for treatment of dentin hypersensitivity

James R. Collins, dds, Deborah Richardson, dds, Karina Sotero, dds, Luis R. Mateo, ma  &  Irma Mauriz, dds

Abstract: Purpose: To evaluate the clinical efficacy of a single professional application of a Pro-Relief desensitizing fluoride-free paste containing 8% arginine and calcium as compared to a fluoride-free prophylaxis paste on dentin hypersensitivity reduction in adults with a clinical diagnosis of dentin hypersensitivity. Methods: This single-center, parallel group, double-blind and randomized clinical study conducted in Santo Domingo, Dominican Republic included 50 (25 per group) adult male and female subjects. Each study subject had two teeth hypersensitive to air blast stimuli when applied directly at its cervical surface (gingivo-facial 1/3). An air blast hypersensitivity score equal or greater to 2 (Schiff Cold Air Sensitivity Scale) was randomly assigned to one of two treatment groups (1) Pro-Relief in-office desensitizing fluoride-free paste containing 8% arginine and calcium carbonate (Test Paste group), and (2) a fluoride-free prophylaxis paste (Control Paste group). Prior to their baseline examination, subjects were instructed to return to the clinical facility having refrained from eating and drinking for 2 hours. An assessment of air blast hypersensitivity and examinations of oral soft and hard tissue were performed at the baseline. Subjects were provided a professional in-office prophylaxis with their assigned prophylaxis paste. A post hypersensitivity examination was performed immediately after the oral prophylaxis. Results: All subjects completed the study. At the post-hypersensitivity examination, subjects assigned to the Test Paste group and Control Paste group both exhibited statistically significant (P= 0000) reductions (compared to baseline), to air blast hypersensitivity of 44.7% and 25.6%, respectively. At the post-hypersensitivity examination, subjects in the Test Paste group exhibited a statistically significant (P= 0.005) reduction of 24.4% in mean air blast hypersensitivity scores as compared to the Control Paste group. (Am J Dent 2013;26:63-67).

Mail: Dr. James R. Collins, Department of Periodontology, Graduate School, Catholic University Santo Domingo, Av. Bolívar #905, Ens. La Julia. Santo Domingo, Dominican Republic. E-mail: jcollins@ucsd.edu.do

Plaque removal efficacy of oscillating-rotating power toothbrushes:

Review of six comparative clinical trials

Julie Grender, phd,  Karen Williams, rdh, ms, phd,  Pat Walters, rdh, msdh, msob, Malgorzata Klukowska, dds, phd  &  Hansjoerg Reick, me

Abstract: Purpose: This review of six clinical trials provides a comprehensive overview of the results of statistical analyses to explore between-brush differences, specifically in the lingual, gingival marginal, and approximal (“hard-to-clean”) areas, in post-brushing plaque removal of oscillating-rotating (O-R) power toothbrushes compared to either a marketed sonic power toothbrush or a manual toothbrush control. Methods: All studies were single-center, randomized and controlled, and examiner-blind.  Four trials were four-period crossover design with replicate single-use brushing, while two studies were parallel group investigations (4 or 12 weeks) with multiple brushings and assessments at each visit.  Generally healthy subjects were enrolled.  Plaque evaluations were via the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI) or the Rustogi Modification of the Navy Plaque Index (RMNPI). At each evaluation visit, subjects brushed with either the randomly assigned O-R power brush [Oral-B Professional Care Series 4000 (Triumph) or Oral-B Vitality with Floss Action or Precision Clean brush head] or a control brush [Sonicare FlexCare with ProResults brush head (three trials) or an American Dental Association (ADA) reference manual toothbrush (three trials)]. ANCOVA and ANOVA analyses subsequently evaluated specifically the ‘hard-to-clean’ tooth surfaces for between-brush differences. Results: In total, 462 subjects completed the trials and were evaluable. While all toothbrushes provided significant post-brushing versus baseline plaque removal efficacy, the magnitude of the reduction was consistently superior for the O-R brush compared to either the sonic power or manual brush control in all the ‘hard-to-clean” region-specific analyses.  Adjusted mean RMNPI or TMQHPI benefits favoring the O-R brush relative to the sonic brush control were collectively 18% to 34% greater on lingual surfaces (P≤ 0.044), 32% to 49% greater on lingual approximal surfaces (P< 0.001), and 32% and 31% greater in lingual mandibular and lingual mandibular anterior regions, respectively (P≤ 0.005). Post-brushing whole mouth adjusted mean reduction RMNPI or TMQHPI benefits favoring the O-R brush compared to the manual brush control were collectively 31% to 206% greater on lingual surfaces (P≤ 0.001), 29% to 217% greater on lingual approximal surfaces (P≤ 0.001), and 67% to 526% greater in lingual gingival margin regions, respectively (P≤ 0.001). All study toothbrushes were well-tolerated. (Am J Dent 2013;26:68-74).

Mail: Dr. Julie Grender, Procter & Gamble Health Care Research Center, 8700 Mason-Montgomery Road, Mason, OH, 45040, USA. E-mail: grender.jm@pg.com

Effect of low-fluoride dentifrices supplemented with calcium glycerophosphate on enamel demineralization in situ

Jackeline  Gallo  do  Amaral, dds, msc,  Kikue  Takebayashi Sassaki, dds, phd, Cleide Cristina Rodrigues Martinhon, dds, phd  &  Alberto Carlos Botazzo Delbem, dds, phd

Abstract: Purpose: To evaluate whether a low-fluoride dentifrice with calcium glycerophosphate (CaGP) reduced the demineralization process in situ. Methods: A cross-over design with four treatment phases of 7 days each was used. Ten volunteers wore palatal devices containing four blocks of bovine dental enamel. The enamel was treated (ex-vivo) with a placebo, 500 µg-F/g (500), 500 µg-F/g with 0.25%CaGP (500 CaGP), and 1,100 µg-F/g (1,100) dentifrices (twice a day/1 minute) under cariogenic challenge from sucrose solution. To evaluate mineral loss, surface and cross-sectional hardness were performed. The fluoride, calcium, and phosphorus ion concentrations from enamel and dental plaque were determined. The insoluble extracellular polysaccharide (EPS) concentrations were also analyzed. The data were submitted to ANOVA (1-way) followed by the Student-Newman-Keuls test (P< 0.05). Results: The mineral loss and EPS concentration were lowest in the 500 CaGP and 1,100 dentifrice groups. The use of the 500 CaGP and 1,100 dentifrices resulted in similar fluoride, calcium, and phosphorus concentrations in the enamel and in dental plaque (P> 0.05). The ionic activities of calcium phosphate phases for the 500 CaGP and 1,100 dentifrices were similar (P ≥ 0.492). The low-fluoride dentifrice with 0.25%CaGP demonstrated efficacy similar to that of the positive control (1,100 dentifrice) with respect to in situ demineralization. (Am J Dent 2013;26:75-80).

Mail: Dr. Alberto Carlos Botazzo Delbem, Dept. of Pediatric Dentistry and Public Health, Araçatuba School of Dentistry, Paulista State University (UNESP), Rua José Bonifácio 1193, Araçatuba, SP, CEP 16015-050, Brazil. E-mail: adelbem@foa.unesp.br or adelbem@pq.cnpq.br

In vitro caries lesion rehardening and enamel fluoride uptake from fluoride

varnishes as a function of application mode

Frank  Lippert, msc, phd,  Anderson  T. Hara, dds, ms, phd,  Esperanza  Angeles  Martinez-Mier, dds, msd, phd &  Domenick  T.  Zero, dds, ms

Abstract: Purpose: To study the laboratory predicted anticaries efficacy of five commercially available fluoride varnishes (FV) by determining their ability to reharden and to deliver fluoride to an early caries lesion when applied directly or in close vicinity to the lesion (halo effect). Methods: Early caries lesions were created in 80 polished bovine enamel specimens. Specimens were allocated to five FV groups (n=16) based on Knoop surface microhardness (KHN) after lesion creation. All tested FV claimed to contain 5% sodium fluoride and were: CavityShield, Enamel Pro, MI Varnish, Prevident and Vanish. FV were applied (10 ± 2 mg per lesion) to eight specimens per FV group (direct application); the remaining eight specimens received no FV but were later exposed to fluoride released from specimens which received a FV treatment (indirect application). Specimens were paired again and placed into containers (one per FV). Artificial saliva was added and containers placed into an incubator (27 hours at 37°C). Subsequently, FV was carefully removed using chloroform. Specimens were exposed to fresh artificial saliva again (67 hours at 37°C). KHN was measured and differences to baseline values calculated. Enamel fluoride uptake (EFU) was determined using the acid etch technique. Data were analyzed using two-way ANOVA. Results: The two-way ANOVA highlighted significant interactions between FV vs. application mode, for both ΔKHN and EFU (P< 0.001). All FV were able to reharden and deliver fluoride to caries lesions, but to different degrees. Furthermore, considerable differences were found for both variables between FV when applied either directly or in close vicinity to the lesion: MI Varnish and Enamel Pro exhibited greater fluoride efficacy when applied in vicinity rather than directly to the lesion, whereas CavityShield and Vanish did not differ. Prevident exhibited a higher EFU when applied directly, but little difference in rehardening. (Am J Dent 2013;26:81-85).

Mail: Dr. Frank Lippert, Department of Preventive and Community Dentistry, Oral Health Research Institute, Indiana University School of Dentistry, 415 Lansing Street, Indianapolis, IN 46202, USA. E-mail: flippert@iupui.edu

The role of occlusal loading in the pathogenesis of non-carious

cervical lesions

John  R.  Antonelli, dds, ms,  Timothy  L.  Hottel, dds, ms, mba,  Robert  Brandt, dds, ms,  Mark  Scarbecz, phd &  Tejas  Patel, bds

Abstract: Purpose: To evaluate the putative role of occlusal loading in the pathogenesis of non-carious cervical lesions (NCCLs) in subjects who exhibited mixed excursive guidance [i.e., immediate canine guidance on one side and group function (GF) on the other]. Methods: 20 subjects with Angle Class 1 occlusion and having from 1 to 5 NCCLs on separate teeth were selected. Only subjects who displayed mixed excursive guidance were recruited so that they could serve as their own controls. Non-carious cervical lesions were recorded on casts mounted in semi-adjustable articulators. Results: On the GF sides, 22.5% of all teeth that contacted in working excursions exhibited NCCLs; only 2.1% of the teeth on the canine guided sides exhibited NCCLs, which were found exclusively in canines. Although a case for the multifactorial etiology of NCCLs remains strong, our data, albeit limited, seems to support the dominant role of occlusion in lesion formation. (Am J Dent 2013;26:86-92).

Mail: Dr. John R. Antonelli, College of Dental Medicine, Nova Southeastern University, Health Professions Division, 3200 South University Drive, Fort Lauderdale, FL 33328 USA.  E-mail: antonell@nova.edu

A double-blind randomized clinical trial of a silorane-based resin composite in class 2 restorations: 18-month follow-up

Fabiana Santos GonÇalves, dds, mdsc,  Carolina Dolabela Leal, dds, mdsc,  Audrey Cristina Bueno, dds, mdsc, Amanda Beatriz Dahdah Aniceto Freitas, dds, phd,  Alysson Nogueira Moreira, dds, phd &  ClÁudia Silami MagalhÃes, dds, phd

Abstract: Purpose: To compare the clinical performance of a silorane-based with a methacrylate-based restorative system in class 2 restorations after an 18-month follow-up. Methods: This randomized, double-blind and controlled study included 33 subjects receiving 100 direct resin composite restorations that were completely randomized to silorane-based group (Filtek P90/Silorane System Adhesive - 3M ESPE) or methacrylate-based group (Filtek P60/Adper SE Plus - 3M ESPE). The restorative system was determined by chance using a coin toss until 50 units for each group were completed. Each subject contributed with one to seven restorations. A single operator performed all of the restorative procedures. Two calibrated examiners (kw ≥ 0.7) assessed the restorations at baseline and after 18 months according to modified United States Public Health System (USPHS) criteria. The data were analyzed with Mann-Whitney U-test, Wilcoxon signed rank and Kaplan-Meier survival curves (α= 0.05). Results: After 18 months, 88 restorations were evaluated, and five unacceptable restorations were observed. Proximal contact loss was the main reason for failure (three) followed by composite fracture (two). The marginal integrity of the silorane-based group was significantly worse than that of the methacrylate-based group (P= 0.035). Comparing baseline to 18-month evaluations, the silorane-based group showed significant differences for marginal discoloration, marginal integrity and surface texture (P< 0.05); and the methacrylate-based group differed significantly for marginal discoloration and surface texture (P< 0.05). Combined survival rate for both groups together was 95%. No statistically significant difference was found between methacrylate-based (98%) and silorane-based (92%) overall survival rate (Log rank test; P= 0.185). (Am J Dent 2013;26:93-98).

Mail: Dr. Cláudia Silami Magalhães, Av. Antônio Carlos, 6627, Campus Pampulha, CEP 31270-901, Belo Horizonte, MG, Brazil. E-mail: silamics@yahoo.com

Influence of selective enamel etching on the bonding effectiveness

of a new “all-in-one” adhesive

Cecilia Goracci, dds, phd,  Carlo Rengo, dds,  Leonardo Eusepi, dds,  Jelena Juloski, dds,

Alessandro Vichi, dds, phd   &   Marco Ferrari, md, dds, phd

Abstract: Purpose: To evaluate in vitro the all-in-one adhesive G-Bond Plus/G-aenial Bond (GBP), used according to the selective enamel etching (SEE) technique, compared to Optibond FL, an etch-and-rinse adhesive tested as control (C). Methods: 133 molars provided specimens for enamel and dentin shear bond strength (SBS) testing, microleakage measurements in class 5 restorations, and scanning electron microscope observations of demineralization patterns produced by GBP and 37% phosphoric acid (PA). Results: On enamel: C displayed the highest SBS. PA etching significantly increased enamel SBS of GBP. No statistically significant difference in SBS was noted among the bonding procedures on dentin. On both substrates, C revealed the most satisfactory seal. PA pre-etching did not significantly affect the sealing ability of GBP on either substrate. (Am J Dent 2013;26:99-104).

Mail: Dr. Cecilia Goracci, Department of Dental Materials and Fixed Prosthodontics, Policlinico Le Scotte, University of Siena, Viale Bracci, Siena 53100, Italy. E-mail: cecilia.goracci@gmail.com

Implant coatings: New modalities for increased osseointegration

Ann  Wennerberg, dds, phd,  Kostas  Bougas, dds, phd,  Ryo  Jimbo, dds, phd  &  Tomas  Albrektsson, md, phd, rcsg

Abstract: Purpose: To present new techniques for implant coatings, biological tissue response to them, and, if applicable, clinical outcome. Methods: A search for publications was done in PubMed using search words such as coated dental implants, clinical outcome, dental implant coatings and combinations thereof. Further, a manual search was done. 216 papers were found; the selection was directed towards in vivo investigations. Results: Several different coatings are described in the literature, many of them with the purpose to be bioactive. Such surface coatings include hydroxyapatite, bioglass, proteins, polysaccharides and drugs. The majority of the publications are evaluations in vitro; most of the in vivo studies are directed to implant incorporation in bone. Rather few exist that use a coat to promote soft tissue adhesion or prevention of infection. (Am J Dent 2013;26:105-112).

Mail: Dr. Ann Wennerberg, Department of Prosthodontics, Faculty of Odontology, Malmö University, 205 06 Malmö, Sweden.  E-mail:  ann.wennerberg@mah.se