Efficacy of a stannous fluoride dentifrice for relieving dentinal hypersensitivity in Chinese population: an 8-week randomized clinical trial.

OBJECTIVES: To compare the effectiveness of using a 0.454% stannous fluoride-containing dentifrice twice daily in relieving dentinal hypersensitivity (DH) in a Chinese population. MATERIALS AND METHODS: This was a single-centre, randomized, controlled, examiner-blind, three-treatment-arm, parallel-group study in participants with clinically diagnosed DH. Subjects who met inclusion criteria (n = 197) were randomly allocated into 3 groups: test group (n = 66)-using a 0.454% stannous fluoride-containing dentifrice twice daily; positive control group (n = 64)-using a 5.0% calcium sodium phosphosilicate-containing dentifrice twice daily; negative control group (n = 67)-using a 1150 ppm of NaF dentifrice twice daily. Status of DH was assessed at week 4 and week 8 by the same independent examiner. Changes from baseline in Schiff sensitivity score, tactile threshold and Dentine Hypersensitivity Experience Questionnaire (DHEQ) score were analysed using analysis of covariance models. The DHEQ evaluated subject-perceived oral health-related quality of life (OHRQoL). RESULTS: Statistically significant improvements in mean Schiff scores (p < 0.0001 for all products at Weeks 4 and 8), tactile threshold (p < 0.0001 for test and negative control at Weeks 4 and 8: Week 4 p = 0.0040 and Week 8 p < 0.0001 for positive control) and all DHEQ scores (p < 0.01 for all groups) were observed. No statistically significant differences were observed in the adjusted mean between all dentifrices at both timepoints, potentially driven by a placebo effect. Forty-two treatment-emergent adverse events (TEAEs) were reported (n = 32 subjects), with 2 serious AEs (n = 1) in the test group. TEAEs were not considered treatment-related. CONCLUSIONS: All groups demonstrated statistically significant improvements in Schiff score, tactile threshold and OHRQoL. However, due to a possible placebo effect in the negative control, there were no statistically significant differences between the dentifrices. CLINICAL RELEVANCE: This study adds to the growing research exploring why the placebo effect is a common phenomenon in DH studies. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04950465.

Occluding Efficiency of Different Desensitizing Agents and Er,Cr:YSGG Laser on Dentin Tubules.

PURPOSE: This study aimed to evaluate the effects of two desensitizers and the Er,Cr:YSGG laser on human dentin tubules, applied alone or in combination. METHODS: Ninety-six dentin specimens were obtained from extracted third molars and divided into six groups: Group 1: no-treatment (Control); Group 2: nano-hydroxyapatite desensitizer (NhapD); Group 3: NhapD+Er,Cr:YSGG laser (L); Group 4: Er,Cr:YSGG laser (L); Group 5: glutaraldehyde desensitizer (GD); and Group 6: GD+L, respectively. All specimens were evaluated using scanning electron microscopy. The diameter and the number of open dentin tubules, the tubules' occluding ratio, and the mineral coverage area were measured via the Image J software at 2000× magnification. Atomic force microscopy was used to determine the blocking mechanism of desensitizing treatments and the surface morphology of dentin specimens. One-way ANOVA and Tukey tests were used for statistical analysis. RESULTS: The number of open tubules and the mean diameter of tubules for all treatment groups showed statistically significant differences from the control group The NhapD+L group had a significantly lower number of open tubules than the L and GD groups. The NhapD+L and L groups significantly had higher occluding ratios than the other groups. CONCLUSIONS: The present study showed that the Er,Cr:YSGG laser alone was effective in terms of tubule occlusion and also contributed to increasing the occluding ratio of nano-hydroxyapatite. It may be recommended to use the Er,Cr:YSGG laser with nano-hydroxyapatite desensitizers to achieve effective tubule occlusion.

Efficacy of a novel dentifrice containing bioactive glass-ceramic for dentinal hypersensitivity: A double-blind randomized controlled trial in Chinese adults.

OBJECTIVE: To assess the efficacy and safety of a toothpaste containing 7.5 % HX-BGC in combating dentinal hypersensitivity. METHODS: A single-center, randomized, double-blind, three-group parallel-controlled design was employed, with Schiff Index and Yeaple Index as measurement indicators. The study evaluated the effectiveness of HX-BGC toothpaste, NovaMin toothpaste, and a negative control toothpaste without desensitizing agents. Eligible subjects underwent baseline examination after a 2-week washout period, and those meeting inclusion criteria and not meeting exclusion criteria entered the study. Participants were randomly assigned to use one of the three toothpastes. Follow-up examinations were conducted immediately after a single use and at 2, 4, and 6 weeks. Intra-group and inter-group comparisons were made for Schiff and Yeaple indices. Safety of the experimental toothpastes was assessed through participant feedbacks and oral soft tissue examinations. RESULTS: Subjects in the three groups were balanced in terms of age and gender distribution, with no baseline differences in indicators. Immediately after a single application of toothpaste, Yeaple indices increased, and Schiff indices decreased, with no significant differences among the groups. After 2 weeks of continuous use, Yeaple indices increased in all groups, with significant differences observed between the HX-BGC group and the other two groups. Schiff indices decreased in all groups, with the NovaMin group showing significant differences compared to the negative control group. At weeks 4 and 6, both indices in the HX-BGC group and the NovaMin group were significantly better than those in the negative control group, with the HX-BGC group outperforming the NovaMin group in the Yeaple index. No serious adverse reactions related to the study products were observed or reported by any participants. CLINICAL SIGNIFICANCE: This clinical trial confirmed the efficacy of HX-BGC in anti-dentinal hypersensitivity and supported the clinical application of the dentifrice containing HX-BGC. CONCLUSION: Compared to the negative control group, both HX-BGC and NovaMin toothpaste groups demonstrated more significant effects in combating dentinal hypersensitivity. No adverse reactions related to the experimental toothpastes were observed.

Desensitizing Agent Previously Applied During In-Office Bleaching: A Double-Blind Randomized Clinical Trial

Abstract Objective: To compare the clinical effect of two desensitizing agents used before the application of a bleaching gel based on 35% hydrogen peroxide (HP). Material and Methods: 30 patients were selected, and two desensitizing agents with different mechanisms of action were applied: Fluorine Neutral 2% (FN), which acts by blocking dentinal canaliculi while Potassium Nitrate 5% with 2% Sodium Fluoride (PN/SF) that acts in nerve transmission and blockade. Desensitizers were used before the application of 35% HP. For whitening, three clinical sessions were performed, with an interval of seven days, with three applications of the bleaching gel for 15 minutes, totaling 45 minutes/session. Tooth sensitivity (TS) was assessed with the numerical analog scale, and a spectrophotometer was used to obtain the color variation (ΔE). ΔE were submitted to ANOVA and Tukey test (p<0.05), and TS data were submitted to a two-way ANOVA analysis. Results: For sensitivity experience, the Tukey test indicated differences between PN/SF and the placebo I, but there was no statistically significant difference between FN and the placebo II. The TS was lower when the desensitizing gel was used during the bleaching procedure compared to after treatment, regardless of the desensitizing agents. Conclusion: PN/SF before in-office tooth bleaching can reduce TS intensity, and the use of desensitizing gel before bleaching did not affect the bleaching efficacy.

Assessment of Efficiency of Bioactive Glass, Self-Assembling Peptide, and Ozone Remineralising Agents on Artificial Carious Lesion

ABSTRACT Objective: To assess the efficacy of bioactive glass, self-assembling peptide, and ozone-remineralizing agents on the artificial carious lesion. Material and Methods: On the extracted 60 premolar teeth, an artificial carious lesion/demineralization was created. Later, the remineralization of demineralized teeth was done with respective remineralizing agents (Group A: Calcium sodium phosphosilicate (bioactive glass), Group B: Self-assembling peptide, Group C: Ozone remineralizing agents and Group D (Control): De ionized water. The degree of demineralization and remineralization were evaluated using the Vickers Hardness Number. Results: There was a decrease in microhardness from baseline to demineralization in all the groups, and this reduction was found to be statistically considerable. After the remineralization of demineralized samples with respective remineralizing agents, there was an increase in microhardness of 312.38, 276.67, and 254.42 in groups A, B, and C, respectively. In contrast, in Group D, there were no changes. Conclusion: Bioactive glass and self-assembling peptides had higher remineralizing capacities, which can be used to treat early carious lesions.

Dentine tubule occlusion effect of hydrolyzed casein in a bioactive glass-based dental desensitizing gel.

OBJECTIVES: The effectiveness of three different groups of polyethylene glycol (PEG)-based gels containing powders on dentin hypersensitivity (DH) treatment were assessed and compared with Actimins® as commercial reference group. METHODS: Hydroxyapatite nanorods (nHA) and sol-gel-derived 45S5 bioglass (SGD 45S5) powders were synthesized through hydrothermal and sol-gel methods, respectively. First, 25 demineralized dentin disks were divided into five groups. Then, the prepared gels based on 45S5 bioglass with and without hydrolyzed casein (HC) as experimental, nHA gel and Actimins® as positive and commercial reference groups were applied twice a day on disks by a micro applicator. To mimic the oral environment, treated disks were immersed in artificial saliva in a water bath at 37 °C for 7 days. However, in the negative control group, no agent was applied on the samples. FE-SEM, EDS, AFM, and XRD were performed to assess tubule occlusion. One-way ANOVA test was used for statistical analysis and p*<0.05 was set as the significance level. RESULTS: The nHA with an average aspect ratio of 2.77 and the SGD 45S5 powders with a polygonal morphology and the average size of 48.64±11.38 µm were synthesized. After treatment, tubule occlusion in HC-SGD 45S5 and nHA gels were shown to be higher than other groups. The root mean square roughness (Rrms) of the above-mentioned gels showed to be 121.54±9.25 nm, and 312.6 ± 9 nm, respectively. CONCLUSION: The nHA containing group exhibited the highest tubule occlusion efficiency (i.e., tubule diameter of 0.92±0.32 µm) with a superior mineral precipitation. HC as a novel material demonstrates to be potentially beneficial in DH treatment. CLINICAL SIGNIFICANCE: DH as a common issue may be reduced or eliminated by occlusion of patent dentinal tubules. There are various types of desensitizing agents capable of controlling the DH by the occlusion of patent dentinal tubules. The desensitizing gels developed in this study showed to be promising for clinical and home-use applications.

Treating hypersensitivity in older adults with silver diamine fluoride: A randomised clinical trial.

OBJECTIVE: This study aimed to evaluate the desensitizing effect of topically applied 38% silver diamine fluoride (SDF) solution on the exposed root surface of hypersensitive teeth in older adults. METHOD: This double-blind randomised clinical trial recruited healthy older adults with dentine hypersensitivity. A trained examiner tested the most hypersensitive tooth root surface with a blast of compressed cold air from a three-in-one syringe. The participants gave a sensitivity score (SS) in visual analogue scale from 0 (no pain) to 10 (agonizing) at the baseline visit. Then, they received 38% SDF or 5% potassium nitrate solution (control) as intervention on the root surface. After the intervention, they received a compressed cold air test and reported the SS again. The compressed cold air test followed by intervention was repeated at 4- and 8-week follow ups. The primary outcome was the reduction in SS at 8-week follow-up with reference to the SS at baseline before intervention. Shapiro-Wilk and Mann-Whitney U tests were performed for data analysis following a normality test of SS. RESULTS: This trial recruited 148 participants, and 139 (94%) participants completed the trial. The median percentage reductions in SS in the SDF and potassium nitrate groups were 60% and 50%, respectively (p < 0.001). CONCLUSION: According to the results, 38% SDF solution reduced hypersensitivity on the exposed root surface of older adults. In addition, 38% SDF was more effective than 5% potassium nitrate solution to reduce hypersensitivity on the exposed root surface of older adults. CLINICAL SIGNIFICANCE: Dentin hypersensitivity is common amongst older adults and negatively affects their quality of life. To date, there is no gold standard professionally applied desensitizing therapy in treating hypersensitivity. Evidence from this clinical trial could aid clinical practice and improve oral health in older adults. TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov (NCT05392868).

A randomized clinical trial for comparing the efficacy of desensitizing toothpastes on the relief of dentin hypersensitivity.

The 4-week double-blind clinical trial to manage dentin hypersensitivity (DH) using different desensitizing toothpastes was conducted. 53 participants with DH were enrolled in this trial. The participants were randomized into 3 groups: Group N; no active ingredient-containing toothpaste (Pleasia fluoride-free), Group SC; a toothpaste containing strontium chloride (Sensodyne Original), and Group TP; a toothpaste containing tricalcium phosphate (Vussen S). They were instructed to brush their teeth manually for 3 min, 3 times per day for 4 weeks with the allocated toothpastes, and were assessed at baseline (0), 2, and 4 weeks, respectively. Schiff sensitivity score was recorded to 3 different stimuli (air-blast, cold, and acid) at each assessment. Overall DH was also assessed using a visual analog scale (VAS). The longer participants used the toothpastes, the greater reduction in DH in all groups to the three stimuli. Group TP demonstrated significant reduction of DH compared to group N for air-blast and cold stimuli. Group TP showed significantly lower VAS than group N and SC. Tricalcium phosphate containing toothpaste used in this trial was most useful to reduce DH. It can be one of the treatment options that alleviate DH.

Comparative efficacy of self-administered dentifrices for the management of dentine hypersensitivity - A systematic review and network meta-analysis.

OBJECTIVES: This systematic review with network meta-analysis synthesises available randomised controlled trials evidence concerning efficacy of self-administered dentifrices for management of dentine hypersensitivity (DH) pain. STUDY SELECTION: Following systematic review registration (CRD42019154064), three data bases (MEDLINE, Embase, CENTRAL) were searched to December 2022 for parallel randomised controlled trials conducted in adults diagnosed with DH, using at least two recognised stimuli, assessing the short-term efficacy of home-use dentifrice treatment in reducing pain. Thirty-two studies and 4,638 participants were included. A Network meta-analysis (NMA) approach was used to compare relative effectiveness between interventions. CONCLUSIONS: Twice daily application of self-applied dentifrice containing formulations of stannous, potassium +/- stannous, or arginine can be recommended for the reduction of dentine hypersensitivity pain. There is a need for standardised methodology guideline development to improve the conduct, analysis and reporting of DH clinical studies. CLINICAL RELEVANCE: This is the first comprehensive NMA to be performed, that follows guidelines for conduct of DH trials to determine the efficacy of self-applied dentifrices for the management of dentine hypersensitivity. Indirect comparisons can be made between formulations that have not been compared to one another in randomised controlled trials.

Three-dimensional visualization of dentine occlusion based on FIB-SEM tomography.

The occlusion of dentinal tubules has become a rapid and effective method for treating dentin hypersensitivity. Accurate evaluation of dentin occlusion is critical to illustrate the efficacy of oral care products and to optimize dental therapy in the clinics, which is limited by the conventional two-dimensional (2-D) characterization methods. Here, we demonstrate the visualization of the dentin occlusion via three-dimensional (3-D) characterization using a focused ion beam-scanning electron microscopy (FIB-SEM) tomography. Using the "Slice and View" approach, the material used for occluding dentin tubules is imaged with a very high-resolution voxel (10 nm × 10 nm × 20 nm) from 2-D SEM images and then reconstructed into a 3-D volume, which presents the mode of action of toothpaste for treating dentin hypersensitivity. Meanwhile, quantitative analysis of the depth of occlusion is successfully obtained. This work validates the feasibility of FIB-SEM tomography in the analysis of dentin occlusion within the complicated networks of dentine tubules at the nanoscale, and provides a novel approach to facilitate the research and development of oral care products.

In vitro dentin permeability and tubule occlusion of experimental in-office desensitizing materials.

OBJECTIVES: This study investigates the dentin permeability (by hydraulic conductance) and tubule occlusion (by confocal and scanning electron microscopies) of in-office desensitizing materials. MATERIALS AND METHODS: Bovine dentin blocks were immersed in EDTA to open dentinal tubules. Placebo varnish (PLA), fluoride varnish (FLU), NaF 5% + 5% nanoparticulate sodium trimetaphosphate varnish (TMP), universal adhesive system (SBU), S-PRG filler varnish (SPRG), Biosilicate (BIOS), and amelotin (AMTN) solution were the materials tested. After application, the specimens underwent an erosive-abrasive challenge. Dentin permeability was evaluated at T0 (initial), T1 (after treatment), and T2 (after challenge). Confocal and scanning electron microscopy (SEM) were used to evaluate, respectively, length and number of dentinal tubule occlusions and opened dentinal tubules, after challenge. Permeability and SEM data were analyzed by two-way repeated measures ANOVA and Tukey's tests. Confocal data were analyzed by one-way ANOVA, Tukey's test, and Kruskal-Wallis and Dunn's tests. Spearman and Pearson's correlation tests were also used. Significance level was set at 5%. RESULTS: At T1, the AMTN group showed the lowest permeability value, following the increasing order at T2: AMTN = SBU < BIOS = SPRG < TMP < FLU < PLA. The SBU group had the highest value of occluded dentinal tubule length. The AMTN group presented more occluded dentinal tubules compared to PLA and FLU. AMTN and SBU had the lowest values of opened dentin tubules. Results showed a negative correlation between the analyses. CONCLUSION: The SBU and AMTN solution were more effective in reducing dentin permeability by occluding dentin tubules. CLINICAL RELEVANCE: All materials reduced permeability after challenge, except fluoride varnish.

Clinical Efficacy of Mouthwashes with Potassium Salts in the Treatment of Dentinal Hypersensitivity: A Systematic Review and Meta-analysis.

AIM: This systematic review and meta-analysis evaluated whether the home use of mouthwashes containing potassium salts is effective in reducing and controlling dentin hypersensitivity (DH). METHODS AND MATERIALS: This study is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist and was registered in PROSPERO (CRD42021228410). Randomized clinical trials evaluating the use of mouthwashes containing potassium salt for daily household mouthwash for at least four weeks to reduce DH compared with a control mouthwash were selected, with no limitation on year of publication. Electronic research was carried out in PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library by two independent researchers. One hundred thirty-three articles were obtained, and nine were selected according to the inclusion criteria. RESULTS: The selected studies evaluated DH through tests of sensitivity to tactile and evaporative stimuli and showed that, for the tactile stimulus, there were no baseline differences between groups (p=0.12; mean difference: -0.33; confidence intervals [CI]: -0.73 to 0.08). However, there were significant differences after two weeks of use (p=0.00001; mean difference: 4.67; CI: 4.53 to 4.81), after four weeks (p=0.00001; mean difference: 13.29; CI: 13.03 to 13.55), and after eight weeks (p=0.00001; mean difference: 8.88; CI: 5.73 to 12.02) favoring the experimental group. The results of the evaporative test showed no differences in the baseline assessment between the two groups (p=0.50; mean difference: -0.02; CI: -0.09 to 0.04), but after four weeks (p=0.00001; mean difference: -0.32; CI: -0.44 to -0.20), and eight weeks of use (p=0.00001; mean difference: -0.42; CI: -0.57 to -0.27) there were differences favoring the experimental group. The incidence of side effects showed no differences between the two groups (p=0.89; mean difference: 1.03; CI: 0.67 to 1.58). CONCLUSION: The daily use of mouthwashes containing potassium salt is effective in the treatment of dentinal hypersensitivity, as a complementary step to brushing at least twice a day for two weeks, four weeks, and up to eight weeks, without presenting side effects.

Clinical trials evaluating desensitising agents. Some design and analysis issues.

INTRODUCTION: The purpose of this short communication is to draw attention to an efficient design for trials to evaluate desensitising agents, and an appropriate statistical analysis. METHODS: Two recent sensitivity trials conducted by the Bristol Dental School Clinical Trials Group are reviewed. RESULTS: The methodology used was effective to establish efficacy of the products evaluated. CONCLUSIONS: This methodology is recommended for wider use. CLINICAL SIGNIFICANCE: Effective clinical trial methodology enables establishment of efficacy of desensitising products leading to patient benefit.

The 100 Most-Cited Papers in Dentin Hypersensitivity: A Bibliometric Analysis

ABSTRACT Objective: To identify the 100 most-cited articles in DH and analyze their characteristics. Material and Methods: A search was performed on the Web of Science (WoS) and the 100 most-cited articles were selected. The following data were extracted: citations, year of publication, authorship, institution, country, journal, language, study design, topic of interest, conflict of interest (COI), and sponsorship. The VOSviewer software was used to visualize bibliometric networks. Poisson regression analysis was performed to measure associations between several citations and the characteristics of the studies. Results: The number of citations ranged from 346 to 48. The most-cited article was published in 1997 by Holland in the Journal of Clinical Periodontology. This journal published the most papers, followed by the Journal of Oral Rehabilitation and Journal of Dentistry. Laboratory research, review, and clinical trial were the study designs most prevalent. Reviews (p<0.05; PR= 1.853) and method development studies (p<0.05; PR= 1.853) had a more chance to present more citations. The main topics of interest were the clinical effectiveness of desensitizers and in vitro analysis of dentin morphology. Sponsorship and COI were underreported. England and USA presented the greatest number of citations and connections in the coauthorship network map. Conclusion: Most of the articles were original research, and their topics of interest were mainly the clinical effectiveness of desensitizing agents and dentin morphology.

Ensaios clínicos randomizados sobre tratamentos de hipersensibilidade dentinária ­ conformidade com as diretrizes do CONSORT e mapeamento das características dos estudos: uma revisão sistemática / Randomized clinical trials of dentin hypersensitivity treatments ­ compliance with CONSORT guidelines and mapping of trials features: a systematic review

A hipersensibilidade dentinária (HD) é definida como uma dor aguda, de curta duração, que ocorre em resposta à estímulos externos direcionados a áreas de dentina exposta. Esta revisão sistemática objetivou avaliar a literatura disponível quanto à conformidade dos ensaios clínicos randomizados (ECRs) sobre tratamentos de HD com a Declaração CONSORT, além de realizar um mapeamento de suas características (tipo de intervenção, métodos de avaliação de sensibilidade, escalas utilizadas, modo de aplicação etc.), e analisar o risco de viés destes mesmos estudos. Apenas ECRs entraram nesta revisão. Foi traçada uma estratégia de busca específica para cada bases de dados: MEDLINE via PubMed, Scopus, Web of Science, LILACS, Biblioteca Brasileira em Odontologia (BBO) e EMBASE, além das buscas manuais. A análise e coleta de dados foram realizadas por dois revisores independentes que selecionaram os estudos em potencial primeiro pelo título e resumo e, após, pela leitura completa dos selecionados. Os artigos foram avaliados quanto à conformidade ao CONSORT em uma escala: 0 = sem descrição, 1 = descrição deficiente e 2 = descrição adequada, para cada item. Análise do risco de viés dos artigos foi realizada através da plataforma The Risk Of Bias Tool 2.0. Análises descritivas também foram realizadas. Dos 3078 artigos analisados, 2867 foram excluídos por não atenderem aos critérios de inclusão, não apresentarem comparação entre tratamentos ou não serem ECRs. Após as exclusões, 211 ECRs permaneceram para avaliação. Os periódicos que mais contribuíram foram o American Journal of Dentistry (13,7%) e Journal of Dentistry (8,5%). Os países com mais publicações foram a Índia (24,6%), seguido pelo Brasil (17,5%). Quanto à pontuação dos artigos para cada item CONSORT analisado, 92,42% dos artigos obtiveram pontuação máxima em "Elegibilidade", demonstrando haver uma descrição clara dos critérios de elegibilidade para participantes na maioria dos estudos. O item com menor quantidade de artigos com pontuação máxima foi "Tamanho do efeito estimado" (25,6%), demonstrando uma certa dificuldade dos autores em descrever adequadamente o tamanho do efeito estimado do(s) desfecho(s) e sua precisão com um intervalo de confiança de 95%. A maioria dos artigos apresentou risco "incerto" de viés. Com as análises feitas, concluiu-se que a adesão dos ECRs ao CONSORT requer mais atenção, uma vez que seguir suas diretrizes pode, a longo prazo, resultar em uma melhoria significativa dos relatos de ECRs, o que acarretará inúmeros benefícios tanto para a ciência acerca do tema, quanto para a posterior aplicação clínica (AU)

Dentin hypersensitivity (DH) is defined as an acute, short-term pain that occurs in response to external stimuli directed at areas of exposed dentin. This systematic review aimed to assess the available literature regarding the compliance of randomized clinical trials (RCTs) on DH treatments with the CONSORT statement, in addition to mapping their characteristics (type of intervention, sensitivity assessment methods, scales used, application mode, etc.), and to analyze the risk of bias of these same studies. Only RCTs were included in this review. A specific search strategy was designed for each of the following databases: MEDLINE via PubMed, Scopus, Web of Science, LILACS, Brazilian Dental Library (BBO) and EMBASE, in addition to manual searches. Data analysis and collection were performed by two independent reviewers who selected the potential studies at first by title and abstract, then by complete reading of the selected ones. Articles were evaluated for compliance with the CONSORT statement on a scale: 0 = no description, 1 = deficient description and 2 = adequate description, for each item. Analysis of the risk of bias was performed using The Risk Of Bias Tool 2.0. Descriptive analyzes were also performed. Among the 3078 articles analyzed, 2867 were excluded because they did not meet the inclusion criteria, did not present a comparison between treatments, or were not RCTs. After deletions, 211 RCTs remained for evaluation. The journals that most contributed were the American Journal of Dentistry (13.7%), Journal of Dentistry (8.5%%) and the Journal of Clinical Dentistry (7.1%). India (24.6%) and Brazil (17.5%) were the countries with the most publications. As for the score received by the articles for each CONSORT item analyzed, 92.42% of the articles obtained the maximum score in "Eligibility", demonstrating that there is a clear description of the eligibility criteria for participants in most studies. The item with the lowest number of articles with the maximum score was "Estimated effect size" (25.6%), demonstrating a particular difficulty for authors to adequately describe the estimated effect size of the outcomes and its precision with a confidence interval of 95%. Most articles presented an "uncertain" risk of bias. After these analyses, it was concluded that the adherence of RCTs to CONSORT requires more attention, since following its guidelines can, in the long term, result in a significant improvement in RCT reports, which may bring numerous benefits both to the science on the subject, as well as for the clinical application of what is being studied. (AU)

Effectiveness and cytotoxicity of two desensitizing agents: a dentin permeability measurement and dentin barrier testing in vitro study.

BACKGROUND: When evaluating the efficacy and safety of various desensitizing products in vitro, their mechanism of action and clinical utility should be considered during test model selection. This study aimed to evaluate the effects of two desensitizers, an in-office use material and an at-home use material, on dentin specimen permeability, and their dentin barrier cytotoxicity with appropriate test models. METHODS: Two materials, GLUMA desensitizer (GLU) containing glutaraldehyde and remineralizing and desensitizing gel (RD) containing sodium fluoride and fumed silica, were selected. Human dentin specimens were divided into three groups (n = 6): in groups 1 and 2, GLU was applied, and in group 3, RD was applied and immersed in artificial saliva (AS) for 24 h. Dentin specimen permeability before and after each treatment/post-treatment was measured using a hydraulic device under a pressure of 20 cm H2O. The perfusion fluid was deionized water, except in group 2 where 2% bovine serum albumin (BSA) was used. The representative specimens before and after treatment from each group were investigated using scanning electron microscopy. To measure cytotoxicity, test materials were applied to the occlusal surfaces of human dentin disks under which three-dimensional cell scaffolds were placed. After 24-h contact within the test device, cell viability was measured via 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays. RESULTS: GLU significantly reduced the dentin permeability and occluded the dentinal tubules when 2% BSA was used as perfusion fluid. RD significantly reduced dentin permeability and occluded the tubules, but permeability rebounded after AS immersion. GLU significantly decreased cell viability, but RD was non-cytotoxic. CONCLUSIONS: In vitro GLU application induced effective dentinal tubule occlusion only following the introduction of simulated dentinal fluid. RD provided effective tubule occlusion, but its full remineralization potential was not realized after a short period of immersion in AS. GLU may harm the pulp, whereas RD is sufficiently biocompatible.

Resin-based materials to control human dentin permeability under erosive conditions in vitro: A hydraulic conductance, confocal microscopy and FTIR study.

OBJECTIVES: To characterize the behavior of three different polymeric agents before and after an erosive challenge on dentin permeability, to analyze their degradation in both conditions, and to analyze their degree of conversion (DC). METHODS: The permeability of human dentin disks (1.0 ± 0.2 mm) was measured with smear layer, after its removal, after treatment (LpTreat) with Gluma Desensitizer, PRG Barrier Coat (PBC) or Icon infiltrant (n = 11/group) and after exposure to citric acid (LpEro) (6%, pH 2.1, 1 min). The specimens were analyzed under a Laser Scanning Confocal Microscope (n = 2/group) and the products' DC were calculated. Data were subjected to 2-way repeated measures ANOVA and post-hoc Bonferroni (permeability analysis), to paired t-test (for specimens treated with Icon) and to t-test (DC analysis) (α < 0.05). RESULTS: Icon showed the lowest LpTreat and LpEro values, while PBC and Gluma did not differ from each other under these conditions. Icon and PBC showed LpEro similar to a dentin with smear layer. Under the Laser Scanning Confocal Microscope, more deposits were noticeable on dentin after treating with PBC. Gluma presented the deepest penetration in dentin. The DC of PBC was the highest. SIGNIFICANCE: Icon caused the highest reduction on permeability values, followed by PBC and Gluma. PBC generated more deposits covering dentin and seemed to be more efficient after an erosive challenge. The association of a polymeric resin with inorganic ion-releasing fillers seem to be a great strategy to manage dentin hypersensitivity under erosive conditions.

Assessment of the Ability of Desensitizing and Conventional Mouth Rinses to Promote Dentin Tubule Occlusion.

This study aimed to evaluate the effect of desensitizing and conventional mouth rinses on dentin tubule occlusion. Dentin hypersensitivity was simulated by EDTA application for five minutes. The specimens were randomly allocated into the following groups: desensitizing mouth rinses (Colgate Sensitive, Elmex Sensitive Professional, Listerine Advanced Defense Sensitive, Sensodyne Cool Mint); conventional mouth rinses (Colgate Plax, Elmex Caries Protection, Listerine Anticaries, Sensodyne Pronamel); a negative control (C-: distilled water); and Clinpro XT Varnish was the positive control (C+). Subsequently, the specimens were submitted to an erosive or abrasive challenge (performed separately) and to an erosive/abrasive cycling for five days (n=10 for each challenge). After treatment, challenges, and cycling, the specimens were analyzed in an environmental scanning electron microscope to verify the number of open dentin tubules (ODTs), counted by using Image J software (National Institutes of Health, Bethesda, MD, USA). Data were analyzed by the Kruskal-Wallis, Friedman and Dunn tests, with Bonferroni correction (α=0.05). Groups did not differ at baseline (p>0.05). At the post-treatment, erosion and abrasion stages, C+ was the only group that showed a reduction in ODTs compared to C-(p<0.05). In the other groups, numbers did not differ significantly from C- (p>0.05). After cycling, none of the groups exhibited significant reduction in ODTs other than C- (p>0.05); however, C+, Listerine Anticaries, and Colgate Plax had a lower number of ODTs than Listerine Sensitive and Sensodyne Pronamel. No mouth rinse was able to promote significant occlusion of the dentin tubules after treatment and the challenges. C+ was the only product that effectively promoted tubular occlusion, but this effect did not withstand several erosive and abrasive challenges.

Occlusion effects of bioactive glass and hydroxyapatite on dentinal tubules: a systematic review.

OBJECTIVE: Bioactive glass and hydroxyapatite are biocompatible materials used as an adjunct to various dental materials. The present study aimed to evaluate the occlusion effects of bioactive glasses and hydroxyapatite on dental tubules. MATERIALS AND METHODS: We searched the PubMed/Medline, Embase, and Web of Science databases for the relevant records. The methodological quality of the studies was assessed by an accepted quality assessment tool. RESULTS: From the electronic databases, 372 articles were retrieved. After evaluating the records, 35 in vitro studies were included. The studies revealed a low risk of bias. The primary outcomes from bioactive glass studies demonstrated the potential efficacy of both bioactive glass and hydroxyapatite in dentin tubule occlusion compared to the control. CONCLUSION: The current systematic review showed that bioactive glass and hydroxyapatite could effectively occlude the dentinal tubules. Thus, desensitizing agents containing bioactive glass and hydroxyapatite can be used to manage dentin hypersensitivity (DH). However, long-term follow-up clinical trials are required in the future before definitive recommendations can be made. CLINICAL RELEVANCE: This work achieved a satisfactorily systematic review for assessing desensitizing agents containing bioactive glass and hydroxyapatite in dentine hypersensitivity treatments recommended for clinical practice and research.

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

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