A double blind controlled trial comparing three treatment modalities for dentin hypersensitivity

A Comparative Study on the Safety and Efficacy of Erbium Laser Therapy Versus Traditional Treatments in Managing Dentin Hypersensitivity: An Observational Study

Background This study aimed to explore the potential efficacy and safety of laser therapy compared with traditional desensitizing treatments in the management of dentin hypersensitivity. Methodology A comprehensive observational study was conducted on 138 adult individuals aged 18-65 diagnosed with dentin hypersensitivity. Participants were allocated to either the laser therapy or traditional treatment group. The laser therapy group received treatment using the Fotona LightWalker® Erbium laser at 2,940 nm. The energy density was set at 20 J/cm² using continuous and contact modes, with the laser tip held perpendicularly to the irradiated site. Each session lasted five minutes, conducted bi-weekly for three months. Traditional treatment included the in-office application of 5% sodium fluoride varnish application once every 15 days for three months and the use of desensitizing toothpaste as part of regular oral hygiene routines. Follow-up assessments were conducted 6 and 12 months post-treatment to evaluate the longevity and stability of the treatment effects. Primary outcomes were assessed by dentin hypersensitivity reduction measured using Visual Analog Scale (VAS) scores and tactile hypersensitivity assessments. Results Laser therapy consistently surpassed traditional treatment in reducing dentin hypersensitivity, as reflected by the significantly lower VAS scores. Notably, at 3, 6, and 12 months, laser therapy demonstrated mean VAS scores of 2.5 (±1.5), 1.2 (±0.9), and 0.6 (±0.5), respectively, while the traditional treatment group exhibited higher scores (3.8 ± 1.2, 4.5 ± 1.0, and 4.0 ± 0.7, respectively). Statistical analysis revealed that these differences were highly significant (p < 0.001). Tactile hypersensitivity assessments echoed these findings, with laser therapy consistently maintaining lower scores (0.8 ± 0.7 at 6 months, 0.4 ± 0.3 at 12 months) compared to traditional treatment (3.5 ± 1.0 at 6 months, 4.0 ± 0.7 at 12 months) with statistical significance at all time points (p < 0.001). Conclusions Although this study lacks a randomized controlled design, the observed substantial reduction in VAS scores and tactile hypersensitivity assessments, along with the favorable safety profile of laser therapy, suggest its potential as an effective alternative for managing dentin hypersensitivity.

Influence of Er:YAG and ND:YAG laser irradiation and fluoride application on surface roughness and dentin surface wear after erosive challenge - An in vitro study

Background

To evaluate the effectiveness of Er:YAG and Nd:YAG laser on dentin hypersensitivity prevention, associated or not to acidulated phosphate fluoride (APF) after erosive challenge.

Material and Methods

104 specimens were obtained from bovine dentine and divided into groups (n=13): G1: Er:YAG; G2: Er:YAG followed by application of APF; G3: application of APF followed by Er:YAG, simultaneously; G4: Nd:YAG; G5: Nd:YAG followed by application of APF; G6: application of APF followed by Nd:YAG, simultaneously; G7:application of APF; G8: untreated. The parameters for Er:YAG were:10s, distance of 4mm, water cooling flow of 2mL/min, 2Hz, 3.92J/cm2. For the Nd:YAG: 10s, distance of 1mm, without cooling, 10Hz, 70.7J/cm2. The erosive drink was a cola at 4°C, 3×/day for 1 minute, for 5 days. Roughness and wear analysis were done in confocal laser microscope. Data were statistically analyzed (α=0.05).

Results

As regards roughness, there was no statistically difference among the groups. The groups irradiated with Er:YAG had a volume loss lower. G6 showed higher values than the groups irradiated with Er:YAG and lower than the other groups. The other groups irradiated with Nd:YAG showed similar wear results to the control.

Conclusions

The Er:YAG laser showed the lowest volume loss from wear analysis, suggesting the increased the acid resistance of dentin. Key words:Dentine sensitivity, Lasers, Sodium fluoride.

Effect of Iontophoresis on the Effectiveness of Nano-Hydroxyapatite and Pro-argin in In-Office Treatment of Dentin Hypersensitivity: A Split-Mouth Randomized Clinical Trial

Background and objectives Dentin hypersensitivity (DH) treatment is one of the main challenges dentists face in their daily clinical practice. Current therapies provide only temporary relief and require multiple applications to exhibit results, and there is a lack of evidence related to the long-term effects of these agents. Nano-hydroxyapatite (n-HA) and pro-argin (8.0% arginine-calcium carbonate) have recently been used for dentin desensitization with a one-time in-office application, but the effects are interim. However, a standard treatment protocol demands definitive or enduring results. Since iontophoresis amplifies the transport of neutral and ionized drugs across a membrane, the use of these desensitizing agents with iontophoresis may be beneficial to accomplish satisfactory results. This study was conducted to evaluate whether iontophoresis could enable better penetration of nano-hydroxyapatite and pro-argin into the dentin, enhancing and prolonging their therapeutic effect. Materials and methods Forty-five participants with dentin hypersensitivity in the age group of 20 to 60 years were included. In each individual, four teeth with cervical lesions (one from each quadrant) were selected and divided randomly into four groups: group I: desensitizing paste containing nano-hydroxyapatite, group II: desensitizing paste containing nano-hydroxyapatite with iontophoresis, group III: desensitizing paste containing pro-argin, and group IV: desensitizing paste containing pro-argin with iontophoresis; followed by one-time application of the agents. Sensitivity was assessed by tactile, air blast, and cold-graded thermal tests (CGTTs) before and immediately after application, after one week, and at the end of the first, third, and sixth months. Statistical analysis Statistical analysis was done by repeated measures ANOVA for within-group comparison. Intergroup comparison was done using one-way ANOVA and Tukey's post-hoc test. Results All the groups showed a statistically significant reduction in dentin hypersensitivity (p<0.001). The reduction in hypersensitivity in various groups can be graded as group II (3.578/1.800/1.556) > group IV (3.367/1.755/1.555) > group I (2.3781/1.022/0.822) > group III (2.222/0.911/0.778) as evaluated by tactile, air blast, and cold-graded thermal tests, respectively. Group II and group IV presented a significant reduction in sensitivity levels consistent for up to six months. Conclusion Nano-hydroxyapatite and pro-argin can be used effectively for reducing dentin hypersensitivity. Iontophoresis can be a valuable adjunct for their improved delivery, enhancing and prolonging their effectiveness.

Evaluation of Propolis Hydrogel for the Treatment of Dentinal Sensitivity: A Clinical Study

BACKGROUND

Propolis is a natural resinous substance collected by honeybees, chiefly from buds and the leaves, branches, and bark of trees. Its role as a wound-healing gel has been studied, but the use of a propolis hydrogel in the treatment of dentinal hypersensitivity has not been evaluated. Dentin hypersensitivity (DH) is commonly treated via iontophoresis using fluoridated desensitizers. The aim of the present study was to compare and evaluate the effects of a 10% propolis hydrogel, 2% sodium fluoride (NaF), and 1.23% acidulated phosphate fluoride (APF) when used in conjunction with iontophoresis for the treatment of cervical dentin hypersensitivity (DH).

METHODS

Systemically healthy patients complaining of DH were selected for this single-centre, parallel, double-blind randomized clinical trial. Three substances were selected as desensitizers for study in the present trial: a 10% propolis hydrogel, 2% sodium fluoride, and 1.23% acidulated phosphate fluoride, all in conjunction with iontophoresis. Any decrease in DH following the application of specific stimuli was assessed at baseline, before and after application, on the 14th day following use, and on the 28th day following the intervention.

RESULTS

Intra-group comparisons show diminished values of DH at maximum post-op follow-up intervals which were significantly trimmed down from the baseline (p < 0.05). The 2% NaF demonstrated a significant reduction in DH over 1.23% APF and the 10% propolis hydrogel (p < 0.05). However, there was no statistically significant difference in the mean difference between the APF and propolis hydrogel groups assessed via tactile, cold, and air tests (p > 0.05).

CONCLUSION

All three desensitizers have proved to be useful when used in conjugation with iontophoresis. Within the limitations of this study, a 10% propolis hydrogel can be used as a naturally occurring alternative to commercially available fluoridated desensitizers.

The effect of iontophoresis delivery of fluoride in stannous fluoride desensitizing toothpaste on dentin permeability in human extracted teeth

This study aimed to determine the effect of iontophoresis delivery of fluoride in stannous fluoride (SnF₂) toothpaste on dentin permeability in human extracted third molars. For dentin permeability test, 26 dentin specimens were randomly divided into 4 groups; SnF₂ without-iontophoresis (n = 10), SnF₂ with-iontophoresis (n = 10), no SnF₂ without-iontophoresis (n = 3), and no SnF₂ with-iontophoresis (n = 3). The hydraulic conductance of dentin (HD) was measured after smear layer removal, immediate treatment, 7 days, and acid challenge. The other 26 specimens were also prepared under these different conditions to assess degree of dentinal tubule occlusions using scanning electron microscopy (SEM). Percentage decrease of HD in SnF₂ without-iontophoresis after immediate treatment, 7 days and acid challenge were 38.38 ± 13.61, 56.92 ± 17.22 and 33.07 ± 23.57%. The corresponding values in SnF₂ with-iontophoresis were 42.16 ± 14.49, 62.35 ± 15.67 and 50.01 ± 12.60%, respectively. There was a significant difference between without- and with-iontophoresis groups after acid challenge (p < 0.05). For SEM, after 7 days, SnF₂ with-iontophoresis showed deeper dentinal tubule occlusion (p < 0.05) and more resistance to acid challenge than SnF₂ without-iontophoresis. No significant change was observed in groups of no SnF₂ treatment. Cathode iontophoresis could enhance the effect of SnF₂ toothpaste in decreasing dentin permeability and increasing resistance to acid challenge.

The effect of fluoride iontophoresis on seal ability of self-etch adhesive in human dentin in vitro

Background

Fluoride iontophoresis (FI) is a non-invasive method for the transfer of fluoride ions under electrical pressure into dental hard tissue. This study aimed to determine the effect of FI on the seal ability of self-etch adhesive in human dentin using dentin permeability test and scanning electron microscopy (SEM).

Methods

The experiments were divided into 2 series: series 1 was performed on 28 extracted intact third molars and series 2 was performed on 28 extracted carious third molars (ICDAS 4 and 5). In each series, 20 teeth were used for dentin permeability test and 8 teeth were used for SEM study. For dentin permeability test, the specimens were divided into dentin without FI (control) and dentin with FI (experimental) subgroups. Hydraulic conductance (HD) of dentin was measured before and after adhesive treatment, and calculated for the percentage decrease of HD in each subgroup. Two-way ANOVA and Tukey test were used for statistical analysis. SEM study was used to assess the seal ability of self-etch adhesive and penetration of fluoride ions into dentinal tubules.

Results

HD after self-etch adhesive treatment reduced by 57.75 ± 17.99% in intact dentin with FI, 46.60 ± 17.03% in intact dentin without FI, 45.00 ± 15.30% in caries affected dentin without FI, and 37.28 ± 14.72% in caries affected dentin with FI. There was no significant difference in percentage decrease of HD between dentin without FI and dentin with FI (P = 0.742); meanwhile, intact dentin with FI had significant greater percentage decrease than caries affected dentin with FI (P < 0.05). SEM findings showed FI produced more particle formation and deeper precipitation in intact dentin than those in caries affected dentin.

Conclusions

FI did not affect the seal ability of self-etch adhesive in human dentin when compared to without FI. However, FI could augment the seal ability of the self-etch adhesive in intact dentin better than that in caries affected dentin.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02146-w.

Comparison of the Effectiveness of Combined Diode Laser and GLUMA Bonding Therapy With Combined Diode Laser and 5% Sodium Fluoride Varnish in Patients With Dentin Hypersensitivity

Introduction: Dentin hypersensitivity (DH) is one of the most common complaints of patients referred to a dental office, so this study aimed to compare the effectiveness of combined diode laser and GLUMA bonding therapy with combined diode laser and 5% sodium fluoride varnish in patients with DH. Methods: Sixty patients were divided into three groups (bonding, laser-bonding, laser-varnish), and before the intervention, the amount of DH was measured with the visual analogue scale (VAS) scale. In the bonding group, GLUMA Desensitizer solution was applied and then air-dried. In the bonding-laser group, first bonding was used, and then the affected tooth was irradiated with a diode laser. In the varnish-laser group, 5% sodium fluoride varnish was coated and then the laser was irradiated with the said method. DH was measured immediately after the treatment and then 2, 7 and 30 days after the treatment. Results: Laser-varnish treatment was not different from laser-bonding treatment at all measurement times (P=1). Laser-varnish and bonding treatment were not significantly different up to one week after the intervention, but on the 30th day after the intervention, the difference in pain was significant (P=0.01). There was no significant difference in laser-bonding treatment up to one week after the intervention, but on the 30th day after the intervention, the difference in pain was significant (P=0.003). Conclusion: The combined treatment with GLUMA bonding and the 660 nm diode laser is effective in reducing DH and this is more effective than GLUMA bonding alone in the long term. However, it does not have a significant advantage over the combined varnish-laser method, but it seems that due to its ease of use, it can be a suitable alternative to the varnish-laser method.

A randomized clinical trial of dentin hypersensitivity reduction over one month after a single topical application of comparable materials

Dentinal hypersensitivity (DH) is a condition that causes patient discomfort. To evaluate the clinical efficacy of Gluma, fluoride varnish and Tetric N-Bond self-etch system in relieving DH immediately and over 30 days following a single topical application. The present randomized clinical trial was conducted on 55 patients with an age range 20–49 years. 70 teeth in total were incorporated and randomly assigned to the three groups. Parameters examined were: Tactile, air blast, and cold stimuli. VAS was used to assess tactile stimulus whereas the Schiff Cold Scale for air blast and cold stimuli. DH was evaluated immediately, at two weeks and 1 month follow up. Gluma showed a statistically significant reduction in DH scores over other materials. It was concluded that Gluma have statistically significant results over other materials in relieving DH immediately and over 30 days following a single topical application.

Trial Registration: Clinical Trials.gov Identifier: NCT04351412, King Abdulaziz University Protocol Record 129-09-19. Registered 17 April 2020 – Retrospectively registered. http://ClinicalTrials.gov/NCT04351412.

Shockwave application enhances the effect of dentin desensitizer

OBJECTIVES

The purpose of this study was to develop a new device that can improve the effect of desensitizer using shockwaves and to verify its efficacy.

METHODS

A micro-shockwave generator was developed using a piezoelectric actuator (PIA-1000, piezosystem jena GmbH, Jena, Germany), an Arduino Uno microcontroller (Arduino, Torino, Italy), and a high voltage pulser (HVP-1000, piezosystem jena GmbH) at 700 V (400 A) and 100 μs. The occlusal surfaces of 20 extracted human upper and lower third molars without caries or restoration were reduced to expose the occlusal dentin, and the prepared occlusal surfaces were acid-etched with 32% phosphoric acid to remove the smear layer. The tooth specimens were connected to a fluid flow measurement instrument (nanoFlow, IB SYSTEMS, Seoul, Korea), permeability through dentin via dentinal fluid flow (DFF) was measured for 300 s, and the average DFF rate (Baseline DFF rate) was calculated. A desensitizer (SuperSeal, Phoenix Dental, Fenton, MI, USA) was applied to the acid-etched occlusal dentin surface of 10 randomly selected tooth specimens, left for 10 s, and rubbed with a microbrush for 30 s (Group 1). For the remaining teeth, the desensitizer was applied, and a shockwave (100 μm stroke, 10,000 G) was applied for 10 s (2 shots/s) and rubbed with a microbrush for 30 s (Group 2). After desensitizer application, subsequent DFF was measured for 600 s, and the average DFF rate was calculated (post-application DFF rate). DFF was continuously measured in real-time at 25 ± 0.5 ℃ under a hydrostatic pressure of 25 cm. The percentage reduction in DFF rate after desensitizer application (with or without shockwave) was calculated with respect to baseline DFF rate. Data were analyzed with independent t-test (α = 0.05).

RESULTS

For all tooth specimens, DFF rate decreased after desensitizer application irrespective of the presence of shockwaves. The percentage reduction in DFF rate of SuperSeal with shockwave (Group 2) was 42.8 ± 19.0%, which was significantly higher than the 26.2 ± 13.6% of the SuperSeal only group (Group 1) (p < 0.05).

SIGNIFICANCE

Measurement of DFF change in real-time shows that shockwaves can help reduce dentin permeability beyond that SuperSeal dentin desensitizer produced alone.

Evaluation and Comparison of Efficacy of Gluma® and D/Sense® Desensitizer in the Treatment of Root Sensitivity Induced by Non-Surgical Periodontal Therapy

BACKGROUND:

Dentinal hypersensitivity is one of the most common sequels of non-surgical periodontal therapy. Resulted discomfort may restrain patients from oral hygiene maintenance, thus affects the long-term success of periodontal therapy. So, it becomes a prime concern of the clinician to manage the post-operative hypersensitivity.

AIM:

This clinical investigation aimed to evaluate and compare the efficacy of D/Sense^® and Gluma^® in preventing post-operative sensitivity after non-surgical periodontal therapy.

MATERIAL AND METHODS:

The present randomised, double-blind, split-mouth study was conducted on forty-five (22 male, 23 female) systemically healthy patients, with the mean age of 40 ± 17.5 years. Visual Analogue scale was used to evaluate root sensitivity after application of tactile and cold stimuli at baseline, 1, 2, 4 and 6 weeks after scaling and root planing. After scaling and root planning, the sites were randomly divided into different groups for the application of desensitising agents. Collected data were analysed by using, analysis of variance (ANOVA) for inter-group and paired t-test for intra-group comparisons.

RESULTS:

No adverse or side effects were reported by any of the patients throughout the study period. Gluma^® showed a statistically significant reduction in the VAS score for root sensitivity as compared to D/Sense^®, at 1, 2- and 4-weeks follow-up period (p < 0.05). Whereas, at 6th-week follow-up, both the solution showed almost similar score for root hypersensitivity. Intragroup comparison for D/Sense^® revealed a significant difference in scores from baseline to all intervals (p < 0.05), except baseline to 6 weeks (p > 0.05). Whereas Gluma^® showed a significant difference in scores from baseline to 2nd-week follow-up (p < 0.05).

CONCLUSION:

The result of the present investigation revealed that application of Gluma® resulted in better control on iatrogenic root hypersensitivity as compared to the D/Sense^® during the initial follow-up period.

Comparative evaluation of neodymium-doped yttrium aluminum garnet laser with nanocrystalline hydroxyapatite dentifrices and herbal dentifrices in the treatment of dentinal hypersensitivity

Background

The aim of this study was to compare and evaluate the efficacy of neodymium-doped yttrium aluminum garnet laser with and without herbal and nanohydroxyapatite dentifrices in management of dentinal hypersensitivity (DH).

Materials and Methods

A total of 180 patients who responded to air-blast test and cold-water test using verbal rating scale (VRS) were included in this study. The patients were randomly assigned to six groups (n = 30): control group (CG), scaling and root planning (SRP) + nanocrystalline hydroxyapatite dentifrices, SRP + nanocrystalline hydroxyapatite dentifrices + laser, SRP + herbal dentifrices, SRP + herbal dentifrices + laser, and SRP + laser. Each group was evaluated at baseline, 1 week, 1 month, and 6 months. In every visit of each patient, their clinical examination was done.

Results

Among all groups', repeated ANOVA measures and Kruskal-Wallis test was performed in which laser groups showed maximum reduction in DH in all indices while the CG showed minimum reduction in DH. The VRS values showed maximum reduction in SRP + nanocrystalline hydroxyapatite dentifrices + laser group with mean of 0.3 ± 0.5 and minimum reduction in CG with mean of 3.0 ± 0.5 (P < 0.001).

Conclusion

Among all the groups, SRP + Nanocrystalline hydroxyapatite + Laser can be an effective treatment modality for DH.

Selected Medicines Used in Iontophoresis

Iontophoresis is a non-invasive method of systemic and local drug delivery using an electric field. Iontophoresis enables diffusion of the selected drug via skin, mucosa, enamel, dentin, and other tissues. The amount of delivered therapeutic molecules is about 10⁻2000 times greater than conventional forms of delivery. Among other fields, this method is used in dentistry, ophthalmology, otorhinolaryngology, and dermatology. According to related literature, the most important drugs studied or administered by iontophoresis are: Local anesthetics, opioids, steroids, non-steroidal anti-inflammatory drugs, antibacterial drugs, antifungal drugs, antiviral drugs, anticancer drugs, fluorides, and vitamins. The present review covers current available data regarding the selected medicines used in iontophoresis. Furthermore, indications and conditions of iontophoresis application are reviewed.

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.

Observations on dentine hypersensitivity in general dental practices in the United Arab Emirates

Dentine hypersensitivity is a common clinical finding with a wide variation in prevalence values and etiological factors. The objective of this cross-sectional study was to investigate the prevalence and some etiological factors of dentine hypersensitivity of Emirati patients visiting general dental clinics in the United Arab Emirates (UAE) over a period of three calendar months.

MATERIALS AND METHODS

Six general dental practitioners examined 204 Emirati patients over a period of three calendar months and patients who had dentine hypersensitivity diagnosed were questioned further about their smoking habits and the frequency, severity, and duration of their pain. Furthermore, cervical tooth surface loss was noted.

RESULTS

A total of 55 patients were diagnosed as having dentine hypersensitivity, giving a prevalence figure of 27%. The most common teeth affected were the lower anterior teeth.

CONCLUSIONS

The prevalence of dentine hypersensitivity in Emirati patients visiting a general dental clinic in the UAE was 27%. The most common etiology appeared to be the loss of cervical tooth surface structure.

The efficacy of 8% Arginine-CaCO₃ applications on dentine hypersensitivity following periodontal therapy: a clinical and scanning electron microscopic study

Objectives: Periodontal therapy is one of the etiological factors of dentine hypersensitivity (DH). This study aimed to evaluate the efficacy of %8Arginine-CaCO3 on DH that affects patients after periodontal treatment. Study design: Seventy-one teeth from the volunteers (n=36) with history of DH caused by periodontal therapy were included in this study, and randomly divided into two groups: group-1, who received 8%Arginine-CaCO3 and group-2, who received 1.23%NaF-gel. The clinical indices were recorded at first visit.DH was evaluated by using tactile, air-blast, and thermal stimuli. The subject’s response was recorded at baseline, immediately (Day-0) and one month after the application. Results and conclusions: The results were statistically analyzed, and it was found that 8% Arginine-CaCO3 treatment was more effective than 1.23% NaF-gel at time intervals. Sensitivity score differences between the groups were statistically significant at Day-28. The 8% Arginine-CaCO3 group exhibited statistically significant reduction in DH on three stimuli at baseline to Day-28. It was concluded that 8% Arginine-CaCO3 is more effective than 1.23% NaF-gel in reduction of patients’ pain.

Key words:Arginine, desensitizing agent, hypersensitivity, periodontal treatment, scaling and root planning, sodium fluoride.