Randomized controlled clinical trial on the efficacy of dentin desensitizing agents

A novel treatment based on powder jet deposition technique for dentin hypersensitivity: a randomized controlled trial

BACKGROUND

This study aimed to evaluate the efficacy and safety of dentin hypersensitivity (DH) treatment using a newly developed device based on a powder jet deposition (PJD) technique that creates a hydroxyapatite (HAP) layer on the dentin surface, thereby alleviating the hypersensitivity. The effect of the PJD treatment was compared with that of conventional treatment using Teethmate Desensitizer (TMD; calcium-phosphate containing material with TTCP (Ca4(PO4)2O) and DCPA (CaHPO4)), which has been used clinically in Japan with well-confirmed effectiveness.

MATERIALS AND METHODS

A randomized controlled trial was conducted including 35 patients who had symptoms of DH in two or more quadrants. Two test teeth were selected per patient (70 teeth in total) and randomly assigned to PJD or TMD treatment. The efficacy was evaluated using the improvement rate for air and scratch pain according to the scores obtained via visual analog scale 12 weeks after treatment. The safety assessment was performed focusing on gingival index (GI) and spontaneous pain. The t-test was used to analyze the non-inferiority of PJD treatment compared to TMD treatment.

RESULTS

The improvement rate of air pain was 69.0% for PJD and 69.7% for TMD. The improvement rate of scratch pain was 80.8% for PJD and 81.7% for TMD. Non-inferiority with a margin of 10% was not observed for both air and scratch pain. No change was observed in GI from baseline and the improvement rate of spontaneous pain for PJD was higher than that for TMD.

CONCLUSION

Non-inferiority of PJD to TMD treatment was not observed in this study; however, it was not statistically demonstrated, and the results were thus interpreted as inconclusive. PJD did improve the DH symptoms, as did TMD. PJD's therapeutic effect was most likely attributable to the deposition of a HAP layer on the tooth surface, which would alleviate hypersensitivity for at least 12 weeks without causing severe adverse events.

TRIAL REGISTRATION

UMIN-CTR. ID: UMIN000025022. date: 02/12/2016.

The Effectiveness of Calcium Phosphates in the Treatment of Dentinal Hypersensitivity: A Systematic Review

Dentin hypersensitivity (DH) pain is a persistent clinical problem, which is a common condition known to affect patients' quality of life (QoL), but no treatment has ever been agreed upon. Calcium phosphates, available in different forms, have properties that allow sealing the dentinal tubules, which may relieve dentin hypersensitivity. The aim of this systematic review is to evaluate the ability of different formulations of calcium phosphate to reduce dentin hypersensitivity pain level in clinical studies. The inclusion criterion was as follows: clinical randomized controlled studies using calcium phosphates in treating dentin hypersensitivity. In December 2022, three electronic databases (Pubmed, Cochrane and Embase) were searched. The search strategy was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The bias assessment risks results were carried out using the Cochrane Collaboration tool. A total of 20 articles were included and analyzed in this systematic review. The results show that calcium phosphates have properties that reduce DH-associated pain. Data compilation showed a statistically significant difference in DH pain level between T0 and 4 weeks. This VAS level reduction is estimated at about -2.5 compared to the initial level. The biomimetic and non-toxic characteristics of these materials make them a major asset in treating dentin hypersensitivity.

The efficacy of a novel zinc-containing desensitizer CAREDYNE Shield for cervical dentin hypersensitivity: a pilot randomized controlled trial

Background

Recently, a novel zinc-containing desensitizer, CAREDYNE Shield, was developed. This new type of desensitizer induces chemical occlusion of dentinal tubules for desensitization and releases zinc ion for root caries prevention. Despite these features, its clinical effectiveness in the improvement of cervical dentine hypersensitivity remains to be elucidated. Thus, we aimed to evaluate the effectiveness of CAREDYNE Shield in patients with CDH.

Methods

Forty CDH teeth which matched the eligibility criteria were randomly allocated to two groups in a 1:1 ratio: the CAREDYNE Shield group (intervention group) and the Nanoseal group (control group). The pain intensity in response to air stimuli, gingival condition, and oral hygiene status of CDH teeth were assessed before and at 4 weeks after treatment. The primary outcome was the reduction of pain intensity in response to air stimuli from baseline to 4 weeks after intervention.

Results

From November 2019 to April 2021, 24 participants with 40 teeth were enrolled in this study and 33 teeth in 20 participants were assessed at 4 weeks after treatment. A significant reduction of pain in response to air stimuli was observed in both groups; however, no significant difference was observed between the groups.

Conclusions

This study showed that CAREDYNE Shield is effective for CDH and its effectiveness is similar to Nanoseal.

Trial registration

UMIN Clinical Trials Registry (UMIN-CTR), UMIN000038072. Registered on 21st September 2019, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043331

Assessment of the Oral Health Impact Profile (OHIP-14) improvement of different treatments for dentin hypersensitivity in noncarious cervical lesions-a randomized clinical study

OBJECTIVES

To assess the improvement on oral health-related quality of life (OHRQoL) of individuals with cervical dentin hypersensitivity (CDH) with the noncarious cervical lesion (NCCLs) subjected to different treatments.

MATERIAL AND METHODS

A single-blind randomized clinical trial was conducted with patients (n = 74) randomly allocated into three groups according to the treatment performed: PO, potassium oxalate (Oxa-Gel BF); LL, low-power laser irradiation; and POLL, potassium oxalate (Oxa-Gel BF) associated with low-power laser irradiation. The treatments were applied in four steps, weekly. The questionnaire Oral Health Impact Profile (OHIP-14) was applied before initiating and immediately after the fourth session. The greater the sum of the score, the smaller the measurement of OHRQoL.

RESULTS

The total mean values of the variables at the final moment were significantly lower than the initial one for all dimensions (p value ranging from < 0.001 to 0.006). Furthermore, the OHIP-14 scores final analysis between the groups indicated that the POLL group compared to LL had a significantly lower final score for the functional limitation (p = 0.009), physical pain (p = 0.049), and psychological discomfort (p = 0.035) dimensions and that group PO compared to group LL had a significantly lower final score for the functional limitation dimension (p = 0.024).

CONCLUSIONS

There was a reduction in the OHIP-14 score for all dimensions, indicating an improvement in patients' quality of life after the use of desensitizing therapies. Patients in group LL had a higher functional limitation, physical pain, and psychological discomfort.

CLINICAL RELEVANCE

This study indicated improvement of desensitizing therapies for CDH to improve patients' OHRQoL.

TRIAL REGISTRATION

This trial was registered in the Brazilian Clinical Trials Registry Platform (REBEC protocol number RBR-4ybjmt).

Effect of sodium fluoride varnish, Gluma, and Er,Cr:YSGG laser in dentin hypersensitivity treatment: a 6-month clinical trial

Dentinal hypersensitivity (DH) is a common clinical condition usually associated with exposed dentinal surfaces. The aim of this study was to study the effect of sodium fluoride varnish, Gluma, and Er,Cr:YSGG laser, in the dentin hypersensitivity treatment. One hundred sixty-five teeth with dentin hypersensitivity in 55 patients were involved in this study. Teeth are divided into five groups based on the received treatment (n = 33): G group: Gluma; F group: sodium fluoride varnish (5%); L group: Er,Cr:YSGG laser (wavelength 2780 nm, frequency 20 Hz, power 0.25 W, energy density 44.3 J/cm², and pulse width of 150 µs at distance of 1 mm for 30 s) which was followed by Er,Cr:YSGG laser; GL group: Gluma + laser; VL group: both sodium fluoride varnish and Gluma, which are common treatments for hypersensitivity, were selected as control groups. The treatment was performed in one session, and the sensitivity to air spray conditioning was recorded after the treatment, at 15 min, 1 week, 1 month, and 6 months as the VAS. Statistical analysis was performed using SPSS Ver. 21 software. One-way ANOVA was used to compare the VAS between all treatment groups at each time-point. One-way repeated measurements ANOVA (RM-ANOVA) and two-way-repeated measurements ANOVA (RM-ANOVA) were used to compare the hypersensitivity of each group and sensitivity of all treatment groups, respectively. Tukey post hoc test was used to compare the groups pairwise. The hypersensitivity between different groups at before and 15 min after the treatment was not significantly different (P = 0.063). The hypersensitivity of all studied groups was decreased after the treatment. The Er,Cr:YSGG laser, alone or in combination with Gluma, in 1 week, 1 month, and 6 month follow-ups, had significantly reduced the hypersensitivity instead of sodium fluoride varnish. All treatments significantly reduced the dentin hypersensitivity up to 6 months. Er,Cr:YSGG laser alone or in combination with Gluma was more effective than sodium fluoride varnish; however, it was not significantly different from other treatments. In a 6-month follow-up of dentine hypersensitivity treatment, Gluma had a significantly higher effect than sodium fluoride. Trial registration: IRCT20190422043343N1. Registered 19 July 2019.

Evaluation of Dentin Tubule Plugging Efficiencies and Effects on Dentin Surface Roughness of Dentin Desensitizing Agents, the Er,Cr:YSGG Laser, and Their Combination After Erosion-Abrasion Cycles: An In Vitro Study

OBJECTIVES

The purposes of this in vitro study were to evaluate the tubule plugging efficiencies and effects on the surface roughness of dentin of different dentin desensitizing agents (DDAs; Teethmate Desensitizer, Kuraray; Gluma Desensitizer, Kulzer; Clinpro White Varnish, 3M ESPE; Enamelast, Ultradent) and the Er,Cr:YSGG laser (Biolase, Waterlase), both alone and in combination with DDAs, after application and after an erosion-abrasion cycle.

METHODS AND MATERIALS

For surface roughness examinations, superficial buccal dentin specimens were divided into 10 groups: the control, Teethmate Desensitizer, Gluma Desensitizer, Enamelast, Clipro White Varnish, Er,Cr:YSGG Laser, Teethmate Desensitizer-Laser, Gluma Desensitizer-Laser, and Enamelast-Laser, and Clinpro White Varnish-Laser groups. Profilometric analyses and scanning electron microscopy (SEM) examinations were performed after applications and after a 5-day erosive-abrasive cycle. For the statistical analysis of surface roughness measurements, 2-way analysis of variance (ANOVA), 1-way ANOVA, and Tukey post hoc test were used.

RESULTS

Among the treatments, only DDAs alone did not cause increase in surface roughness after application. All of the laser applications increased the surface roughness of dentin, and after the erosion-abrasion cycle, all of the test groups had increased surface roughness. However, SEM images showed that morphological changes were less frequently observed in all of the experimental groups than in the control group. In addition, all of the laser-DDA combinations had stronger tubule occlusion effects than did DDAs alone, even after erosion-abrasion.

CONCLUSIONS

All of the test treatments showed protective effects on dentin surfaces against the negative effects of erosion-abrasion. The addition of the laser to DDA applications increased tubular plugging efficiencies of DDAs, and the tubule plugs of the combination treatments were resistant to the erosion-abrasion cycle.

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).

The control of pain due to dentin hypersensitivity in individuals with molar-incisor hypomineralisation: a protocol for a randomised controlled clinical trial

INTRODUCTION

Dentin hypersensitivity (DH) is defined as high sensitivity of the vital dentin when exposed to thermal, chemical or tactile stimuli. Two mechanisms are required for the occurrence of DH: (1) the dentin must be exposed and (2) the dentinal tubules must be open and connected to the pulp. Molar-incisor hypomineralisation (MIH) is a qualitative abnormality of a genetic origin that affects tooth enamel and, in most cases, is accompanied by DH. The control of tooth sensitivity is fundamental to the successful treatment of MIH. The aim of the proposed randomised, controlled, clinical trial is to evaluate the effectiveness of different protocols for the control of DH in patients with teeth affected by MIH.

METHODS AND ANALYSIS

One hundred and forty patients who meet the inclusion criteria will be allocated to four groups. Group 1 will be the control group (placebo). In Group 2, sensitive teeth will be sealed with PermaSeal (Ultradent). In Group 3, sensitive teeth will receive low-level laser (LLL, AsGaAl) at a wavelength of 780 nm (Laser XT Therapy, DMC, São Carlos, Brazil). In Group 4, sensitive teeth will be treated with both LLL and PermaSeal (Ultradent). DH will be evaluated 15 min after the application of the treatments and the patients will be reevaluated 1 week, 1 month, 3 months and 6 months after the treatments. The primary outcome of this study is change in pain/sensitivity, when evaluated through a Visual Analogue Scale, to determine the effectiveness of the proposed treatments, as well as differences among the evaluation times for each proposed treatment.

ETHICS AND DISSEMINATION

This protocol has been ethically approved by the local medical ethical committee (protocol number: 4.020.261). Results will be submitted to international peer-reviewed journals and presented at international conferences.

TRIAL REGISTRATION NUMBER

NCT04407702.

Adhesive dentistry: Current concepts and clinical considerations

OBJECTIVES

To address contemporary concepts in adhesive dental materials with emphasis on the evidence behind their clinical use.

OVERVIEW

Adhesive dentistry has undergone major transformations within the last 20 years. New dental adhesives and composite resins have been launched with special focus on their user-friendliness by reducing the number of components and/or clinical steps. The latest examples are universal adhesives and universal composite resins. While clinicians prefer multipurpose materials with shorter application times, the simplification of clinical procedures does not always result in the best clinical outcomes. This review summarizes the current evidence on adhesive restorative materials with focus on universal adhesives and universal composite resins.

CONCLUSIONS

(a) Although the clinical behavior of universal adhesives has exceeded expectations, dentists still need to etch enamel to achieve durable restorations; (b) there is no clinical evidence to back some of the popular adjunct techniques used with dental adhesives, including glutaraldehyde-based desensitizers and matrix metalloproteinase inhibitors; and (c) the color adaptation potential of new universal composite resins has simplified their clinical application by combining multiple shades without using different translucencies of the same shade.

CLINICAL SIGNIFICANCE

New adhesive restorative materials are easier to use than their predecessors, while providing excellent clinical outcomes without compromising the esthetic quality of the restorations.

Low-power laser and potassium oxalate gel in the treatment of cervical dentin hypersensitivity-a randomized clinical trial

OBJECTIVE

To evaluate the effectiveness of different protocols for the treatment of cervical dentin hypersensitivity (CDH) in non-carious cervical lesions (NCCLs).

MATERIALS AND METHODS

The CONSORT checklist was used to design this study. The sample with n = 74 participants (389 NCCLs) was randomly allocated into three groups: G1, potassium oxalate (Oxa-Gel BF); G2, GaAlAs (gallium-aluminum-arsenate) low-power laser (100 mW, 808nn, 60 J/cm²); and G3, potassium oxalate (Oxa-Gel BF) associated with the GaAlAs low-power laser. The CDH was triggered by the evaporative stimulus test (EST) and by the tactile stimulus test (TST). The visual analog scale (VAS) was used to quantify the degree of CDH. Changes in sensitivity were assessed from baseline over 3 weeks. Data were analyzed for NCCLs using mixed-effects models with unstructured direct product covariance structure (α = 0.05).

RESULTS

After the first application, participants from G1 and G3 had a reduction in CDH (p < 0.05) compared with group G2 for TST. After the second application, G3 participants had a reduction in CDH (p < 0.05) in relation to G2 for both stimuli. Reduction in CDH (p < 0.05) occurred over 3 weeks for EST and TST for all groups; however, there was no difference between groups at the end of the therapies.

CONCLUSION

Potassium oxalate was more effective in reducing immediate CDH. After four applications, all groups showed similar results for the reduction of CDH.

CLINICAL RELEVANCE

GaAlAS laser irradiation and oxalate potassium gel could reduce the symptoms of CDH; thus, they are viable alternatives for the treatment of this condition. Chemical occlusion of dental tubules showed effective results after a shorter time interval.

TRIAL REGISTRATION

Brazilian Clinical Trials Registration Platform under protocol number RBR-4ybjmt. http://www.braziliantrials.com/?keywords=RBR-4ybjmt&order=%7Eensaios.patrocinador_primario.

Clinical Efficacy of Different Dentin Desensitizers

CLINICAL RELEVANCE

Teethmate Desensitizer, Clinpro White Varnish, Shield Force Plus, and Gluma could be recommended for treating dentin hypersensitivity in terms of clinical efficacy.

SUMMARY

Objective: The aim of this study was to evaluate the clinical efficacy of widely used dentindesensitizing agents (DDAs) (Teethmate Desensitizer, Clinpro White Varnish, Shield Force Plus, and Gluma) in the treatment of dentin hypersensitivity (DH) according to different evaluation parameters over a four-week follow-up period.Methods and Materials: This study was a randomized, single-center, controlled, parallel group study involving 144 teeth in 40 subjects. The baseline DH levels of the subjects were determined using different evaluation parameters. Daily life hypersensitivity and evaporative air stimulus hypersensitivity scores were recorded using a visual analog scale (VAS), and tactile hypersensitivity scores were recorded using a Yeaple probe and measured in grams and on the VAS. Subjects who experienced evaporative air stimulus DH (30-80 mm on the VAS) and tactile hypersensitivity (10-50 g with the Yeaple probe) were included in the study. After application of the DDAs, these evaluation parameters were recorded throughout the follow-up period (immediately after application and at one day and two and four weeks post-application).Results: All four DDAs demonstrated clinical dentin-desensitizing effects throughout the follow-up period according to evaporative air hypersensitivity, tactile sensitivity (g-VAS), and daily life hypersensitivity scores (p<0.05). Only Clinpro White Varnish had tactile sensitivity (g) scores that were similar at baseline and the one-day follow-up (p>0.05). A comparison of DH-reducing effects among the DDAs revealed that they yielded different results immediately after application and at the one-day follow-up time point, depending on which evaluation parameter was used. However, all DDAs showed similar DH-reducing effects at the two- and four-week follow-up time points.Conclusions: Teethmate Desensitizer, Clinpro White Varnish, Shield Force Plus, and Gluma DH showed clinical efficacy for four weeks. DDAs may produce inconsistent clinical evaluation scores not only across different evaluation parameters but also between early and later follow-up time points.

A randomized, controlled, two-month pilot trial of stannous fluoride dentifrice versus sodium fluoride dentifrice after oxalate treatment for dentinal hypersensitivity

OBJECTIVES

To compare the effects of a stannous fluoride dentifrice and a sodium fluoride dentifrice on dentinal hypersensitivity when used with an oxalate-based regimen combining in-office and at-home treatment.

MATERIALS AND METHODS

In this single-center, randomized, controlled, double-blind, pilot clinical trial, 30 subjects were professionally treated at baseline with a 3% oxalate/potassium salt solution on up to two target teeth, then randomized 1:1 to either 0.454% stannous fluoride or 0.243% sodium fluoride overlabeled dentifrice. Both groups were given 6 sensitivity strips (3.14% potassium oxalate gel) and a soft, manual toothbrush. Subjects were permitted to apply strips on up to two teeth, up to three times per tooth, at home as desired throughout the study. Dentinal sensitivity (cold air blast challenge) was assessed at baseline, immediately after post-professional treatment, and at day 60 using the Schiff scale and a Visual Analog Scale (VAS).

RESULTS

Immediately after professional oxalate treatment, the overall mean Schiff and VAS score decreased 25.6% and 22.4% from baseline, respectively (p ≤ 0.001 for both). At day 60, further reductions in both mean scores were seen in both groups. There were no significant differences between the groups at day 60. All treatments were well tolerated.

CONCLUSIONS

In subjects treated with oxalates for dentinal hypersensitivity, both stannous fluoride and sodium fluoride dentifrices are well tolerated, are feasible for routine use, and do not detract from the desensitizing effects of an in-office and at-home oxalate combination treatment regimen.

CLINICAL RELEVANCE

Either stannous fluoride or sodium fluoride dentifrices can be recommended to dentinal hypersensitivity patients who undergo professional oxalate treatment.

Influence of desensitizing agents in management of noncarious cervical lesion and bonded restorations: A preliminary 12-week report

OBJECTIVES

The primary objective of this study was to investigate the effectiveness in reducing dentin hypersensitivity in noncarious cervical lesions (NCCLs) by home-based desensitizing toothpaste (TP), in-office Gluma desensitizer application, and resin-modified glass-ionomer cement (RMGIC) restoration. The secondary objective was to evaluate the long-term outcome of the glass-ionomer cement restoration following the application of bioactive glass-containing desensitizer TP.

MATERIALS AND METHODS

A total of 73 patients or 151 teeth were included in the study and randomly allotted to one of the four different treatment groups. Pre- and postoperative symptom and air-blast/tactile sensitivity scores were recorded for statistical analysis. Postoperative sensitivity was analyzed at 1, 4, and 12 weeks after treatment. Nonparametric statistical tests were employed.

RESULTS

Kruskal-Wallis test noted a significant reduction in postoperative sensitivity at all time periods with the RMGIC group compared to other treatment options. Significantly higher patient dropout was observed in desensitizing TP regimen.

CONCLUSIONS

This interim 12-week report on dentin hypersensitivity management of NCCLs concludes that resin-modified glass-ionomer restoration was able to achieve a significant instant reduction in sensitivity and patient satisfaction compared to other noninvasive at-home and in-office procedures.

CLINICAL RELEVANCE

This interim 12-week report on dentin hypersensitivity management of noncarious cervical lesions concludes that resin-modified glass-ionomer restoration was able to achieve a significant reduction in sensitivity, and patient satisfaction was higher compared to other noninvasive at-home and in-office procedures.

The efficacy of the novel zinc-containing desensitizer CAREDYNE Shield on dentin hypersensitivity: a study protocol for a pilot randomized controlled trial

Background

Dentin hypersensitivity (DH) is a condition characterized by short and sharp episodes of pain which will arise in response to tactile, chemical, thermal, evaporative or osmotic stimuli. The painful symptoms cause discomfort in patients and reduce their quality of life. Recently, the novel zinc-containing desensitizer CAREDYNE Shield has been developed as a new type of desensitizer that acts by inducing chemical occlusion of dentinal tubules, and releasing zinc ion for root caries prevention. However, the clinical effectiveness of CAREDYNE Shield on DH remains unclear. Therefore, the aim of this study is to evaluate the effectiveness of CAREDYNE Shield on DH by comparing with that of another desensitizer, Nanoseal, commonly used in Japan.

Methods/design

This study protocol is a two-arm, parallel, pilot randomized controlled trial. Forty DH patients will be randomly allocated to two groups. Participants in the intervention group will be treated with CAREDYNE Shield, while those in the control group will be treated with Nanoseal. The primary outcome is the reduction of pain intensity in response to air stimuli measured with a 5-point verbal response scale from baseline to 4 weeks after the intervention, and Fisher’s exact test will be used for analyses.

Discussion

CAREDYNE Shield can be casually applied to subgingival areas and proximal surfaces because it reacts with only tooth substance. Furthermore, zinc has been reported to reduce the demineralization of enamel and dentin and inhibit biofilm formation, plaque growth and dentin-collagen degradation. Therefore, CAREDYNE Shield may be expected to be a useful novel desensitizer that acts not only as a desensitizer but also as a root caries inhibitor.

Trial registration

UMIN Clinical Trials Registry (UMIN-CTR), ID: UMIN000038072. Registered on 21 September 2019.

Trial status

This study (protocol version number: version 1.4.0; approved on 22 October 2019) is ongoing. The recruitment of participants began in December 2019 and will be continued until November 2020 (Hanke, Am Dent Assoc 27:1379–1393, 1940).

Effect of artificial saliva on permeability of dentin treated with phosphate containing desensitizer measured by digital flow meter

The aim of this study was to investigate the effects of artificial saliva on permeability measured using a highly sensitive digital flow meter of dentin discs treated with a phosphate containing desensitizer compound (Teethmate desensitizer; TD). Four random groups (n=10) were treated either with TD or distilled water (DW), then stored in artificial saliva (AS) or DW for 1 day, 1 week and 1 month. Flow rates under 2 kPa pressure were calculated as percentage reduction (PR%) from the baseline. The PR% of TD/AS group was significantly lower after 1 day and 1 week, but the PR%s of 1 month groups among TD/AS, TD/DW and DW/AS were not significantly different. The SEM photograph of TD/AS group displayed that the dentin surface was densely covered with mineral deposits. Ca and phosphate ions from the artificial saliva could penetrate into the tubules and precipitate as hydroxyapatite, resulting in the reduction in permeability.

Effect of erosive and abrasive stress on sealing ability of different desensitizers: In-vitro study

This in vitro study examined the sealing ability of different desensitizing agents under a chemo-mechanical stress condition. For the study, a total of 144 extracted, caries-free human third molars were used to produce 1 mm-thick dentin discs. The specimens were divided randomly into four groups: Superseal (SS), Gluma (GL), Gluma Self-etch (GS), and Tooth Coat (TC). For each group, the permeability was measured before and after applying the desensitizer, after being exposed to Coca Cola for 5 minutes, and after 3150 strokes of a brushing abrasion. The decrease in permeability after the erosive and abrasive stress was analyzed by ANOVA and Tukey post hoc test. As a result, the dentin permeability decreased significantly for all desensitizers immediately after application (p < 0.05). SS and GS showed a significant difference in permeability reduction observed immediately after application and after acid action with Coca Cola (p < 0.05). After brushing abrasion, the permeability reduction decreased significantly for all desensitizers tested in this study (p < 0.05). TC showed the largest decrease in dentinal permeability compared to that of the other desensitizers and the differences were significant after brushing abrasion (p < 0.05). All tested desensitizers were effective in reducing dentin permeability. The behavioral characteristics under erosive and abrasive stress varied according to the products used. TC exhibited excellent sealing ability among the other desensitizers.

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.

Novel treatment of in-office tooth bleaching sensitivity: A randomized, placebo-controlled clinical study

OBJECTIVES

Aim of this clinical trial was to investigate the effect of a calcium phosphate based desensitizer paste applied prior to in-office tooth whitening on bleaching sensitivity (BS).

METHODS

This crossover study was designed as randomized double-blinded, placebo-controlled trial. The desensitizer paste Teethmate AP (TAP) contains tetracalcium phosphate and dicalcium phosphate anhydrous in glycerol and polyethylene glycol, whereas placebo (PLA) is a calcium phosphate free analog. Fifty patients with sound maxillary incisors and canines were enrolled. Tooth shades were determined with a Vitapan Classic Shade guide. Randomly, TAP and PLA were applied to the left or to the right anterior teeth. After rinsing and air-drying the bleaching gel (Opalescence Boost PF 40%) was applied and left on the labial surfaces for 15 minutes. Sensitivity was recorded using a 10 cm visual analog scale (VAS) before, at 5, 10, and 15 minutes during, and at 1 hour, 1, 2, and 7 days after bleaching. Tooth whitening was determined with the shade guide after 1 day and 1 week.

RESULTS

Prebleaching desensitization with TAP reduced BS significantly when compared with PLA. Between 1 and 7 days the average sensitivity scores were close to zero, whereas the average scores for PLA were significantly higher during this time interval. Independent from the desensitizing treatment after 1 and 7 days the medians of the shades were between 5 and 3.5 units brighter.

CONCLUSIONS

Prebleaching desensitization with TAP was effective in reducing BS during and after tooth whitening treatment and had no adverse effect on the bleaching result.

CLINICAL SIGNIFICANCE

Prebleaching topical application of a calcium phosphate containing compound reduced significantly bleaching sensitivity during a single 15 minutes treatment and up to one week with a 40% hydrogen peroxide containing gel without compromising tooth whitening.

Effect of two desensitizing agents on dentin permeability in vitro

Objective

The aim of this in vitro study was to investigate the effect of two desensitizing agents and water on hydraulic conductance in human dentin.

Material and Methods

GLUMA Desensitizer PowerGel (GLU) contains glutaraldehyde (GA) and 2-hydroxyethyl methacrylate (HEMA), and Teethmate Desensitizer (TD) is a powder comprising tetracalcium phosphate (TTCP) and dicalcium phosphate anhydrous (DCPA) that is mixed with water. Deionized water was used as a negative control (CTR). Thirty discs with a thickness of 1.2 mm were cut from the coronal dentin of the third molars and cleaned with 0.5 M EDTA (pH 7.4). After being mounted in a split-chamber device, the discs were pressurized with water at 1 kPa and 3 kPa in order to measure flow rates with a highly sensitive micro-flow sensor and to calculate hydraulic conductance as a baseline value (BL). Following the application of GLU, TD, and CTR (n=10), hydraulic conductance was remeasured with intermittent storage in water after 15 min, 1 d, 1 w, and 1 m. Reduction in permeability (PR%) was calculated from hydraulic conductance. Data were statistically analyzed using nonparametric methods (α<0.05). Representative discs were inspected by SEM.

Results

PR% for GLU and TD were 30-50% 15 min and 1 m after their application. Post hoc tests indicated that PR% of CTR was significantly greater than those of GLU and TD at all time points tested. The PR% of GLU and TD were not significantly different. SEM examinations showed noncollapsed collagen meshes at the tubular entrances after GLU, and crystalline precipitates occluding the tubular orifices after TD, whereas CTR specimens showed typical patterns of etched dentin.

Conclusions

The present study on hydraulic conductance in dentin discs treated with two chemically different desensitizing agents and water as a control demonstrated that both products may be characterized as effective.

Effects of a Dicalcium and Tetracalcium Phosphate-Based Desensitizer on In Vitro Dentin Permeability

The present study evaluated the effectiveness of a dicalcium and tetracalcium phosphate-based desensitizer in reducing dentin permeability in vitro. Dentin fluid flow was measured before and after treatment of dentin with patent dentinal tubules using 1 or 3 applications of the dicalcium and tetracalcium phosphate containing agent TeethmateTM (TM) and comparing the results with two sodium fluoride varnishes VellaTM (VLA) and VanishTM (VAN), after storage in artificial saliva for 24 h, 48 h and 7 days. Significant differences were observed among the 4 methods employed for reducing dentin permeability (p < 0.001) and the 3 post-treatment times (p < 0.001). VLA and VAN never achieved 50% permeability reductions consistently in any of the 3 time periods. Only the calcium phosphate-based desensitizer applied for 3 times consistently reduced dentin permeability by 50% after 24 h. When applied once, the permeability reduction of TM increased progressively over the 3 time periods. After 7 days, only one and three applications of the calcium phosphate-based desensitizer consistently reduced dentin permeability by more than 50%. Permeability reductions corresponded well with scanning electron microscopy examination of dentinal tubule orifice occlusion in dentin specimens treated with the agents. Overall, the dicalcium and tetracalcium phosphate-based desensitizer is effective in reducing dentin permeability via a tubule occlusion mechanism. The ability of the agent to reduce dentin permeability renders it to be potentially useful as a clinical dentin desensitizing agent, which has to be confirmed in future clinical studies. By contrast, the two sodium fluoride varnishes are not effective in dentin permeability reduction and should be considered as topical fluoride delivering agents rather than tubular orifice-blocking agents.

Di-Calcium Phosphate and Phytosphingosine as an Innovative Acid-Resistant Treatment to Occlude Dentine Tubules

The present investigation evaluated the ability of an experimental di-calcium phosphate (DCP) desensitising agent used alone or combined with phytosphingosine (PHS) to occlude dentine tubules and resist a citric acid (CA) or artificial saliva (AS) challenge. Three groups of human dentine specimens (DS) were treated with the following: (1) PHS alone, (2) DCP or (3) a combination of PHS and DCP. Dentine hydraulic conductance of DS was evaluated using a digital flow sensor at 6.9 kPa. The average fluid volume for each of the treated DS was used to calculate the total dentine permeability reduction (%P) prior to and following CA immersion for 1 min or AS immersion for 4 weeks. The treated DS were subjected to both scanning electron microscopy (SEM) and Fourier transform infrared (FTIR) spectroscopy analysis. Statistically significant differences (%P) were identified between the groups by ANOVA and Fisher's multiple comparison test (p < 0.05), respectively. Interestingly, both PHS and DCP appeared to work synergistically. DS treated with DCP or PHS/DCP demonstrated a significant reduction (%P) prior to and following CA or AS challenge (p < 0.05). Both the SEM and FTIR analyses showed consistent brushite crystals occluding the dentine tubules. Conversely, the application of PHS alone failed to demonstrate any significant reduction of dentine permeability (p > 0.05) or show any evidence of occlusion of the dentine tubules. DCP can be used alone or combined with PHS to decrease the dentine permeability as well as to resist a CA and AS challenge. These results would, therefore, suggest that DCP may be a suitable treatment option for dentine hypersensitivity.

Efficacy of a bioactive material and nanostructured desensitizing on dentin hypersensitivity treatment

Abstract Introduction Dentin hypersensitivity is a frequent occurrence in dental practice. It is clinically characterized by acute, short, and temporary pain in response to mechanical, chemical, thermal, or osmotic stimuli resulting from dentin exposure. Objective To compare in vivo the effect of an experimental crystalline bioactive material and nanostructured desensitizing on the pain assessment among patients with cervical dentin hypersensitivity. Material and method Thirty patients were selected for this study, who were randomly assigned to two groups (n=15) in a split-mouth design. Each patient received two treatments: group 1 (fluoride gel and bioactive material) and group 2 (fluoride gel and nanostructured desensitizing). Pain analyses were performed using a visual analogue scale, ranging 0-10. Baseline pain measurement was performed prior to initial treatment (T0) and new measurements were carried out weekly for 3 weeks (T1, T2, and T3) before materials were reapplied. Final pain analysis was performed 3 months after initial treatment (T4). Degree of pain reduction was calculated using the formula T0 - Tperiod after treatment. The data of the pain measurements were analyzed using 2-way repeated measure ANOVA and Tukey’s test (α=0.05). Result Regardless of evaluation period, there was no statistical difference on pain reduction between the treatments (p>0.05). The degree of pain was reduced significantly in each evaluated period for all tested treatments (p<0.05), by approximately three degrees after 3 months. Conclusion The tested desensitizing materials were effective on dentin hypersensitivity reduction.

Microleakage in Class V Composite Restorations after Desensitizing Surface Treatment with Er:YAG and CO2 Lasers

Aims: Glutaraldehyde, CO₂ and Er:YAG lasers can be used for treatment of dentin hypersensitivity. However, their application may have adverse effects on the clinical service of restorations. This study aimed to assess the microleakage in composite restorations following surface treatment with Glutaraldehyde desensitizer, CO₂ and Er:YAG laser irradiation for treatment of dentin hypersensitivity. Materials and methods: This experimental study was conducted on 60 extracted sound human teeth. Class V cavities were prepared measuring 3×3 mm using a diamond bur. Specimens were randomly divided into 4 groups of 15. Group one:no surface treatment, Group two:applying Glutaraldehyde desensitizer, Groups of three and four were irradiated with CO₂ and Er:YAG lasers, respectively. Surfaces were restored with bonding agent (Single Bond 2, 3M, USA) and Z250 composite (3M, USA). Specimens were thermocycled and immersed in 1% methylene blue solution for 24 hours. Microleakage scores were assessed under a stereomicroscope at ×20 magnification. Data were analyzed using SPSS and the Kruskal Wallis test (P=0.05). Results: There was no significant difference between microleakage of groups in enamel margins (P=0.694). The difference in microleakage at the dentin margin was significant between groups (P=0.018). Conclusions: Application of Glutaraldehyde-desensitizer and CO₂ laser irradiation of surfaces prior to composite restoration do not increase microleakage at the enamel or dentin margins but tooth surface treatment with Er:YAG laser significantly increased the microleakage at the dentin margins.

Randomized, placebo-controlled study of the efficacy of a calcium phosphate containing paste on dentin hypersensitivity

OBJECTIVE

Hypersensitivity of non-carious cervical lesions (DH) is a frequently encountered disease. This randomized, controlled, single-blind crossover study evaluated the effectiveness of a calcium phosphate containing desensitizer paste (TAP) on DH in comparison to water as placebo (PLA).

METHODS

In this clinical trial 35 patients were randomly assigned to the test and the negative control group. Using a 10cm long VAS (visual analog scale) patients should respond with DH score >6 on one tooth in each of two quadrants for allocation. Pain stimuli were a 2-seconds air blast (AB) and probe scratching (PS) of the exposed dentin. VAS scores were determined pre-operatively (PRE), immediately after treatment (POST), at 1 week, 1, 3 and finally after 6 months.

RESULTS

Both TAP and PLA applications decreased DH significantly at POST and throughout the 6-months recalls (p<0.001). Pain reductions upon AB stimulation of TAP treated teeth, assessed at POST and 6 months were 35 and 55%, upon PS stimuli 21 and 54%, respectively. PLA treated lesions responded to AB at POST and after 6 months with 20 and 36% pain reduction, to PS with 11 and 30% pain reduction, respectively. Differences between TAP and PLA pain scores were statistically significant at all recalls (p<0.05).

SIGNIFICANCE

TAP paste reduced DH successfully during this 6-months trial. The calcium phosphate crystallites included in the paste and the presumed hydroxyapatite precipitates upon exposure to saliva were hypothetically able to occlude open dentinal tubules, at least to some extent. TAP is considered a biocompatible desensitizer paste.