Pit and fissure depth in the enamel of mandibular third molars: An open gate for microleakage?

The aim of this descriptive ex vivo study was to evaluate qualitatively the depth of pit and fissures (P&F) of the enamel in human mandibular third molars. Fifty (n=50) extracted human mandibular third molars were cleaned and disinfected. All tooth surfaces were coated with nail varnish except for a 1-mm margin around the periphery of the occlusal surface. The teeth were immersed for 48 hours at 37 °C in 1% methylene blue dye solution prepared in artificial saliva. After cleaning, the crowns were separated from the root at the cementoenamel junction and subsequently sectioned longitudinally in buccolingual direction at the location of the central fossa. All sections were examined using a stereoscopic microscope and photographed. The images were downloaded on a computer. The length of penetration of the P&F was recorded using the following scoring system: C1: P&F extended to half of the enamel thickness; C2: P&F extended beyond half of the enamel thickness without reaching the dentine-enamel junction; C3: P&F extended to the dentine-enamel junction. For pits, C1, C2 and C3 were observed in 35, 9 and 6 teeth, respectively, while for fissures, C1, C2 and C3 were observed in 15, 18 and 17 teeth, respectively. The P&F detected in the samples extended to the deepest portions of enamel, quite frequently reaching the enamel-dentine junction. Clinicians should recognize that even if pits and fissures are not clinically obvious, they penetrate deep into the enamel and frequently reach the dentine-enamel junction. Effective treatment is recommended to block access to P&F, thus preventing ingress of bacteria.

Objetivos: El objetivo del presente estudio descriptivo fue evaluar cualitativamente mediante un ensayo ex vivo la profundidad de las fosas y fisuras (F&F) del esmalte en terceros molares inferiores humanos. Materiales y métodos: Cincuenta (n=50) terceros molares inferiores sanos extraídos se lavaron, se descontaminaron y se recubrieron con esmalte para uñas hasta 1 mm menos del área de las F&F. Luego se sumergieron durante 48 horas a 37°C en una solución de azul de metileno al 1% (pH 7,4) preparada con saliva artificial. Posteriormente se lavaron y se separaron las coronas a nivel del límite amelocementario. En cada molar se realizó una sección longitudinal de 1 mm de espesor con orientación vestíbulo-lingual a nivel de la fosa central. Las secciones fueron analizadas con microscopio estereoscópico y fotografiadas. Las imágenes se transfirieron a una computadora. Se determinó cualitativamente la extensión de las F&F en el espesor del esmalte y se las clasificó de acuerdo a 3 categorías. C1: extensión hasta la mitad del espesor del esmalte; C2: extensión que supera la mitad del espesor del esmalte sin afectar el límite amelodentinario; C3: extensión que llega al límite amelodentinario. Resultados: Para las fosas, 35, 9 y 6 especimenes correspondieron a las categorías C1, C2 y C3 respectivamente. Para las fisuras, 15, 18 y 17 especimenes correspondieron a las categorías C1, C2 y C3 respectivamente. Conclusiones: Las fosas y fisuras de la muestra analizada se extienden hasta la zona más profunda del espesor del esmalte. Con cierta frecuencia llegan hasta el límite amelodentinario.

Pit and fissure depth in the enamel of mandibular third molars / Profundidad de fosas y fisuras en el esmalte de terceros molares inferiores

ABSTRACT The aim of this descriptive ex vivo study was to evaluate qualitatively the depth of pit and fissures (P&F) of the enamel in human mandibular third molars. Fifty (n=50) extracted human mandibular third molars were cleaned and disinfected. All tooth surfaces were coated with nail varnish except for a 1-mm margin around the periphery of the occlusal surface. The teeth were immersed for 48 hours at 37 °C in 1% methylene blue dye solution prepared in artificial saliva. After cleaning, the crowns were separated from the root at the cementoenamel junction and subsequently sectioned longitudinally in buccolingual direction at the location of the central fossa. All sections were examined using a stereoscopic microscope and photographed. The images were downloaded on a computer. The length of penetration of the P&F was recorded using the following scoring system: C1: P&F extended to half of the enamel thickness; C2: P&F extended beyond half of the enamel thickness without reaching the dentine-enamel junction; C3: P&F extended to the dentine-enamel junction. For pits, C1, C2 and C3 were observed in 35, 9 and 6 teeth, respectively, while for fissures, C1, C2 and C3 were observed in 15, 18 and 17 teeth, respectively. The P&F detected in the samples extended to the deepest portions of enamel, quite frequently reaching the enamel-dentine junction. Clinicians should recognize that even if pits and fissures are not clinically obvious, they penetrate deep into the enamel and frequently reach the dentine-enamel junction. Effective treatment is recommended to block access to P&F, thus preventing ingress of bacteria.

RESUMEN Objetivos: El objetivo del presente estudio descriptivo fue evaluar cualitativamente mediante un ensayo ex vivo la profundidad de las fosas y fisuras (F&F) del esmalte en terceros molares inferiores humanos. Materiales y métodos: Cincuenta (n=50) terceros molares inferiores sanos extraídos se lavaron, se descontaminaron y se recubrieron con esmalte para uñas hasta 1 mm menos del área de las F&F. Luego se sumergieron durante 48 horas a 37°C en una solución de azul de metileno al 1% (pH 7,4) preparada con saliva artificial. Posteriormente se lavaron y se separaron las coronas a nivel del límite amelocementario. En cada molar se realizó una sección longitudinal de 1 mm de espesor con orientación vestíbulo-lingual a nivel de la fosa central. Las secciones fueron analizadas con microscopio estereoscópico y fotografiadas. Las imágenes se transfirieron a una computadora. Se determinó cualitativamente la extensión de las F&F en el espesor del esmalte y se las clasificó de acuerdo a 3 categorías. C1: extensión hasta la mitad del espesor del esmalte; C2: extensión que supera la mitad del espesor del esmalte sin afectar el límite amelodentinario; C3: extensión que llega al límite amelodentinario. Resultados: Para las fosas, 35, 9 y 6 especimenes correspondieron a las categorías C1, C2 y C3 respectivamente. Para las fisuras, 15, 18 y 17 especimenes correspondieron a las categorías C1, C2 y C3 respectivamente. Conclusiones: Las fosas y fisuras de la muestra analizada se extienden hasta la zona más profunda del espesor del esmalte. Con cierta frecuencia llegan hasta el límite amelodentinario.

A 12-month clinical evaluation of pit-and-fissure sealants placed with and without etch-and-rinse and self-etch adhesive systems in newly-erupted teeth

OBJECTIVES: The objective of this one-year clinical study was to investigate the effect of two adhesive systems (Adper Single Bond, a two-step etch-and-rinse and Clearfil SE Bond, a two-step self-etch system) on pit-and-fissure sealant retention in newly-erupted teeth. This study compared the success of the sealants in mesial and distopalatal grooves with and without these two adhesive systems. MATERIAL AND METHODS: In a clinical trial, 35 children aged 6-8 years undergoing sealant placement were recruited. This one-year clinical study scored 70 mesial and 70 distopalatal sealants of newly-erupted permanent maxillary first molar, with a split-mouth design. All children received sealant alone in one permanent maxillary molar tooth. Children were randomized into two groups. One group received Self-etch (Se) bond plus sealant and the other group received Single Bond plus sealant in another permanent maxillary molar tooth. Clinical evaluation at 3, 6 and 12 months was performed and the retention was studied in terms of the success and failure. RESULTS: The success rate of sealant in the distopalatal groove, using SeB at 3, 6 and 12 months was 93.3% (95% CI: 68.0, 99.8), 73.3% (95% CI: 44.9, 92.2) and 66.7% (95% CI: 38.4, 88.2), respectively. It was greater than that of the distopalatal groove in SB group with a success rate of 62.5% (95% CI: 35.4, 84.8), 31.3% (95% CI: 11.8, 58.7) and 31.3% (95% CI: 11.8, 58.7), at the three evaluation periods. The success rate of sealant in the mesial groove using SeB was 86.6% (95% CI: 59.5, 98.3), 53.3% (95% CI: 26.6, 78.7) and 53.3% (95% CI: 26.6, 78.7), while this was 100% (95% CI: 79.4, 100.0), 81.3% (95% CI: 54.4, 96.0) and 81.3% (95% CI: 54.4, 96.0) using SB, at 3, 6 and 12-month evaluation periods. CONCLUSIONS: These results support the use of these two bonding agents in pit-and-fissure sealants under both isolated and contaminated conditions. Further, Se bond seemed to be less sensitive to moisture contamination.

Emprego do cimento de ionômero de vidro: uma revisão sistemática / Use of glass ionomer cements: a systematic review

Introducao: Os cimentos de ionomero de vidro (CIV) sofreram grandes mudancas na sua composicao, como a adicao de ions metalicos ou componentes resinosos, o que contribuiu para a melhora de suas propriedades fisicas e seu uso como material restaurador terapeutico de grande aplicabilidade clinica. Objetivo: Realizar uma revisao sistematica acerca das publicacoes sobre o emprego deste material em odontologia e direcionar os profissionais de saude com relacao ao uso do ionomero, mostrando os aspectos desse material que sao avaliados. Metodo: As publicacoes utilizadas foram selecionadas a parti r de uma pesquisa em bases de dados (Medline ? Literatura Internacional em Ciencias da Saude, BBO ? Bibliografia Brasileira de Odontologia e Scopus) compreendendo o periodo de 2000 a 2008, utilizando os termos: cimentos de ionomero de vidro e glass ionomer cements. Conclusao: Os artigos analisados evidenciaram desempenho clinico satisfatorio do CIV quando utilizado em restauracoes, na tecnica do Tratamento Restaurador Atraumatico (TRA) e como selantes de fossas e fissuras, apresentando nessas tres aplicacoes boa retencao, adaptacao marginal e durabilidade, baixa deterioracao e baixo indice de falhas, em periodos superiores a um ano. O sucesso clinico do CIV tem sido relatado por varios autores que afirmam ter, este material, um papel bastante relevante na pratica odontologica. Verificou-se que ha uma tendencia a padronizacao dos estudos que avaliam restauracoes, TRA e selantes, o que facilita a analise comparativa dos trabalhos.

Introduction: Glass ionomer cements (GIC) have undergone remarkable changes in their composition, such as the addition of metallic ions or resin components to their composition, which contributed to improve their physical properties and increased their use as a restorative material of great clinical applicability. Objective: To perform a systematic review about the publications on the use of this material in dentistry and offer information to health professionals with respect the use of GIC, addressing the aspects of these material that are evaluated. Method: The publications used in this review were retrieved from a search in online databases - Medline (International Health Science Literature), BBO (Brazilian Dental Bibliography), and Scopus - for the period between 2000 and 2008, using the term glass ionomer cements in Portuguese and English. Conclusion: The articles analyzed showed a sati sfactory clinical behavior of GIC when used in restorations, atraumatic restorative treatment (ART) and as pit-and-fissure sealants, showing for these three applications good retention, marginal adaptation and durability, low deterioration and low failure rate within periods longer than 1 year. The clinical success of GIC has been reported by several authors who affirm that this material has a highly relevant role in dental practice. It was observed a tendency towards a standardization of the studies that evaluate the use of glass ionomer cements for restorations, ART and sealing of pit and fissures, which facilitates the comparative analysis of the studies.

Características bioquímicas e microbiológicas do biofilme dentário formado in situ sobre materiais que contêm flúor ou fosfato de cálcio amorfo / Biochemical and microbiological characteristics of in situ dental plaque formed on materials containing fluoride or amorphous calcium phosphate

Muito tem se avaliado a respeito das propriedades físicas e químicas dos selantes de fóssulas e fissuras, mas pouco sobre seus efeitos no biofilme dentário. O objetivo deste estudo foi analisar as características bioquímicas e microbiológicas do biofilme dentário formado in situ sobre materiais que liberam flúor ou cálcio e fosfato. Dez voluntários utilizaram dispositivo intrabucal palatino contendo corpos-de-prova de materiais (Fuji IX GP, Auralay XF e Aegis) ou blocos de esmalte bovino. A fase experimental consistiu de 4 etapas de 8 dias cada e a utilização de sacarose para formação do biofilme. No 7º dia dos períodos experimentais foi determinado o pH do biofilme e no 8º dia, o biofilme dentário formado foi coletado para determinação de flúor (F), cálcio (Ca), fósforo (P) e polissacarídeos extracelulares insolúveis (PEI) além da microbiota. Verificou-se a liberação de F, Ca e P de cada material e dos blocos de esmalte após ciclagem de pH. Após a verificação da homogeneidade dos dados, testes paramétricos e não-paramétricos foram realizados para análise dos resultados (p<0,05). O biofilme dentário formado sobre os materiais que liberam flúor apresentou maior presença de F, Ca e P e menor número de estreptococos do grupo mutans quando comparado ao bloco de esmalte. Após o uso da sacarose (7º dia), o pH do biofilme foi maior na presença do material ionomérico. O biofilme sobre o material que contém fosfato de cálcio amorfo mostrou similar concentração de Ca e P, quando comparado aos materiais que contém flúor, e uma ação tamponante no meio, sem efeito na microbiota. Concluiu-se que os materiais que liberam flúor aumentaram as concentrações de F, Ca e P e diminuíram a de PEI e a microbiota cariogênica do biofilme dentário; e o que contém fosfato de cálcio amorfo aumentou as concentrações de Ca e P.

The chemical and physical properties of the pit and fissures sealants have been widely evaluated but rare researches focus on the effects on dental plaque. The aim of this study was to evaluate the biochemical and microbiological characteristics of the in situ dental plaque formed on materials that release fluoride or calcium and phosphate. Ten volunteers wore an intraoral palatal device containing specimens of materials (Fuji IX GP, Auralay XF and Aegis) or bovine enamel blocks. The experimental phase consisted of 4 stages with duration of 8 days each and use of sucrose to form the dental plaque. The dental plaque pH was determined at the 7th day of the experimental periods and the dental plaque was collected at the 8th day to determine the fluoride (F), calcium (Ca), phosphorus (P), insoluble extracellular polysaccharides (EPS) and microbiota. It was observed release of F, Ca and P from each material and from the enamel blocks after pH cycling. After verification of data homogeneity, parametric and non-parametric tests were performed (p<0.05). The dental plaque formed on the materials that release fluoride presented more F, Ca and P and reduced number of Streptococcus mutans in comparison to the enamel block. After use of sucrose (7th day), the dental plaque pH was higher with the presence of ionomeric material. The dental plaque on the material containing amorphous calcium phosphate exhibited similar Ca and P concentration compared to the ones on fluoride materials, and buffering action with no effect on the microbiota. It was concluded that the materials that release fluoride increased F, Ca and P concentrations, decreased EPS concentration and the cariogenic microbiota of the dental plaque; the amorphous calcium phosphate material increased concentrations of Ca and P.