Evaluation of Stain Removal Efficacy and Color Stability of Three Different Dentifrices on Artificially Stained Enamel Surface-An In Vitro Study.

AIM: The aim of the present study was to assess the stain removal ability and color stability of three distinct dentifrices on artificially stained enamel surface. MATERIALS AND METHODS: This study included 75 intact, healthy premolars free of dental caries that were extracted during orthodontic therapy. The samples were allowed to dry for 6 hours after being submerged in the prepared tea solution for roughly 18 hours every day. Then this procedure was repeated for seven successive days. All samples were randomly divided into three experimental groups with 25 samples in each group. Group I: control dentifrice, group II: dentifrice containing hydrogen peroxide, group III: dentifrice containing papain and bromelain. A specially designed toothbrushing simulator was used to brush every sample in the relevant group. Using a spectrophotometer and a measurement program, color measurement was evaluated after staining process after 4 weeks and 8 weeks of teeth cleaning. Using a profilometer, the surface roughness values (Ra) were assessed. RESULTS: After 8 weeks of brushing of stained samples, the color stability was better in dentifrice containing hydrogen peroxide (1.14 ± 0.11) followed by dentifrice containing papain and bromelain (1.22 ± 0.08) and control group (1.30 ± 0.09). And after 8 weeks of brushing of stained samples, the surface roughness was more in dentifrice containing hydrogen peroxide (0.237 ± 0.02) followed by dentifrice containing papain and bromelain (0.229 ± 0.13) and control group (0.207 ± 0.05). CONCLUSION: The present study concluded that the dentifrice containing hydrogen peroxide showed a superior whitening effect on the stained enamel surface than dentifrice containing papain and bromelain and control dentifrice. CLINICAL SIGNIFICANCE: The development of various dentifrice products has been greatly aided by the increased demand for an improved esthetic appearance. Teeth's natural color and any external stains that could accumulate on the tooth surface combine to determine a tooth's color. Additionally, the use of whitening dental pastes to remove external stains has grown in favor. With the development of these whitening toothpastes, dentifrices' ability to lessen or eliminate extrinsic dental stains has increased. How to cite this article: Mishra D, Kamath DG, Alagla M, et al. Evaluation of Stain Removal Efficacy and Color Stability of Three Different Dentifrices on Artificially Stained Enamel Surface-An In Vitro Study. J Contemp Dent Pract 2024;25(1):68-71.

Effects of Leukocyte-rich platelet-rich plasma and Leukocyte-poor platelet-rich plasma on cartilage in a rabbit osteoarthritis model.

Osteoarthritis is a prevalent chronic disease. One of its primary pathological processes involves the degeneration of articular cartilage. Platelet-rich plasma (PRP) contains cytokines and growth factors that can stimulate the repair and regeneration of articular cartilage tissues. PRP may also slow the progression of osteoarthritis. The purpose of this experiment is to compare the efficacy of Leukocyte poor (LP) - PRP and Leukocyte rich (LR) - PRP in treating rabbit osteoarthritis and to investigate their mechanisms of action. Analyzing the impact of leukocytes on PRP therapeutic effectiveness will provide a valuable clinical reference for the choice of which PRP is better for the treatment of osteoarthritis. A rabbit osteoarthritis model was established by injecting papain into the knee joint cavity, and LP-PRP and LR-PRP were prepared through different centrifugation methods for injection into the knee joint cavity. Eight weeks after injection, rabbit knee cartilage specimens were observed for gross changes, HE staining, senna O-solid green staining, and immunohistochemistry of type II collagen and were quantitatively compared using Pelletier's score, Mankin's pathology score, and ImageJ image processing software. Injection of papain into the knee joint cavity successfully established a rabbit model of osteoarthritis. All three evaluation indexes differed significantly from those of the blank group (P<0.05). LP-PRP and LR-PRP exhibited therapeutic effects when compared with the model group. The two PRP groups had similar gross tissue appearance and pathology (P>0.05). The LR-PRP group had higher collagen type-II expression (P < 0.05) than the LP-PRP group. Both LP-PRP and LR-PRP proved therapeutic for the rabbit papain osteoarthritis model. The difference in leukocyte content between the two groups did not yield different cartilage morphology or other factors by 8 weeks posttreatment. LR-PRP displayed the ability to release more factors relevant to the metabolism of type II collagen than LP-PRP, enabling the preservation of into cartilage collagen content of type II collagen and delaying osteoarthritis progression.

Treatment time, pain experience and acceptability of the technique for caries removal in primary teeth using the ART approach with or without Brix3000™ papain gel: a preliminary randomised controlled clinical trial.

PURPOSE: To compare the Atraumatic Restorative Treatment (ART) associated with Brix3000™ to ART considering treatment time, pain experienced, and acceptability to children. METHODS: This study was accepted in Research Ethics Committee in July 2019 (number 3469402). Healthy patients (n = 20) aged 3-9 years, with at least one primary molar with occlusal dentine caries without cusp involvement were randomly allocated to either the ART + Brix3000™ group or the ART-only group. The sample was characterised by sex, age, tooth location and caries experience. Time spent and pain experience scores were recorded at prophylaxis, caries removal and restoration. The pain experience (intense, moderate, or mild) was evaluated by the Face, Legs, Activity, Cry, Consolability-revised scale (FLACC-r). Acceptability was assessed by a five-point hedonic facial scale (dichotomised into 'like' and 'indifferent/dislike' bins) and by an open-question interview. Mann-Whitney, Chi-square, and Fisher's exact tests were applied to discern differences in time, pain/sample characterisation and acceptability, respectively. RESULTS: The ART + Brix3000™ group required 8.6 ± 3.1 min to remove caries tissue, whereas the ART group required only 4.8 ± 2.0 min (p = 0.03). The total time spent with treatments was 13.1 ± 4.0 min for ART + Brix3000™, and 9.8 ± 2.7 min for ART (p = 0.03). There was no difference in pain experience and acceptability found among the groups (p > 0.05). CONCLUSION: Although the ART + Brix3000™ technique demanded more treatment time than the ART alone, there were no differences in either pain experience or acceptability.

Materiais inteligentes na odontologia minimamente invasiva: remoção, recuperação e restauração da dentina / Smart materials in minimally invasive dentistry: dentin removal, recovery and restoration

O objetivo da presente tese foi analisar as características das interações de materiais inteligentes quando aplicados em dentina, avaliando as técnicas de remoção, a recuperação e a restauração do tecido cariado. Para isso, foram realizados 6 estudos englobando os conceitos atuais da odontologia de mínima intervenção. O primeiro estudo consiste em uma revisão bibliométrica, que realizou um levantamento nas bases de dados MEDLINE, Scopus, Web of Science, Cochrane Library, Lilacs/BBO e Embase, evidenciando o potencial bioativo dos materiais estudados e a necessidade de testá-los em dentina totalmente ou parcialmente desmineralizada através de estudos laboratoriais. O segundo estudo visou comparar in vitro diferentes técnicas para remoção de cárie artificialmente produzidas: o uso de broca, cureta e dois agentes químico-mecânicos (Papacárie Duo Gel®, Fórmula e Ação e Brix3000®, Brix Medical Science). Para isso, foram realizados escaneamentos em micro-CT antes e após a remoção de cárie com o intuito de comparar o volume e a densidade mineral da dentina, demonstrando que não houve diferença entre as técnicas quanto a quantidade de tecido removido (p>0,05). Além disso, nesse mesmo estudo, foi avaliado o potencial de cimentos de polialquenoato (Poly Zinc®, Prevest DenPro e Ketac Molar®, 3M ESPE) na recuperação da densidade mineral da dentina remanescente, mostrando que o cimento de policarboxilato de zinco apresentou um desempenho melhor (33,6%) quando comparado ao cimento de ionômero de vidro (6%; p<0,01). Quanto à seletividade in vitro dos agentes químico-mecânicos à base de papaína, um terceiro estudo foi conduzido, testando as alterações na morfologia e rugosidade superficial da dentina hígida antes e após a aplicação dos géis, comprovando que esses géis são específicos e seguros, sendo que os valores da rugosidade superficial não apresentaram diferenças estatísticas (p>0,05). No quarto estudo foi avaliado in vitro a interação de materiais restauradores liberadores de íons aplicados sobre a dentina artificialmente cariada. Excetuando o compósito resinoso testado (Aura®, SDI), tanto o cimento de ionômero de vidro (Fuji IX®, GC) quanto os cimentos a base de silicato de cálcio (Endo-pass®, DEI e Theracal®, Bisco) provocaram precipitação mineral na interface com a dentina. Esses resultados foram confirmados através de análises quantitativas (α = 5%) e qualitativas. O quinto estudo analisou in vitro dois cimentos de ionômero de vidro modificados por resina (CIVMR; Ionolux®, VOCO e ACTIVA®, Pulpdent) quando aplicados sobre sistemas adesivos universais simplificados (Futurabond®, VOCO e Scotchbond®, 3M) com o objetivo de comparar a força de união a longo prazo desses materiais aplicados sobre dentina. Foi possível constatar que a composição dos sistemas adesivos influencia mais do que o protocolo de aplicação, seja a aplicação convencional ou autocondicionante. Entretanto, quando bem empregados, os CIVMR, podem melhorar a longevidade de adesão desses sistemas adesivos (p<0,05). O sexto estudo consiste em uma revisão de literatura narrativa que apresenta os materiais liberadores de íons disponíveis no mercado, seus mecanismos ação e suas indicações clínicas. Com isso, pode-se concluir que grande parte dos estudos sobre materiais bioativos ainda são limitados a experimentos in vitro e que, apesar de apresentarem resultados positivos quanto a sua bioatividade em recuperar densidade e promover precipitação mineral, esses resultados ainda não podem ser extrapolados clinicamente. Quanto as técnicas de remoção seletiva de cárie, talvez conhecer os conceitos biológicos, fisiológicos e químicos dos processos seja mais importante do que a técnica aplicada em si. Isso também serve no emprego dos materiais bioativos já disponíveis no mercado, que de acordo com a sua composição, a indicação clínica pode variar. (AU)

The aim of the present study was to analyze the type of interactions between smart materials and dentin by studying the techniques for carious tissue removal, dentin recovery and tissue restoration. In order to do this, 6 studies were carried out, involving the current concepts of minimally invasive dentistry. The first study consisted of a bibliometric review, in which we carried out a survey in MEDLINE, Scopus, Web of Science, Cochrane Library, Lilacs/BBO and Embase databases, on the bioactive potential of restorative materials and their effect in sound, completely or partially demineralized dentin through laboratory studies. The second study aimed to compare in vitro different techniques for dentin caries removal: drill, hand excavator and two chemical-mechanical agents (Papacárie Duo Gel®, Fórmula e Ação and Brix3000®, Brix Medical Sciences). In order to do this, micro-CT scans were performed before and after caries removal to compare the volume and mineral density of dentin, and the results showed no difference among the techniques regarding the amount of tissue removed (p>0.05). At the same study, the potential of polyalkenoate cements (Poly Zinc®, Prevest DenPro and Ketac Molar®, 3M ESPE) to recover mineral density of the remaining dentin was evaluated, showing that the zinc polycarboxylate cement presented higher performance (33.6%) compared to the glass ionomer cement (6%; p<0.01). To test the in vitro selectivity of the chemical-mechanical agents based on papain, a third study was conducted to test the changes in the morphology and surface roughness of sound dentin before and after the application of papain gels. The results showed that they are specific and safe, as the surface roughness values after application were not statistically significant different (p>0.05). The fourth study evaluated in vitro the interaction of ion-releasing restorative materials applied on artificially carious dentin. With the exception of the resin composite (Aura®, SDI), both glass ionomer cement (Fuji IX®, GC) and calcium silicate-based cements (Endo-pass®, DEI and Theracal®, Bisco) resulted in mineral precipitation at the interface with dentin. These results were confirmed through quantitative (α= 5%) and qualitative analyses. The fifth study analyzed in vitro two resin-modified glass ionomer cements (RMGIC; Ionolux®, VOCO and ACTIVA®, Pulpdent) when applied with simplified universal adhesive systems (Futurabond®, VOCO and Scotchbond®, 3M) with the aim to compare the long-term bond strength between these materials and dentin. It was possible to verify that the composition of the adhesive systems influenced more than the application protocol (conventional or self-etch mode). However, RMGIC can improve the longevity of adhesion of these adhesive systems (p<0.05). The sixth study consisted of a narrative critical literature review presenting the ion-releasing materials available on the market, their mechanisms of action and their clinical indications. It can be thus concluded that most studies on bioactive materials are still limited to in vitro experiments and, despite showing positive results regarding bioactivity in recovering density and promoting mineral precipitation, these results still can not be extrapolated to clinical applications. Regarding the selective potential of caries removal techniques, the knowledge of biological, physiological and chemical concepts of the processes is more important than the technique used. This can be also applied to the use of bioactive materials available on the market, which according to their composition, may present different clinical indications and applications. (AU)

El objetivo de la presente tesis fue analizar las características de las interacciones de los materiales inteligentes cuando se aplican a la dentina para estudiar las técnicas de remoción, recuperación y restauración del tejido. Para ello se realizaron 6 estudios que engloban los conceptos actuales de la odontología de mínima intervención. El primer estudio consiste en una revisión bibliométrica, que realizó una revisión en las bases de datos MEDLINE, Scopus, Web of Science, Cochrane Library, Lilacs/BBO y Embase, evidenciando el potencial bioactivo de los materiales estudiados y la necesidad de probarlos en dentina totalmente o parcialmente desmineralizada a través de estudios de laboratorio. El segundo estudio tuvo como objetivo comparar in vitro diferentes técnicas para la remoción de caries producidas artificialmente: el uso de material rotatorio, cureta y dos agentes químico-mecánicos (Papacárie Duo Gel® y Brix3000®). Para ello, se realizaron análisis en micro-CT antes y después de la remoción de caries con el fin de comparar el volumen y la densidad mineral de la dentina, demostrando que no hubo diferencia entre las técnicas en la cantidad de tejido removido (p>0,05). Además, en el mismo estudio se evaluó el potencial de los cementos de polialquenoato (Poly Zinc®, Prevest DenPro y Ketac Molar®, 3M ESPE) en la recuperación de la densidad mineral de la dentina remanente, demostrando que el cemento de policarboxilato de zinc presentó un comportamiento mejor (33,6%) en comparación con el cemento de ionómero de vidrio (6%; p<0,01). Con relación la selectividad in vitro de los agentes químico-mecánicos a base de papaína, se realizó un tercer estudio probando los cambios en la morfología y rugosidad superficial de la dentina sana antes y después de la aplicación de los geles, demostrando que estos geles son específicos y seguros, siendo que los valores de rugosidad superficial no presentaron diferencias estadísticas (p>0.05). El cuarto estudio evaluó in vitro la interacción de materiales restauradores liberadores de iones aplicados sobre dentina cariada artificialmente. Excepto por el compuesto de resina (Aura®, SDI), tanto el cemento de ionómero de vidrio (Fuji IX®, GC) como los cementos a base de silicato de calcio (Endo-pass®, DEI y Theracal®, Bisco) causaron precipitación mineral en la interfaz con la dentina. Estos resultados se confirmaron mediante análisis cuantitativos (α = 5%) y cualitativos. El quinto estudio analizó in vitro dos cementos de ionómero de vidrio modificados con resina (CIVMR; Ionolux®, VOCO y ACTIVA®, Pulpdent) aplicados sobre sistemas adhesivos universales simplificados (Futurabond®, VOCO y Scotchbond®, 3M) con el objetivo de comparar la fuerza de unión a largo plazo de estos materiales aplicados a la dentina. Se pudo verificar que la composición de los sistemas adhesivos influye más que el protocolo de aplicación, sea la aplicación convencional o el autograbado. Sin embargo, el CICMR puede mejorar la longevidad de la adhesión de estos sistemas adhesivos (p<0.05). El sexto estudio consiste en una revisión narrativa de la literatura que presenta los materiales liberadores de iones disponibles en el mercado, sus mecanismos de acción y sus indicaciones clínicas. Con esto, se puede concluir que la mayoría de los estudios sobre materiales bioactivos aún se limitan a experimentos in vitro y que, a pesar de mostrar resultados positivos con relación a su bioactividad para recuperar densidad y promover la precipitación mineral, estos resultados aún no son extrapolables clínicamente. En cuanto a las técnicas de eliminación selectiva de caries, quizás sea más importante conocer los conceptos biológicos, fisiológicos y químicos de los procesos que la técnica elegida. Esto también sirve para el uso de materiales bioactivos disponibles en el mercado, que, según su composición, la indicación clínica puede variar. (AU)

TRA associado ou não ao Brix3000, tendências mundiais e o conhecimento sobre técnicas de mínima intervenção para o controle da cárie dentária / ART associated or not with Brix3000, world trends and knowledge of minimal interventional dentistry for the control of dental caries

A presente dissertação foi dividida em três estudos: o primeiro avaliou o Tratamento Restaurador Atraumático (TRA) associado ou não ao Brix3000™ quanto ao tempo de tratamento, experiência de dor e aceitabilidade de crianças (n=20) de 3-9 anos em um ensaio clínico controlado e randomizado. O tempo foi cronometrado do início ao fim do tratamento. A experiência de dor foi avaliada pela versão revisada da escala "Face, Legs, Activity, Cry, Consolability" (FLACC-r) e a aceitabilidade por uma escala facial hedônica. O grupo TRA + Brix3000™ gastou 4 minutos a mais (13,14±4,0 min) que o grupo TRA (9,8±2,7 min) (p=0,03). Não houve diferença quanto à aceitabilidade e à dor (p>0,05). O segundo estudo caracterizou a literatura científica mundial sobre produtos de remoção químico-mecânica de tecido cariado (RQMTC), por meio de mineração de dados bibliométricos, metodológicos e dos resultados de 397 artigos. Houve maior número de publicações entre 2011-2020, no Journal of Dental Research, desenvolvidos no Brasil e Índia. Estudos in vitro foram mais prevalentes, seguidos dos estudos clínicos. Nestes últimos, Carisolv™e Papacarie™ foram os produtos mais utilizados, prescritos para uso isolado e comparados ao uso de brocas. Os produtos para RQMTC foram mais estudados em crianças, cujos dentes foram restaurados com o cimento de ionômero de vidro, nos quais o tempo gasto e dor foram os principais desfechos. Observou-se que a RQMTC demanda maior tempo, entretanto, promove redução de ansiedade, dor e necessidade de anestesia local. O estudo 3 avaliou o conhecimento de dentistas brasileiros sobre odontologia de mínima intervenção (OMI) pelo desenvolvimento, validação e aplicação de uma escala de conhecimento (Minimal Interventional Dentistry for Dental Caries Knewlodge Scale - MIDDeC-KS), de 12 itens (0-12 pontos). Quanto maior a pontuação, maior o conhecimento do dentista. Dados sociodemográficos e de formação acadêmica foram coletados. A escala (α=0,72; ICC=0,85) foi aplicada por meio da plataforma Survey Monkey™ a 637 dentistas que demostraram ter conhecimento médio de 7,4±2,5 sobre OMI. As maiores pontuações foram alcançadas por mulheres (7,8±2,4; p=0,00); profissionais com mais de 10 anos de formados (7,6±2,6; p=0,02); emfaculdades públicas (7,8±2,4; p=0,00), atuando no setor público (7,9±2,3; p=0,00) ou acadêmico (8,8±2,3; p=0,04). Pontuações maiores foram alcançadas por especialistas em Odontopediatria (9,2±1,6) e menores por Cirurgiões buco-maxilo-faciais (3,1±2,1). Houve maior conhecimento sobre controle de dieta, biofilme e aplicação tópica de flúor. Técnica de Hall, infiltrante resinoso e RQMTC foram as técnicas menos conhecidas. Com a presente dissertação, concluiu-se que o TRA associado ao Brix3000™ demandou mais tempo de tratamento, sem diferença quanto à aceitabilidade e à dor. Os estudos com produtos para RQMTC aumentaram ao longo dos anos, principalmente em países em desenvolvimento. Os estudos clínicos com crianças tendem a avaliar o tempo gasto e a dor em comparação ao uso de brocas e, a RQMTC reduz ansiedade, dor e necessidade de anestesia, embora aumente o tempo de tratamento. Foi constatada suficiente evidência psicométrica da escala MIDDeC-KS. As maiores pontuações foram alcançadas por profissionais do gênero feminino e especialistas em Odontopediatria, com maior conhecimento sobre controle de dieta, biofilme e aplicação tópica de flúor. (AU)

This dissertation was divided into three studies: the first evaluated the Atraumatic Restorative Treatment (ART) associated or not with Brix3000 ™ in terms of treatment time, pain experience and acceptability of children (n=20) aged 3-9 years through a randomized controlled clinical trial. The time was calculated from the beginning to the end of the treatment. Pain experience was assessed by the revised version of the "Face, Legs, Activity, Chy, Consolability" (FLACC-r) scale and acceptability by a hedonic facial scale. The ART + Brix3000 ™ group spent 4 minutes longer (13.14±4.0 min) than the ART group (9.8±2.7 min) (p=0.03). There was no difference regarding acceptability and pain (p>0.05). The second study characterized the world scientific literature on chemical-mechanical carious tissue removal (CMCTR) products, through bibliometric, methodological and results data mining of the 397 articles. There was a greater number of publications between 2011-2020, in the Journal of Dental Research, which were developed in Brazil and India. In vitro studies were more prevalent, followed by clinical studies. In the latter, Carisolv ™ and Papacarie ™ were the most used products prescribed for isolated use and compared to the use of drills. CMCTR products have been most studied in children whose teeth were restored with glass ionomer cement, in which time spent and pain were the main outcomes. Clinical application of CMCTR takes more treatment time but can also reduce patient anxiety, pain and need for anesthesia Study 3 assessed the knowledge of Brazilian dentists about minimal intervention dentistry (MID) through the development, validation, and application of a 12-item (0-12 points) knowledge scale (Minimal Interventional Dentistry for Dental Caries Knewlodge Scale - MIDDeC-KS). The higher the score, the greater the knowledge of the dentist. Gender, educational level, specialty, academic training institutions and workplace were collected. The final scale (α=0.72; ICC=0.85) was applied through the Survey Monkey™ platform to 637 dentists who demonstrated an average knowledge of 7.4±2.5 about MID. The highest scores were achieved by women (7.8±2.4; p=0.00); professionals with more than 10 years of graduation (7.6±2.6; p=0.02); in public colleges (7.8±2.4; p=0.00), working in the public sector (7.9±2.3; p=0.00) or academic (8.8±2.3; p =0.04). Higher scores were achieved by specialists in Pediatric Dentistry (9.2±1.6) and lowest by maxillofacial surgeons (3.1±2.1). There was greater knowledge about diet and biofilm control, as well as topical application of fluoride. Hall technique, resin infiltration and CMCTR were the least known MID techniques. With the present master thesis, it was concluded that ART associated with Brix3000™ required more treatment time, with no difference in terms of acceptability and pain. Studies with products for CMCTR have increased over the years, mainly in developing countries. The clinical studies with children tend to assess the time spent and pain compared to the use of drills. CMCR clinical application reduces anxiety, pain and need for anesthesia, despite increase treatments' time Sufficient psychometric evidence of the MIDDeC-KS scale was observed. The highest scores were achieved by women, specialists in Pediatric Dentistry, with more knowledge about diet control, biofilm, and topical fluoride application. (AU)

TRA associado ou não ao Brix3000, tendências mundiais e o conhecimento sobre técnicas de mínima intervenção para o controle da cárie dentária / ART associated or not with Brix3000, world trends and knowledge of minimal interventional dentistry for the control of dental caries

A presente dissertação foi dividida em três estudos: o primeiro avaliou o Tratamento Restaurador Atraumático (TRA) associado ou não ao Brix3000™ quanto ao tempo de tratamento, experiência de dor e aceitabilidade de crianças (n=20) de 3-9 anos em um ensaio clínico controlado e randomizado. O tempo foi cronometrado do início ao fim do tratamento. A experiência de dor foi avaliada pela versão revisada da escala "Face, Legs, Activity, Cry, Consolability" (FLACC-r) e a aceitabilidade por uma escala facial hedônica. O grupo TRA + Brix3000™ gastou 4 minutos a mais (13,14±4,0 min) que o grupo TRA (9,8±2,7 min) (p=0,03). Não houve diferença quanto à aceitabilidade e à dor (p>0,05). O segundo estudo caracterizou a literatura científica mundial sobre produtos de remoção químico-mecânica de tecido cariado (RQMTC), por meio de mineração de dados bibliométricos, metodológicos e dos resultados de 397 artigos. Houve maior número de publicações entre 2011- 2020, no Journal of Dental Research, desenvolvidos no Brasil e Índia. Estudos in vitro foram mais prevalentes, seguidos dos estudos clínicos. Nestes últimos, Carisolv™ e Papacarie™ foram os produtos mais utilizados, prescritos para uso isolado e comparados ao uso de brocas. Os produtos para RQMTC foram mais estudados em crianças, cujos dentes foram restaurados com o cimento de ionômero de vidro, nos quais o tempo gasto e dor foram os principais desfechos. Observou-se que a RQMTC demanda maior tempo, entretanto, promove redução de ansiedade, dor e necessidade de anestesia local. O estudo 3 avaliou o conhecimento de dentistas brasileiros sobre odontologia de mínima intervenção (OMI) pelo desenvolvimento, validação e aplicação de uma escala de conhecimento (Minimal Interventional Dentistry for Dental Caries Knewlodge Scale - MIDDeC-KS), de 12 itens (0-12 pontos). Quanto maior a pontuação, maior o conhecimento do dentista. Dados sociodemográficos e de formação acadêmica foram coletados. A escala (α=0,72; ICC=0,85) foi aplicada por meio da plataforma Survey Monkey™ a 637 dentistas que demostraram ter conhecimento médio de 7,4±2,5 sobre OMI. As maiores pontuações foram alcançadas por mulheres (7,8±2,4; p=0,00); profissionais com mais de 10 anos de formados (7,6±2,6; p=0,02); em faculdades públicas (7,8±2,4; p=0,00), atuando no setor público (7,9±2,3; p=0,00) ou acadêmico (8,8±2,3; p=0,04). Pontuações maiores foram alcançadas por especialistas em Odontopediatria (9,2±1,6) e menores por Cirurgiões buco-maxilo-faciais (3,1±2,1). Houve maior conhecimento sobre controle de dieta, biofilme e aplicação tópica de flúor. Técnica de Hall, infiltrante resinoso e RQMTC foram as técnicas menos conhecidas. Com a presente dissertação, concluiu-se que o TRA associado ao Brix3000™ demandou mais tempo de tratamento, sem diferença quanto à aceitabilidade e à dor. Os estudos com produtos para RQMTC aumentaram ao longo dos anos, principalmente em países em desenvolvimento. Os estudos clínicos com crianças tendem a avaliar o tempo gasto e a dor em comparação ao uso de brocas e, a RQMTC reduz ansiedade, dor e necessidade de anestesia, embora aumente o tempo de tratamento. Foi constatada suficiente evidência psicométrica da escala MIDDeC-KS. As maiores pontuações foram alcançadas por profissionais do gênero feminino e especialistas em Odontopediatria, com maior conhecimento sobre controle de dieta, biofilme e aplicação tópica de flúor. (AU)

This dissertation was divided into three studies: the first evaluated the Atraumatic Restorative Treatment (ART) associated or not with Brix3000 ™ in terms of treatment time, pain experience and acceptability of children (n=20) aged 3-9 years through a randomized controlled clinical trial. The time was calculated from the beginning to the end of the treatment. Pain experience was assessed by the revised version of the "Face, Legs, Activity, Chy, Consolability" (FLACC-r) scale and acceptability by a hedonic facial scale. The ART + Brix3000 ™ group spent 4 minutes longer (13.14±4.0 min) than the ART group (9.8±2.7 min) (p=0.03). There was no difference regarding acceptability and pain (p>0.05). The second study characterized the world scientific literature on chemical-mechanical carious tissue removal (CMCTR) products, through bibliometric, methodological and results data mining of the 397 articles. There was a greater number of publications between 2011-2020, in the Journal of Dental Research, which were developed in Brazil and India. In vitro studies were more prevalent, followed by clinical studies. In the latter, Carisolv ™ and Papacarie ™ were the most used products prescribed for isolated use and compared to the use of drills. CMCTR products have been most studied in children whose teeth were restored with glass ionomer cement, in which time spent and pain were the main outcomes. Clinical application of CMCTR takes more treatment time but can also reduce patient anxiety, pain and need for anesthesia Study 3 assessed the knowledge of Brazilian dentists about minimal intervention dentistry (MID) through the development, validation, and application of a 12-item (0-12 points) knowledge scale (Minimal Interventional Dentistry for Dental Caries Knewlodge Scale - MIDDeC-KS). The higher the score, the greater the knowledge of the dentist. Gender, educational level, specialty, academic training institutions and workplace were collected. The final scale (α=0.72; ICC=0.85) was applied through the Survey Monkey™ platform to 637 dentists who demonstrated an average knowledge of 7.4±2.5 about MID. The highest scores were achieved by women (7.8±2.4; p=0.00); professionals with more than 10 years of graduation (7.6±2.6; p=0.02); in public colleges (7.8±2.4; p=0.00), working in the public sector (7.9±2.3; p=0.00) or academic (8.8±2.3; p =0.04). Higher scores were achieved by specialists in Pediatric Dentistry (9.2±1.6) and lowest by maxillofacial surgeons (3.1±2.1). There was greater knowledge about diet and biofilm control, as well as topical application of fluoride. Hall technique, resin infiltration and CMCTR were the least known MID techniques. With the present master thesis, it was concluded that ART associated with Brix3000™ required more treatment time, with no difference in terms of acceptability and pain. Studies with products for CMCTR have increased over the years, mainly in developing countries. The clinical studies with children tend to assess the time spent and pain compared to the use of drills. CMCR clinical application reduces anxiety, pain and need for anesthesia, despite increase treatments' time Sufficient psychometric evidence of the MIDDeC-KS scale was observed. The highest scores were achieved by women, specialists in Pediatric Dentistry, with more knowledge about diet control, biofilm, and topical fluoride application. (AU)

Novel in-office peroxide-free tooth-whitening gels: bleaching effectiveness, enamel surface alterations, and cell viability.

To evaluate the bleaching ability, the effect on enamel surface and cytotoxicity of novel tooth-whitening formulations containing papain, ficin, or bromelain. Forty bovine dental discs (6 cm ×4 cm) were pigmentated and randomly allocated into the following groups (n = 10): Group 1, 20 wt% carbamide peroxide (control); group 2, 1% papain-based whitening; group 3, 1% ficin-based whitening; and group 4, 1% bromelain-based whitening. The whitening gels were prepared and applied on the enamel three times per day once a week, for 4 weeks. Color measurement was obtained by CIEDE2000. Enamel Knoop microhardness and roughness were evaluated. The WST-1 assay was used to evaluate the cell viability of mouse fibroblast cells (L929). Data were statistically analyzed by one-way analysis of variance (ANOVA) and Student Newman Keuls's post hoc test at α = 0.05 significance level. Bromelain, ficin-based, and carbamide peroxide bleaching gels showed a similar color change (p < 0.001). Higher enamel hardness decrease and higher enamel roughness were caused by the carbamide peroxide (p < 0.05). The experimental whitening gels did not affect cell viability. Tooth bleaching gels containing bromelain, papain, or ficin have substantial clinical potential to be used in the development of peroxide-free tooth whitening gels.

Clinical Value of Debriding Enzymes as an Adjunct to Standard Early Surgical Excision in Human Burns: A Systematic Review.

Burns are a significant public health burden worldwide. In addition to those who die, millions remain with life-threatening deformities and disabilities resulting in stigma and rejection. Surgical excision is currently the standard of care for removing necrotic tissues in burn wounds to prepare the wound bed for grafting or enhancing the healing process. However, there is a growing interest on enzymatic debridement as an adjunct therapy in burn wounds. The aim of this study was to investigate clinical trials using debriding agents for burn wound in humans in a systematic review. This was a systematic review of electronic databases including CINAHL, PubMed, Ovid Medline, Web of Science, Google Scholar, and Embase from January 1969 to February 2019. The study protocol was registered in PROSPERO registry. The following keywords were searched: "burn wounds", "enzymatic debridement", "papain", "papain-urea", "pine apple", "Bromelain", "collagenases", "Nexobrid", "Debrase", "Debridase", "Actinidia deliciosa", "Sutilains", "Debrace", "piruvat acid". Those studies fulfilling the inclusion and exclusion criteria with low score of bias based on Cochrane Bias Tool were reviewed. Sixteen investigations fulfilled our inclusion criteria to be reviewed. Six, seven, and three clinical trials on humans were found regarding collagenase, bromelain, and miscellaneous agents. Collagenase has been reported to be effective in burns below 25% of TBSA, especially in outpatients' clinics. However, Nexobrid has been shown to be effective in deep burns and decreases the percentage of graft without significant adverse effects. There was not enough evidence supporting the clinical values of Papain, Sutilains, Urea, etc. Surgical excision still remains the standard of care for burn wounds debridement. However, enzymatic debridement, especially Bromelain might help to reduce sessions for surgical debridement or area under graft as an adjunct treatment. Despite the fact, more studies with larger sample sizes and with less conflicts of interest are needed to clearly elucidate the exact role of Bromelain.

Silk peptide production from whole silkworm cocoon using ultrasound and enzymatic treatment and its suppression of solar ultraviolet-induced skin inflammation.

Silk fibroin, which is derived from sericin through degumming, is mainly used as a biomaterial. However, interest in functional verification and industrial applications of sericin has been growing for several years. We used ultrasonication to simplify the extraction process of the silk peptide under low salt conditions at 20 °C, instead of using the conventional conditions of high salt and temperature. The concentration of the silk peptide was measured to determine the optimized extraction time and solvent, which were 4 h and 0.1 N NaOH, respectively. The molecular weight of the enzyme-treated silk peptide was measured using SDS-PAGE and GPC. Silk peptide treated with papain after ultrasound had a molecular weight of less than 5 kDa, and the papain treated-silk peptide reduced solar ultraviolet-induced COX-2 expression through inhibition of ERK phosphorylation. This is the first study investigating simultaneous extraction of fibroin and sericin, which can be used for mass production of food materials.

The effect of antimicrobial photodynamic therapy on infected dentin in primary teeth: A randomized controlled clinical trial protocol.

BACKGROUND: Antimicrobial photodynamic therapy (aPDT) has been used for the treatment of dental caries. Papacarie is a gel composed of papain and chloramine employed for the partial removal of carious tissue, effective against bacteria, however, some studies report that this antibacterial action is not quite so evident. The aim of this study is to evaluate the clinical effect of aPDT on infected dentin in dental caries lesion in primary teeth. METHODS: Thirty-two primary molars with deep occlusal dental caries will be selected and divided in 2 groups: G1 - caries removal with a low-speed drill and G2 - application of aPDT with PapacarieMBlue. After treatment, all the teeth will be restored with glass ionomer cement and followed up clinically and radiographically, with evaluations at 3, 6, and 12 months. Dentin samples before and after treatment will be analyzed microbiologically. The data will be submitted to descriptive statistical analysis of the association between the categorical variables and both age and gender using the chi-square test and Fisher exact text. The Student t test and analysis of variance will be used for the comparison of mean signs and symptoms of reversible pulpitis. Pearson correlation coefficients will be calculated for the analysis of correlations among the continuous variables. DISCUSSION: Adding methylene blue dye to the formula of PapacarieMBlue might potentiate the antimicrobial action of aPDT and work more effectively on the infected dentin combined with a conservative, minimally invasive treatment. TRIAL REGISTRATION: NCT02734420 on 10 march 2016.

Costs and benefits of Papacarie in pediatric dentistry: a randomized clinical trial.

Papacarie gel is an agent that eliminates the need for local anesthesia and reduces the need for using a drill. However, there is no information regarding the cost per procedure. Therefore we analyzed the cost, per procedure, of Papacarie gel compared to the traditional method (drilling), and performed a comparison between these methods of carious tissue removal. A randomized clinical trial was performed with 24 children with an average age of 5.9 years old. Of these children, 12 were boys and 12 were girls, which resulted in a total of 46 restorations. Patients were separated into: Papacarie group (caries removal with the chemical-mechanical method - Papacarie gel) and Drill group (caries removal with the traditional method - drilling). Values of the materials used in the procedures, heart rate (before, 5 minutes during, and after dental treatment), and the total consultation duration were recorded. A level of significance of 5% was adopted. Papacarie had a lower cost per procedure ($ 0.91) when compared to the traditional method ($ 1.58). Papacarie provided a cost reduction of 42% compared to the traditional method. Using local anesthesia ($ 2.17), the cost reduction increased to 58%. In the procedure using drill + Papacarie ($ 1.37), the cost reduction was 33%. Heart rate, consultation duration, and number of restorations were not statistically different. Papacarie shows an excellent cost benefit for minimally invasive removal of carious tissue and is a feasible alternative for public health care.

Effects of Papacarie on children with dental caries in primary teeth: a systematic review and meta-analysis.

BACKGROUND: Caries in primary teeth hinder the child to bite and chew and influence their development. Papacarie has the characteristics of selective removal of decayed tissue and can preserve healthy dentine to the maximum, but its efficiency has not been critically evaluated compared to conventional method. AIM: This review is aiming at comparing the Papacarie and traditional method in caries removal in primary dental caries with children. DESIGN: Comprehensive literature searching at PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science to January 2018. RESULTS: Six randomized controlled trials (RCTs) and four prospective controlled clinical trials (CCTs) were included. The microbiota in caries dentine was significantly reduced using the Papacarie treatment (MD = 0.57, 95% CI 0.04 to 1.09, P = 0.03), and the anxiety feeling declined more in the Papacarie group (MD = -1.01, 95% CI -1.72 to -0.30, P < 0.005). There was a greater 200.79 (MD = 200.79, 95%CI 152.50 to 249.09, P < 0.00001) increase in time taken for the Papacarie treatment compared with the conventional method. CONCLUSION: Papacarie exerts a positive effect in reducing the bacteria and decreases the pain during caries removal in primary teeth although it costed a longer treatment time compared with the conventional method.

Microleakage Evaluation of Composite Restorations Following Papain-Based Chemo-Mechanical Caries Removal in Primary Teeth.

AIM: To evaluate the microleakage of composite restorations following Papain-based chemo-mechanical caries removal compared to the conventional drilling method. The characteristic of the hybrid layer was also studied using scanning electron microscopy. STUDY DESIGN: The sample included thirty freshly extracted and exfoliated primary molars with open proximal carious dentin lesions. Teeth were divided into two equal groups, according to method of caries removal. Following caries removal, cavity preparations were restored with composite resin. After thermocycling, teeth were sealed apically and coated with nail polish except the surface of restorations and the surrounding 1mm. Teeth were immersed in basic fuschin dye solution, then they were sectioned mesiodistally. The extent of dye penetration was detected using a light stereomicroscope. After microleakage test, the resin/dentin interface was examined using scanning electron microscopy. RESULTS: There was no significant difference in the degree of leakage between both groups. In the Papacarie group, longer and numerous resin tags were observed with statistically significant thicker hybrid layer than those following the drilling method. However, there was no significant difference between the diameters of resin tags of both groups. CONCLUSIONS: Papacarie does not adversely affect the microleakage of composite restorations and provides a suitable surface for bonding.

Fibrin gel versus papain gel in the healing of chronic venous ulcers: A double-blind randomized controlled trial.

Objectives Compare the efficacy and safety of fibrin gel to 8% papain gel for wound dressing of venous ulcers. Method Patients with chronic venous ulcers were randomly assigned to one in three groups: Group 1-fibrin gel; Group 2-8% papain gel; Group 3-carbopol gel (control). Patients were seen every 15 days during 2 months, verifying reduction of the ulcer area, local infection, exudation, and epithelization. All serious or nonserious adverse events were recorded. Results Fifty-five patients (total of 63 ulcers) were randomly distributed in three groups (G1 = 21; G2 = 19; G3 = 23). No patient was excluded or discontinued treatment throughout the study. The areas of the ulcers were similarly reduced in all groups (14.3%, 21.1%, and 30.4% in groups 1, 2, and 3, respectively), and all had significant reduction in exudation and contamination. Conclusion The data demonstrate that neither fibrin gel nor papain gel were able to improve the process of ulcer-healing, as compared to control.

Dentin Topographic Features following Chemomechanical Caries Removal in Primary Teeth.

AIM: Study the topographic features of dentin after caries removal with a chemomechanical agent (Papacarie) compared with the conventional drilling method. STUDY DESIGN: The sample included 7 exfoliated and extracted primary teeth with carious dentin lesions, not reaching the pulp. Each tooth was sectioned longitudinally through the center of the carious lesions into two halves. The teeth were then divided into two groups according to the method of caries removal. Following caries removal, dentin topography and the cut section were examined using the scanning electron microscope. RESULTS: Papacarie produced an irregular, porous, rough and globular dentin appearance. The dentin surfaces were generally free of smear layer, visible bacteria and the dentinal tubules were opened. The dentin cut surfaces showed patent dentinal tubules with open orifices. The drilling method created a smooth and amorphous surface with a continuous smear layer occluding the dentinal tubules. Numerous bacteria were also observed. The cut dentin surfaces showed patent dentinal tubules with their orifices plugged with smear layer. CONCLUSIONS: Papacarie produced a rough and porous surface with partial or complete removal of the smear layer and opened dentinal tubules, while the drill produced a smooth surface with uniform smear layer occluding the dentinal tubules.

The use of papain gel cream and sunflower oil in promoting healing in a wound in dogs: three case reports / Uso de gel creme de papaína na cicatrização de feridas em cães: relato de três casos

Papain is a proteolytic enzyme removed from the leaves of green papaya and/or latex. This enzyme is widely known as a medicinal fruit used extensively in human medicine for the treatment of wounds of various etiologies. However, studies and reports in veterinary medicine are scarce. Another herbal drug widely used in wound healing is Sunflower oil (Helianthus annus). It has inflammatory and antimicrobial properties which stimulate the local neovascularization, promoting tissue granulation, cell migration, fibroblast proliferation, and differentiation. Three dogs were treated with infected necrosis wounds, considered large, extent, and severe, with varied etiology. All cases were treated with papain gel with the exception of one dog, which was given the sunflower oil at the end of the treatment. Papain gel shows effectiveness in the treatment of wounds especially with wound debridement and removal of necrotic tissue. In addition, the healing time was shorter when compared to the treatment with sunflower oil. Finally, the herbal drugs have a low cost and high accessibility. This study contributes to create a new research regarding the use of this drug in animal wound healing.(AU)

A papaína é uma enzima proteolítica retirada do mamão-papaia verde e/ou do látex das folhas do mamoeiro, tendo propriedades medicinais conhecidas na medicina humana para tratamento de feridas de diversas etiologias. Estudos e/ou relatos na medicina veterinária são escassos. Nesse sentido, objetivou-se descrever três casos de cães, que foram atendidos no Hospital Veterinário da Universidade Federal de Lavras, Brasil, todos com feridas infectadas, necrosadas, com etiologia variada e consideradas de grande extensão e gravidade, sendo tratados com gel de papaína. O tratamento demonstrou efetividade na recuperação das feridas, com a formação de grande quantidade de tecido de granulação, em um período menor que os tratamentos convencionais. Por se tratar de um fitoterápico, de baixo custo e alta acessibilidade, o gel de papaína pode ser utilizado no tratamento de feridas de grande extensão em cães e, assim como em humanos, parece ter um efeito benéfico no processo de cicatrização. Pesquisas devem ser conduzidas para elucidar a ação desse produto nos tecidos, bem como as diferentes concentrações a serem administradas.(AU)

Assistência de enfermagem a um paciente com integridade da pele prejudicada relacionada à erisipela: relato de experiência / Nursing assistance to a patient with impaired skin integrity related to erysipelas: experience reporting

Erisipela é um processo infeccioso cutâneo causado por uma bactéria que se propaga pelos vasos linfáticos. Há a veemência em realizar uma orientação adequada quanto ao reconhecimento do problema, ao seguimento do tratamento e aos cuidados com a prevenção das complicações. Este é um relato de experiência de Enfermeiras residentes em Alta Complexidade de um Hospital Universitário do Nordeste do Brasil, na assistência a um paciente com integridade da pele prejudicada relacionada à erisipela. Foi realizado acompanhamento do paciente no período de maio a agosto de 2015, em que foi utilizado diferentes técnicas para tratamento e o mesmo evoluiu com cicatrização e cura da lesão. Possibilitou o crescimento técnico-científico dos profissionais assim como da abordagem da experiência para demais equipes promotoras de cuidado com o paciente. Descritores: Cuidado de Enfermagem; Erisipela; Lesão de Pele.

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Un proceso de la erisipela de Ia piei y infecciosa causada por una bacteria se propaga cola para los vasos linfáticos. Hay una vehemencia de conducta orientación adecuada para el reconocimiento por hacer problema, ao seguimiento de tratamiento y atención a la prevención de complicaciones. Esto y a enfermeras relato de experiencia residentes de alta dei hospital dei noreste de Brasil, mantenimiento universidad complejidad zumbido y zumbido con el paciente integridad de la piei relacionados con la erisipela con discapacidad. Se Ilevó a cabo la monitorización dei paciente cualquier período de mayo a agosto, 2015, estábamos en que diferentes técnicas utilizadas tratamiento párrafo e incluso evolucionamos con la formación de cicatrices y la curación de la lesión. El posible crecimiento de los profesionales científicos técnicos, así como enfoque experiencia párrafo también equipos que promueven el cuidado dei paciente.

Use of Proteolytic Enzymes in the Treatment of Proteinaceous Esophageal Food Impaction.

BACKGROUND: Proteinaceous esophageal food impaction typically requires endoscopic intervention. An alternative approach is the use of proteolytic enzymes. Concerns regarding the use of proteolytic enzymes include the risk of perforation and aspiration pneumonitis. OBJECTIVE: We retrospectively reviewed our series of 69 patients treated with papain to determine the safety and efficacy of proteolytic enzymes. METHODS: Patients were retrospectively reviewed if treated for an esophageal food impaction from 1999 through 2008. RESULTS: Median age was 56 years (range 19-91 years), with 46 male and 23 female patients. In 27 patients (39%) this was their first presentation, in 14 (20%) it was the second, and 28 (41%) had multiple previous episodes. Meat was the cause in 49 (71%), chicken in 6 (9%), fish in 3 (4%), and unspecified in 11 (16%). All patients presented with dysphagia for solids, 56 (81%) could not tolerate liquids. Papain solution, 1 tsp in 8 oz of water, was given to patients in an unlimited quantity. Papain was successful in relieving the obstruction in 60 patients (87%). The remaining 9 patients (13%) underwent endoscopy with successful retrieval. No patient suffered a perforation, either with papain ingestion or endoscopy. There were no episodes of pneumonitis or pneumonia. CONCLUSIONS: We have used proteolytic enzymes with a high success rate and with minimal complication. Further, if proteolytic enzymes fail, endoscopy can be performed safely and effectively. We recommend the use of proteolytic enzymes as the initial management in all patients with proteinaceous food impaction of the esophagus.

Chemomechanical versus drilling methods for caries removal: an in vitro study.

The purpose of this study was to compare the performance of chemomechanical caries removal (CMCR) with that of conventional drilling for efficacy of caries removal, time spent, morphological changes and microhardness of surface dentin, and microleakage of subsequent restorations. Forty-six carious deciduous molars were randomly divided into two groups: one each for caries removal by (1) CMCR and by (2) drilling. The completeness of caries removal was evaluated by visual and tactile criteria and a caries detector device. Twenty teeth in each group were restored with glass ionomer (GI) and subjected to thermocycling before undergoing microleakage and microhardness tests. In each group, three restored teeth were used for polarized light microscopic analysis, and three unrestored teeth for scanning electron microscopy (SEM). There was no significant difference in the completeness of caries removal between groups. However, time spent for caries removal by CMCR was significantly longer than that required for drilling. Restorations in the CMCR group had significantly more microleakage than those in the drilling group. Dentin hardness of the cavity floor after CMCR was also significantly lower. Microscopic analyses showed roughened and irregular dentin surfaces in the CMCR group, unlike the smooth surfaces observed in the drilling group. In conclusion, CMCR was as efficacious as drilling in term of completeness of caries removal, but required longer excavation times and resulted in lower microhardness of residual dentin as well as more microleakage after restorations with GI. Further laboratory and clinical evaluations on the efficiency and performance of CMCR for the durability of subsequent restorations are required.

Enamel Deproteinization using Papacarie and 10% Papain Gel on Shear Bond Strength of Orthodontic Brackets Before and After Acid Etching.

OBJECTIVE: To suggest Papacarie(®) as a new deproteinizing agent in comparison with indigenously prepared 10% papain gel before and after acid etching that may enhance the quality of the bond between enamel surface and composite resin complex. STUDY DESIGN: One hundred and twenty five extracted human premolars were utilized and divided into five groups: In the group 1, enamel surface was etched and primer was applied. In group 2, treatment with papacarie(®) for 60 seconds followed by etching and primer application. In group 3, etching followed by treatment with papacarie(®) for 60 seconds and primer application. In group 4, treatment with 10% papain gel for 60 seconds followed by etching and primer application. In group 5, etching followed by treatment with 10% papain gel for 60 seconds and primer application . After bonding the brackets, the mechanical testing was performed using a Universal testing machine. The failure mode was analyzed using an adhesive remnant index. The etching patterns before and after application of papacarie(®) and 10% papain gel was also evaluated using SEM. The values obtained for shear bond strength were submitted to analysis of variance and Tukey test (p < 0.05). RESULTS: It was observed that group 2 and group 4 had the highest shear bond strength and was statistically significant from other groups (p=0.001). Regarding Adhesive remnant index no statistical difference was seen between the groups (p=0.538). CONCLUSION: Papacarie(®) or 10% papain gel can be used to deproteinize the enamel surface before acid etching to enhance the bond strength of orthodontic brackets.