The association between Nd:YAG laser and desensitizing dentifrices for the treatment of dentin hypersensitivity

Evaluation of the Effectiveness on Dentin Hypersensitivity of Sodium Fluoride and a New Desensitizing Agent, Used Alone or in Combination with a Diode Laser: A Clinical Study

(1) Background: Dentine Hypersensitivity (DH) is a frequent clinical problem that causes long-term painful discomfort to patients and is a diagnostic and therapeutic challenge for dentists. The aim of this research was to verify the efficacy of a Sodium Fluoride (NaF) gel and the VivaSens® varnish used alone or in combination with a Creation Soft Diode Laser (DL) to treat DH pain. (2) Methods: The study included 121 Non-Carious Cervical Lesions (NCCLs) in 48 patients who complained of DH pain of variable intensity, between 4 and 7 points in VAS, after application of a cold stimulus. Four study groups of 12 patients each were created and subjected to four different types of treatment. Group 1 comprised 27 NCCLs with a total VAS score of 142, who received a topical treatment of NaF. Group 2 comprised 34 NCCLs with a total VAS score of 179, who were treated with NaF in association with DL. Group 3 comprised 31 NCCLs with a total VAS score 172, who received the VivaSens varnish. Group 4 comprised 29 NCCLS with a total VAS score of 155, who were treated with VivaSens in association with DL, using a power of 0.2 Watt in continuous emission and a fiber of 400 µm diameter. (3) Results: The results for each NCCL were evaluated by the cold stimulus response and recorded according to the VAS at the end of each treatment (t1) as well as after one week (t2), 1 month (t3), and 6 months (t4). All treatments resulted in pain relief at all study times, but the best results were obtained for Group 4 at t1, with a total VAS score of 26, and for Group 2 at t2, t3, and t4, with total VAS scores of 41, 51, and 65, respectively. (4) Conclusions: The treatment with VivaSens allowed pain relief immediately after its application, but the greatest long-term benefits (t2, t3, and t4) were obtained with the topical application of NaF associated with a DL.

Effect of bioactive glasses and neodymium:yttrium-aluminum-garnet laser on dentin permeability

Context:

Dental hypersensitivity and loss of dental tissues are commonly observed in patients, and most of the problems are caused due to total or partial exposure of dentinal tubules.

Aims:

The purpose of this study is to evaluate the performance of 45S5 bioactive glass and niobophosphate (NbG) associated with neodymium: yttrium-aluminum-garnet (Nd:YAG) laser for the reduction of dentin permeability.

Materials and Methods:

Fifty bovine dentin discs were made and distributed randomly into five groups (n = 10). The Nd:YAG laser was applied with the bioactive glasses using the energy parameters (60 and 80 mJ), forming the groups; NbG_60: NbG + Nd:YAG (60 mJ); NbG_80: NbG + Nd:YAG (80 mJ), 45S5_60: 45S5 + Nd:YAG (60 mJ); 45S5_80: 45S5 + Nd:YAG (80 mJ) and C: control (untreated dentin). The permeability was measured with a split chamber device. The samples were subjected to the erosive challenge and a new permeability measurement was done. Furthermore, the dentin was analyzed by scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDS).

Statistical Analysis Used:

The data were analyzed using Kruskal–Wallis and Dunn's tests (α = 0.05).

Results:

Greater reduction in dentinal permeability was observed for 45S5 bioactive glasses (45S5_60 and 45S5_80) followed by NbG_80 and NbG_60 (P < 0.05). The SEM/EDS analysis showed the formation of a barrier after the dentin treatment.

Conclusions:

Bioactive glasses with Nd:YAG laser on the dentin surface may be a promising alternative for the reduction of dentin permeability.

Comparative evaluation of the efficacy of the desensitizing and remineralizing agent in the reduction of dentin hypersensitivity after orthodontic debonding - a randomized clinical trial

Introduction

Enamel loss is a common problem during various orthodontic procedures. The study aims to compare the efficacy of a desensitizer and remineralizer in the reduction of the dentin hypersensitivity (DH) associated with enamel microcracks after orthodontic debonding.

Methods

A unicentric two arm parallel study with 30 subjects randomly assigned to each groups following debonding. Group-1 subjects were treated with Gluma® desensitizer (5% glutaraldehyde and 35% hydroxyethyl methacrylate (HEMA)) and the Group-2 intervention included a remineralizing agent GC Tooth Mousse Plus® (casein phospho peptide and amorphous calcium Fluro phosphate (CPP:ACFP)). The Visual Analogue Scale (VAS) was utilized to evaluate DH as subjective perception of pain following the Air blast test and Cold test. The VAS scale was indexed from 0–10 markings based on the intensity of perception. Five different time points T0 and T1 - immediately after debonding and intervention on day 1, T2 – 48 hours, and T3 after 72 hours were taken for the assessment of VAS scores.

Results

The VAS scores for the airblast test for group 1 were (2.73, 0, 0.06, 0.03) and group 2 (2.46, 0, 0.16, 0.13) at different periods. The sensitivity scores for the cold blast test for group 1 were (2.73, 0, 0.13, 0.03) and for group 2 (2.46, 0, 0.16, 0.13). There was 98 percent reduction in DH between T0 and T3 and was statistically significant (p<0.05) for both the groups.

Conclusion

Gluma® desensitizer and GC Tooth Mousse Plus® are equally effective in the reduction of DH in the orthodontic patient following debonding.

Association of Nd:YAG laser and calcium-phosphate desensitizing pastes on dentin permeability and tubule occlusion

Objective

To evaluate the efficacy of Nd:YAG laser associated with calcium-phosphate desensitizing pastes on dentin permeability and tubule occlusion after erosive/abrasive challenges.

Methodology

Dentin specimens were exposed to 17% ethylene diamine tetra-acetic acid (EDTA) solution for 5 min and randomly allocated into five groups: G1, control (no treatment); G2, Nd:YAG laser (1 W, 10 Hz, 100 mJ, 85 J/cm2); G3, Laser + TeethmateTM Desensitizer; G4, Laser + Desensibilize Nano P; and G5, Laser+Nupro^®. Specimens underwent a 5-day erosion-abrasion cycling. Hydraulic conductance was measured post-EDTA, post-treatment, and post-cycling. Post-treatment and post-cycling permeability (%Lp) was calculated based on post-EDTA measurements, considered 100%. Open dentin tubules (ODT) were calculated at the abovementioned experimental moments using scanning electron microscopy and ImageJ software (n=10). Data were analyzed using two-way repeated measures ANOVA and Tukey’s test (α=0.05).

Results

G1 presented the highest %Lp post-treatment of all groups (p<0.05), without significantly differences among them. At post-cycling, %Lp significantly decreased in G1, showed no significant differences from post-treatment in G3 and G4, and increased in G2 and G5, without significant differences from G1 (p>0.05). We found no significant differences in ODT among groups (p>0.05) post-EDTA. At post-treatment, treated groups did not differ from each other, but presented lower ODT than G1 (p<0.001). As for post-cycling, we verified no differences among groups (p>0.05), although ODT was significantly lower for all groups when compared to post-EDTA values (p<0.001).

Conclusion

All treatments effectively reduced dentin permeability and promoted tubule occlusion after application.

Combining Nd

YAG laser with calcium-phosphate pastes did not improve the laser effect. After erosive-abrasive challenges, treatments presented no differences when compared to the control.

Associative Protocol for Dentin Hypersensitivity Using Nd:YAG Laser and Desensitizing Agent in Teeth with Molar-Incisor Hypomineralization

Objective: The aim of this article was to describe and discuss a clinical case in which the Nd:YAG laser and a desensitizing agent were associated in a protocol for dentin hypersensitivity (DH) in teeth with molar-incisor hypomineralization (MIH). Background data: DH is a common condition among the population, being one of the main reasons for patients to seek for a dental treatment. MIH can be considered a condition that induces DH. Methods: The patient was referred for evaluation, complaining of hypersensitivity during eating or drinking cold foods. Clinical evaluation revealed the presence of MIH on the first lower molars. Aiming to treat DH, two strategies for dentin desensitization were associated: the use of a high-power laser (Nd:YAG laser, 1.064 nm; Lares Research), with a 300 μm quartz optical fiber, 1 W of power, 100 mJ of energy, 10 Hz of repetition rate, and 85 J/cm² of energy density, followed by the application of two layers of a desensitizing agent (Gluma Desensitizer). Results: DH was evaluated immediately, after 1 week and after 1 month of the treatment. Clinical outcomes were satisfactory, confirming the efficacy and considerable durability of the protocol used for the reduction of DH originated from MIH. Conclusions: The association of Nd:YAG laser and a desensitizing agent for controlling DH was effective, showing to be an interesting protocol.

In Vitro Effect of Innovative Desensitizing Agents on Dentin Tubule Occlusion and Erosive Wear

Purpose:

The purpose of this study was to evaluate the effects of four in-office desensitizing products on dentin tubule occlusion and erosive wear.

Methods:

Dentin hypersensitivity was simulated by EDTA application for five minutes. The specimens were randomly allocated into five groups (n=11), according to treatment: No treatment - Control (C), Duraphat (DUR), Desensibilize Nano P (NP), ClinPro XT Varnish (XTV), and ClinPro White Varnish (CWV). They were then submitted to erosive/abrasive cycling for five days. After EDTA, treatment, and cycling, the specimens were analyzed with an environmental scanning electron microscope (ESEM) to verify the number of opened dentin tubules (ODT) which were counted by using ImageJ software, and with a profilometer to determine the surface curvature/loss. ESEM data were analyzed with two-way repeated measure analysis of variance and Tukey tests. For the profilometer, data were analyzed with Kruskal-Wallis, Tukey, and Mann-Whitney tests.

Results:

After treatment, all groups showed lower ODT than the control, without significant differences between them. After cycling, the only group that showed lower ODT than the control was group XTV; however, it did not significantly differ from the other groups. For the profilometric analysis, there were significant differences in SL between the experimental times after treatment and after cycling for all groups (p&lt;0.05). After cycling, no surface loss was detected in groups DUR and XTV, which presented a significantly different curvature than group NP and the control group, but not from group CWV. Surface loss was detected for the control and groups NP and CWV, without difference among them.

Conclusion:

All desensitizing agents tested presented promising results concerning the obliteration of dentin tubules immediately after treatment. XTV was the only desensitizer capable of preventing the reopening of the tubules after the erosive/abrasive challenges. XTV and DUR presented a protective effect against dentin erosive wear.