scientific evidence. Conclusion: Although there is a limited number of studies in the scientific literature with appropriate methodological quality, the available evidence proves the effectiveness of cyanoacrylate in the treatment of DH. Clinical Relevance. Cyanoacrylate is easy to access, effective, easily applicable, and a low-cost product with satisfactory results.

Counselling treatment versus counselling associated with jaw exercises in patients with disc displacement with reduction-a single-blinded, randomized, controlled clinical trial.

OBJECTIVE: To compare effectiveness of counselling program versus counselling program plus jaw exercises to reduce pain and click in patients with temporomandibular joint disc displacement with reduction (DDWR). MATERIALS AND METHODS: Patients were divided into two groups: instructions for temporomandibular disorders (TMD) plus jaw exercises (test, n = 34), only TMD instructions (control, n = 34). Pain was analyzed by palpation (RDC/TMD). It was investigated if the click caused discomfort. Both groups were evaluated at baseline, 24 h, 7 days, and 30 days' post treatment. RESULTS: The click was present in 85.7% (n = 60). In 30-day evaluation, there was a statistically significant difference between groups in the right median temporal muscle (p = 0.041); and there was a statistically significant difference in treatment self-perception (p = 0.002) and click's discomfort (p < 0.001). CONCLUSION: The exercise with recommendations showed better results, resolution of the click, and self-perception of the treatment effectiveness. CLINICAL RELEVANCE: This study presents therapeutic approaches that are easy to perform and that can be monitored remotely. In view of the current stage of the global pandemic, these treatment options become even more valid and useful. CLINICAL TRIAL REGISTER: This clinical trial was registered at Brazilian Clinical Trials Registry (ReBec) under protocol RBR-7t6ycp ( http://www.ensaiosclinicos.gov.br/rg/RBR-7t6ycp/ ), Date of registration: 26/06/2020.

Oral health-related quality of life in patients with disc displacement with reduction after counselling treatment versus counselling associated with jaw exercises.

OBJECTIVE: The aim of this study was to compare the effectiveness of two types of treatment (counselling programme versus counselling programme plus jaw exercises) to improve the quality of life of patients with disc displacement with reduction (DDWR). MATERIALS AND METHODS: Patients were divided into two groups. The test group received guidelines for temporomandibular disorders (TMD) plus jaw exercises for DDWR, and the control group received only guidelines for TMD. The total number of investigated patients was 70, thus 35 per group. The oral health-related quality of life was assessed by the OHIP-14 questionnaire. Both groups were evaluated at the baseline and 30 days post-treatment. RESULTS: In the counselling group, there was statistically significant decrease in pain (P = .015) and social disability (P = .046) subscales. In the counselling plus jaw exercise group, there was statistically significant decrease in all subscales (P < .05). At 30 days follow-up, there was a statically significant difference between the two groups in pain (P = .004), psychological discomfort (P < .001), psychological disability (P < .001) and social disability (P = .029) subscales. CONCLUSION: The counselling programme plus jaw exercise protocol showed greater improvement in oral health-related quality of life than the group performing only the counselling programme in patients with DDWR.

Does the third molar position influence periodontal status and overall condition of patients with acute pericoronitis? A cross-sectional study.

PURPOSE: The teeth positioning may be an important associated factor for the pericoronitis' clinical signs. Our objective was to verify the association between lower third molar position according to the Pell and Gregory classification and clinical variables in patients with pericoronitis. METHODS: Cross-sectional analysis of panoramic radiographs and medical records of patients with pericoronitis. Primary outcomes: pain and oral health-related quality of life (OHRQoL); secondary outcomes: mouth opening, edema/erythema extension, visible plaque index, bleeding on probing index, periodontal pocket probing depth, and distal alveolar bone crest height of the adjacent second molar. RESULTS: The edema/erythema extension was higher in the IIA position compared with the IA position (p = 0.03). Regarding the OHRQoL, the OHIP-14 score was 21.0 (± 9.26, range from 4 to 44). The most scored domain was physical pain (5.24), followed by psychological discomfort (4.43). Third molars in IIA position are associated with worse OHRQoL than IB and IIB positions (p = 0.03). CONCLUSIONS: There was a higher extension of edema/erythema and worse OHRQoL when the third molar was in IIA position. Prophylactic removal of mandibular third molar in position IIA may avoid the onset of mucosal edema/erythema and prevent pericoronitis from promoting impairment of individuals' quality of life.

Scales for pain assessment in cervical dentin hypersensitivity: a comparative study / Escalas para avaliação da dor na hipersensibilidade dentinária cervical: um estudo comparativo

Abstract Background Currently, different pain scales are used extensively to measure clinical pain, especially in dental practice. Objective This study aims to compare pain scales used in clinical research and dental practice, identifying the easiest to understand by patients with Cervical Dentin Hypersensitivity. Method Seventy-four patients with Cervical Dentin Hypersensitivity were stimulated by a thermic test of the sensitive tooth, followed by application of different pain measurement scales (Visual Analogue Scale, Faces Pain Scales, Numeric Rating Scale, and Verbal Rating Scale) and by a questionnaire to evaluate the patient's perception regarding the ease of understanding scales. The statistic tests used were the Wilcoxon, Spearman correlation, and Chi-Square tests. Results The results founded a strong positive correlation between the scales (r = 0.798 to 0.960 p <0.001). The was easiest scale to understand according to the patients was the Verbal Rating Scale (52.7%). Conclusion The pain measurement scales evaluated provide similar information about pain reported in the Cervical Dentin Hypersensitivity allowing the comparison between studies that used them to measure pain. The affinity of the patient with the pain scale can guide the clinical dental practice in the different levels of health care.

Resumo Introdução Atualmente, diferentes escalas têm sido utilizadas para medir a dor no contexto clínico, especialmente na prática odontológica. Objetivo O objetivo deste estudo foi comparar as escalas de dor comumente utilizadas em pesquisas clínicas e na prática clínica odontológica, identificando as mais fáceis de serem compreendidas pelos pacientes com hipersensibilidade dentinária cervical. Método Setenta e quatro pacientes com hipersensibilidade dentinária cervical foram estimulados por um teste térmico para avaliação do dente sensível, seguido pela aplicação de diferentes escalas para avaliação de dor (Escala Visual Analógica, Faces de Dor, Escala Numérica e Escala Verbal) e de um questionário complementar para avaliar a percepção do paciente em relação à facilidade de compreensão das escalas. Os resultados foram submetidos aos testes de correlação de Wilcoxon, Spearman e Qui-Quadrado. Resultados Uma forte correlação positiva foi encontrada entre as quatro escalas avaliadas (r = 0,798 a 0,960; p < 0,001). De acordo com os pacientes, a escala de mais fácil compreensão foi a Escala Verbal (52,7%). Conclusão As escalas para mensuração da dor fornecem informações semelhantes sobre a dor relatada na hipersensibilidade dentinária cervical. A afinidade do paciente pela escala de dor pode direcionar a escolha da escala a ser utilizada na prática clínica odontológica nos diversos níveis de atenção à saúde.

Sensitivity and specificity of assessment scales of dentin hypersensitivity - an accuracy study.

The aim of the present study was to compare the sensitivity and specificity of pain scales used to assess dentin hypersensitivity (DH). The preferred scale, and toothbrushing habits of participants were also investigated. This cross-sectional study was conducted with students and employees of a Brazilian Federal University who presented DH. The participants answered a questionnaire about their toothbrushing and drinking habits. Hypersensitive and non-sensitive teeth were submitted to tactile and ice stick stimuli. Then, the subjects marked their pain level in the visual analogue (VAS), numeric scale (NS), faces pain scale (FPS) and verbal evaluation scale (VES). DH was also assessed by Schiff scale (SS). The data were analyzed by Wilcoxon and Chi-Square tests, as well as by ROC curve. The mean age of the sample (56 women, 16 men) was 27.8 years. The most prevalent acidic beverage was coffee (36.0%) and the most preferred scale was the NS (47.2%). The pain level was statistically higher in teeth with DH compared to teeth without DH (p < 0.05). The accuracy ranged from 0.729 (SS) to 0.750 (NS). The highest sensitivity value was 81.9% for NS. The SS presented the highest specificity (91%). The visual analog, numerical, verbal evaluation, faces pain, and Schiff scales were accurate for DH diagnosis. The Schiff scale was the preferred scale for DH assessment.

Clinical and radiographic evaluation of the Periodontium with biologic width invasion.

BACKGROUND: The biologic width is defined as the coronal dimension to the alveolar bone that is occupied by healthy gingival tissue. The objective of the present study was to correlate radiographic findings of biologic width invasion with the periodontium status. METHODS: It were included 14 patients with restored teeth with biological width invasion, on the proximal sites, observed clinically and radiographically. 122 proximal sites were evaluated, 61 in the test group (biological width invasion) and 61 in the control group (adequate biological width). Smokers and patients presenting periodontal disease or restorations with contact in eccentric movements, horizontal over-contour or secondary caries were excluded from the sample. The invasion of the biologic width was diagnosed when the distance from the gingival margin of restoration to the bony crest was less than 3 mm. Intrabony defect and bone crest level, as well as, their vertical and horizontal components were radiographically evaluated when present. Plaque index, bleeding on probing, probing depth, gingival recession height, keratinized gingival height and thickness, and clinical attachment level were clinically evaluated. Data were subjected to Spearman's Correlation and Wilcoxon's test. RESULT: The most prevalent tooth with biological width invasion was the first molar. There was a statistically significant correlation between the bone crest (p < 0.001), vertical (p < 0.001) and horizontal (p = 0.001) components. In the test group, there was a statistically significant correlation between bleeding on probing (p < 0.001; r = 0.618) and width of gingival recession (p = 0.030; r = - 0.602) with the intraosseous component; and between keratinized gingival height and bone level (p = 0.037; r = - 0.267). In the control group, there was a correlation between plaque index (p = 0.027; r = - 0.283) with bone level and correlation between keratinized gingival thickness and bone level (p = 0.034; r = - 0.273) and intrabony component (p = 0.042; r = 0.226). CONCLUSION: A statistically significant relationship was found between bleeding on probing and gingival recession in patients who presented intrabony defects due to the invasion of biological width, which may be also related to the thickness of the keratinized gingiva.

Sensitivity and specificity of assessment scales of dentin hypersensitivity - an accuracy study

Abstract The aim of the present study was to compare the sensitivity and specificity of pain scales used to assess dentin hypersensitivity (DH). The preferred scale, and toothbrushing habits of participants were also investigated. This cross-sectional study was conducted with students and employees of a Brazilian Federal University who presented DH. The participants answered a questionnaire about their toothbrushing and drinking habits. Hypersensitive and non-sensitive teeth were submitted to tactile and ice stick stimuli. Then, the subjects marked their pain level in the visual analogue (VAS), numeric scale (NS), faces pain scale (FPS) and verbal evaluation scale (VES). DH was also assessed by Schiff scale (SS). The data were analyzed by Wilcoxon and Chi-Square tests, as well as by ROC curve. The mean age of the sample (56 women, 16 men) was 27.8 years. The most prevalent acidic beverage was coffee (36.0%) and the most preferred scale was the NS (47.2%). The pain level was statistically higher in teeth with DH compared to teeth without DH (p < 0.05). The accuracy ranged from 0.729 (SS) to 0.750 (NS). The highest sensitivity value was 81.9% for NS. The SS presented the highest specificity (91%). The visual analog, numerical, verbal evaluation, faces pain, and Schiff scales were accurate for DH diagnosis. The Schiff scale was the preferred scale for DH assessment.

Association between mandibular third molar position and the occurrence of pericoronitis: A systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to investigate the association between mandibular third molar position and occurrence of pericoronitis. DESIGN: The systematic review was performed based on PRISMA criteria (Prospero: CRD42018102835). The electronic search was performed in Medline, Virtual Health Library and Web of Science (until August 2018), without language restriction. Two researchers independently selected studies, extracted data, and assessed methodologic quality. Twenty-one articles were included in the review, comprising 6895 patients, with 1913 third mandibular molars being affected by pericoronitis. Ten studies were incuded in meta-analysis. RESULTS: The third molar in vertical position of Winter is the one with the greatest chance of presenting pericoronitis, compared to the other positions, while the horizontal position decreases this chance. There was no significant difference in the chance of pericoronitis between positions I and II of Pell & Gregory (OR: 0.29; IC: 0.07-1.23, I2 = 88%). Third molars classified in position A had greater chance of pericoronitis when compared to those in position B (OR: 7.13; IC: 1.31-38.74, I2 = 93%). The vertical position of the lower third molar is more associated with the occurrence of pericoronitis when compared to the other positions. CONCLUSIONS: Vertical position of the lower third molar is more associated with the occurrence of pericoronitis when compared to the other Winter' positions. Considering Pell and Gregory positions, position A had a greater chance of pericoronitis compared to position B. The prophylactic removal of lower third semi-erupted vertical molar or in position A is indicated to prevent pericoronitis.

Prevalence of self-reported versus diagnosed dentinal hypersensitivity: a cross-sectional study and ROC curve analysis.

OBJECTIVE: This study aimed to identify and compare the self-reported and diagnosed prevalence of dentinal hypersensitivity (DH) in an University population; and to verify accuracy, sensitivity and specificity of DH stimuli tests. MATERIAL AND METHODS: Three hundred and eighty patients (67.2% women and 32.8% men) were assessed by questionnaire, clinical exam, tactile and cold water tests. The intensity of DH was assessed using a visual analogue scale, and a calibrated examiner measured the scores using a caliper. The ICC for intra-examiner was 0.990. Scores above 5 mm were considered sensitive teeth. The association between variables was assessed by Chi-square test. ROC curve analysis determined accuracy, sensitivity and specificity of the tests (p < .05). RESULTS: The mean age of participants was 24.08 years. 158 (41.7%) volunteers self-reported the presence of DH, while, 88.7% of the participants were clinically diagnosed (p = .023). In total, 8958 teeth were evaluated, of those 3367 (37.6%) were diagnosed sensitive. The most prevalent teeth with DH were incisors and premolars. The accuracy of the tests with cold water and tactile were 99%. The sensitivity and specificity for cold water and tactile tests were 99.9%, 99.7%, 99.1% and 87.6%, respectively. CONCLUSION: The self-reported prevalence of DH was significantly lower than that clinically diagnosed. The cold test proved to be a highly accurate stimulus for the diagnosis of DH.

Associated factors to cervical dentin hypersensitivity in adults: a transversal study.

BACKGROUND: This cross-sectional study aimed to identify the factors associated to the cervical dentin hypersensitivity (DH) in Brazilian adult population. METHODS: Three hundred and eighty patients (67.2% women and 32.8% men) were assessed by questionnaire and thermal test with ice. Participants marked in a visual analogue scale (VAS) the intensity of pain, and a calibrated examiner (ICC 0.990) measured the scores using a caliper. Pain scores above 0.5 mm were considered sensitive teeth. The DH associated factors were investigated by clinical examination. The association between variables was assessed by Spearman correlation and the Chi-square test. Logistic regression was used to determine the variables that predict DH (p < 0.05). RESULTS: The mean age of participants was 24.08 years. In this population, 8958 teeth were evaluated, of those 3037 (33.9%) were diagnosed sensitive. The most prevalent associated factors to DH were abnormal tooth positioning (9.0%), occlusal trauma (6.5%) and gingival recession (5.6%). The erosion predicted significantly the DH on both simple (OR 7.85, p < 0.001) and multiple(OR 4.36, p < 0.001) analysis. CONCLUSION: The exposure of dentinal tubules by erosion is probably the major predictor of dentin hypersensitivity. The healthy tooth is able to protect against DH.

Effects of the inspiratory muscle training and aerobic training on respiratory and functional parameters, inflammatory biomarkers, redox status and quality of life in hemodialysis patients: A randomized clinical trial.

OBJECTIVE: Evaluate and compare the isolated and combined effects of Inspiratory Muscle Training (IMT) and Aerobic Training (AT) on respiratory and functional parameters, inflamatory biomarkers, redox status and health-related quality of life (HRQoL) in hemodialysis patients. METHODS: A randomised controlled trial with factorial allocation and intention-to-treat analysis was performed in hemodialysis patients. Volunteers were randomly assigned to performe 8-weeks of IMT at 50% of maximal inspiratory pressure (MIP), low intensity AT or combined training (CT). Before the interventions, all the volunteers went 8-weeks through a control period (without training). Measures are taken at baseline, 8-week (after control period) and 16-week (after the interventions). Primary outcomes were functional capacity (incremental shuttle walk test), MIP and lower limbs strength (Sit-to-Stand test of 30 seconds). Plasma levels of interleukin-6 (IL-6), soluble tumor necrosis factor receptor 1 (sTNFR1) and 2 (sTNFR2), adiponectin, resistin and leptin, redox status parameters and HRQoL (KDQOL-SF questionnaire) were the scondary outcomes. Data analyses were performed by two-way repeated measurements ANOVA. RESULTS: 37 hemodialysis patients aged 48.2 years old (IC95% 43.2-54.7) were randomized. Increase of MIP, functional capacity, lower limbs strength and resistin levels, and reduction of sTNFR2 levels in 16-week, compared to baseline and 8-week, were observed in all the groups (p<0.001). IMT improved functional capacity, MIP and lower limbs strength in 96.7m (IC95% 5.6-189.9), 34.5cmH2O (IC95% 22.4-46.7) and 2.2repetitions (IC95% 1.1-3.2) respectively. Increase in resistin leves and reduction in sTNFR2 leves after IMT was 0.8ng/dL (IC95% 0.5-1.1) and 0.8ng/dL (IC95% 0.3-1.3), respectively, without between-group differences. Compared to baseline and 8-week, adiponectin levels (p<0.001) and fatigue domain of the HRQoL (p<0.05) increased in 16-week only in CT. CONCLUSION: IMT, AT and CT improved functional parameters and modulated inflammatory biomarkers, in addition, IMT provoked a similar response to low intensity AT in hemodialysis patients. TRIAL REGISTRATION: Registro Brasileiro de Ensaios clínicos RBR-4hv9rs.

Laser and Cyanoacrylate for the Treatment of Dentine Hypersensitivity: Survival Analysis and Predictive Factors.

OBJECTIVE: The aim of the present study was to determine how long the effects of laser and cyanoacrylate last when used as treatments for dentine hypersensitivity (DH). In addition, the predictive factors of DH recurrence and the prevalence of DH according to type of tooth were investigated. MATERIALS AND METHODS: Sixty-two patients contributed with 434 sensitive teeth. Two hundred sixteen teeth were randomized to receive laser treatment (wavelength of 795 nm) and 218 received cyanoacrylate treatment. Both treatments were applied three times at intervals of 48 hours. Dentine hypersensitivity was assessed by air stimulus at baseline and 1, 30, 90 and 180 days after treatment by a blinded researcher. Additionally, possible etiologic factors were assessed. The data were analyzed by Kaplan-Meier survival curves and by logistic regression. RESULTS: Both groups had signifi cant reductions in DH. Treatment failure occurred in 276 (63.6%) treated teeth and 158 (36.4%) teeth maintained the result of the treatment until the end of the study (censored teeth). The survival rate at 6 months was 36% for laser treatment, and 36% for cyanoacrylate. There was no signifi cant difference between the survival curves (p = 0.703). Gingival recession and abfraction increased the risk of treatment failure by 2.04 (p = 0.002) and 2.76 (p less than 0.001) times, respectively. CONCLUSIONS: Overall, these two approaches to DH treatment had a survival rate of 36%at 6 months. The most prevalent hypersensitive tooth is the first premolar. Gingival recession and abfraction predict the recurrence of DH irrespective of patient age and sex.

Do TMJ symptoms improve and last across time after treatment with red (660 nm) and infrared (790 nm) low level laser treatment (LLLT)? A survival analysis.

OBJECTIVE: Temporomandibular disorder (TMD) is a variety of clinical problems that originate from the area of the temporomandibular joint (TMJ), masticatory muscles, and surrounding tissues. There are different treatment options; however, there is no evidence that low level laser treatment (LLLT) will last about six months. The aim of this study was to determine the survival rate of treatment with red (660 nm) and infrared (790 nm) laser in cases of TMDs. METHODS: In 19 subjects, one side of the face (half face) was randomly selected to receive intervention, in a total of 116 sensitive points. Pain was measured at baseline and time intervals of 24 h, 30, 90, and 180 days after treatment. Laser irradiation with 4 j/cm² in the TMJs and 8 j/cm² in the muscles was used in three sessions. Kaplan-Meier survival analysis and logistic regression were performed. RESULTS: Both treatments showed statistically significant results (p < 0.001). The survival rate for red and infrared laser was 0.24 and 0.30, respectively, at 180 days. Grinding teeth and headache were associated with recurrent pain. DISCUSSION: Both lasers were effective in the treatment of TMD symptoms and had a low survival rate at 180 days.

Prevalence of bruxism in undergraduate students.

OBJECTIVE: The aim of this study was to determine the prevalence of bruxism in students at the Federal University of the Jequitinhonha and Mucuri Valleys in Brazil. The secondary objectives were to identify the factors associated with bruxism; prevalence of dental wear; and to distinguish the signs and symptoms of temporomandibular dysfunction when present, and verify its relationship with bruxism. METHODS: Two hundred fifty-three students (106 males, 147 females) were clinically examined and answered a questionnaire. Trained researchers performed the dental wear evaluation. The incisal edge and occlusal surface were classified as follows: no wear, wear into enamel, wear into dentin, and extensive wear into dentin. Demographic data and factors related to bruxism were obtained by a questionnaire. The participants who presented dental wear and habit of clenching/grinding teeth were classified as bruxers. The data were analyzed by the SPSS program (p < 0.05). RESULTS: The results showed that 31.6% of the students had bruxism. Of the 7084 teeth evaluated, 376 (5.3%) had some type of facet wear. The teeth that had the highest prevalence of wear facets were the canines. Stress, muscle pain, temporomandibular joint (TMJ) pain, and TMJ noise were significantly associated with bruxism (p < 0.001). CONCLUSION: The prevalence of bruxism was 31.6% in this population. The factors most associated with bruxism were stress, muscle pain, TMJ pain, and TMJ noise.

Oral Health-Related Quality of Life Before and After Treatment of Dentin Hypersensitivity With Cyanoacrylate and Laser.

BACKGROUND: The aim of this longitudinal study is to verify changes in the oral health-related quality of life of patients 180 days after treatment of dentin hypersensitivity (DH) with laser and cyanoacrylate. METHODS: This clinical, controlled, randomized, double-masked trial used a split-mouth design, and quadrants were randomized to receive either laser or cyanoacrylate treatments. All patients received both treatments. The study included 62 patients aged 12 to 60 years (mean: 31.4 years) in whom a total of 432 teeth were treated. Quadrants were randomly distributed into two groups: cyanoacrylate (n = 218 teeth) or laser (n = 216 teeth) treatment. DH was evaluated with air and cold stimuli at 24 hours, 30, 90, and 180 days after treatment. The Oral Health Impact Profile (OHIP-14) questionnaire was applied at baseline and 180 days after treatment. RESULTS: There were statistically significant differences in the following OHIP-14 subscales before and after treatment: physical pain (P = 0.002), psychologic discomfort (P <0.001), psychologic disability (P = 0.003), social disability (P = 0.01), and total score (P <0.001). At the end of the study, 80.6% of participants reported an improvement in their condition. CONCLUSION: There was a reduction in the impact of DH on the quality of life of study participants after interventions with laser and cyanoacrylate.

Impact of mandibular third molar extraction in the second molar periodontal status: A prospective study.

AIM: The aim of the present study was to assess the periodontal condition and sensitivity of second mandibular molars after the extraction of the adjacent third molar, while also assessing the quality of life of the patients. MATERIALS AND METHODS: Twenty-three healthy patients were assessed in terms of probing depth, gingival height, gingival thickness, dental sensitivity, plaque index and bleeding on probing (adjacent second mandibular molar), before the surgical procedure, as well as 60 and 180 days after the surgery. The following data were also recorded and measured: the position and size of the impacted teeth; the size of the alveoli after surgery and the quality of life of the patient. RESULTS: Significant differences were found for probing depth and gingival height before and after 180 days. The plaque index increased significantly after surgery (P = 0.004), as did bleeding on probing. No significant difference was found for the quality of life. The size of the third molar extracted was correlated with bleeding on probing 180 days after the surgery. CONCLUSION: An improvement was noted in the periodontal condition of the second mandibular molars after the extraction, based on the assessments of probing depth and gingival height. The position of the third molar affected the periodontal condition of the second mandibular molar. No alterations were recorded for dental sensitivity or the quality of life after the extraction.

A commentary on randomized clinical trials: How to produce them with a good level of evidence.

Randomized clinical trial (RCT) is the gold standard study for the evaluation of health interventions and is considered the second level of evidence for clinical decision making. However, the quality of the evidence produced by these studies is dependent on the methodological rigor employed at every stage of their execution. The purpose of randomization is to create groups that are comparable independent of any known or unknown potential confounding factor. A critical evaluation of the literature reveals that, for many years, RCTs have been developed based on inaccurate methodological criteria, and empirical evidence began to accumulate. Thus, guidelines were developed to assist authors, reviewers, and editors in the task of developing and assessing the methodological consistency of this type of study. The objective of this article is to review key aspects to design a good-quality RCT, supporting the scientific community in the production of reliable evidence and favoring clinical decision making to allow the patient to receive the best health care.

Effectiveness of Three Desensitizing Dentifrices on Cervical Dentin Hypersensitivity: A Pilot Clinical Trial.

AIM: Cervical dentin hypersensitivity (CDH) is defined as an acute pain of short duration that occurs in dentin exposed to the oral environment. The aim of this study was to evaluate the effi cacy of three desensitizing toothpastes (Sensodyne® Rapid-Relief, Colgate® Sensitive Pro-Relief, Nano P®) for immediate and intermediate-term relief of CDH, when compared with a control toothpaste (Cocoricó®). MATERIALS AND METHODS: Eight patients were enrolled in this clinical study. One hundred thirty-eight hypersensitive teeth were randomized into four groups according to the com- position of the desensitizing toothpaste tested: Group I) strontium acetate and calcium carbonate; II) calcium carbonate and arginine 8%; III) calcium phosphate nanoparticles; and IV) a control toothpaste. A split mouth design was used for one application each of the desensitizing dentifrices. Assessment of CDH was done by evaporative and cold stimuli at baseline, immediately, 24 hours and 30 days after the treatment. RESULTS: The toothpastes presented similar effectiveness and statistically significant improvement in 30 days compared to baseline. Group III showed statistically significant relief for cervical dentin hypersensitivity immediately after the treatment. CONCLUSIONS: The only toothpaste that presented immediate relief effect was the paste containing calcium phosphate nanoparticles in the form of hydroxyapatite.

Clinical and Radiographic Evaluation of the Periodontium with Biologic Width Invasion by Overextending Restoration Margins - A Pilot Study.

AIM: The aim of this study was to correlate radiographic examination with the clinical periodontal condition in cases of biologic width invasion by overextending restoration margins in restored premolars and molars. MATERIALS AND METHODS: The present pilot study involved nine people (mean age 32 years) with biologic width invasion by 21 surfaces overextending restoration margins in restored premolars and molars. Radiographs were made in a standardized unit using the interproximal technique and were evaluated by a single calibrated investigator. The clinical periodontal parameters were analyzed with the use of a computerized periodontal probe. Exploratory analysis and Spearman's correlation were used to perform statistical analyses (SPSS, p < 0.05). RESULTS: The most prevalent teeth with biologic width invasion were second premolars and first molars. Mean plaque index was 30.76%, and bleeding on probing was 27.0%. The mesial surface was invaded in 47.6% of cases and the distal surface in 52.4%. The 21 sites with biologic width invasion were found in patients with the following periodontal status: periodontal health (11 sites), gingivitis (2 sites), mild periodontitis (7 sites) and moderate periodontitis (1 site). There was a correlation between plaque index and bleeding on probing with the horizontal component of the bone level. CONCLUSIONS: There was correlation between the radiographic parameters of biologic width invasion and clinical conditions. The measure of the bone crest level correlated with the gingival recession. The horizontal component of bone defect correlated with plaque index and bleeding on probing.