Dentin sensitivity and aspiration of odontoblasts
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Clinical evaluation of posterior restorations over wet and dry dentin using an etch-and-rinse adhesive: A 36-month randomized clinical trial
2024, Dental MaterialsTo evaluate the clinical performance of posterior restorations over wet and dry dentin with an etch-and-rinse adhesive after 36 months of clinical service.
Forty-five participants were recruited, each one had at least two posterior teeth that needed restoration. Ninety restorations were placed on Class I or Class II cavities. For the restoration protocol, a simplified etch-and-rinse adhesive (Adper Single Bond 2) was applied over wet (WD) or dry dentin (DD) and later restored with a bulk-fill composite (Filtek Bulk Fill) under rubber dam isolation. Each restoration was evaluated using the World Dental Federation (FDI) criteria after 6, 12, and 36 months of clinical service, regarding the following principal restoration characteristics: postoperative sensitivity, marginal discoloration, marginal adaptation, fracture of material and retention, and recurrence of caries. Kruskal Wallis analysis of variance rank (α = 0.05) and Kaplan-Meier survival analysis were used for statistical analysis.
After 36 months of clinical evaluation, no significant difference between groups was observed in each FDI criterion (p > 0.05). Twenty restorations (WD=10, DD=10) showed minor marginal staining, and twenty-two restorations (WD=11, DD=11) presented small marginal adaptation defects (p > 0.05). Four restorations were lost (WD = 2, DD = 2) and the fracture rates (95% confidence interval) were 94.9% for each one, without significant difference between wet and dry dentin (p > 0.05).
The degree of dentin moisture does not seem to affect the clinical performance of a simplified etch-and-rinse adhesive in posterior restorations when the adhesive is applied vigorously over the dentine surface.
Effects of Propolis-Based Herbal Toothpaste on Dentine Hypersensitivity
2024, International Dental JournalThe objective of this in vitro study was to compare the effectiveness of a propolis-based herbal toothpaste with 5% sodium fluoride varnishin obstructing human dentinal tubules; Scanning electron microscopy was utilised to obtain quantitative and qulitative data on tubular obstruction.
Thirty-nine extracted human premolar teeth were collected. The cementum layer was removed using a water-cooled diamond bur and the smear layer using ethylenediaminetetraacetic acid (EDTA) 17%. Then, the samples were randomly divided into 3 groups (n = 13 each), as follows: group 1: dentin discs exposed to the propolis-based herbal toothpaste (Herbex); group 2: dentin discs exposed to 5% sodium fluoride varnish; and group 3: control. Then, all discs were observed and imaged in 4 non-overlapping fields by an electron microscope at 2000× magnification. The topography and number of open, closed, and semi-closed tubules were counted in all images. The data were analysed using Kruskal–Wallis test, Mann–Whitney U test, and Friedman test. The statistical analysis was performed with SPSS statistic 22.0 software, with a significance level of α = 0.05.
In pairwise comparisons of the groups considering the percentage of open, closed, and semi-closed tubules, the difference was not statistically significant between the 5% sodium fluoride varnish and propolis groups in the closed and semi-closed tubules, but it was statistically significant with the control group. Additionally, the percentage of open tubules in the propolis-based herbal toothpaste group was significantly lower than in the 5% sodium fluoride varnish and control group.
Both propolis-based herbal toothpaste and 5% sodium fluoride varnish is effective in blocking human dentin tubules to various extents.
Glutaraldehyde-based desensitizer does not influence postoperative sensitivity and clinical performance of posterior restorations: A 24-month randomized clinical trial
2023, Dental MaterialsTo evaluate the influence of a glutaraldehyde-based desensitizer (GL) on postoperative sensitivity (POS) in posterior bulk-fill resin composite restorations using an adhesive applied in the self-etch (SE) and etch-and-rinse (ER) strategies; and to assess the clinical performance of the restorations.
Posterior resin composite restorations (n = 228) at least 3 mm deep were inserted in 57 subjects using a split-mouth design. The adhesive was applied with/without prior application of a GL. A resin composite was used for all restorations. Spontaneous POS (risk and intensity), as well as POS caused by stimulation with an air blast and assess the response to horizontal and vertical percussion was assessed using two scales in the baseline and after 7, 14, and 30 days. In addition, some parameters were evaluated using FDI criteria up to 24 months of clinical service.
No significant POS was observed (p > 0.05). A higher absolute risk and intensity of spontaneous POS was observed within 7 days (35.1%), without statistically significant differences among groups. At 24 months 5 restorations were considered clinically unsatisfactory, and 73 restorations showed minor discrepancies in adaptation, with no significant differences between groups (p > 0.05).
A GL agent does not influence POS in posterior restorations with bulk-fill resin composite. It may be considered a dispensable clinical step in the restorative protocol.
Shockwave application enhances the effect of dentin desensitizer
2021, Dental MaterialsThe purpose of this study was to develop a new device that can improve the effect of desensitizer using shockwaves and to verify its efficacy.
A micro-shockwave generator was developed using a piezoelectric actuator (PIA-1000, piezosystem jena GmbH, Jena, Germany), an Arduino Uno microcontroller (Arduino, Torino, Italy), and a high voltage pulser (HVP-1000, piezosystem jena GmbH) at 700 V (400 A) and 100 μs. The occlusal surfaces of 20 extracted human upper and lower third molars without caries or restoration were reduced to expose the occlusal dentin, and the prepared occlusal surfaces were acid-etched with 32% phosphoric acid to remove the smear layer. The tooth specimens were connected to a fluid flow measurement instrument (nanoFlow, IB SYSTEMS, Seoul, Korea), permeability through dentin via dentinal fluid flow (DFF) was measured for 300 s, and the average DFF rate (Baseline DFF rate) was calculated. A desensitizer (SuperSeal, Phoenix Dental, Fenton, MI, USA) was applied to the acid-etched occlusal dentin surface of 10 randomly selected tooth specimens, left for 10 s, and rubbed with a microbrush for 30 s (Group 1). For the remaining teeth, the desensitizer was applied, and a shockwave (100 μm stroke, 10,000 G) was applied for 10 s (2 shots/s) and rubbed with a microbrush for 30 s (Group 2). After desensitizer application, subsequent DFF was measured for 600 s, and the average DFF rate was calculated (post-application DFF rate). DFF was continuously measured in real-time at 25 ± 0.5 ℃ under a hydrostatic pressure of 25 cm. The percentage reduction in DFF rate after desensitizer application (with or without shockwave) was calculated with respect to baseline DFF rate. Data were analyzed with independent t-test (α = 0.05).
For all tooth specimens, DFF rate decreased after desensitizer application irrespective of the presence of shockwaves. The percentage reduction in DFF rate of SuperSeal with shockwave (Group 2) was 42.8 ± 19.0%, which was significantly higher than the 26.2 ± 13.6% of the SuperSeal only group (Group 1) (p < 0.05).
Measurement of DFF change in real-time shows that shockwaves can help reduce dentin permeability beyond that SuperSeal dentin desensitizer produced alone.
Crystal growth in dentinal tubules with bio-calcium carbonate-silica sourced from equisetum grass
2020, Journal of the Formosan Medical AssociationCitation Excerpt :Dentin hypersensitivity is a common clinical condition that can be characterized by a short, sharp pain caused by exposed dentinal surface in response to stimuli, typically thermal, evaporative, tactile, osmotic, or chemical. Based on Brannstrom's hydrodynamic theory, the occurrence of pain could be explained by the fluid movement within the dentinal tubules.1,2 The reduction of dentin permeability could be achieved by the occlusion of tubules, which is quite effective for treating dentin hypersensitivity.3–5
One effective way to deal with dentin hypersensitivity is to develop materials to seal the tubules. The porous bio-calcium carbonate-silica (BCCS) contained well-dispersed CaCO3 would form calcium phosphates to seal the dentinal tubules when mixed with an acidic solution. The acidic hydrothermal treatment and calcination to isolate the BCCS from the agricultural waste like equisetum grass was used, which would be more environmentally friendly than chemically synthesized mesoporous biomaterials. The aim of this study was to develop mesoporous materials from natural resources to occlude the dentinal tubules which could be more environmentally-friendly.
Dentin disc samples were prepared and treated with different methods as follows: (1) BCCS mixed with H3PO4; (2) BCCS mixed with KH2PO4; (3) Seal & Protect® was used as a comparison group. Sealing efficacy was evaluated by measuring the depths and percentages of precipitate occlusion in dentinal tubules with SEM.
The N2 adsorption–desorption isotherm of the BCCS demonstrated a pore size of around 15.0 nm and a surface area of 61 m2g-1. From the results of occlusion percentage and depth, the BCCS treated with H3PO4 or KH2PO4 demonstrated promising sealing efficacy than the commercial product.
This synthetic process used the agricultural waste equisetum grass to produce bio-calcium carbonate-silica would be environmentally friendly, which has great potential in treating exposed dentin related diseases.
The ability of a potassium oxalate gel strip to occlude human dentine tubules; a Novel in vitro: In situ Study
2020, Journal of DentistryTo determine if an oxalate strip reduced fluid flow in dentine samples and whether this reduction was maintained following a 14 day intra-oral period.
Dentine tubule fluid flow was measured by a modified Pashley cell in 40 acid-etched dentine discs 1 mm thick, diameter >10 mm, with an acquired pellicle, pre-equilibrated with Hartmann’s solution and conditioned by toothbrushing, pre and post treatment (10 min) with an oxalate (3.14 %) gel strip or no treatment. One control and one test sample were exposed in-situ for 14 days to the oral environment in 20 healthy adult volunteers, and fluid flow re-measured. The appliance containing the two samples was removed for brushing with water after mealtimes when the participant brushed their teeth and for a 2 min daily soak in chlorhexidine.
Fluid flow rate was reduced significantly immediately following treatment with the oxalate strip compared to baseline flow rate by 58 %. Following 14 days in-situ oral environment phase, a significant further reduction in fluid flow compared to baseline was identified in both control and oxalate strip treated samples, both (p < 0.0001), but the reduction was greater in the test samples, 94 % vs 87 %, p < 0.01.
This novel investigation is the first to show fluid flow measurement using the Pashley model in dentine samples that have been housed in the mouth for 14 days. Treatment with an oxalate strip designed for dentine hypersensitivity alleviation reduced dentine fluid flow more than control providing evidence that the oxalate treatment withstood the oral environment over a prolonged time.
This study demonstrated the efficacy and durability of the oxalate precipitate over a 14 day period in achieving and maintaining dentine tubule occlusion when participants had no dietary restrictions. This demonstrates the suitability of the oxalate strip for the treatment of patients suffering from dentine hypersensitivity pain.