Delayed tooth reimplantation with 4-year follow-up: the management of ankylosis during facial growth.

This case report describes the consequences of delayed (24 hours) reimplantation of an avulsed maxillary central incisor, findings over a 4-year follow-up period, and the management of ankylosis during facial growth. After a traumatic event, a 10-year-old boy was taken to a hospital emergency department due to injuries to his face, including avulsion of the maxillary left central incisor. Despite the short amount of time before arriving at the hospital (10 minutes) and use of the correct storage medium (milk), the tooth was not reimplanted, and the parents did not receive instructions to seek dental treatment. The next day, the child was brought to a dental school because he objected to the loss of his tooth. The treatment chosen was delayed tooth reimplantation. At the 1-year follow-up, the reimplanted tooth was infraoccluded, and periapical radiography revealed signs of ankylosis and initial replacement root resorption. At the 2- and 3-year follow-up examinations, resorption and infraocclusion of the central incisor had progressed. In this case, the delayed reimplantation resulted in ankylosis that had a significant clinical impact due to the patient's facial growth. Direct resin restoration of the reimplanted tooth was therefore performed 3 years after trauma. Despite continued resorption and infraocclusion of the tooth observed 4 years posttrauma, the esthetic, low-cost treatment was well accepted, and the patient's quality of life was improved until definitive treatment can be performed.

Susceptibility of bovine dental enamel with initial erosion lesion to new erosive challenges.

This in vitro study evaluated the impact of initial erosion on the susceptibility of enamel to further erosive challenge. Thirty bovine enamel blocks were selected by surface hardness and randomized into two groups (n = 15): GC- group composed by enamel blocks without erosion lesion and GT- group composed by enamel blocks with initial erosion lesion. The baseline profile of each block was determined using the profilometer. The initial erosion was produced by immersing the blocks into HCl 0.01 M, pH 2.3 for 30 seconds, under stirring. The erosive cycling consisted of blocks immersion in hydrochloric acid (0.01 M, pH 2.3) for 2 minutes, followed by immersion in artificial saliva for 120 minutes. This procedure was repeated 4 times a day for 5 days, and the blocks were kept in artificial saliva overnight. After erosive cycling, final profile measurement was performed. Profilometry measured the enamel loss by the superposition of initial and final profiles. Data were analyzed by t-test (p<0.05). The result showed no statistically significant difference between groups (GS = 14.60±2.86 and GE = .14.69±2.21 µm). The presence of initial erosion on bovine dental enamel does not enhance its susceptibility to new erosive challenges.

In situ effect of CPP-ACP chewing gum upon erosive enamel loss.

OBJECTIVE: This in situ study investigated the ability of a CPP-ACP chewing gum in preventing erosive enamel loss. Material and Methods: During three experimental crossover phases (one phase per group) of seven days each, eight volunteers wore palatal devices with human enamel blocks. The groups were: GI - Sugar free chewing gum with CPP-ACP; GII - Conventional sugar free chewing gum; and GIII - No chewing gum (control). Erosive challenge was extraorally performed by immersion of the enamel blocks in cola drink (5 min, 4x/day). After each challenge, in groups CPP and No CPP, volunteers chewed one unit of the corresponding chewing gum for 30 minutes. Quantitative analysis of enamel loss was performed by profilometry (µm). Data were analyzed by Repeated-Measures ANOVA and Tukey's test (p<0.05). RESULTS: The use of chewing gum (CPP and No CPP) resulted in lower erosive enamel loss compared with the control group (p<0.05). CPP-ACP chewing gum (CPP) did not improve the protection against erosive enamel loss compared with conventional chewing gum (No CPP) (p>0.05). CONCLUSION: The CPP-ACP chewing gum was not able to enhance the anti-erosive effect of conventional chewing gum against enamel loss.

In situ effect of CPP-ACP chewing gum upon erosive enamel loss

Abstract Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is able to increase salivary calcium and phosphate levels at an acidic pH. Previous studies demonstrated that a CPP-ACP chewing gum was able to enhance the re-hardening of erosion lesions, but could not diminish enamel hardness loss. Therefore, there is no consensus regarding the effectiveness of CPP-ACP on dental erosion. Objective This in situ study investigated the ability of a CPP-ACP chewing gum in preventing erosive enamel loss. Material and Methods: During three experimental crossover phases (one phase per group) of seven days each, eight volunteers wore palatal devices with human enamel blocks. The groups were: GI - Sugar free chewing gum with CPP-ACP; GII - Conventional sugar free chewing gum; and GIII - No chewing gum (control). Erosive challenge was extraorally performed by immersion of the enamel blocks in cola drink (5 min, 4x/day). After each challenge, in groups CPP and No CPP, volunteers chewed one unit of the corresponding chewing gum for 30 minutes. Quantitative analysis of enamel loss was performed by profilometry (µm). Data were analyzed by Repeated-Measures ANOVA and Tukey's test (p<0.05). Results The use of chewing gum (CPP and No CPP) resulted in lower erosive enamel loss compared with the control group (p<0.05). CPP-ACP chewing gum (CPP) did not improve the protection against erosive enamel loss compared with conventional chewing gum (No CPP) (p>0.05). Conclusion The CPP-ACP chewing gum was not able to enhance the anti-erosive effect of conventional chewing gum against enamel loss.

Efeito da aplicação de diferentes materiais resinosos sobre o esmalte erodido, submetido à erosão e/ou abrasão in vitro e in situ / Effect of resin-based materials application against erosion/abrasion - a in vitro and in situ study

O presente trabalho teve como objetivo avaliar em esmalte, a aplicação de materiais resinosos com e sem excesso, quando submetido à erosão de curta duração in vitro (subprojeto 1) e avaliar a resistência desses materiais quando submetidos à erosão e/ou abrasão em estudo prolongado in vitro (subprojeto 2) e in situ (subprojeto 3). O estudo foi desenvolvido com espécimes/blocos preparados a partir de esmalte bovino previamente erodidos (imersão em HCl 0,01 M, pH 2,3 por 30 s), os quais foram aleatorizados entre os grupos e tratados de acordo com as recomendações do fabricante. No subprojeto 1 foram avaliados dois fatores: o tipo de tratamento (controle, selante de fossas e fissuras, sistema adesivo convencional de 3 passos, sistema adesivo autocondicionante e infiltrante) e a condição do material (com/sem remoção de material na superfície de esmalte). Em metade dos espécimes, após a aplicação dos materiais houve a remoção de seu excesso na superfície de esmalte, anteriormente à fotoativação. Após os tratamentos os espécimes foram submetidos à ciclagem erosiva por 5 dias (HCl 0,01 M, pH 2,3, por 2 min e saliva artificial por 2 h, 4 vezes/dia) e os resultados delinearam os demais sobreprojetos. No subprojeto 2 foram avaliados dois fatores: o tipo de tratamento (controle, selante de fossas e fissuras, sistema adesivo convencional de 3 passos e infiltrante) e o tipo de desgaste (erosão, abrasão, erosão/abrasão). Após os tratamentos, os espécimes sem remoção do excesso foram submetidos à ciclagem erosiva (HCl 0,01 M, pH 2,3, por 2 min e saliva artificial por 2 h, 4 vezes/dia), abrasiva (30 movimentos recíprocos, com força de 1,5 N e solução de slurry 1:3, dentifrício fluoretado) e associação de ambas (erosão 4 vezes/dia + 2 vezes/dia de abrasão) durante 30 dias. No subprojeto 3 foram avaliados três fatores: tipo de tratamento (controle, selante de fossas e fissuras, sistema adesivo convencional de 3 passos e infiltrante), o tipo de desgaste (erosão, erosão/abrasão) e o tempo de desafio (5 e 28 dias). Em uma única fase, 21 voluntários usaram um dispositivo palatino contendo os blocos de esmalte tratados sem remoção do excesso (uma fileira correspondia à erosão e a outra a erosão/abrasão, e cada uma continha 2 espécimes por tratamento). Durante 28 dias úteis de desafio, os blocos foram submetidos ex vivo à erosão (HCl 0,01 M, pH 2,3, por 2 min, e saliva humana por 2 h, 4 vezes/dia), e erosão/abrasão (erosão, 4 vezes/dia + 2 vezes/dia de abrasão, com movimentos oscilatórios por 15 s e solução de slurry 1:3, com dentifrício fluoretado), sendo que após os desafios e durante os finais de semana, os aparelhos permaneceram imersos em saliva artificial, totalizando 28 dias de ciclagem. Os resultados foram avaliados por perfilometria e os dados foram submetidos à ANOVA, seguido do teste Tukey (p <0,05). No subprojeto 1, observou-se que todos os materiais sem remoção do excesso formaram uma camada protetora sobre o esmalte, e após o desafio erosivo, permaneceram sobre a superfície inibindo a sua perda. Nos grupos onde o excesso de material foi removido, houve perda de esmalte no selante, adesivo convencional e infiltrante já após o tratamento, e todos os materiais nos quais o excesso foi removido houve perda de esmalte estatisticamente semelhante ao grupo controle, com exceção do selante, que promoveu menor perda de esmalte. No subprojeto 2, houve diferença na espessura de material após o tratamento, sendo que o adesivo foi o que apresentou maior espessura, seguido do selante e infiltrante. Após a fase in vitro, observou-se que a erosão/abrasão resultou em perda de esmalte significativamente maior que a erosão e esta, por sua vez, maior que a abrasão. Todos os materiais, independente do tipo de desgaste, se mantiveram após os 30 dias de desafio, porém, o adesivo foi o que sofreu maior perda em espessura, diferindo estatisticamente do selante e infiltrante. No subprojeto 3, houve diferença na espessura de material após o tratamento, sendo que o infiltrante foi o grupo que apresentou maior espessura, seguido do selante e depois do adesivo. Após a fase in situ, não houve diferença entre erosão e erosão/abrasão, e ao comparar os materiais, com 5 e 28 dias de desafio, não foi observada mudança significativa na espessura de material. A perda de esmalte foi superior com 28 dias de desafio. Considerando os resultados, conclui-se que os materiais resinosos aplicados sobre o esmalte erodido foram efetivos na inibição da perda de esmalte, quando submetidos a desafios erosivos associados ou não a abrasão in vitro e in situ.(AU)

This study aimed to evaluate the application of resin-based materials on enamel with and without removal of the excess subjected to short erosion in vitro (subproject 1) and to evaluate the resistance of these materials when subjected to erosion and/or abrasion in a prolonged study in vitro (subproject 2) and in situ (subproject 3). Specimens/blocks of bovine enamel previously eroded (immersion in 0.01 M HCl, pH 2.3 for 30 s) were randomized among groups and treated following the manufacturer's instructions. On subproject 1 there were 2 factors under study, type of treatment (control, sealant, self-etching adhesive, 3-step adhesive and infiltrant) and materials condition (with/without material excess removal). After materials application, in half of the specimens, the excess was removed, prior to polymerization. The specimens were subjected to erosive cycling for 5 days (0.01 M HCl, pH 2.3 for 2 min and artificial saliva for 2 h, 4 times/day). On the subproject 2, there were 2 factors under study, type of treatment (control, sealant, adhesive and infiltrant) and type of wear (erosion, abrasion, erosion/abrasion). After the treatments, the specimens were subjected to erosive cycling (0.01 M HCl, pH 2.3 for 2 min and artificial saliva for 2 h, 4 times/day), abrasive (30 reciprocal movements, force 1.5 N and slurry with fluoride dentifrice) and combination of both (erosion, 4 times/day + abrasion 2 times/day) for 30 days. On subproject 3, there were 3 factors under study, types of treatment (control, sealant, adhesive and infiltrant), type of wear (erosion, erosion/abrasion) and challenge time (5 and 28 days). In a single phase, 21 volunteers used a palatal appliance (one row corresponded to erosion and the other to erosion/abrasion, 2 specimens per treatment in each row). During 20 days of challenge, the blocks were subjected to erosion (0.01 M HCl, pH 2.3 for 2 min, and human saliva for 2 h, 4 times/day), and erosion/abrasion (erosion 4 times/day + abrasion 2 times/day with oscillatory motions for 15 s and slurry with fluoridated dentifrice). After the challenges and during the weekends, the appliance was kept immersed in artificial saliva. The results were evaluated by profilometry and the data were analyzed by ANOVA, followed by the Tukeys test (p<0.05). On subproject 1, it was observed that all materials without excess removal formed a layer over enamel. After the erosive challenge this layer remained inhibiting enamel loss. Sealant, 3- steps adhesive and infiltrant with material excess removal showed enamel loss after treatment. All materials with excess removal, showed loss of enamel statistically similar to the control group, except for the sealant, that promoted minor enamel loss. On subproject 2, after the treatment, materials thickness showed significance differences. The adhesive had the highest thickness followed by the sealant and infiltrant. There was no significant difference between sealant and infiltrant. After the erosive challenge in vitro it was observed that erosion/abrasion resulted in significantly higher enamel loss than erosion, which was higher than abrasion. All materials, regardless wear conditions, were maintained after the 30 days of challenge, however, the adhesive showed greatest material thickness loss, statistically differing from the sealant and infiltrant. On subproject 3, the application of resin-based materials did not cause superficial enamel loss. After the erosive challenge, there was no difference between the conditions ERO and ERO + ABR (p=0.869). All materials promoted protection against erosion compared to control group (p=0.001). The infiltrant group showed a thicker layer of material above enamel compared to the other materials (p =0.001). Based on results, it is concluded that the resin-based materials applied onto enamel were effective in inhibiting enamel loss subjected to erosive challenges associated or not with abrasion in vitro and in situ.(AU)

Effect of different salivary exposure times on the rehardening of acid-softened enamel.

This in situ study assessed the effect of different times of salivary exposure on the rehardening of acid-softened enamel. Bovine enamel blocks were subjected in vitro to a short-term acidic exposure by immersion in 0.05 M (pH 2.5) citric acid for 30 s, resulting in surface softening. Then, 40 selected eroded enamel blocks were randomly assigned to 10 volunteers. Intraoral palatal appliances containing 4 enamel blocks were constructed for each volunteer, who wore the appliance for 12 nonconsecutive hours: initial 30 min, followed by an additional 30, and then by an additional 1 hour. For the last additional 10 hours the appliances were used at night, during the volunteers' sleep. Surface hardness was analyzed in the same blocks at baseline, after erosion and after each period of salivary exposure, enabling percentage of surface hardness recovery calculation (%SHR). The data were tested using repeated measures ANOVA and Tukey's test (α = 0.05). Increasing periods of salivary action promoted a progressive increase in the surface hardness (p < 0.001). However a similar degree of enamel rehardening (p = 0.641) was observed between 2 hours (49.9%) and 12 hours (53.3%) of salivary exposure. Two hours of salivary exposure seems to be appropriate for partial rehardening of the softened enamel surface. The use of the intraoral appliance during sleep did not improve the enamel rehardening after erosion.

Impact of Saliva and Intraoral Appliance on Erosion Lesions Rehardening Ability - A Pilot Study

Objective: To evaluate the ability of different periods of salivary exposure and two different removable appliances to rehardening initial erosive lesions. Material and Methods: This randomized, single blind in situ study was conducted with 2 crossover phases. The factors under study were: period of salivary exposure (15 minutes, 30 minutes, 1 hour and 2 hours) and type of oral appliance (maxillary or mandibular). Two hundred enamel blocks were selected by initial surface hardness (SHi). Enamel blocks were demineralized in vitro (0.05M citric acid; pH2.5 for 15 seconds), surface hardness (SHd) was remeasured and 160 blocks were selected and randomized among groups. Thus, there were 2 blocks per period of salivary exposure in each type of oral appliance for each one of the 10 volunteers. In each phase, one of the removable appliances was tested. The response variable was percentage of surface hardness recovery (%SHR=[(SHf-SHd)/SHi)]x100). Two-way ANOVA and Tukey's post hoc test were applied adopting 5% of significance. Results: No difference was found among oral appliances on enamel rehardening (p>0.01). Salivary exposure of 2 hours promoted similar enamel rehardening when compared to 1 hour (p>0.05), which showed similar rehardening to 30 min. All mentioned period of salivary exposure promoted superior rehardening than 15 min (p>0.01). Conclusion: The salivary time exposure between erosive attacks might be 2 hours to achieve a feasible maximum rehardening. In addition, both maxillary and the mandibular appliance have presented a similar rehardening ability.

Effect of different salivary exposure times on the rehardening of acid-softened enamel

Abstract This in situ study assessed the effect of different times of salivary exposure on the rehardening of acid-softened enamel. Bovine enamel blocks were subjected in vitro to a short-term acidic exposure by immersion in 0.05 M (pH 2.5) citric acid for 30 s, resulting in surface softening. Then, 40 selected eroded enamel blocks were randomly assigned to 10 volunteers. Intraoral palatal appliances containing 4 enamel blocks were constructed for each volunteer, who wore the appliance for 12 nonconsecutive hours: initial 30 min, followed by an additional 30, and then by an additional 1 hour. For the last additional 10 hours the appliances were used at night, during the volunteers' sleep. Surface hardness was analyzed in the same blocks at baseline, after erosion and after each period of salivary exposure, enabling percentage of surface hardness recovery calculation (%SHR). The data were tested using repeated measures ANOVA and Tukey's test (α = 0.05). Increasing periods of salivary action promoted a progressive increase in the surface hardness (p < 0.001). However a similar degree of enamel rehardening (p = 0.641) was observed between 2 hours (49.9%) and 12 hours (53.3%) of salivary exposure. Two hours of salivary exposure seems to be appropriate for partial rehardening of the softened enamel surface. The use of the intraoral appliance during sleep did not improve the enamel rehardening after erosion.

Changes in Oral Health-related Behavior of Infants following a Preventive Program of Continuing Education Directed to their Parents

To evaluate changes in oral health-related behavior of infants following preventive program of continuing education directed to their parents.Material and Methods:We analyzed 53 dental files of infants aged up to 36 months, who participated in the Prevention and Education Program of the Infants Clinic, School of Dentistry of Bauru (USP), and attended at least 2 visits with a maximum of 4 missing appointments. Initially an educational lecture was conducted, pointing issues related to diet and oral hygiene. At the following visit, the professional filled in a form with questions about diet and hygiene performed at home. The following information was extracted from dental files: reason of the first visit, age, number of teeth, number of visits, missing appointments, and dietary and oral hygiene risk factors. The data were tabulated and analyzed using descriptive statistics comparing the information obtained from the first visit to that of the last one.Results:The reason for the first visit was dental caries prevention (88.68%) followed by dental trauma (7.55%), and needed of curative treatment (3.77%). The mean age of the sample was 14.85 months, the tooth number mean was 12.64 at first visit, the mean number of visits was 7 and the mean missing appointments was 0.83. The percentage of infants with inadequate diet and hygiene habits was 88.68% and 62.26%, and only 12.762% and 57.57% of these have changed their habits, respectively.Conclusion:After the preventive program of continuing education, the dietary habits showed were more difficult to change in relation to hygiene ones...