Clinical Evaluation of Different Delivery Methods of At-Home Bleaching Gels Composed of 10% Hydrogen Peroxide.

OBJECTIVES:: This study aimed to compare the tooth sensitivity, gingival irritation, and bleaching efficacy of at-home whitening performed with 10% hydrogen peroxide (HP) using a conventional tray-delivered system or two different bleaching systems (strips or prefilled disposable trays). METHODS AND MATERIALS:: Sixty patients, with maxillary incisors darker than A2 were selected for this single-blind, parallel randomized clinical trial. Teeth were bleached during 14 days with a 30-minute gel contact with teeth per day. The 10% HP was delivered in a bleaching tray (White Class, FGM) in strips (White Strips, Oral-B) or prefilled disposable trays (Opalescence Go, Ultradent). The color changes were evaluated by subjective (Vita Classical and Vita Bleachedguide) and objective (Easyshade Spectrophotometer) methods at baseline and 30 days after the second bleaching session. Tooth sensitivity was recorded during 14 days with a five-point numeric rating scale (NRS) and 0-10 visual analog scale (VAS). The risk of gingival irritation was also recorded during 14 days on a dichotomous scale. All data were submitted to appropriate statistical analysis (α=0.05). RESULTS:: No significant difference was observed in the risks of tooth sensitivity among groups ( p>0.09). However, the conventional bleaching tray produced a higher intensity of tooth sensitivity when compared with the strips and prefilled disposable tray systems ( p<0.04). Regarding gingival irritation, the prefilled disposable tray system showed a lower risk of gingival irritation when compared with the conventional bleaching tray ( p=0.003). Significant whitening was observed in all groups after 30 days of clinical evaluation with no significant difference between them ( p>0.06). CONCLUSIONS:: All 10% HP bleaching systems showed similar whitening after a 14-day use. However, the strips and prefilled disposable trays produced lower intensity of tooth sensitivity than the conventional bleaching tray system. The prefilled disposable tray produced lower risk of gingival irritation when compared to the conventional bleaching tray.

Evaluation of instant desensitization after a single topical application over 30 days: a randomized trial.

BACKGROUND: The aim of this study was to evaluate the efficacy of ProArgin(™) (8% arginine), Gluma(®) and NovaMin(®) (5% calcium phosphosilicate) in relieving dentinal hypersensitivity immediately and over 30 days following a single topical application. METHODS: A three-cell, parallel group randomized trial was conducted among 56 patients exhibiting dentinal hypersensitivity with tooth as the unit of study. ProArgin(™) paste, Gluma(®) Desensitizer and NovaMin(®) paste were applied on randomly assigned teeth in each participant. Three stimuli were tested: tactile stimulated by running an explorer and measured using VAS (1-10 scale); air blast and cold water stimulated hypersensitivity measured using the Schiff Sensitivity Scale at baseline, immediately, 15 days and 30 days after application. Friedman test and Wilcoxon test were used for within group comparisons. Kruskal-Wallis test and Mann-Whitney U test were used for between group comparisons. RESULTS: All three groups showed significant reductions in hypersensitivity from baseline at all time points (p < 0.05). ProArgin(™) paste elicited a significantly higher reduction in hypersensitivity (p < 0.016) compared to Gluma(®) and NovaMin(®) for all stimuli at the end of 30 days. CONCLUSIONS: A single topical application of ProArgin(™) paste is significantly more effective than both a single topical application of Gluma(®) and NovaMin(®) paste in relieving dentinal hypersensitivity immediately and over 30 days.

Estudo clínico comparativo entre diferentes sistemas de clareamento de uso em consultório / Comparative clinical trial between different in-office bleaching systems

Objetivos: Estudos clínicos longitudinais que acompanham os pacientes por longos períodos não são muito comuns na literatura, ainda mais quando associados a grandes amostras (veio do fim do resumo). Por isso, o objetivo do trabalho foi determinar a eficiência, estabilidade de cor e sensibilidade dental, trans e pós operatória, dentro de um período de 365 dias, de quatro protocolos de clareamento em consultório. Material e Métodos: Foi realizado um estudo clínico randomizado, cego (para os pacientes), composto por 120 sujeitos (n=30). A amostra foi formada por pacientes adultos, sem distinção de gênero e etnia, e idade superior a 18 anos que foram selecionados por meio de avaliação clínica na qual foi verificada a cor dos dentes, a condição de higiene oral e a presença de restaurações e/ou próteses nas regiões em que os procedimentos seriam realizados. Todos os sujeitos foram submetidos a uma sessão de clareamento de acordo com as instruções do fabricante e obedecendo a aplicação ou não da luz, para os clareadores baseados no sistema Foto-Fenton (havia faltado citar nos métodos do resumo), e qual o seu tipo: Zoom Advanced Power, peróxido de hidrogênio (PH) 25% - Zoom! + luz UVA (Phillips Oral Healthcare); Zoom Whitespeed, PH 25% - Zoom! + luz Whitespeed (Phillips Oral Healthcare); Zoom sem luz, PH 25% - Zoom! (Phillips Oral Healthcare). Boost, PH 38% - Opalescence Xtra Boost (Ultradent). As alterações de cor foram avaliadas utilizando as escalas Vita Classical e Vita Bleachedguide 3D Master e o Espectrofotômetro Vita-Easyshade. As medições foram feitas em incisivos centrais e caninos uperiores antes, imediatamente e 7, 14, 30, 180 e 365 dias após o tratamento. Os dados foram analisados estatisticamente por meio do software Statistica 8.0 (StatSoft - Tulsa, OK) através da análise de variância (ANOVA) para medidas repetidas na avaliação das médias e as comparações foram realizadas através de contrastes (Tukey). Resultados: Para a escala Vita Classical, Zoom AP e WS foram semelhantes entre si porém diferentes de Opalescence e Zoom sem luz, exceto para a avaliação de 30 dias (caninos) e 365 dias (incisivos) onde o Zoom WS demonstrou dados semelhantes ao Opalescence e Zoom sem luz Já para a escala Vita Bleached, Zoom AP e WS foram semelhantes entre si, porém diferentes de Opalescence e Zoom sem luz, exceto para as avaliações de 30 e 180 dias onde o Zoom WS demonstrou dados semelhantes ao Opalescence e Zoom sem luz (caninos). Para dentes incisivos, os achados foram semelhantes, exceto que houve diferença entre o Zoom AP e WS e as semelhanças entre Zoom WS, Opalescence e Zoom sem luz foram encontradas nas avaliações de 180 e 365 dias. Na avalição com o espectrofotômetro Vita Easyshade Zoom AP e WS foram semelhantes entre si e diferentes do Opalescence que, por sua vez, foi diferente do Zoom sem luz, exceto para as avaliações de 7, 14 e 30 dias (caninos). Para incisivos, Zoom AP e WS foram semelhantes entre si e diferentes de Opalescence e Zoom sem luz, exceto para a avaliação de 14 dias onde o Zoom AP foi diferente do Zoom WS. Por fim, a sensibilidade apresentou um aumento nos seus valores na avaliação imediatamente após o clareamento, com uma redução na avalição de 7 dias, para todos os grupos que ainda apresentaram valores de sensibilidade semelhantes em todos os períodos de avaliação. Conclusão: O acompanhamento até 365 dias demonstrou a eficiência dos protocolos de clareamento analisados uma vez que nenhum deles recidivou para os tons iniciais, demonstrando a durabilidade dos procedimentos. Os dois grupos com os clareadores Foto-Fenton obtiveram maior efeito clareador (substituiu desempenho, tinha ficado vago), exceto nas seguintes avaliações: Vita Classical, 30 dias (caninos) e 365 dias (incisivos) e Vita Bleached, 30 e 180 dias (caninos) e 180 e 365 dias (incisivos). Observou-se uma estabilização da cor após sete dias em todos os grupos. A sensibilidade...

Objectives: Longitudinal clinical studies that follow patients for long periods are not very common in the literature, especially when associated with large samples. The objective of this study was to determinate the efficacy, color stability and sensitivity within a 365 day period of four in-office bleaching protocols. Methods: A randomized clinical trial, blinded (for patients), composed of 120 subjects (n=30) was conducted. The sample consisted of adult patients, without gender and ethnic distinction, with age superior than 18 years old that were selected through clinical evaluation in which was verified the color of teeth, the condition of oral hygiene and the presence of restorations and/or prostheses in the areas where the procedures would be carried out. All subjects were submitted to a session of bleaching according to the manufacturer's instructions: Zoom Advanced Power, 25% hydrogen peroxide (HP) - Zoom! + UVA light (Phillips Oral Healthcare); Zoom Whitespeed, 25% HP - Zoom! + Whitespeed light (Phillips Oral Healthcare); Zoom without light, 25% HP - Zoom! (Phillips Oral Healthcare). Boost, 38% HP - Opalescence Xtra Boost (Ultradent). Color changes were evaluated using Vita Classical and Vita Bleachedguide 3D Master shade guides and Vita-Easyshade spectrophotometer. Measurements were made on the superior central incisive and canines before, immediately and 7, 14, 30, 180 and 365 days after the treatment. Statistical analysis of the data were made with the software Statistica 8.0 (StatSoft - Tulsa, OK) through the analysis of variance (ANOVA) for repeated measures in the mean evaluation and comparisons were made by using contrasts (Tukey). Results: For the Vita Classical shade guide, Zoom AP and WS were similar but different from Opalescence and Zoom without light except for the 30 day (canines) and 365 days evaluations (incisives) where the Zoom WS showed similar data to Opalescence and Zoom without light...

Estudo clínico comparativo entre diferentes sistemas de clareamento de uso em consultório / Comparative clinical trial between different in-office bleaching systems

Objetivos: Estudos clínicos longitudinais que acompanham os pacientes por longos períodos não são muito comuns na literatura, ainda mais quando associados a grandes amostras (veio do fim do resumo). Por isso, o objetivo do trabalho foi determinar a eficiência, estabilidade de cor e sensibilidade dental, trans e pós operatória, dentro de um período de 365 dias, de quatro protocolos de clareamento em consultório. Material e Métodos: Foi realizado um estudo clínico randomizado, cego (para os pacientes), composto por 120 sujeitos (n=30). A amostra foi formada por pacientes adultos, sem distinção de gênero e etnia, e idade superior a 18 anos que foram selecionados por meio de avaliação clínica na qual foi verificada a cor dos dentes, a condição de higiene oral e a presença de restaurações e/ou próteses nas regiões em que os procedimentos seriam realizados. Todos os sujeitos foram submetidos a uma sessão de clareamento de acordo com as instruções do fabricante e obedecendo a aplicação ou não da luz, para os clareadores baseados no sistema Foto-Fenton (havia faltado citar nos métodos do resumo), e qual o seu tipo: Zoom Advanced Power, peróxido de hidrogênio (PH) 25% - Zoom! + luz UVA (Phillips Oral Healthcare); Zoom Whitespeed, PH 25% - Zoom! + luz Whitespeed (Phillips Oral Healthcare); Zoom sem luz, PH 25% - Zoom! (Phillips Oral Healthcare). Boost, PH 38% - Opalescence Xtra Boost (Ultradent). As alterações de cor foram avaliadas utilizando as escalas Vita Classical e Vita Bleachedguide 3D Master e o Espectrofotômetro Vita-Easyshade. As medições foram feitas em incisivos centrais e caninos uperiores antes, imediatamente e 7, 14, 30, 180 e 365 dias após o tratamento. Os dados foram analisados estatisticamente por meio do software Statistica 8.0 (StatSoft - Tulsa, OK) através da análise de variância (ANOVA) para medidas repetidas na avaliação das médias e as comparações foram realizadas através de contrastes (Tukey). Resultados:

Para a escala Vita Classical, Zoom AP e WS foram semelhantes entre si porém diferentes de Opalescence e Zoom sem luz, exceto para a avaliação de 30 dias (caninos) e 365 dias (incisivos) onde o Zoom WS demonstrou dados semelhantes ao Opalescence e Zoom sem luz Já para a escala Vita Bleached, Zoom AP e WS foram semelhantes entre si, porém diferentes de Opalescence e Zoom sem luz, exceto para as avaliações de 30 e 180 dias onde o Zoom WS demonstrou dados semelhantes ao Opalescence e Zoom sem luz (caninos). Para dentes incisivos, os achados foram semelhantes, exceto que houve diferença entre o Zoom AP e WS e as semelhanças entre Zoom WS, Opalescence e Zoom sem luz foram encontradas nas avaliações de 180 e 365 dias. Na avalição com o espectrofotômetro Vita Easyshade Zoom AP e WS foram semelhantes entre si e diferentes do Opalescence que, por sua vez, foi diferente do Zoom sem luz, exceto para as avaliações de 7, 14 e 30 dias (caninos). Para incisivos, Zoom AP e WS foram semelhantes entre si e diferentes de Opalescence e Zoom sem luz, exceto para a avaliação de 14 dias onde o Zoom AP foi diferente do Zoom WS. Por fim, a sensibilidade apresentou um aumento nos seus valores na avaliação imediatamente após o clareamento, com uma redução na avalição de 7 dias, para todos os grupos que ainda apresentaram valores de sensibilidade semelhantes em todos os períodos de avaliação. Conclusão: O acompanhamento até 365 dias demonstrou a eficiência dos protocolos de clareamento analisados uma vez que nenhum deles recidivou para os tons iniciais, demonstrando a durabilidade dos procedimentos. Os dois grupos com os clareadores Foto-Fenton obtiveram maior efeito clareador (substituiu desempenho, tinha ficado vago), exceto nas seguintes avaliações: Vita Classical, 30 dias (caninos) e 365 dias (incisivos) e Vita Bleached, 30 e 180 dias (caninos) e 180 e 365 dias (incisivos). Observou-se uma estabilização da cor após sete dias em todos os grupos. A sensibilidade...

Objectives: Longitudinal clinical studies that follow patients for long periods are not very common in the literature, especially when associated with large samples. The objective of this study was to determinate the efficacy, color stability and sensitivity within a 365 day period of four in-office bleaching protocols. Methods: A randomized clinical trial, blinded (for patients), composed of 120 subjects (n=30) was conducted. The sample consisted of adult patients, without gender and ethnic distinction, with age superior than 18 years old that were selected through clinical evaluation in which was verified the color of teeth, the condition of oral hygiene and the presence of restorations and/or prostheses in the areas where the procedures would be carried out. All subjects were submitted to a session of bleaching according to the manufacturer's instructions: Zoom Advanced Power, 25% hydrogen peroxide (HP) - Zoom! + UVA light (Phillips Oral Healthcare); Zoom Whitespeed, 25% HP - Zoom! + Whitespeed light (Phillips Oral Healthcare); Zoom without light, 25% HP - Zoom! (Phillips Oral Healthcare). Boost, 38% HP - Opalescence Xtra Boost (Ultradent). Color changes were evaluated using Vita Classical and Vita Bleachedguide 3D Master shade guides and Vita-Easyshade spectrophotometer. Measurements were made on the superior central incisive and canines before, immediately and 7, 14, 30, 180 and 365 days after the treatment. Statistical analysis of the data were made with the software Statistica 8.0 (StatSoft - Tulsa, OK) through the analysis of variance (ANOVA) for repeated measures in the mean evaluation and comparisons were made by using contrasts (Tukey). Results:

For the Vita Classical shade guide, Zoom AP and WS were similar but different from Opalescence and Zoom without light except for the 30 day (canines) and 365 days evaluations (incisives) where the Zoom WS showed similar data to Opalescence and Zoom without light...

Survival of porcelain laminate veneers with different degrees of dentin exposure: 2-year clinical results.

PURPOSE: To evaluate the clinical performance of porcelain laminate veneers (PLVs) after 2 years. MATERIALS AND METHODS: Twenty-eight patients were treated with 125 PLVs. The experimental variables were preparation design (incisal overlap [IO] and incisal bevel [IB]) and adhesion surface (enamel [E], enamel with minimal dentin exposure [MDE], and enamel with severe dentin exposure (SDE)]. Marginal adaptation, marginal discoloration, secondary caries, postoperative sensitivity, and patient satisfaction were assessed according to the modified United States Public Health Service criteria. Each restoration was examined for fractures and debonding. In addition, gingival tissue health by gingival plaque, bleeding, and recession was recorded. An experienced clinician evaluated the restorations at baseline and after 6, 12, and 24 months, and survival rates evaluating relative and absolute failures were calculated (p = 0.05). RESULTS: Eleven (8.8%) veneers failed, and the overall cumulative survival rate was 91.2% after 2 years of followup. IB and IO preparation designs exhibited survival rates of 94% and 85.7%, respectively, but this difference was not statistically significant (p > 0.05). PLVs bonded to SDE were more likely to fail than those bonded to E and MDE (p < 0.05). There was no significant difference between the failure rate of PLVs bonded to E and those bonded to MDE (p > 0.05). CONCLUSIONS: PLVs have high survival rates when bonded to enamel only, as well as to enamel with minimal dentin exposure. However, extensive dentin exposure should be avoided during the preparation.

Outcome of restorative treatment in young patients with amelogenesis imperfecta. a cross-sectional, retrospective study.

OBJECTIVES: The longevity of dental restorations in patients with amelogenesis imperfecta (AI) is limited. The aim of this paper is to compare oral health and longevity of dental restorations in a group of young patients with AI compared to a control group. METHODS: Patients included were 82 patients with AI, 40 boys and 42 girls, 6 to 25 years old (mean age 14.5±4.3 years) and a control group matched in age, gender and residential area. All patients received an examination recording dental caries, gingivitis, previous therapy, replaced restorations, tooth sensitivity, and number of dental visits. Patient dental records, extending from 6 to 10 years before the study, provided data on previous care. RESULTS: Annual mean number of dental visits in the AI group was 2.9±1.7 compared to 1.9±1.2 in the control group (p<0.001). DMFS was 8.1±15.6 in the AI group compared to 1.0±2.0 in the control group (p<0.001). The longevity of dental restorations was significantly lower in the patients with AI, with 24.7±35.1% of the AI group requiring replacement of fillings during the observation period compared to 9.23±23.7% in the control group (p=0.001). Patients with hypomineralized/hypomaturized AI have restorations of shorter longevity than those with hypoplastic AI (p<0.01). Porcelain crowns had significantly longer survival than composite resin materials in the AI group (p<0.001). Clinical Significance This study shows the need for long-lasting restorative solutions for patients with AI. It also shows the importance of establishing an early permanent therapy plan for these patients to avoid frequent dental visits.

Three-year prospective clinical performance of a one-step self-etch adhesive and a nanofiller hybrid resin composite in Class V lesions.

PURPOSE: This 3-year prospective clinical study evaluated the clinical performance of a one-step self-etching adhesive (Futurabond NR) in combination with a nanohybrid composite (Grandio) for the treatment of different Class V cavities. METHODS: 122 restorations were placed in 42 patients (mean age of 54 +/- 13.2 years) evaluated according to modified Ryge-criteria at baseline, 6 months, 1, 2 and 3 years. The lesions comprised 91 Class V non-caries cervical lesions (NCCL) and 31 Class V cavities due to caries or restoration replacement. While carious lesions as well as restoration replacement required preparation of dentin, it was not roughened in case of NCCL. Macro-mechanical retention with undercuts was not used. The statistical analysis was carried out based on Bonferroni adjusted McNemar test (global alpha = 0.05) including the criteria marginal adaptation, color match, surface texture, anatomical form, retention and clinical acceptance and pain. The occurrence of secondary caries, preoperative and postoperative sensitivity was also examined. RESULTS: After 3 years of clinical service the restorations showed a significant deterioration of all studied parameters. After 3 years, 65% of the restorations were rated as excellent or acceptable in terms of clinical acceptance, 9% appeared tolerable and 26% were rated as not acceptable which mainly resulted from restoration losses. Within the observed timeframe the retention rate decreased to 75%, which means that 30 out of the 122 restorations were partially or completely lost. There was a difference in the 3-year retention rate of NCCL (71%) and the caries/restoration replacement group (87%) but it was not statistically significant.

A randomized double-blind placebo-controlled study of the efficacy of Clinpro XT varnish and Gluma dentin desensitizer on dentin hypersensitivity.

PURPOSE: To evaluate the effect of Clinpro XT Varnish (VXT) paste-liquid, resin-modified glass-ionomer and the resinous dentin desensitizing varnish and Gluma Dentin Desensitizer (Gluma) in treating dentin hypersensitivity (DH). METHODS: This short-term (4-week) randomized, double-blind, placebo-controlled, split-mouth study included a total of 119 teeth from 31 individuals which were randomized into three groups: VXT, Gluma, and placebo (warm water). Dentin sensitivity was evaluated by subjects' perception of DH determined by pretreatment tooth sensitivity score (TSS) measured on a 0-10 visual analogue scale (VAS) after tactile (probe) or thermal/evaporative (blast of air) stimuli. TSS was scored at baseline, immediately after treatment (Day 0), after 1 week and after 4 weeks. RESULTS: For both stimuli, mean TSS was significantly decreased in the VXT and Gluma groups at all time points (all, P < 0.001) compared with baseline. Regarding comparisons of TSS between treatment groups, the VXT group had significantly lower mean TSS compared with the Gluma group (P< 0.05) and placebo control group (P< 0.05) at all time points after treatment regardless of stimuli. Group Effect, Time Effect, and Group x Time Effect were all significantly different (all, P < 0.001).

A randomized controlled clinical trial to assess the desensitizing effect of a stannous fluoride dentifrice.

PURPOSE: To assess the dentin hypersensitivity-reducing effectiveness of a 0.454% stannous-containing dentifrice as compared to a marketed negative control dentifrice after the first brushing as well as after 3 days and 2 weeks of twice daily use. METHODS: This was a 2-week, randomized, double-blind, parallel group, single-center clinical investigation in confirmed dentin hypersensitivity adult sufferers. At baseline, subjects were stratified by age, gender, and thermal sensitivity scores, and randomly assigned to a marketed 0.454% stannous fluoride (SnF2) dentifrice or a marketed sodium fluoride (NaF) dentifrice negative control. Following baseline assessment of tactile and thermal sensitivity via the Yeaple Probe and air-blast/Schiff Air Index evaluations, respectively, subjects brushed once on-site with their assigned test product following the same usage instructions. Post-brushing tactile and thermal sensitivity were then assessed ('Immediate' evaluation). Subjects subsequently brushed twice daily at home for a 2-week period, with the same tactile and thermal efficacy evaluations repeated at Day 3 and Week 2 post-baseline. RESULTS: All 116 enrolled subjects completed all evaluations. The stannous fluoride dentifrice provided significantly (P < 0.0001) superior dentin hypersensitivity reduction compared to the negative control dentifrice at each time point and by both evaluation measures: superior mean relative Yeaple Probe (tactile) benefits were 124.5% after one use, 203.8% after 3 days, and 222.5% after 2 weeks; and superior mean relative Schiff Air Index (thermal) benefits were 27.6% after a single use, 44.6% at Day 3, and 74.2% at Week 2. Both dentifrices were well-tolerated.

Short-term Efficacy of Agents Containing KNO3 or CPP-ACP in Treatment of Dentin Hypersensitivity.

OBJECTIVE: To evaluate the short-term efficacy of agents containing KNO3 or casein phosphopeptide- amorphous calcium phosphate (CPP-ACP) in the treatment of dentin hypersensitivity. METHODS: UltraEZ, containing KNO3 and MI Paste, containing CPP-ACP were applied in this study. The dentin hypersensitivity of 102 subjects was established by a tactile stimulus with a Yeaple preasure probe, and the degree of hypersensitivity was measured using a visual analogue scale (VAS). The patients were divided into four groups: A, B, C and D, using a random number table. UltraEZ, a placebo of UltraEZ, MI Paste, and a placebo of MI Paste were applied to group A, B, C and D respectively for 2 weeks. Dentin hypersensitivity was measured using VAS before the treatment (baseline), on day 2, 7, and 14 during the treatment, and on day 30 and 60 posttreatment. RESULTS: The efficacy of UltraEZ on dentin hypersensitivity was significantly better than that of the corresponding placebo group on day 7 during the treatment, whereas the efficacy of MI Paste exhibited better than that of the placebo group on day 14 during the treatment. However, there were no differences between the efficacy of the two agents on day 14 during the treatment, day 30 or day 60 posttreatment. CONCLUSION: Both UltraEZ and MI Paste had a significant effect on dentin hypersensitivity. UltraEZ showed quicker effects than MI Paste, but MI Paste had a greater sustained action after treatment than UltraEZ.

Subgingival air-polishing with erythritol during periodontal maintenance: randomized clinical trial of twelve months.

OBJECTIVES: To evaluate repeated subgingival air-polishing in residual pockets with a new erythritol powder containing 0.3% chlorhexidine. MATERIAL AND METHODS: Single-centre, examiner masked, randomized clinical trial of 12 months with a two-arm, within-subject parallel design. Fifty patients in periodontal maintenance were monitored in 3-month intervals. At months 0, 3, 6 and 9, all sites presenting with a probing depth (PD) >4 mm were subject to subgingival air-polishing (test side) or ultrasonic debridement (control side). The primary endpoint was presence/absence of PD >4 mm after 12 months. RESULTS: Totally 6918 sites were monitored at baseline, 457 of them had a PD >4 mm (range 5-9 mm). The number of pockets >4 mm per subject, PD and bleeding on probing were significantly lower at month 12. Differences between test and control were not significant. There was a significant difference in favour of air-polishing for the perception of pain/discomfort. Differences of frequencies at >1000 and >100,000 cells/ml of six microorganisms between baseline and month 12 were not significant. At month 12, test sites were less frequently positive for Aggregatibacter actinomycetemcomitans at >1000 cells/ml than controls, and counts never exceeded 100,000 cells/ml. CONCLUSIONS: Repeated subgingival air-polishing reduced the number of pockets >4 mm similar to ultrasonic debridement. It was safe and induced less pain.

Five-year clinical performance of the dentine deproteinization technique in non-carious cervical lesions.

OBJECTIVE: The aim of this study was to evaluate the 5-year clinical performance of composite restorations of non-carious cervical lesions (NCCL) using a total-etch adhesive system with or without collagen removal with 10% sodium hypochlorite (NaOCl). METHODS: In this study randomized controlled split-mouth clinical trial, one-hundred and thirty-eight NCCL were restored into 30 patients. Each patient received at least one pair of composite restorations (Filtek A110/3M ESPE), bonded either with 2 techniques: Conventional Technique--acid etching with 37% phosphoric acid+Prime & Bond NT (Denstply DeTrey); Deproteinization Technique--acid etching with 37% phosphoric acid+10% NaOCl for 1min+Prime & Bond NT. The two techniques were evaluated using the United States Public Health Service (USPHS) criteria at baseline, 18 months, 3 and 5 years. After five years, one-hundred and six restorations were evaluated in 24 patients. Data were analyzed using the Chi-Square test (p<0.05). RESULTS: There were no statistically significant differences between the two techniques regarding the evaluated parameters (p>0.05). CONCLUSION: After 5 years, the application of 10% NaOCl deproteinization on etched dentine did not affect the clinical performance of composite restorations placed in NCCL when compared to the conventional total-etch technique. CLINICAL SIGNIFICANCE: Clinical studies evaluating the performance of the Deproteinization Technique are scarce. In this study, this technique showed similar clinical performance at the end of 5 years when compared to a conventional total-etch technique.

Evaluation of recession defects treated with coronally advanced flaps and either recombinant human platelet-derived growth factor-BB plus ß-tricalcium phosphate or connective tissue: comparison of clinical parameters at 5 years.

BACKGROUND: In a previously reported split-mouth, randomized controlled trial, Miller Class II gingival recession defects were treated with either a connective tissue graft (CTG) (control) or recombinant human platelet-derived growth factor-BB + ß-tricalcium phosphate (test), both in combination with a coronally advanced flap (CAF). At 6 months, multiple outcome measures were examined. The purpose of the current study is to examine the major efficacy parameters at 5 years. METHODS: Twenty of the original 30 patients were available for follow-up 5 years after the original surgery. Outcomes examined were recession depth, probing depth, clinical attachment level (CAL), height of keratinized tissue (wKT), and percentage of root coverage. Within- and across-treatment group results at 6 months and 5 years were compared with original baseline values. RESULTS: At 5 years, all quantitative parameters for both treatment protocols showed statistically significant improvements over baseline. The primary outcome parameter, change in recession depth at 5 years, demonstrated statistically significant improvements in recession over baseline, although intergroup comparisons favored the control group at both 6 months and 5 years. At 5 years, intergroup comparisons also favored the test group for percentage root coverage and change in wKT, whereas no statistically significant intergroup differences were seen for 100% root coverage and changes to CAL. CONCLUSIONS: In the present 5-year investigation, treatment with either test or control treatments for Miller Class II recession defects appear to lead to stable, clinically effective results, although CTG + CAF resulted in greater reductions in recession, greater percentage of root coverage, and increased wKT.

A split-mouth randomized clinical trial of conventional and heavy flowable composites in class II restorations.

OBJECTIVE: The aim of this study was to evaluate the 2-year clinical performance of class II restorations made with a composite resin with two different viscosities. METHODS: 47 patients received two class II restorations (n=94), one made with GrandioSO (conventional viscosity - CV), and the other with GrandioSO Heavy Flow (flowable viscosity - FV), subjecting both materials to the same clinical conditions. The self-etching adhesive Futurabond M was used for all restorations. The composites were inserted using the incremental technique. The restorations were evaluated using the modified USPHS criteria according to the periods: baseline, 6 months, 1 year and 2 years after restorative procedures. RESULTS: After 24 months, 40 patients attended the recall and 78 restorations were evaluated. In all periods, no secondary caries was observed. After 6 months, there were slightly overall changes of scores for most parameters. After 24 months, the higher number of changes from score Alfa to Bravo was observed for marginal discolouration (32.5% - CV and 39.5% - FV) and colour match (15% - CV and 31.6% - FV), followed by proximal contact (25% - CV and 23.7% - FV) and marginal adaptation (20% - CV and 21.1% - FV). For wear, surface texture and postoperative sensitivity the changes were very small. Just two restorations were lost during the 24-month follow up. Less than 5% of all restorations showed postoperative sensitivity. Chi-square test showed no significant differences between the two materials for all parameters analysed. CONCLUSION: After 2 years of clinical service, no significant differences were observed between GrandioSO conventional and GrandioSO Heavy Flow for the parameters analysed. Both materials provided acceptable clinical behaviour in class II restorations. CLINICAL SIGNIFICANCE: This study presents the possibility of using a flowable composite with high filler content, for performing class II restorations.

Comparison of pattern of failure of resin composite restorations in non-carious cervical lesions with and without occlusal wear facets.

OBJECTIVES: Many studies have reported the clinical problems associated with resin composite restorations in NCCLs. None has compared these clinical problems in NCCLs with and without occlusal wear facets. The present study sets out to determine the proportion of NCCLs that presents occlusal wear facets, and to compare the failure pattern of resin composite restorations in NCCLs with and without occlusal wear facets. METHODS: Teeth with NCCLs were classified into two groups, those with and without occlusal wear facets. Both groups were restored using micro hybrid resin composite. The restorations were evaluated at the end of 2 years concerning post-operative sensitivity, retention, marginal integrity, marginal discolouration, wear, and secondary caries, using the USPHS criteria. Statistical analysis compared the ratings of each criterion between the two groups using Pearson's χ(2) or Fisher's exact test. RESULTS: About one-third (33.8%) of teeth with NCCLs presented with occlusal wear facets, more NCCLs with occlusal wear facets in mandibular teeth (44.7%) than maxillary teeth (24.5%). Retention rate of composite resin restorations in NCCLs with and without occlusal wear facets was 63.9% and 74.4% respectively at the end of 2 years. More marginal discolouration and defects were observed in restorations in NCCLs with occlusal wear facets, the differences were not statistically significant (p>0.05). CONCLUSIONS: The decline in ratings of marginal discolouration and defects, and the lower retention rate of restorations in NCCLs with occlusal wear facets may support the role of occlusal stress and tooth flexure as a cause of failure of restorations in NCCLs. CLINICAL SIGNIFICANCE: The ability to distinguish between stress induced lesions (with occlusal wear facets) and other cervical lesions will have important ramifications for the success of their restorations because they are not subjected to the same physical forces that are responsible for the deterioration of the restoration.

Three-year clinical evaluation of a silorane composite resin.

STATEMENT OF PROBLEM: Composite resins are still outperformed by amalgams in the clinical practice with secondary caries and fractures being their most common failures. A material that suffers less polymerization shrinkage might improve the clinical performance of composite resins. PURPOSE: To evaluate the clinical performance of a low-shrink silorane-based composite resin (Filtek LS Low Shrink Posterior Restorative, 3M ESPE, St. Paul, MN, USA) in comparison with a methacrylate-based composite resin (Tetric EvoCeram, Ivoclar Vivadent, Schaan, Principality of Liechtenstein) over time. MATERIALS AND METHODS: Candidates in need of Class II composite resin restorations participated in this randomized controlled clinical trial. Those were 25 female and six male subjects with average age of 44.3 ± 12.7 years. Participants received 82 restorations, being 54 in premolars and 28 in molars. Procedures, which included the restoration of primary caries lesions or replacement of failing restorations, were done using modified preparations with no bevels or additional retention. Restorations were placed using Filtek LS (and dedicated self-etch adhesive) or Tetric EvoCeram (with AdheSE, Ivoclar Vivadent), following manufacturers' instructions. Incremental placement technique was applied and the restorations were immediately finished. Follow-up evaluations occurred at six, 12, 24, and 36 months and were done using the Fédération Dentaire Internationale criteria. Statistical analysis was performed using generalized estimating equations. RESULTS: The recall rate at 36 months was 89%. All interaction terms were not significant. CONCLUSIONS: Filtek LS performs as well as Tetric EvoCeram performs in the clinical setting at 36 months. CLINICAL SIGNIFICANCE: The silorane-based composite resin Filtek LS and the conventional methacrylate-based composite resin Tetric EvoCeram performed similarly well in posterior restorations over at least 36 months of clinical service.

The effects of two 10% carbamide peroxide nightguard bleaching agents, with and without desensitizer, on enamel and sensitivity: an in vivo study.

OBJECTIVES: This study aimed to compare the effects of two 10% carbamide peroxide (CP) agents with or without desensitizers on tooth sensitivity, colour and enamel morphological changes. METHODS: Twenty subjects used a 10% carbamide peroxide gel with or without fluoride and potassium nitrate for 2 weeks. Sensitivity, spectrophotometric evaluation of colour and morphological analyses of replicas with scanning electron microscope (SEM) were performed before and after treatment. All data were analysed statistically. RESULTS: Both bleaching agents induced sensitivity; however, the 10% CP bleaching agent with fluoride and potassium nitrate produced significantly lower sensitivity (P < 0.05) than the bleaching product without desensitizing agents. In spectrophotometric evaluation, no difference in bleaching effectiveness was found between the tested bleaching gels, and the SEM analysis confirmed the absence of relevant alterations of the enamel surface in both groups. CONCLUSION: The use of 10% carbamide peroxide gel with fluoride and potassium nitrate reduced the incidence of sensitivity during the bleaching treatment compared to a bleaching agent that did not contain desensitizing agents. The bleaching effectiveness of the tested products was comparable.

Randomized trial of the clinical efficacy of a potassium oxalate-containing mouthrinse in rapid relief of dentin sensitivity.

OBJECTIVE: The aim of this randomized clinical trial was to evaluate the efficacy of a mouthrinse containing 1.4% potassium oxalate (Listerine Advanced Defence Sensitive; LADS) plus Colgate Cavity Protection Regular toothpaste, in reducing dentin sensitivity. METHODS: This was an observer- and examiner-blinded, randomized, parallel-group, single-center, controlled, five-day clinical trial. Healthy adults were randomized (2:1:1) to LADS plus Colgate Cavity Protection Regular toothpaste, or to one of the two negative-control toothpastes alone: Crest Cavity Protection Regular or Colgate Cavity Protection Regular. The subjects carried out supervised and unsupervised brushing and rinsing twice a day. Dentin sensitivity was assessed at baseline and during treatment by Yeaple probe (tactile pressure; patient-reported discomfort by visual analogue scale [VAS]), as well as response to air blasts (VAS). RESULTS: All sensitivity assessments were similar at baseline in the 56 randomized subjects. By the third day, the Yeaple probe sensitivity scores for subjects treated with Colgate toothpaste plus LADS improved significantly compared to Crest toothpaste alone (p < 0.05). By the fifth day, the mean scores for subjects treated with Colgate toothpaste plus LADS were significantly improved compared with subjects treated with either toothpaste alone (p < 0.05). The other sensitivity assessments showed that Colgate toothpaste plus LADS achieved statistically significant improvements compared with Colgate and/or Crest toothpaste alone from the third day. CONCLUSIONS: The 1.4% potassium oxalate mouthrinse (LADS) was associated with a reduction in dentinal sensitivity within a five-day period. Statistically significant reductions in all sensitivity variables were achieved by Day 3 and even greater reductions in dentin sensitivity scores were observed after five days.

Validation of a Cumulative Hypersensitivity Index (CHI) for dentine hypersensitivity severity.

AIM: This study developed the Schiff Index into a Cumulative Hypersensitivity Index (CHI) to measure dentine hypersensitivity (DH) severity per subject. It validates this score by investigating if it compares to one comprising a percentage score from all tooth surfaces and as a highest score per subject. MATERIALS AND METHODS: Overall, 350 subjects were recruited from hospital and general practice in south-east England. Buccal, occlusal and oral Schiff Index scores were collected and percentages calculated based on scores 1, 1 and above, 2 and above and 3. CHI scores and highest Schiff Index scores were also recorded per subject. Spearman correlation coefficients (p-values) assessed the relationship between CHI scores, Schiff Index percentages and Schiff Index highest per subject. RESULTS: In subjects with a Schiff Index score of 1 or more on at least one tooth surface (indicating DH was present), correlation of the CHI score to the Schiff Index percentage score was 0.982 (p < 0.001). Correlation of the sextant score to the highest Schiff Index score per subject was 0.963, (p < 0.001). DH was more likely on tooth surfaces with gingival recession (p < 0.001) and without bleeding on probing (p < 0.01). CONCLUSIONS: This study has validated a novel CHI score to indicate DH severity per subject and may help guide clinical management.

Effectiveness of a resin-modified glass ionomer liner in reducing hypersensitivity in posterior restorations: a study from the practitioners engaged in applied research and learning network.

BACKGROUND: The objectives of this randomized comparative effectiveness study conducted by members of the Practitioners Engaged in Applied Research and Learning (PEARL) Network were to determine whether using a resin-modified glass ionomer (RMGI) liner reduces postoperative hypersensitivity (POH) in dentin-bonded Class I and Class II resin-based composite (RBC) restorations, as well as to identify other factors (putative risk factors) associated with increased POH. METHODS: PEARL Network practitioner-investigators (P-Is) (n = 28) were trained to assess sensitivity determination, enamel and dentin caries activity rankings, evaluation for sleep bruxism, and materials and techniques used. The P-Is enrolled 341 participants who had hypersensitive posterior lesions. Participants were randomly assigned to receive an RBC restoration with or without an RMGI liner before P-Is applied a one-step, self-etching bonding agent. P-Is conducted sensitivity evaluations at baseline, at one and four weeks after treatment, and at all visits according to patient-reported outcomes. RESULTS: P-Is collected complete data regarding 347 restorations (339 participants) at baseline, with 341 (98 percent) (333 participants) recalled at four weeks. Treatment groups were balanced across baseline characteristics and measures. RBC restorations with or without an RMGI liner had the same one-week and four-week POH outcomes, as measured clinically (by means of cold or air stimulation) and according to patient-reported outcomes. CONCLUSIONS: Use of an RMGI liner did not reduce clinically measured or patient-reported POH in moderate-depth Class I and Class II restorations. Cold and air clinical stimulation findings were similar between groups. Practical Implications. The time, effort and expense involved in placing an RMGI liner in these moderate-depth RBC restorations may be unnecessary, as the representative liner used did not improve hypersensitivity outcomes.