Evaluation of Fluoraphat Pro and VivaSens® In-Office Desensitizing Agents in Controlling Natural Dental Hypersensitivity: A Clinical Study

Introduction Dental erosion from acidogenic diets, vigorous tooth brushing, excessive tooth whitening, gingival recession, periodontal debridement, or surgery may induce dentine hypersensitivity (DH). It manifests as a phenomenon observed in structurally intact teeth devoid of pathological or defective conditions. Hence, this study aimed to evaluate DH risk reduction after using Fluoraphat Pro (Neumunster, Germany) and VivaSens® (Ivoclar Vivadent, Schaan, Liechtenstein, Switzerland) in-office desensitizing agents. Method Twenty-two participants with at least two hypersensitive teeth were randomly selected. Participants were divided into two groups with 22 teeth each, and a desensitizing agent (Fluoraphat Pro and Vivasens) was applied accordingly. Participants were recalled the next day, and a decrease in sensitivity (if any) was evaluated by self-reporting using a 5-point Likert-type scale. Relative Risk (RR) was used to compare the likelihood of sensitivity between two groups and Cohen's d to measure the effect size. A value of p<0.05 was considered significant for all statistical purposes. Result The relative risk (RR) results indicated that Fluoraphat Pro has significantly lower RR than Vivasens for patients with dental sensitivity (RR = 0.350, 95% CI 0.187 - 0.654, z = 3.28, p = 0.001). Fluoraphat Pro was significantly more effective concerning lower sensitivity in teeth located in the upper right (dCohen = 3.217, p = 0.038) and lower right (dCohen = 3.193, p = 0.017) of the mouth than VivaSens®. Conclusion The two commercially available desensitizing agents Fluoraphat Pro and Vivasens tested in this study were effective in controlling DH. Fluoraphat Pro was more efficient in relieving the risk of dental hypersensitivity than VivaSens®. Further research is needed to evaluate the long-term effects of the desensitizing agents and compare DH reduction with other marketed desensitizing products.

Comparative clinical evaluation of two different formulated in-office newer desensitizing agents (Clinpro XT and Tokuyama Shield Force Plus) in reducing dentin hypersensitivity - A randomized clinical trial

Aim

The aim of this study was to assess the effectiveness of two various in-office newer desensitizing agents in reducing dentinal hypersensitivity in patients with mild-to-moderate sensitivity for a 1-month follow-up.

Materials and Methods

Forty subjects with cervical dentin hypersensitivity (otherwise healthy patients) were included. A split-mouth, randomized clinical trial was conducted. A Visual Analog Scale (VAS) was used to record the initial sensitivity levels at the baseline visit. Each individual has been exposed to thermal (ethyl chloride spray) and evaporative (air blast) stimuli to elicit sensitivity. A single application of two different in-office desensitizing agents, Clinpro XT Varnish (3M ESPE, Minnesota, USA) and Shield Force Plus (Tokuyama Dental, Tokyo, Japan), was done. The sensitivity scores were recorded after the application of the desensitizing agent immediately, after 1 week, and after 1 month using both air and cold stimuli in the same manner as initially.

Results

Mean VAS scores represent teeth that were more sensitive to cold stimuli compared to air blasts in both groups. For both stimuli at all-time intervals except baseline, there is a significant difference between CXT and SFP, with low mean VAS scores for CXT. Post hoc analysis revealed that in the CXT group, there is a significant difference in mean VAS score between pre-and postintervention at all-time intervals except between immediate and 1-week time intervals (P < 0.001) but only at immediate and 1-week time intervals in SFP.

Conclusion

Clinpro XT Varnish is more efficient compared to Shield Force Plus at all-time points irrespective of the stimuli after a 1-month follow-up.

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.

Postoperative sensitivity in posterior resin composite restorations with prior application of a glutaraldehyde-based desensitizing solution: A randomized clinical trial

OBJECTIVES

To evaluate the effect of a glutaraldehyde-based desensitizer on the postoperative sensitivity (POS) in posterior resin composite restorations up to 12 months using a universal adhesive (Tetric N-Bond Universal) with selective enamel etching (SE) or an etch-and-rinse (ER) strategy.

METHODS

Class I and class II resin composite restorations (n = 220) at least 3 mm deep were inserted in 55 subjects. The universal adhesive was applied using the SE (self-etch strategy on dentin with selective enamel etching) or the ER strategy, with or without prior application of a glutaraldehyde-based desensitizer (Gluma Desensitizer - GL) to form groups SEGL and ERGL. A bulk-fill resin composite (Tetric NCeram Bulk Fill) was used for all restorations. Spontaneous POS was assessed 7 days after the restorative procedure using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). After 7, 14, and 30 days of completing each restoration, the subjects were reassessed to evaluate POS caused by stimulation with an air blast, horizontal and vertical percussion. In addition, marginal discoloration, marginal adaptation, fracture, and recurrence of caries were evaluated using the FDI (World Dental Federation) criteria after 7 days and at 12 months.

RESULTS

No significant spontaneous or stimuli-induced POS was observed when restorations with or without GL were compared (p>0.05). A higher risk of spontaneous POS was observed within 7 days (40.0%; 95% CI 28.1 to 53.1), without statistically significant differences among groups. None of the participants reported POS at 12 months, however five restorations were considered clinically unsatisfactory (p > 0.05).

CONCLUSIONS

The previous application of GL did not significantly reduce spontaneous or stimuli-induced POS in posterior resin composite restorations at any time, regardless of the adhesive strategy used.

CLINICAL SIGNIFICANCE

The use of a glutaraldehyde-based desensitizing agent did not generate lower incidence of postoperative sensitivity in resin composite posterior restorations.

Efficacy of a calcium-phosphate/fluoride varnish and ionomeric sealant on cervical dentin hypersensitivity: A randomized, double-blind, placebo-controlled clinical study

BACKGROUND

Dentin hypersensitivity (DH) is a common problem in the population that can have a significant impact on the quality of life of those who suffer from the condition.

OBJECTIVES

Compare the efficacy of two treatments for DH: Ca/PO₄ ^- /F^- varnish (Clinpro White Varnish) and ionomeric sealant (IS) (Clinpro XT Varnish) with a placebo.

METHODS

Participants (121) with at least one tooth with visual analogue scale (VAS) score of 4 and above were randomly and blindly allocated to the groups. Treatments were performed by a trained researcher. DH was evaluated by another blind researcher after the treatment and after 1 week, 4 weeks, 3 months and 6 months. After 4 weeks, placebo received the DH treatment with IS; thus, the participants were not assessed after 3 and 6 months. Primary outcome was DH reduction after 4 weeks. Differences in VAS scores in the other time intervals and entire values of VAS were considered secondary outcomes. Comparisons were made among the groups (α = 0.05).

RESULTS

IS showed the highest VAS value difference between baseline and 4 weeks (mean ± SD: 3.7 ± 2.2), differing significantly from placebo (2.3 ± 1.7) and Ca/PO4/F^- varnish (2.6 ± 2.0). Ca/PO4^- /F^- varnish did not differ from placebo. In all time intervals, VAS values of all groups were significantly lower than the baseline value, without differences among groups. For the long-term differences in VAS values (3 and 6 months), the IS exhibited significantly higher values than Ca/PO4^- /F^- varnish.

CONCLUSIONS

The IS was the most efficacious product for reducing DH, whereas Ca/PO4^- /F^- varnish did not differ from placebo. Registered in ClinicalTrials.gov (NCT04591444).

Comparison between effectiveness of dentine desensitizer and one bottle self-etch adhesive on dentine hypersensitivity

BACKGROUND

Dentine hypersensitivity is one of the most common chief complaints of patients observed by dentists in their practice. However, there is a lack of universal consensus over the selection of reliable treatment modality.

OBJECTIVES

To compare the effectiveness between dentine desensitizer and self-etch adhesive in patients complaining of moderate to severe dentine hypersensitivity pain.

METHODS

A total of 254 patients with moderate to severe dentine hypersensitivity were randomly divided into Group A (Single Bond Universal Agent) and Group B (Seal & Protect Agent) according to the treatment provided. Sensitivity was assessed by means of mechanical (probing) and evaporative (air blast) stimuli. Discomfort Internal Scale (DIS) was explained to patients. DIS scores were recorded after one minute and one month following the application of both agents. Descriptive statistics were calculated. Stratification was done to control confounder and post stratification chi-square test was also applied.

RESULT

The statistically significant difference (p= 0.000) in effectiveness between the two groups was observed. The mean discomfort internal scale score at baseline, after 1 minute and after 1 month in Group A was 3.65 ± 0.60, 2.33 ± 0.64 and 0.41 ± 0.71 respectively, while in Group B, it was 3.55 ± 0.58, 2.40 ± 0.62 and 0.72 ± 0.92 respectively. Overall, 86.6% patients observed improvement in dentinal sensitivity in Group A while in Group B only 67.7% patients reported reduction in sensitivity.

CONCLUSION

Self-etch adhesive significantly reduces dentin hypersensitivity, immediately after one minute of its application and is effective for a period of one month compared to desensitizing agent.

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.

Effect of two desensitizing agents on dentin hypersensitivity: A randomized split-mouth clinical trial

Background:

Clinical research is important to evaluate the effect of desensitizing agents.

Aims:

This randomized clinical trial evaluated the immediate and 1 week desensitizing effect of two desensitizing agents Uno Topical Gel and Profluorid.

Materials and Methods:

Thirtyfive patients with teeth presenting with dentin hypersensitivity were included in this clinical trial. Each quadrant in a patient was randomly assigned to one of two groups: Uno Topical Gel or Profluorid Varnish. A VAS score was used to assess tooth sensitivity at baseline, immediately after application of desensitizer and after 1 week. Additionally, 30 dentin discs were prepared, divided into Group 1(Control Group), Group 2 (Profluorid Varnish) and Group 3 (Uno Topical Gel) and examined using scanning electron microscopy (SEM) after 1hour and 24 hours to evaluate tubule occlusion.

Statistical Analysis:

Clinical data were analysed using Friedman's test and Mann – Whitney U test. SEM data was analysed using Student's 2-sample t-test.

Results:

Uno group was significantly better to evaporative stimuli immediately (P=0.01) after application. After 1 week, Uno group was significantly better to tactile (P=0.000) and evaporative (P=0.000) stimuli than Profluorid. SEM images showed that 1 hour after application, Uno and Profluorid demonstrated more than 90% and 80% dentin tubule occlusion respectively. At 24 hours, Uno and Profluorid demonstrated more than 50% and 60% dentin tubule occlusion respectively.

Conclusions:

Uno Topical Gel was significantly better than Profluorid in reducing pain of dentin hypersensitivity due to tactile and evaporative stimuli after 1 week.

Crystal growth in dentinal tubules with bio-calcium carbonate-silica sourced from equisetum grass

BACKGROUND/PURPOSE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

A randomised controlled trial to investigate the efficacy of an oxalate strip for the management of dentine hypersensitivity pain

OBJECTIVES

To compare a 3.14% potassium oxalate strip and 8% arginine calcium carbonate toothpaste for the reduction of dentine hypersensitivity after 2 and 4 weeks.

METHODS

This was an examiner-blind, parallel study in 80 healthy adults with dentine hypersensitivity (Schiff score >2) in >1 tooth. After acclimatisation, participants were randomised to the oxalate desensitising strip with fluoride toothpaste or the arginine desensitising toothpaste control which also contained fluoride. Products were applied under supervision of study staff after measuring baseline sensitivity, thereafter the strip or control toothpaste (fingertip application) was applied after 1 and 2 weeks, and teeth brushed twice-daily with the fluoride (test group) or the fluoridated arginine control toothpaste. Sensitivity was assessed following airblast (Schiff and VAS) and tactile stimuli (Yeaple probe) at baseline, 2 and 4 weeks.

RESULTS

Both groups showed significant reductions from baseline in VAS, Schiff and Yeaple sensitivity scores after 2 and 4 weeks (p < 0.0005). The oxalate group had significantly lower Schiff and higher Yeaple probe scores compared to control after both time points (p < 0.0002 and p < 0.05), but while scores favoured the oxalate group, there were no significant differences in VAS.

CONCLUSIONS

This study demonstrated application of a 3.14% potassium oxalate strip combined with toothbrushing with paste was more effective in pain management of dentine hypersensitivity than brushing with arginine toothpaste.

CLINICAL SIGNIFICANCE

Treatment of sensitive teeth with the oxalate strip reduced dentine hypersensitivity after 2 and 4 weeks to a significantly greater degree than a positive control sensitivity toothpaste demonstrating that oxalate strips are an effective targeted treatment for dentine hypersensitivity sufferers.

Inhibition of dentin matrix-bound cysteine cathepsins by potassium fluoride

Matrix metalloproteinases (MMPs) and cysteine cathepsins (CCs) can break down unprotected type I collagen fibrils in dentin matrix. This study investigated the use of potassium fluoride (KF) as a potential inhibitor of MMPs and CCs in dentin. Demineralized dentin beams were divided into groups (n = 10 in each group) and incubated in artificial saliva (AS, control), either alone or with one of seven concentrations of KF (6-238 mM fluoride) for 1, 7, and 21 d. After 21 d, all groups were further aged in AS for 6 months. Total MMP activity was screened using the colorimetric MMP assay. The activities of MMP-2 and MMP-9 were investigated using gelatin zymography. At the end of each incubation, changes in loss of dry mass and CC-mediated or total dissolution of collagen peptides were measured via precision weighing, C-terminal crosslinked telopeptide of type I collagen (CTX), and hydroxyproline (HYP) assays. The beams were examined using scanning electron microscopy. After 21 d, total MMP activities, dry mass loss, and CTX release for the groups exposed to 179 and 238 mM fluoride were significantly lower compared with the control group. After 6 months, all groups showed similar total MMP activity, dry mass loss, and HYP release, and CTX levels were significantly lower when the fluoride concentration was ≥24 mM. Calcium fluoride (CaF₂ )-like precipitates were observed over the beams. In summary, KF significantly inhibited the catalytic activity of dentin matrix-bound CCs but did not seem to be effective for MMP-mediated activity.

Effectiveness of resin-based materials against erosive and abrasive enamel wear

OBJECTIVE

The objective of this study was to test the effectiveness of resin-based materials against erosive enamel wear under erosive and abrasive challenges by orange juice and tooth brushing.

METHODS

Fifty enamel specimens from third molars were assigned to five groups: ICON resin infiltration with no etching (ICON-NE), ICON resin infiltration with 15 % HCl etching (ICON-AE), Seal & Protect sealant (S&P), Tetric EvoFlow (TEF), and control. Erosive lesions were first created on enamel, then treated with resin-based materials. Erosive and abrasive challenges by orange juice and tooth brushing were repeated after treatments. Erosive wear of the treated areas was measured with 3D scanning microscopy, and data were analyzed using ANOVA and paired t tests.

RESULTS

Treatments with ICON, S&P, and TEF created a protective material coating of 4.5 ± 1.9 μm, 44.3 ± 8.1 μm, and 84.6 ± 15.7 μm in thickness on the lesion surfaces, respectively. After 15 cycles of erosive and abrasive challenges, enamel or material losses were 21.9 ± 2.3 μm for control, 24.5 ± 4.0 μm for ICON-NE, 24.6 ± 7.4 μm for ICON-AE, 11.2 ± 4.1 μm for S&P, and 3.9 ± 1.9 μm for TEF, respectively. The protective coatings were completely lost in the ICON infiltration groups but remained intact in both the S&P and TEF groups after erosive and abrasive challenges.

CONCLUSION

In contrast to a resin sealant and a flowable composite, ICON infiltration resin was not effective in protecting enamel surfaces from erosive and abrasive wear.

CLINICAL RELEVANCE

Sealant and flowable composite resin may create protective coatings on eroded enamel surfaces and prevent further tissue loss.

Ability of three desensitizing agents in dentinal tubule obliteration and durability: An in vitro study

Aim:

The purpose of this study was to evaluate the effectiveness of three desensitizing agents on dentinal tubule obliteration and their durability in use on the dentinal tubules.

Materials and Methods:

Sixty specimens were obtained from 30 extracted sound human maxillary first premolars. Each tooth was mesiodistally sectioned to obtain 30 buccal and 30 lingual surfaces, and enamel was removed in order to simulate hypersensitive dentin. Specimens were divided into four groups with 15 specimens each. Group 1 samples were immersed in artificial saliva, Group 2 samples were coated with Vivasens, Group 3 samples were coated with VOCO Admira Protect, and Group 4 samples were coated with Neo Active Apatite suspension. These specimens were examined under scanning electron microscope (SEM) to find out the occluding ability of the respective products. The specimens were brushed to find out their durability for 1 week and 1 month and were examined under SEM.

Statistical Analysis:

The results were statistically analyzed by analysis of variance (ANOVA) and Tukey's test.

Results:

Group 1 differed significantly from the Vivasens, Admira, and Neo Active Apatite groups at 5% level of significance (P < 0.05). The Vivasens group differed significantly from the Admira and Neo Active Apatite groups at 5% level of significance (P < 0.05).

Conclusion:

The Ormocer-based Admira Protect showed the best results.

Dentine sensitivity: past, present and future

OBJECTIVE

This review defines dentine sensitivity (DS), its prevalence, its aetiology, the mechanism(s) responsible for DS, its diagnosis and its treatment. The review then examines the modes of action of various treatments for DS including potassium salts, strontium salts, bioglasses, arginine/calcium carbonate and professional treatments such as adhesives and oxalates. The methods used to evaluate the various treatment modalities are discussed, including laboratory studies and randomised controlled clinical trials.

DATA SOURCES AND STUDY SELECTION

A literature search was conducted using PubMed, Ovid Medline and Cochrane reviews for information on DS and its treatments, as well as laboratory and clinical studies used to evaluate the efficacy of various DS treatments. With regard to efficacy of treatments for DS only reports of clinical studies that were randomised, controlled and blinded were reviewed. The authors offer new insights into the shortcomings of the recent systematic review of the use of oxalates for DS.

CONCLUSION

The authors introduce the concept of a novel desensitising mouthrinse containing 1.4% potassium oxalate: Listerine® Advanced Defence Sensitive mouthrinse. Readers of this supplement issue of the Journal of Dentistry are invited to review the significance of managing the clinical problem of DS. They are also invited to assess data from laboratory and randomised controlled clinical studies in order to understand the advantages offered by regular use of 1.4% potassium oxalate-containing mouthrinse, Listerine Advanced Defence Sensitive, in particular its resistance to daily erosive and/or abrasive challenges.

Effect of Desensitizing Agents on the Bond Strength of Mild and Strong Self-etching Adhesives

BACKGROUND

Desensitizing agents are used, almost as routine practice, in many adhesive restorative procedures. There is still debate as to their effect in dentin bonding, particularly with self-etching adhesives. The present study aimed to evaluate the effect of different desensitizing agents on the bond strength of mild and strong self-etching adhesive systems to dentin.

MATERIALS AND METHODS

One hundred twenty recently extracted, noncarious human molars were used to obtain superficial dentin substrate for bonding. No desensitizer was used in the control groups. The experimental groups were pretreated with Gluma Desensitizer, MicroPrime B, and Dentin Desensitizer immediately prior to bonding with self-etching adhesives Optibond XTR, Xeno IV, and iBond. A bonding jig was used to fabricate composite cylinders, which were stored for either 24 hours or three months, after which the shear bond strength (SBS) was evaluated using a notched-edge testing device at a crosshead speed of 1 mm/min. Failure mode distribution was also evaluated at 24 hours and three months. A two-way analysis of variance, Tukey test, and Student t-test, with a significance level of p<0.05, were used for data analysis.

RESULTS

At 24 hours, there was no significant difference in SBS when the same adhesive was used with any of the experimental desensitizing agents compared with the control group without desensitizer. However, at three months, Dentin Desensitizer bonded with Optibond XTR demonstrated significantly lower SBS (p<0.001), while Gluma bonded with iBond showed significantly higher SBS values (p=0.034) relative to their corresponding control group. Only MicroPrime B bonded with Xeno IV and iBond with no desensitizer demonstrated a significant reduction in SBS after three months (p=0.034 and p=0.002, respectively). The most prevalent type of failure was adhesive.

CONCLUSION

Desensitizing agents can be used in combination with self-etching adhesives to control hypersensitivity without adversely affecting their bond strength to dentin.

The Effect of Three Desensitizing Agents on Dentin Hypersensitivity: A Randomized, Split-mouth Clinical Trial

The aim of this study was to evaluate the efficacy of three desensitizing agents to provide relief to dentin hypersensitivity after one session in a four-week follow-up. Forty selected patients participated in a double-blind study following a split-mouth model. One application of the desensitizing agents (A, Admira Protect [Voco]; B, Bifluorid 12 [Voco]; and C, Colgate Pro-Relief in office [Colgate Palmolive]) was performed in three different quadrants for each patient. Each tooth was evaluated by tactile and evaporative stimuli, and the sensitivity response was measured using the Visual Analogue Scale. Evaluations were performed at baseline, immediately after treatment, and after one, two, three, and four weeks. The application of Kruskal-Wallis and Dunn multiple comparisons tests (5%) for both tactile and evaporative stimuli showed that all agents presented a significant desensitizing effect. In groups A and B this relief was maintained for four and three weeks, respectively, as measured by tactile stimulus and for four weeks with evaporative stimulus. The desensitizing effect for group C was maintained for two weeks for both tactile and evaporative stimuli. It is concluded that all desensitizing agents tested were effective in reducing sensitivity compared to baseline values. One application of Admira Protect and Bifluorid 12 presented a longer-lasting desensitizing effect than did Colgate Pro-Relief (applied in the office) on both tactile and evaporative stimuli.

The evaluation of dentinal tubule occlusion by desensitizing agents: a real-time measurement of dentinal fluid flow rate and scanning electron microscopy

The aims of this study were to examine changes in dentinal fluid flow (DFF) during the application of a desensitizing agent and to compare the permeability reduction levels among different types of desensitizing agents. A cervical cavity was prepared for the exposure of cervical dentin on an extracted human premolar connected to a subnanoliter fluid flow measuring device under 20 cm of water pressure. The cavity was acid-etched with 32% phosphoric acid to make dentin highly permeable. The different types of desensitizing agents that were applied on the cavity were Seal&Protect as the light-curing adhesive type, SuperSeal and BisBlock as oxalate types, Gluma Desensitizer as the protein-precipitation type, and Bi-Fluoride 12 as the fluoride type. DFF was measured from the time before the application of the desensitizing agent throughout the application procedure to five minutes after the application. The characteristics of dentinal tubule occlusion of each desensitizing agent were examined by scanning electron microscopy. The DFF rate after each desensitizing agent application was significantly reduced when compared to the initial DFF rate before application for all of the desensitizing agents (p<0.05). Seal&Protect showed a greater reduction in the DFF rate when compared to Gluma Desensitizer and Bi-Fluoride 12 (p<0.05). SuperSeal and BisBlock exhibited a greater reduction in DFF rate when compared to Bi-Fluoride 12 (p<0.05). The dentin hypersensitivity treatment effects of the employed desensitizing agents in this study were confirmed through real-time measurements of DFF changes. The light-curing adhesive and oxalate types showed greater reduction in the DFF rate than did the protein-precipitation and fluoride types.

A practice-based randomised controlled trial of the efficacy of three interventions to reduce dentinal hypersensitivity

OBJECTIVES

The aim of this study was to evaluate the efficacy of three different interventions (non-desensitising toothpaste, desensitising toothpaste and professionally applied dentine bonding agent) in reducing dentinal hypersensitivity over a 2-week, 3-month and 6-month-period in a dental practice setting.

METHODS

This was a randomised controlled, single-blind; parallel-group trial conducted in general dental practice by a single general dental practitioner. Seventy-five subjects were randomly allocated to three groups; non-desensitising toothpaste (NDT), desensitising toothpaste (DT) and professionally applied desensitising agent (DA). Dentinal hypersensitivity was measured using a Visual Analogue Scale (VAS) to record the response from a standardised short blast of air from a triple syringe. Dentinal hypersensitivity was recorded at baseline, two weeks, three months and six months for all groups.

RESULTS

Dentinal hypersensitivity reduced significantly (p<0.0001) in both groups DT and DA, in addition the reduction in sensitivity was sustained and continued to improve over a 6-month-period. The greatest reduction in dentinal hypersensitivity was recorded in group DA.

CONCLUSIONS

The results from this study suggest that application of dentine bonding agents, to teeth diagnosed with dentine hypersensitivity provides the greatest improvement in dentine hypersensitivity at 2 weeks and 6 months. This reduction in dentine hypersensitivity is greater than that achieved by the desensitising toothpaste tested and a non-desensitising toothpaste.

Effect of oxalate desensitizer on the bonding durability of adhesive resin cements to dentin

PURPOSE

This study investigated whether the tubular occluding effect of oxalate desensitizer (OX) during adhesive cementation improved bonding of a self-etch and two etch-and-rinse resin cements to dentin after 6 months.

METHODS

A flat dentin surface was prepared on 120 extracted premolars, which were randomly divided into six groups of 20 teeth each according to the adhesive resin cement system used: ED primer II/Panavia F2.0, Excite DSC (Ex DSC)/Variolink II, and One-Step Plus (OS Plus)/Duolink, with or without OX (BisBlock) application. After cementation of an indirect composite rod, two subgroups (n=10) were tested after 24 h and 6 months of water storage plus thermocycling, and shear bond strengths were recorded in MPa.

RESULTS

Statistical tests showed that although oxalate had a borderline significant negative effect on initial bonding of ED primer II/Panavia F2.0, it significantly improved bonding durability (p<0.05). OX severely compromised the initial bond strength of Ex DSC/Variolink II (p<0.001) but had no effect on the reduction in bonding after aging. OX was compatible with OS Plus/Duolink and did not affect the loss of bonding strength after 6 months (p>0.05).

CONCLUSION

Combining an oxalate desensitizer with three types of resin cements had different effects on bond strength to dentin after aging, depending on the interaction of oxalate with the adhesive system associated to the resin cement.

Dentin hypersensitivity and oxalates: a systematic review

Treatment of dentin hypersensitivity with oxalates is common, but oxalate efficacy remains unclear. Our objective was to systematically review clinical trials reporting an oxalate treatment compared with no treatment or placebo with a dentin hypersensitivity outcome. Risk-of-bias assessment and data extraction were performed independently by two reviewers. Standardized mean differences (SMD) were estimated by random-effects meta-analysis. Of 677 unique citations, 12 studies with high risk-of-bias were included. The summary SMD for 3% monohydrogen-monopotassium oxalate (n = 8 studies) was -0.71 [95% Confidence Interval: -1.48, 0.06]. Other treatments, including 30% dipotassium oxalate (n = 1), 30% dipotassium oxalate plus 3% monohydrogen monopotassium oxalate (n = 3), 6% monohydrogen monopotassium oxalate (n = 1), 6.8% ferric oxalate (n = 1), and oxalate-containing resin (n = 1), also were not statistically significantly different from placebo treatments. With the possible exception of 3% monohydrogen monopotassium oxalate, available evidence currently does not support the recommendation of dentin hypersensitivity treatment with oxalates.

Diffusion of peroxides through dentine in vitro with and without prior use of a desensitizing varnish

Different bleaching regimens are used in dentistry possibly penetrating the dentine and affecting the pulp. The aim of the present study was to investigate peroxide diffusion through dentine pre-treated with a desensitizing varnish (Vivasens®) in a standardized in vitro setup during application of different bleaching materials. The penetration was tested using 1.3-mm-thick bovine dentine slabs. The following bleaching materials were tested with and without prior application of the desensitizing varnish on the external side of the dentine slabs: Vivastyle, Whitestrips, Simply White, Opalescence (external bleaching), and sodium perborate (internal bleaching, only tested without varnish; n = 8 samples per subgroup). The penetration of peroxides was measured photometrically using 4-aminoantipyrin as a substrate, the penetration of peroxides was monitored over 240 min. All bleaching agents yielded a diffusion of peroxides through the dentine, the kinetics of penetration were approximately linear for all materials tested. The significantly highest diffusion of peroxides was observed with Opalescence, the lowest with sodium perborate. The adoption of the desensitizing varnish reduced the diffusion of peroxides significantly for all external bleaching materials. Peroxides penetrated the dentine during application of bleaching materials; the penetration of peroxides can be reduced by application of a desensitizing agent.

Dentin hypersensitivity: a randomized clinical comparison of three different agents in a short-term treatment period

OBJECTIVE

Dentin hypersensitivity, or what patients may describe as "sensitive teeth," is defined as a short, sharp pain arising from exposed dentin in response to thermal, evaporative, tactile, electrical, osmotic or chemical stimuli. It is widely accepted that dentin hypersensitivity is an uncomfortable condition that also affects function and quality of life. This study determines the differences in efficiency of three desensitizing products when compared with a placebo.

METHODS

A randomized controlled clinical trial was conducted to compare three different professional dentin desensitizer agents in 52 patients. The age and sex of the patients was recorded. Gluma Desensitizer (Heraeus Kulzer), UltraEZ (Ultradent Products, Inc) and Duraphat (Colgate Oral Pharmaceuticals, Inc, New York, NY, USA) were used as desensitizer agents and distilled water was used as the placebo. The baseline measurement of the dentin hypersensitivity was made by using a visual analog scale (VAS). Twenty-four hours and seven days after application of the desensitizer agents and placebo, a new VAS analysis was conducted for patients' sensitivity level. The desensitizer agents were compared in terms of mean values, and ANOVA was used for testing differences among the groups (p<0.05).

RESULTS

The results showed that the mean pain scores of the placebo group were significantly higher than that of the study groups (p<0.05). The VAS analysis revealed a significant decrease in dentin hypersensitivity over time with the use of agents (p<0.05). No statistically significant difference was found among the three desensitizing agents (p>0.05).

CONCLUSIONS

These three desensitizing agents, which contain different active ingredients, were effective in relieving dentin hypersensitivity. However, no superiority was found in dentin sensitivity relief among the agents.