Clinical Evaluation of Different Delivery Methods of At-Home Bleaching Gels Composed of 10% Hydrogen Peroxide

OBJECTIVES:

This study aimed to compare the tooth sensitivity, gingival irritation, and bleaching efficacy of at-home whitening performed with 10% hydrogen peroxide (HP) using a conventional tray-delivered system or two different bleaching systems (strips or prefilled disposable trays).

METHODS AND MATERIALS:

Sixty patients, with maxillary incisors darker than A2 were selected for this single-blind, parallel randomized clinical trial. Teeth were bleached during 14 days with a 30-minute gel contact with teeth per day. The 10% HP was delivered in a bleaching tray (White Class, FGM) in strips (White Strips, Oral-B) or prefilled disposable trays (Opalescence Go, Ultradent). The color changes were evaluated by subjective (Vita Classical and Vita Bleachedguide) and objective (Easyshade Spectrophotometer) methods at baseline and 30 days after the second bleaching session. Tooth sensitivity was recorded during 14 days with a five-point numeric rating scale (NRS) and 0-10 visual analog scale (VAS). The risk of gingival irritation was also recorded during 14 days on a dichotomous scale. All data were submitted to appropriate statistical analysis (α=0.05).

RESULTS:

No significant difference was observed in the risks of tooth sensitivity among groups ( p>0.09). However, the conventional bleaching tray produced a higher intensity of tooth sensitivity when compared with the strips and prefilled disposable tray systems ( p<0.04). Regarding gingival irritation, the prefilled disposable tray system showed a lower risk of gingival irritation when compared with the conventional bleaching tray ( p=0.003). Significant whitening was observed in all groups after 30 days of clinical evaluation with no significant difference between them ( p>0.06).

CONCLUSIONS:

All 10% HP bleaching systems showed similar whitening after a 14-day use. However, the strips and prefilled disposable trays produced lower intensity of tooth sensitivity than the conventional bleaching tray system. The prefilled disposable tray produced lower risk of gingival irritation when compared to the conventional bleaching tray.

Survival of porcelain laminate veneers with different degrees of dentin exposure: 2-year clinical results

PURPOSE

To evaluate the clinical performance of porcelain laminate veneers (PLVs) after 2 years.

MATERIALS AND METHODS

Twenty-eight patients were treated with 125 PLVs. The experimental variables were preparation design (incisal overlap [IO] and incisal bevel [IB]) and adhesion surface (enamel [E], enamel with minimal dentin exposure [MDE], and enamel with severe dentin exposure (SDE)]. Marginal adaptation, marginal discoloration, secondary caries, postoperative sensitivity, and patient satisfaction were assessed according to the modified United States Public Health Service criteria. Each restoration was examined for fractures and debonding. In addition, gingival tissue health by gingival plaque, bleeding, and recession was recorded. An experienced clinician evaluated the restorations at baseline and after 6, 12, and 24 months, and survival rates evaluating relative and absolute failures were calculated (p = 0.05).

RESULTS

Eleven (8.8%) veneers failed, and the overall cumulative survival rate was 91.2% after 2 years of followup. IB and IO preparation designs exhibited survival rates of 94% and 85.7%, respectively, but this difference was not statistically significant (p > 0.05). PLVs bonded to SDE were more likely to fail than those bonded to E and MDE (p < 0.05). There was no significant difference between the failure rate of PLVs bonded to E and those bonded to MDE (p > 0.05).

CONCLUSIONS

PLVs have high survival rates when bonded to enamel only, as well as to enamel with minimal dentin exposure. However, extensive dentin exposure should be avoided during the preparation.

Five-year clinical performance of the dentine deproteinization technique in non-carious cervical lesions

OBJECTIVE

The aim of this study was to evaluate the 5-year clinical performance of composite restorations of non-carious cervical lesions (NCCL) using a total-etch adhesive system with or without collagen removal with 10% sodium hypochlorite (NaOCl).

METHODS

In this study randomized controlled split-mouth clinical trial, one-hundred and thirty-eight NCCL were restored into 30 patients. Each patient received at least one pair of composite restorations (Filtek A110/3M ESPE), bonded either with 2 techniques: Conventional Technique--acid etching with 37% phosphoric acid+Prime & Bond NT (Denstply DeTrey); Deproteinization Technique--acid etching with 37% phosphoric acid+10% NaOCl for 1min+Prime & Bond NT. The two techniques were evaluated using the United States Public Health Service (USPHS) criteria at baseline, 18 months, 3 and 5 years. After five years, one-hundred and six restorations were evaluated in 24 patients. Data were analyzed using the Chi-Square test (p<0.05).

RESULTS

There were no statistically significant differences between the two techniques regarding the evaluated parameters (p>0.05).

CONCLUSION

After 5 years, the application of 10% NaOCl deproteinization on etched dentine did not affect the clinical performance of composite restorations placed in NCCL when compared to the conventional total-etch technique.

CLINICAL SIGNIFICANCE

Clinical studies evaluating the performance of the Deproteinization Technique are scarce. In this study, this technique showed similar clinical performance at the end of 5 years when compared to a conventional total-etch technique.

Three-year prospective clinical performance of a one-step self-etch adhesive and a nanofiller hybrid resin composite in Class V lesions

PURPOSE

This 3-year prospective clinical study evaluated the clinical performance of a one-step self-etching adhesive (Futurabond NR) in combination with a nanohybrid composite (Grandio) for the treatment of different Class V cavities.

METHODS

122 restorations were placed in 42 patients (mean age of 54 +/- 13.2 years) evaluated according to modified Ryge-criteria at baseline, 6 months, 1, 2 and 3 years. The lesions comprised 91 Class V non-caries cervical lesions (NCCL) and 31 Class V cavities due to caries or restoration replacement. While carious lesions as well as restoration replacement required preparation of dentin, it was not roughened in case of NCCL. Macro-mechanical retention with undercuts was not used. The statistical analysis was carried out based on Bonferroni adjusted McNemar test (global alpha = 0.05) including the criteria marginal adaptation, color match, surface texture, anatomical form, retention and clinical acceptance and pain. The occurrence of secondary caries, preoperative and postoperative sensitivity was also examined.

RESULTS

After 3 years of clinical service the restorations showed a significant deterioration of all studied parameters. After 3 years, 65% of the restorations were rated as excellent or acceptable in terms of clinical acceptance, 9% appeared tolerable and 26% were rated as not acceptable which mainly resulted from restoration losses. Within the observed timeframe the retention rate decreased to 75%, which means that 30 out of the 122 restorations were partially or completely lost. There was a difference in the 3-year retention rate of NCCL (71%) and the caries/restoration replacement group (87%) but it was not statistically significant.

A randomized double-blind placebo-controlled study of the efficacy of Clinpro XT varnish and Gluma dentin desensitizer on dentin hypersensitivity

PURPOSE

To evaluate the effect of Clinpro XT Varnish (VXT) paste-liquid, resin-modified glass-ionomer and the resinous dentin desensitizing varnish and Gluma Dentin Desensitizer (Gluma) in treating dentin hypersensitivity (DH).

METHODS

This short-term (4-week) randomized, double-blind, placebo-controlled, split-mouth study included a total of 119 teeth from 31 individuals which were randomized into three groups: VXT, Gluma, and placebo (warm water). Dentin sensitivity was evaluated by subjects' perception of DH determined by pretreatment tooth sensitivity score (TSS) measured on a 0-10 visual analogue scale (VAS) after tactile (probe) or thermal/evaporative (blast of air) stimuli. TSS was scored at baseline, immediately after treatment (Day 0), after 1 week and after 4 weeks.

RESULTS

For both stimuli, mean TSS was significantly decreased in the VXT and Gluma groups at all time points (all, P < 0.001) compared with baseline. Regarding comparisons of TSS between treatment groups, the VXT group had significantly lower mean TSS compared with the Gluma group (P< 0.05) and placebo control group (P< 0.05) at all time points after treatment regardless of stimuli. Group Effect, Time Effect, and Group x Time Effect were all significantly different (all, P < 0.001).

A randomized controlled clinical trial to assess the desensitizing effect of a stannous fluoride dentifrice

PURPOSE

To assess the dentin hypersensitivity-reducing effectiveness of a 0.454% stannous-containing dentifrice as compared to a marketed negative control dentifrice after the first brushing as well as after 3 days and 2 weeks of twice daily use.

METHODS

This was a 2-week, randomized, double-blind, parallel group, single-center clinical investigation in confirmed dentin hypersensitivity adult sufferers. At baseline, subjects were stratified by age, gender, and thermal sensitivity scores, and randomly assigned to a marketed 0.454% stannous fluoride (SnF2) dentifrice or a marketed sodium fluoride (NaF) dentifrice negative control. Following baseline assessment of tactile and thermal sensitivity via the Yeaple Probe and air-blast/Schiff Air Index evaluations, respectively, subjects brushed once on-site with their assigned test product following the same usage instructions. Post-brushing tactile and thermal sensitivity were then assessed ('Immediate' evaluation). Subjects subsequently brushed twice daily at home for a 2-week period, with the same tactile and thermal efficacy evaluations repeated at Day 3 and Week 2 post-baseline.

RESULTS

All 116 enrolled subjects completed all evaluations. The stannous fluoride dentifrice provided significantly (P < 0.0001) superior dentin hypersensitivity reduction compared to the negative control dentifrice at each time point and by both evaluation measures: superior mean relative Yeaple Probe (tactile) benefits were 124.5% after one use, 203.8% after 3 days, and 222.5% after 2 weeks; and superior mean relative Schiff Air Index (thermal) benefits were 27.6% after a single use, 44.6% at Day 3, and 74.2% at Week 2. Both dentifrices were well-tolerated.

Short-term Efficacy of Agents Containing KNO3 or CPP-ACP in Treatment of Dentin Hypersensitivity

OBJECTIVE

To evaluate the short-term efficacy of agents containing KNO3 or casein phosphopeptide- amorphous calcium phosphate (CPP-ACP) in the treatment of dentin hypersensitivity.

METHODS

UltraEZ, containing KNO3 and MI Paste, containing CPP-ACP were applied in this study. The dentin hypersensitivity of 102 subjects was established by a tactile stimulus with a Yeaple preasure probe, and the degree of hypersensitivity was measured using a visual analogue scale (VAS). The patients were divided into four groups: A, B, C and D, using a random number table. UltraEZ, a placebo of UltraEZ, MI Paste, and a placebo of MI Paste were applied to group A, B, C and D respectively for 2 weeks. Dentin hypersensitivity was measured using VAS before the treatment (baseline), on day 2, 7, and 14 during the treatment, and on day 30 and 60 posttreatment.

RESULTS

The efficacy of UltraEZ on dentin hypersensitivity was significantly better than that of the corresponding placebo group on day 7 during the treatment, whereas the efficacy of MI Paste exhibited better than that of the placebo group on day 14 during the treatment. However, there were no differences between the efficacy of the two agents on day 14 during the treatment, day 30 or day 60 posttreatment.

CONCLUSION

Both UltraEZ and MI Paste had a significant effect on dentin hypersensitivity. UltraEZ showed quicker effects than MI Paste, but MI Paste had a greater sustained action after treatment than UltraEZ.

Effectiveness of desensitizing agents in relieving the pre- and postcementation sensitivity for full coverage restorations: a clinical evaluation

Patients frequently report sensitivity of prepared abutment teeth during the temporization period and after the fnal cementation of full coverage restoration. Purpose of this clinical investigation was to evaluate the effectiveness of desensitizing agents in reducing the pre- and postcementation sensitivity for full coverage restorations and to compare the relative effcacy of three in offce applied desensitizing agents in relieving the postcementation sensitivity with the use of glass ionomer luting cement.

MATERIALS AND METHODS

This study consisted of 30 patients requiring either full coverage restoration or 3 unit fxed partial denture. Total of 40 restorations (n = 40) were made and were randomly assigned into four groups comprising 10 restoration (n = 10) in each group. Group C control where no desensitizer application was done, group BB applied with BisBlock dentin desensitizer (Bisco Inc.), group ST applied with Systemp desensitizer (Ivoclar Vivadent), group GC applied with GC Tooth Mousse desensitizer (GC Asia). Desensitizer application was done immediately after the tooth preparation. Sensitivity of the tested abutment was determined by the patient response to cold, hot and bite stimuli and were recorded on visual analog scale (VAS). Sensitivity level scores was evaluated at 4 time intervals, i.e. 1 week after desensitizer application at baseline precementation appointment and others at 5 minutes, 1 day and 1 week postcementation appointment. VAS score data was statistically analyzed using one-way ANOVA followed by post hoc Tukey's test.

RESULTS

BisBlock and GC Tooth Mousse desensitizer resulted in statistically signifcant (p < 0.01) reduction in postcementation sensitivity of glass ionomer cement in comparison to Systemp desensitizer at 5 minutes, 1 week postcementation time interval with no statistical difference was seen between all desensitizer groups at 1 day postcementation. Application of BisBlock and GC Tooth Mousse desensitizer resulted in highly signifcant (p < 0.01) reduction in sensitivity level at the end of 1 week.

CLINICAL SIGNIFICANCE

Desensitizer's application on the prepared abutment teeth is considerably effective in relieving both pre- and postcementation sensitivity for full coverage restoration over the short duration of time. Immediate reduction in postoperative sensitivity relatively in a short time period may be benefcial in terms of patient's comfort. Nonetheless, multicenter long-term clinical trials should be conducted to confrm the results.

CONCLUSION

Efficacy of BisBlock and GC Tooth Mousse desensitizer was more in relieving the postcementation sensitivity of glass ionomer cement at various time intervals in comparison to Systemp desensitizer. In conclusion, application of desensitizers was beneficial to reduce the pre- and postcementation abutment sensitivity.

Efficacy of diode laser in association to sodium fluoride vs Gluma desensitizer on treatment of cervical dentin hypersensitivity. A double blind controlled trial

PURPOSE

To evaluate the desensitizing efficacy of 2% sodium fluoride solution (NaF), diode laser (DL), a DL and NaF association and a solution of hydroxyl-ethyl-methacrylate and glutaraldehyde (HEMA-G: Gluma desensitizer) in cervical dentin hypersensitivity (CDH).

METHODS

262 teeth of 24 subjects (16 females and eight males; age 21 to 64 years, mean 38 years), each having at least two CHD teeth for each quadrant, were included in this prospective, split mouth, clinical study. Teeth of each oral quadrant were randomized in four groups (SG) to study the effectiveness of NaF (SG-1), of DL (SG-2) NaF-DL combination (SG-3) and HEMA-G (SG-4). The subjects were asked to rate the sensitivity experienced during air stimulation by placing a mark on a visual analogue scale (VAS) before treatment (baseline), immediately after treatment, and after 1, and 6 months.

RESULTS

The outcomes showed a significant reduction of discomfort compared to baseline values for teeth of SG-3 immediately post treatment (82.6%) (P < 0.001), after 1 month (69.5%) (P < 0.001) and after 6 months (60.8%) (P < 0.001), respectively, compared with the reduction scores of 51.6% (P < 0.001), 29.7% (P < 0.05) and 4.7% (P > 0.05), recorded for SG-1; 72.2%, (P < 0.001), 62.5% (P < 0.001), and 47.2% (P < 0.05), recorded for SG-2; 77.4% (P < 0.001), 56.1% (P < 0.001), and 27.3% (P < 0.05), recorded for SG-4.

Comparative evaluation of diode laser, stannous fluoride gel, and potassium nitrate gel in the treatment of dentinal hypersensitivity

The aim of the present study was to compare the efficacy of diode laser (DL) with stannous fluoride and potassium nitrate gels in the treatment of dentinal hypersensitivity (DH). Fifty-four subjects, ages 25-45, having 2 adjacent teeth sensitive to air blast stimulation were included. The subjects were divided randomly into 3 groups (n= 18): Group A, subjects treated with DL; Group B, subjects treated with 0.4% stannous fluoride gel; and Group C, subjects treated with 5% potassium nitrate gel. Each group was evaluated at baseline; at weekly intervals for 2 consecutive weeks; and at 1, 3, and 6 months. All 3 groups showed decreases in the DH scores between baseline and 6 months This was more pronounced in Group A at all time intervals. When the 3 groups were compared between baseline and Week 1, there was a statistically significant decrease across all 3 groups between (P = 0.0020). The greatest difference in the DH scores between baseline and Week 1 was in Group A, compared to Groups B and C. The 940 nm DL was not only efficacious, but also brought about improved immediate relief as compared to stannous fluoride and potassium nitrate gels in the reduction of DH.

Randomized trial of the clinical efficacy of a potassium oxalate-containing mouthrinse in rapid relief of dentin sensitivity

OBJECTIVE

The aim of this randomized clinical trial was to evaluate the efficacy of a mouthrinse containing 1.4% potassium oxalate (Listerine Advanced Defence Sensitive; LADS) plus Colgate Cavity Protection Regular toothpaste, in reducing dentin sensitivity.

METHODS

This was an observer- and examiner-blinded, randomized, parallel-group, single-center, controlled, five-day clinical trial. Healthy adults were randomized (2:1:1) to LADS plus Colgate Cavity Protection Regular toothpaste, or to one of the two negative-control toothpastes alone: Crest Cavity Protection Regular or Colgate Cavity Protection Regular. The subjects carried out supervised and unsupervised brushing and rinsing twice a day. Dentin sensitivity was assessed at baseline and during treatment by Yeaple probe (tactile pressure; patient-reported discomfort by visual analogue scale [VAS]), as well as response to air blasts (VAS).

RESULTS

All sensitivity assessments were similar at baseline in the 56 randomized subjects. By the third day, the Yeaple probe sensitivity scores for subjects treated with Colgate toothpaste plus LADS improved significantly compared to Crest toothpaste alone (p < 0.05). By the fifth day, the mean scores for subjects treated with Colgate toothpaste plus LADS were significantly improved compared with subjects treated with either toothpaste alone (p < 0.05). The other sensitivity assessments showed that Colgate toothpaste plus LADS achieved statistically significant improvements compared with Colgate and/or Crest toothpaste alone from the third day.

CONCLUSIONS

The 1.4% potassium oxalate mouthrinse (LADS) was associated with a reduction in dentinal sensitivity within a five-day period. Statistically significant reductions in all sensitivity variables were achieved by Day 3 and even greater reductions in dentin sensitivity scores were observed after five days.

Adhesively restored anterior maxillary dentitions affected by severe erosion: up to 6-year results of a prospective clinical study

In case of severe dental erosion, the maxillary anterior teeth are often particularly affected. Restoring such teeth conventionally (ie, crowns) would frequently involve elective endodontic therapy and major additional loss of tooth structure. A novel, minimally invasive approach to restore eroded teeth has been developed and is currently being tested in the form of a prospective clinical trial, termed The Geneva Erosion Study. To avoid crowns, two separate veneers with different paths of insertion have been used to restore the affected anterior maxillary teeth, regardless of clinical crown length and amount of remaining enamel. This treatment is called The Sandwich Approach.

OBJECTIVES

The purpose of this case series study was to analyze the mid-term clinical outcome of maxillary anterior teeth affected by severe dental erosion that were restored following the Sandwich Approach.

MATERIALS AND METHODS

Twelve consecutively consulting patients (mean age: 39.4 years) suffering from advanced dental erosion have been enrolled in the study and were subsequently treated. Due to the late interception of the disease, all patients needed a full-mouth rehabilitation, which was performed without any conventional crowns. At the level of the maxillary anterior teeth, a total of 70 palatal indirect composite restorations and 64 facial feldspathic ceramic veneers were delivered. Both types of veneers were adhesively luted with a hybrid composite. Clinical reevaluations were performed 6 months after insertion of the veneers, and then annually, using modified United States Public Health Service (USPHS) criteria. Marginal adaptation, marginal integrity (seal, absence of infiltration), status of pulp vitality, postoperative sensitivity, esthetics, and restoration success/failure, were the principal clinical parameters analyzed.

RESULTS

After an up to 6-year observation time (mean observation time 50.3 months for the palatal veneers and 49.6 months for the facial veneers), no complete or major failure of the restorations was encountered. On the basis of the criteria used, most of the veneers rated Alpha for marginal adaptation and marginal seal. Secondary caries or endodontic complications were not detected. Using visual analogue scale analysis, the patient-centered satisfaction revealed a high esthetic and functional acceptance of 94.6%.

CONCLUSIONS

Compared to conventional crown preparation, restoring compromised maxillary anterior teeth by means of 2 veneers prevents excessive tooth structure removal and loss of tooth vitality. Questions on the longevity of this new treatment arise, due to the nonfavorable initial status of the teeth to be restored (eg, lack of enamel, sclerotic dentin substrate and short clinical crowns). The clinical performance of the teeth treated following the Sandwich Approach seems promising, since none of the treated teeth lost their vitality, no failure of any of the restorations was detected, and the patients' overall satisfaction was high. Even though further investigation is needed to determine the clinical long-term performance of the described treatment modality, the encouraging mid-term results (biological, esthetic, and mechanical success) clearly question if conventional crowns in the anterior maxillary segments can still continue to be considered the best and only option to treat this particular population of patients.

A comparative clinical study investigating the efficacy of a test dentifrice containing 8% strontium acetate and 1040 ppm sodium fluoride versus a marketed control dentifrice containing 8% arginine, calcium carbonate, and 1450 ppm sodium monofluorophosphate in reducing dentinal hypersensitivity

OBJECTIVE

The objective of this clinical study was to evaluate and compare the efficacy in reducing dentin hypersensitivity of an 8% strontium acetate, 1040 ppm sodium fluoride dentifrice to a marketed control 8% arginine, calcium carbonate, 1450 ppm sodium monofluorophosphate dentifrice after twice-daily brushing for two, four, and eight weeks.

METHODS

This was a randomized, examiner-blind, two-arm parallel group, eight-week longitudinal clinical study with seventy-nine subjects, stratified based on baseline tooth sensitivity (Schiff score, Yeaple). Subjects brushed with either an 8% strontium acetate-based dentifrice or a marketed 8% arginine calcium carbonate dentifrice twice daily for approximately one minute. At screening, baseline, weeks two, four, and eight, subjects' tooth sensitivity was determined through both evaporative (Schiff and Visual Analogue Scale [VAS]) and tactile stimuli (Yeaple probe). Subject assessments using each stimulus were performed by the same examiner throughout the study.

RESULTS

Seventy-seven subjects completed this clinical study. Both subject groups exhibited significant cumulative reductions from baseline to Days 14, 28, and 56 in dentin hypersensitivity as measured by Schiff, Yeaple, and VAS (for the 8% strontium acetate group, p < or = 0.0001 for all time points; for the 8% arginine calcium carbonate group, p = 0.0031 for Yeaple at Day 14, p = 0.0015 for VAS at Day 14, and p < 0.0001 for all remaining measures and time points). No significant differences (p > 0.05) were observed between treatments for any of the time points and measures except for tactile sensitivity at Day 56, for which the 8% strontium acetate-based dentifrice was statistically superior (p = 0.0391) to the control 8% arginine calcium carbonate dentifrice.

CONCLUSION

The 8% strontium acetate, 1040 ppm sodium fluoride dentifrice provided significant reductions in dentin hypersensitivity (p < 0.0001) after two, four, and eight weeks of product use. Comparisons to a control 8% arginine calcium carbonate dentifrice showed no significant differences (p > 0.05) apart from tactile (Yeaple) sensitivity at week 8, where the 8% strontium acetate-based dentifrice showed significant improvement over the control (p = 0.0391).

A comparative clinical study investigating the efficacy of a dentifrice containing 8% strontium acetate and 1040 ppm fluoride in a silica base and a control dentifrice containing 1450 ppm fluoride in a silica base to provide immediate relief of dentin hypersensitivity

OBJECTIVE

The objective of this clinical study was to evaluate and compare the efficacy of a dentifrice containing 8% strontium acetate and 1040 ppm fluoride (from sodium fluoride) in a silica base (test dentifrice) to a control dentifrice containing 1450 ppm fluoride (from sodium fluoride) in a silica base, to reduce dentin hypersensitivity immediately after a single dab-on self-application, and after subsequent twice-daily brushing for three days.

METHODS

This was a randomized, examiner-blind, two-arm parallel group, three-day clinical study with seventy-nine subjects, stratified based on baseline tooth sensitivity. Tooth sensitivity was determined through subject responses to both evaporative (Schiff and Visual Analogue Scale [VAS]) and tactile stimuli (Yeaple probe), prior to and immediately after subjects self-applied a single pea-sized amount of either the test or control dentifrice to qualifying sensitive teeth, massaging the toothpaste onto the sensitive area for one minute. Tooth sensitivity was further assessed in response to the same stimuli after subjects brushed twice daily for an additional three days. Subject assessments were performed by the same examiner throughout the study.

RESULTS

Seventy-nine subjects completed this clinical study. Both subject groups exhibited reductions in dentin hypersensitivity directly after a single dab-on application. These reductions were significant across all measures for the test dentifrice. Between-treatment analyses showed the test dentifrice to be significantly better at relieving subjects' sensitivity across all measures (Schiff p = 0.0003, tactile p = 0.0003, and VAS p = 0.0077) compared to the control. After the additional three days of twice-daily brushing, between-treatment analyses showed the test dentifrice to be significantly better at relieving subjects' sensitivity across all measures (Schiff p = 0.0102, tactile p = 0.0493, and VAS p = 0.0067) than the control dentifrice.

CONCLUSION

The 8% strontium acetate, 1040 ppm fluoride dentifrice provided significant within-treatment reductions in dentin hypersensitivity for all measures at both time points (immediate and three-day brushing). Compared to the control dentifrice, significant between-treatment reductions in sensitivity were observed after a single dab-on application for all measures, and following the additional twice-daily brushing for three days in favor of the 8% strontium acetate, 1040 ppm fluoride dentifrice.

Comparing the efficacy in reducing dentin hypersensitivity of a new toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride to a benchmark commercial desensitizing toothpaste containing 2% potassium ion: an eight-week clinical study in Rome, Italy

OBJECTIVE

The objective of this double-blind dentin hypersensitivity clinical study was to investigate the effectiveness of a new desensitizing toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride as sodium monofluorophosphate (MFP), compared to that of a benchmark commercially available desensitizing toothpaste containing 2% potassium ion, dosed as 5.0% potassium nitrate, and 1450 ppm fluoride as sodium fluoride (NaF).

METHODS

A total of 80 subjects were entered into the study, and stratified into two balanced groups according to their baseline mean tactile and mean air blast sensitivity scores. The two groups were randomly assigned to use either the new arginine toothpaste or the benchmark commercially available desensitizing toothpaste containing 2% potassium ion. Subjects were instructed to brush their teeth twice daily (morning and evening) for one minute with their assigned toothpaste and a commercially available soft-bristled toothbrush. Dentin hypersensitivity examinations, which included tactile and air blast sensitivity measures, were conducted at baseline, one week, two weeks, four weeks, and eight weeks. Subject examinations were conducted by the same dental examiner at each examination period.

RESULTS

This clinical study demonstrated that the new toothpaste, containing 8.0% arginine and 1450 ppm fluoride as MFP in a calcium carbonate base, provided a significant reduction in dentin hypersensitivity when used over a period of eight weeks. The study also showed that the new arginine toothpaste provided significantly greater reductions (p < 0.05) in dentin hypersensitivity in response to tactile (38.9%, 28.8%, and 11.6%) and air blast (16.8%, 26.4%, and 33.8%) stimuli than the benchmark commercial desensitizing toothpaste containing 2% potassium ion and 1450 ppm fluoride as NaF in a silica base, after two weeks, four weeks, and eight weeks of product use, respectively.

CONCLUSION

A new toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride as MFP provides significantly increased hypersensitivity relief (p < 0.05) as compared to a benchmark commercial desensitizing toothpaste containing 2% potassium ion, dosed as potassium nitrate, after two weeks, four weeks, and eight weeks of product use.

The clinical effect of a single direct topical application of a dentifrice containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride on dentin hypersensitivity: the use of a cotton swab applicator versus the use of a fingertip

OBJECTIVE

The primary objective of this examiner-blind, randomized clinical study was to compare the effect of a toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride, as sodium monofluorophosphate (MFP), in providing instant relief of dentin hypersensitivity when delivered as a single direct topical application using a cotton swab applicator versus using a fingertip. A secondary objective was to evaluate the effect on dentin hypersensitivity of the dentifrice after seven days of twice-daily at-home brushing, subsequent to the single direct topical application performed at the beginning of the study.

METHODS

Qualifying subjects possessed two baseline-designated hypersensitive teeth with a tactile hypersensitivity score of 10 to 50 grams of force (Yeaple Probe), and an air blast hypersensitivity score of 2 or 3 (Schiff Cold Air Sensitivity Scale). In the first phase of the study, subjects topically self-applied the test product using a fingertip, a previously validated method, for one of the hypersensitive teeth (fingertip test teeth), and a cotton swab applicator for the second hypersensitive tooth (swab test teeth). In the second phase of the study, subjects brushed with the test dentifrice twice daily for seven days. Dentin hypersensitivity assessments, as well as examinations of oral hard and soft tissues, were conducted immediately after direct topical product application, and after the subsequent seven-day brushing period.

RESULTS

Eighty-four subjects complied with the study protocol and completed the study. Immediately after direct topical application, the fingertip test teeth and the swab test teeth exhibited statistically significant (p <0.05) improvements from baseline in mean tactile hypersensitivity scores (191.7% and 182.1%, respectively), and mean air blast hypersensitivity scores (58.1% and 56.3%, respectively). After the seven-day brushing period, the fingertip test teeth and the swab test teeth continued to exhibit statistically significant (p < 0.05) improvements from baseline in mean tactile hypersensitivity scores (191.7% and 190.5%, respectively) and mean air blast hypersensitivity scores (57.4% and 58.2%, respectively). No statistically significant (p > 0.05) differences were indicated between the fingertip test teeth and the swab test teeth with respect to mean tactile hypersensitivity scores or mean air blast hypersensitivity scores immediately after topical application (3.4% and 4.4%, respectively), or after seven days of twice-daily brushing with the product (0.41% and -1.90%, respectively).

CONCLUSION

The results of this examiner-blind clinical study support the conclusions that 1) both fingertip and cotton swab methods of application provide significant reductions in dentin hypersensitivity immediately after a single direct topical application of the 8.0% arginine-calcium carbonate dentifrice, 2) when topical application is followed by seven days of twice-daily brushing with the dentifrice, the sensitivity relief obtained instantly after topical application is maintained, and 3) after topical application and after seven days of brushing, neither method of topical application provided a level of control of dentin hypersensitivity that differed significantly from the other.

[Dentinal hypersensivity after vertical stripping of enamel]

INTRODUCTION

Vertical stripping of enamel in patients with minor or moderate crowding of teeth and Angle's class I is an effective method which supplements orthodontic treatment. Stripping is an alternative to tooth extraction or to extension of alveolar arches which carries the risk of recurrence of crowding and further periodontal difficulties. Stripping also shortens considerably the duration of treatment. Apart from unquestionable advantages, enamel reduction may lead to complications such as caries or hypersensitivity of interproximal surfaces of stripped teeth. The aim of this study was to determine the prevalence of hypersensitivity and to measure the intensity of pain.

MATERIALS AND METHODS

We performed a verbal and visual assessment of pain in a group of 32 patients who underwent stripping during the recent few years as part of orthodontic treatment.

RESULTS

According to verbal assessment, the highest percentage (46.9%) of patients rated their pain as 1 (gentle pain) which corresponded to 1-3 cm on the 10 cm Visual Analog Scale. 37.5% of patients reported no pain.

CONCLUSION

None of the patients described their pain as very strong and discouraging from further treatment. All symptoms subsided without recurrence. The patients found this method to be more effective than alternative ones.

Comparing the efficacy in providing instant relief of dentin hypersensitivity of a new toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride relative to a benchmark desensitizing toothpaste containing 2% potassium ion and 1450 ppm fluoride, and to a control toothpaste with 1450 ppm fluoride: a three-day clinical study in New Jersey, USA

OBJECTIVE

The objective of this double-blind, randomized, parallel-design clinical study was to compare the efficacy in reducing dentin hypersensitivity of a novel toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride to a benchmark desensitizing toothpaste containing 2% potassium ion and 1450 ppm fluoride, and to a control toothpaste containing 1450 ppm fluoride, instantly after a single direct topical self-application using a fingertip, and after subsequent brushing twice daily for three days.

METHODS

Qualifying subjects from the Piscataway, New Jersey, USA area who presented two hypersensitive teeth with a tactile hypersensitivity score (Yeaple Probe) between 10 and 50 grams of force, and an air blast hypersensitivity score of 2 or 3 (Schiff Sensitivity Scale), participated in this study. The first phase of the study consisted of a single topical application of the assigned product directly onto the hypersensitive surface of each of the two baseline-designated hypersensitive teeth. Study subjects applied a pea-size amount of their assigned toothpaste onto the hypersensitive surface of each tooth and massaged each surface for one minute. The second phase of the study consisted of twice-daily at-home brushing with the assigned toothpaste for three days. Dentin hypersensitivity assessments, as well as examinations of oral hard and soft tissues, were conducted at baseline, immediately after direct topical application, and after three days of product use.

RESULTS

One-hundred and twenty-five subjects complied with the study protocol and completed the study. Relative to the benchmark desensitizing toothpaste and the control toothpaste groups, the 8.0% arginine toothpaste group exhibited statistically significant (p < 0.05) reductions in dentin hypersensitivity on both tactile and air blast hypersensitivity scores immediately after direct application. Reductions in sensitivity for the 8.0% arginine toothpaste compared to the benchmark desensitizing toothpaste and control toothpaste were 161.2% and 180.2% (tactile), and 59.8% and 58.0% (air blast), respectively. Relative to the benchmark desensitizing toothpaste and control toothpaste groups, the 8.0% arginine group exhibited statistically significant (p < 0.05) reductions in sensitivity after the subsequent three days of twice-daily regular tooth brushing of 147.1% and 181.2% (tactile), and 70.1% and 70.9% (air blast), respectively.

CONCLUSION

A single fingertip topical self-application of a new 8.0% arginine-calcium carbonate toothpaste directly onto the hypersensitive surface of teeth provides significant immediate improvement in dentin hypersensitivity relative to an identical application of a control toothpaste and to a benchmark potassium-based desensitizing toothpaste. Significant improvements in dentin hypersensitivity were also demonstrated after three days of brushing with the 8.0% arginine-calcium carbonate toothpaste, subsequent to the single topical self-application of the product, relative to an identical application of the control toothpaste and to the potassium-based desensitizing toothpaste. The improvement demonstrated by the 8.0% arginine toothpaste after direct application was maintained after three days of twice-daily brushing.

Comparing the efficacy in providing instant relief of dentin hypersensitivity of a new toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride to a benchmark desensitizing toothpaste containing 2% potassium ion and 1450 ppm fluoride, and to a control toothpaste with 1450 ppm fluoride: a three-day clinical study in Mississauga, Canada

OBJECTIVE

The objective of this double-blind, randomized, parallel-design clinical study was to compare the efficacy in reducing dentin hypersensitivity of a novel toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride to a benchmark desensitizing toothpaste containing 2% potassium ion and 1450 ppm fluoride, and to a control toothpaste containing 1450 ppm fluoride, instantly after a single direct topical self-application using a fingertip, and after subsequent brushing twice daily for three days.

METHODS

Qualifying subjects from the Mississauga, Canada area who presented two hypersensitive teeth with a tactile hypersensitivity score (Yeaple Probe) between 10 and 50 grams of force, and an air blast hypersensitivity score of 2 or 3 (Schiff Sensitivity Scale) participated in this study. The first phase of the study consisted of a single topical application of the assigned product directly onto the hypersensitive surface of each of the two baseline-designated hypersensitive teeth. Study subjects applied a pea-size amount of their assigned toothpaste onto the hypersensitive surface of each tooth, and massaged each surface for one minute. The second phase of the study consisted of twice-daily at-home brushing with the assigned toothpaste for three days. Dentin hypersensitivity assessments, as well as examinations of oral hard and soft tissues, were conducted at baseline, immediately after direct topical application, and after three days of product use.

RESULTS

One-hundred and twenty subjects complied with the protocol and completed the study. Relative to the desensitizing toothpaste and the control toothpaste groups, the 8.0% arginine toothpaste group exhibited statistically significant (p < 0.05) reductions in dentin hypersensitivity on both tactile and air blast measures immediately after completion of the first phase of the study. Reductions in sensitivity for the 8.0% arginine toothpaste, compared to the benchmark desensitizing toothpaste and the control toothpaste, were 130.7% and 139.5% (tactile), and 43.8.0% and 49.6% (air blast), respectively. Relative to the benchmark desensitizing toothpaste and control toothpaste groups, the 8.0% arginine group also exhibited statistically significantly (p < 0.05) reductions in sensitivity after completion of the second phase of the study, of 104.9% and 136.1% (tactile), and 44.5% and 53.2% (air blast), respectively. There was no loss of the instant relief effects in the 8.0% arginine group after the brushing period.

CONCLUSION

A single fingertip topical self-application of the 8.0% arginine-calcium carbonate toothpaste directly onto the hypersensitive surface of teeth provides significant immediate improvements in dentin hypersensitivity relative to an identical application of the control toothpaste and to the benchmark potassium-based desensitizing toothpaste. Significant improvements in dentin hypersensitivity were also demonstrated after three days of brushing with the 8.0% arginine-calcium carbonate toothpaste, subsequent to the single topical self-application of the product, relative to an identical application of the control toothpaste and to the benchmark potassium-based desensitizing toothpaste. The improvement demonstrated by the 8.0% arginine toothpaste after direct application was maintained after three days of twice-daily brushing.

Noncarious class V lesions restored with a polyacid modified resin composite and a nanocomposite: a two-year clinical trial

PURPOSE

The purpose of this study was to compare the clinical performance of a polyacid modified resin composite and a nanocomposite applied with an antibacterial adhesive system over a period of 2 years in noncarious Class V lesions.

MATERIALS AND METHODS

Twenty-four patients with at least two noncarious cervical lesions were enrolled in the study. The teeth were restored with a polyacid modified resin composite (Dyract eXtra, Dentsply DeTrey) or a nanocomposite (Filtek Supreme, 3M/ESPE). Fifty restorations of each material were placed with no marginal bevels and no mechanical retentions using an antibacterial self-etching adhesive system (Clearfil Protect Bond, Kuraray). All lesions were evaluated at baseline, 6, 12, and 24 months periods using the USPHS criteria for color match, marginal discoloration, marginal adaptation, caries formation, anatomic form, postoperative sensitivity, surface roughness, and retention. The changes across the four time points were assessed using Friedman and Wilcoxon Signed Ranks tests. The two restorative materials were compared in the same recall period for each of the criteria using chi-square test (p = 0.05).

RESULTS

Dyract eXtra restorations exhibited a significantly better color match than Filtek Supreme restorations; however, all restorations in both groups were clinically acceptable. Filtek Supreme's retention rate (100%) was found to be significantly better than that of Dyract eXtra (96%). Two Dyract eXtra restorations were completely lost while one was partially fractured (p < or = 0.05). Significant differences were observed in marginal adaptation and color match of Filtek Supreme restorations and marginal discoloration of Dyract eXtra and Filtek Supreme restorations between the baseline and the 2-year scores (p < or = 0.05).

CONCLUSION

Both restorative materials showed acceptable clinical performance in Class V noncarious lesions after 2 years of clinical service.

36-month clinical evaluation of two adhesives and microhybrid resin composites in Class I restorations

PURPOSE

To compare the clinical performance of a self-etching adhesive with that of a popular etch-and-rinse adhesive in Class I posterior composite restorations.

METHODS

60 Class I resin composite restorations (30 per group) were placed in matched pairs using either the self-etch adhesive Xeno III and the microhybrid resin composite Esthet-X or the etch-and-rinse adhesive OptiBond Solo Plus and Point 4 microhybrid resin composite. Subjects were interviewed via telephone 1 week after restoration placement to assess early post-operative sensitivity. In addition, the restorations were evaluated clinically for post-operative sensitivity, marginal quality, wear, and other characteristics immediately after placement and at 6, 12, 18, and 36 months from baseline.

RESULTS

During the first week after placement, subjects reported that 23% of restorations in each group had post-operative sensitivity. Sensitivity decreased greatly with time, and differences between the two groups were never statistically significant. Marginal integrity and discoloration were similar for each group at each recall evaluation. Wear of both resin composites increased over time, but mean wear remained at less than 100 microm for each resin composite at 3 years.

Influence of a desensitizing agent on efficacy of a paint-on bleaching agent

PURPOSE

To evaluate the influence of a desensitizing agent (VivaSens) on efficacy of a paint-on bleaching agent (VivaStyle Paint On Plus).

METHODS

Bleaching was performed for 7 days with VivaStyle Paint On Plus. The varnish was applied twice a day for 10 minutes each. 80 subjects were included in the study and randomly distributed in two groups (n = 40) according to exposed cervical dentin and perceived hypersensitivities. Group A used VivaStyle without VivaSens while Group B used VivaStyle Paint On Plus after a single application of VivaSens. Tooth color was assessed on facial surfaces of first upper incisors with Vita shade guide at baseline and 10 days after bleaching therapy. Sensitivity, with intensity graded from 0 (no sensitivity) to 10 (high sensitivity), was assessed chair-side using a blow of air at baseline, at the end of therapy (7 days) and 10 days after bleaching therapy. Statistical evaluation was performed with non parametric ANOVA.

RESULTS

Thirteen subjects dropped out of the study; six due to gingival burning sensation (A: 3; B: 3) related to the bleaching regimen and seven due to lack of compliance. Directly after completion of bleaching therapy, tooth color had changed significantly compared to baseline in both treatment groups without difference among the groups. Color changes (Delta) according to Vita shade guide were as follows (mean +/- standard deviation): Group A: Delta 2.7 +/- 1.0, Group B: Delta 2.8 +/- 0.9. After bleaching (7 days) the intensity of tooth hypersensitivity (mean +/- standard deviation) was increased significantly compared to baseline in both groups (P < 0.05): Group A: 1.58 +/- 1.91 (baseline: 0.4 +/- 0.5); Group B: 1.3 +/- 1.8 (baseline: 0.5 +/- 0.7). The number of subjects reporting tooth hypersensitivity increased in Group A by 5 (n = 13) and in Group B by 1 (n = 10) subject. Although degree of hypersensitivities and number of subjects with hypersensitivities were lower in Group B, there was no significant difference between the groups.

Comparison of two low sensitivity whiteners

PURPOSE

To evaluate two commercially available doctor-supplied, patient-applied, bleaching systems for their ability to whiten the maxillary anterior teeth while at the same time not causing sensitivity.

METHODS

46 participants were randomly assigned to one of two groups: One group received Rembrandt Xtra-Comfort and the other group Nite White Excel 2Z. Bleaching stents were fabricated and the bleaching systems were used following manufacturers' instructions. Participants recorded tray use and any sensitivity on a daily basis. Participants bleached for 2 weeks followed by 2 weeks of no bleaching. Color was evaluated at the first, second and fourth week following the initial delivery of bleaching trays. Color change was measured using the Vita Classic Shade Guide arranged by value.

RESULTS

As a group, participants in the NW2Z group bleached for 302 days with a total of 48 days (16%) of sensitivity recorded. The Rembrandt Xtra Comfort group bleached for 313 total days with 97 days (31%) of sensitivity recorded. The difference in sensitivity between the two products proved to be statistically significant (Chi-square analysis, P < or = 0.0001). The median shade change for both products following 2 weeks of active treatment was six tabs. At the 4-week evaluation, the median shade change was 5.5 and 6.0 tabs respectively for Rembrandt and Nite White. There was no statistical difference between the products in respect to shade change.

Clinical Evaluation of the Soft-Start (Pulse-delay) Polymerization Technique in Class I and II Composite Restorations

Class I and II composite restorations placed with a Soft-Start technique showed no significant changes in post-op sensitivity to cold or any decreased signs of marginal stress.

Comparison between effectiveness of a low-viscosity glass ionomer and a resin-based glutaraldehyde containing primer in treating dentine hypersensitivity—a 25.2-month evaluation

OBJECTIVES

The null-hypothesis tested was; there is no difference in effectiveness between a new low-viscosity glass ionomer and a resin-based glutaraldehyde containing primer in treating hypersensitive teeth after 2 years.

METHODS

Using a split-mouth design, hypersensitive teeth in 14 adult patients were randomly assigned to 2 treatment groups. Hypersensitive tooth surfaces were covered with a low-viscosity glass ionomer (Fuji VII) and a resin-based glutaraldehyde containing primer (Gluma Desensitizer). The discomfort interval scale (DIS) ranging from 0 to 4 was used to test the level of hypersensitivity before and after treatment, and at 3 months using compressed air blown for 2 s, and at 1 and 25.2 months using a telephone interview. Differences between and within the treatment groups were tested using the sign rank test.

RESULTS

Evaluations in the gluma group were discontinued after 3 months. The mean DIS score for hypersensitive teeth in the glass ionomer group was statistically significantly lower than that in the gluma group, immediately after application (p=0.0005), after 1 month (p=0.02) and after 3 months (p=0.003). After 3 months, 11/14 of the hypersensitive teeth in the glass ionomer group and 2/14 in the gluma group were free of sensitivity. The mean DIS score for hypersensitive teeth in the glass ionomer group remained low after 19.2 months (0.25: S.E.=0.13) and 25.2 months (0.22: S.E.=0.15).

CONCLUSIONS

The null-hypothesis was rejected. The low-viscosity glass ionomer (Fuji VII) is more effective in treating hypersensitive teeth than Gluma Desensitizer after 3 months. The positive treatment effect of the glass ionomer continued until 25.2 months.

Segmental distraction osteogenesis of the anterior mandible for improving facial esthetics. Preliminary results

AIM

To report preliminary results of treatment with gradual repositioning of the anterior mandibular segment using distraction osteogenesis in patients with anterior tooth crowding and/or an unfavorable anteroposterior relationship between the anterior dentoalveolar area and the skeletal base.

METHODS

The following outcome measures were considered: ability of the technique to achieve the desired skeletal jaw position, resolution of the crowding, periodontal condition (recessions and probing pocket depths), temporomandibular joint symptoms, tooth sensitivity, permanent nerve injury, additional complications, and patient satisfaction. Four patients were treated.

RESULTS

All outcome measures indicated that the therapy goal was achieved and the results maintained to date. Periodontal conditions were slightly improved. Two patients were very satisfied; 2 were only partially satisfied with the therapy. In 1 patient the root of the mandibular right first premolar was damaged during the vertical osteotomy procedure and the mandibular right central incisor did not respond to the postoperative sensitivity test. Another patient reported tension at the temporomandibular joint when chewing hard food.

CONCLUSION

The preliminary results are encouraging. However, larger trials are needed to acquire sufficient knowledge of the efficacy, predictability, and ideal indications for the mandibular osteodistraction technique.

Postoperative Sensitivity: A Comparison of Two Bonding Agents

Postoperative sensitivity to cold is a common problem that negatively impacts the patient's dental experience. For this group of participants and over this relatively short period, bonded composite restorations placed in a manner and timeframe consistent with those generally used in private-practice were seen to be less sensitive to cold than they were preoperatively.

Two-year clinical evaluation of lithia-disilicate-based all-ceramic crowns and fixed partial dentures

OBJECTIVES

The aim of this study was to evaluate the clinical performance of crowns and fixed partial dentures (FPDs) made with the Empress 2 system over a 2-year period.

METHODS

Twenty anterior or posterior all-ceramic (Empress 2) crowns and 20 anterior or posterior, three-unit fixed partial dentures were fabricated for 15 patients. Evaluations of the restorations were performed at baseline and once a year during the 2-year follow-up period. U.S. Public Health Service criteria were used to examine the marginal adaptation, color match, secondary caries and visible fractures in the restorations. Survival rate of the restorations were determined using Kaplan-Meier statistical analysis.

RESULTS

U.S. Public Health Service criteria showed 100% Alpha scores concerning recurrent caries for both crowns and FPDs. No crown fractures were observed during the 2-year follow-up, however, 10 (50%) catastrophic failures of FPDs occurred. Five (25%) failures occurred within the 1-year clinical period and the others (25%) within the second year.

SIGNIFICANCE

Single unit Empress 2 all-ceramic crowns exhibited a satisfactory clinical performance over 2-year period. Furthermore, the high fracture rate of Empress 2 FPDs limits the usage of Empress 2 for the fabrication of all-ceramic FPD.

2% Sodium Fluoride-Iontophoresis Compared to a Commercially Available Desensitizing Agent

BACKGROUND

Dentin hypersensitivity is a common clinical condition and age-old complaint, presenting problems to both the patient and the dentist. Besides causing discomfort, the condition may deter a person from establishing or maintaining adequate oral hygiene procedures, further complicating oral health. The failure to practice satisfactory plaque control has well-established consequences on gingival and periodontal health. Thus, a cycle of sensitive teeth leading to reduced plaque control, more periodontal disease, and more recession may be established.

METHODS

The hypersensitive teeth were identified by the patient and verified by the light stroke of a dental explorer along the cervical area of all teeth present. Subjects fulfilling the inclusion and exclusion criteria were evaluated using tactile, 1-second air blast, and cold water stimuli, and the subject's response was recorded on the verbal rating scale. A total of 425 teeth from 50 patients included in this study were randomly divided into two groups: group 1, who received 2% sodium fluoride-iontophoresis (NaF) and group 2, who received an aqueous solution of hydroxy-ethyl-methacrylate and glutaraldehyde (HEMA-G). The teeth were evaluated immediately after treatment and at 2 weeks, 1 month, and 3 months. In case of failure at the 2-week interval, the affected tooth was retreated with the same drug as before and evaluated further.

RESULTS

The results were statistically analyzed, and it was found that group 1 treatment was more effective than group 2 at 1- and 3-month intervals. There was a comparatively greater recurrence of hypersensitivity in group 2. A comparable number of teeth required repeat dosage in both groups. Teeth which required repeat dosage had greater mean discomfort scores at baseline for all three tests than the teeth which did not require a repeat dose.

CONCLUSIONS

Both agents showed significant reduction in sensitivity at all time intervals compared to baseline; however, NaF had a comparatively greater effect than HEMA-G at both the 1- and 3-month intervals; an almost equal number of teeth in both groups required repeat doses. Teeth with a higher initial sensitivity score required a repeat dose. Both agents were found to be equally effective immediately after application; the 2% NaF was comparatively better than HEMA-G in providing long-term relief.

A three-year clinical evaluation of two dentin bonding agents

BACKGROUND

A new restorative called a "giomer composite" has been introduced. The authors conducted a study to determine retention, anatomical form, caries, staining, marginal discoloration, marginal adaptation, surface roughness and sensitivity of giomer compared with those of a microfilled composite.

METHODS

The authors placed 40 sets of restorations randomly in canines and premolars in vivo. They used a giomer composite and a microfilled composite in erosion/abrasion/abfraction Class V lesions that were not altered with rotary instruments. They placed the restorations according to manufacturer's recommendations, and two calibrated examiners evaluated the restorations independently using modified U.S. Public Health Service criteria at baseline and at six, 18 and 36 months. The lesions receiving the restorations did not differ from each other in the amount of circumferential enamel present, the percentage of the surface area of dentin or lesion type.

RESULTS

There were no differences in the restorations at baseline, an evaluation made two weeks after placement. At 36 months, the giomer and microfilled composite restorations were not significantly different from one another in any of the eight criteria evaluated. The percentage agreement between examiners was at least 83 percent for each criterion in each evaluation period.

CONCLUSIONS

Both the giomer and the microfilled composite used in this study meet the clinical portion of the Acceptance Program Guidelines for Dentin and Enamel Adhesives Materials established by the American Dental Association.

CLINICAL IMPLICATIONS

Both the giomer and the microfilled composite used in this study can be used with confidence in Class V lesions.

Clinical evaluation of a self-etching and a one-bottle adhesive system at two years

OBJECTIVES

The clinical performances of a self-etching adhesive system, Clearfil SE Bond, and a one-bottle adhesive system, Prime&Bond NT, were evaluated in non-carious Class V restorations for a period of two years.

METHODS

Ninety-eight restorations were made by one operator for 32 patients. The resin composite used to restore the teeth were Clearfil AP-X and Spectrum TPH for Clearfil SE Bond and Prime&Bond NT, respectively. Two clinicians at the baseline, 6th, 12th and 24th months evaluated the posterior composites according to the modified Ryge criteria's. For this, color match, marginal discoloration, marginal adaptation, recurrent caries, anatomic form, postoperative sensitivity and retention rates were considered. The changes across time and across groups were evaluated statistically.

RESULTS

At two years, 88 restorations were reviewed in 28 patients. The retention rates for Clearfil SE Bond were 93 and 91% for Prime&Bond NT. The percentages of the retention rates of both adhesive systems were not found to be different when calculating the failure rates. Recurrent caries, anatomic form and postoperative sensitivity were scored as Alpha for all restorations. Two cases of both adhesive systems showed slight marginal discoloration problems. Three restorations of Prime&Bond NT and one of Clearfil SE Bond had marginal adaptation problems at two years. One case for each adhesive system had slight color change after the same period.

CONCLUSION

We can conclude that both adhesive systems tested exhibited very good clinical performance at the end of two years.

Direct capping of human pulps with a dentin bonding system or with calcium hydroxide cement

OBJECTIVE

To study human pulp reactions to direct cappings with a dentin adhesive compared with a calcium hydroxide cement, especially with respect to formation of hard tissue in the exposure site.

STUDY DESIGN

Direct pulp cappings were made in 34 caries-free premolars scheduled for extraction due to orthodontic treatment. Half of the teeth were capped with a dentin adhesive, the other half with a calcium hydroxide cement. After periods of from 7 to 70 days, the teeth were extracted and processed for light microscopical examination.

RESULTS

No postoperative sensitivity was experienced. A slight inflammatory reaction was seen in both groups in the short observation period. In the long observation period, significantly more "dentin bridging" was seen in the calcium hydroxide group than in the dentin adhesive group (P < .05).

CONCLUSION

The findings from the present limited material is in accordance with previous findings from human studies and contraindicate use of dentin adhesives for direct pulp capping.

Two-year clinical evaluation of a packable resin-based composite

BACKGROUND

Packable resin-based composites were introduced in 1998, but few clinical studies have been conducted to evaluate them. The authors conducted a clinical study to determine the two-year performance of SureFil (Dentsply DeTrey GmbH, Konstanz, Germany) packable posterior resin-based composite in Class I and II restorations.

METHODS

An operator (L.S.T.) restored 55 cavities in 36 patients (16 Class I restorations and 39 Class II restorations). After cavity preparation, she etched the enamel with 34 percent phosphoric acid, applied Prime & Bond NT (Dentsply DeTrey GmbH) to dentin and etched enamel for 20 seconds and then cured it for 20 seconds. She restored the cavity using 3- to 5-millimeter increments of SureFil. Independent examiners assessed the restorations after placement and at six months, one year and two years for color matching, marginal discoloration, marginal adaptation, secondary caries, surface texture, anatomical form and postoperative sensitivity, using the Ryge criteria.

RESULTS

The authors assessed the changes in the parameters during the two-year period using a software program with Friedman test analysis with a Bonferroni adjustment at significant level of P = .05. At baseline, 31 restorations were graded as Bravo for color match. At the six-month and one-year recall periods (n = 55), 53 restorations remained unchanged. Two restorations from the same patient fell out after one month. After two years (n = 50), there were five Bravos for surface staining and three for marginal adaptation (P < .05).

CONCLUSION

After two years of clinical service, SureFil packable resin-based composite had a success rate of 96 percent, and the authors considered it successful in Class I and II restorations.

CLINICAL IMPLICATIONS

SureFil packable resin-based composite can be successful in clinical situations with limited-sized cavities and proper application of restorative techniques.

Clinical evaluation of a novel liquid tooth whitening gel

PURPOSE

To clinically evaluate a new system for at-home tooth whitening (Colgate Simply-White Whitening Gel), by comparing tooth color improvement and adverse event incidence after 14-days treatment.

MATERIALS AND METHODS

22 subjects (aged 21-46 years) were enrolled into the study. Tooth color and safety assessments were conducted at baseline and following a 2-week at-home treatment. Efficacy was assessed using VITA shade scores. Safety evaluations were performed including the examination of plaque index (PI), bleeding index (BOP), gingival recession and dentin hypersensitivity. Statistical analysis was performed to determine the mean change from baseline.

RESULTS

The new whitening gel releasing 5.9% hydrogen peroxide was significantly effective in lightening tooth shade. After only 2 weeks, patients enrolled in the study exhibited an overall mean 3.56-shade improvement from baseline, far superior than minimum values established in ADA Guidelines for the acceptance of peroxide-containing oral hygiene products. Periodontal health (PI and BOP) improved with time overall. Dentin hypersensitivity slightly increased, but it was very well tolerated. No patient discontinued study participation due to such an adverse event. Therefore, it was concluded that the new Colgate Simply White Clear Whitening Gel provided clinically proven, safe and effective at-home tooth whitening.

Long-term clinical performance and longevity of gold alloy vs ceramic partial crowns

Cast gold partial crowns (CGPC) are an accepted means of restoring posterior teeth. For aesthetic reasons, gold alloys are being increasingly substituted with ceramics. The aim of the present study was to investigate retrospectively the long-term clinical performance and survival of CGPC and compare the results to the ones already reported for ceramic partial crowns (CPC). The CGPC group consisted of 42 patients (24 male, 18 female) randomly sampled from a total of 106 patients with CGPC, with one restoration per patient. The CPC group consisted of 22 patients with a total of 42 restorations. Both types of restoration were done by one experienced dentist. Another two experienced dentists who were not involved in performing the restorations rated both kinds of partial crowns using the modified United State Public Health Service (USPHS) criteria [14]. The Median age of the CGPC was 57 months (range 3-157) and of the CPC and 63 months (range 24-72). Forty-one (98%) of the CGPC and 27 (64%) of the CPC were placed in molars, the rest in premolars. In each group, 40 (95%) restorations were still functioning without any necessity of replacement. Two teeth with CGPC, in situ for 4.5 and 11 years, respectively, had been extracted for periodontal reasons. Two CPC fractured and had to be replaced after 2 and 6.5 years in situ. The USPHS criteria results were similarly good for the gold and ceramic groups. Kaplan-Meier analysis revealed survival probabilities of 72+/-21% and 96+/-4% after 13 and 7 years, respectively, for the CGPC. Survival of the CPC was 81+/-15% after 7 years. No statistically significant difference among survival functions of CGPC and CPC was found. From this data, it can be concluded that the longevity of CPC is not inferior to that of gold alloys. However, more long-term studies comparing the clinical performance and longevity of these two types of indirect restoration in the posterior region with larger numbers of restorations are desirable.

Clinical study to compare two in-office (chairside) whitening systems

The objective of this clinical study was to compare the whitening/bleaching efficacy of two marketed in-office whitening systems: Discus Dental Zoom! Chairside System (25% hydrogen peroxide whitening gel) and Opalescence Xtra Boost Kit (38% hydrogen peroxide whitening gel), using the Vita Shade Guide and chromameter measurements. The study was an examiner-blind, parallel group, randomized and controlled clinical trial conducted in a dental setting. All subjects signed a study consent form prior to admission and were given Crest Regular Toothpaste and an Oral-B 40 straight-handle toothbrush to use during the study. Subjects received a supragingival prophylaxis followed by a screening eligibility Vita Shade assessment from which 22 subjects were selected. At baseline, all six maxillary anterior teeth were assessed with the Vita Shade Guide. Chromameter measurements were taken on either the right maxillary central or left maxillary central (tooth No. 8 or tooth No. 9). Subjects were assigned to one of two treatment groups, and had three applications of their assigned product. Following completion of the treatment phase, and on post-treatment Days 2 and 7, a visual examination of the condition of the oral soft tissues, together with a Vita Shade assessment on maxillary anterior teeth, a chromameter reading and a questionnaire regarding tooth sensitivity were completed. At the termination of the study, the statistical analysis of the Vita Shade scores indicated that both products significantly (p < 0.0001) lightened the color of the teeth. The average improvement was between 6 and 9 shade changes. Additionally, the Zoom! Chairside System was significantly better than the Opalescense Xtra Boost Kit at all time points: post-treatment (p < 0.0001); Day 2 (p < 0.004); Day 7 (p < 0.003). This difference was between 1 and 2 shade changes. The chromameter readings showed a significant difference in the overall color change (delta E) to a lighter color for both the Zoom! Chairside System and the Opalescence Xtra Boost Kit. Using delta E, the Zoom! Chairside System was directionally better than the Opalescense Xtra Boost Kit at Day 2 (p < 0.08), and significantly better at Day 7 (p < 0.025). Analysis of the composite parameters of delta E (L*, a*, b*) showed that no differences could be detected in the a* (redness) parameter. Changes were observed in the L* (brightness) and b* (yellow) parameters which paralleled the delta E differences. There were no significant differences in induced sensitivity between whitening systems at any time point.

Pain experienced by patients during periodontal maintenance treatment

BACKGROUND

The aims of this study were to assess the degree of pain experienced by patients during probing and debridement and to determine whether the pain responses could be predicted by the patient's age, gender, percentage of sites > or = 4 mm deep, and responses to a questionnaire on dental anxiety.

METHODS

Prior to the maintenance procedures, 26 adult patients completed an anxiety questionnaire. Subsequently, measurements of probing depths were performed. The patients activated a tallying device at each probe entry that evoked pain (pain frequency). Pain levels for each quadrant were also assessed with a visual analog scale (VAS). Following probing, the same protocol was repeated during instrumentation (debridement).

RESULTS

Most patients showed low pain responses to both probing and instrumentation as evaluated by both methods of measurement. However, using arbitrary thresholds of pain frequency > or = 50% and VAS > or = 40 mm, approximately 15% of the patients had a painful experience. Stepwise multiple regression analyses disclosed that significant portions of the pain levels could be predicted by gender and the patients' answers to 2 of the dental anxiety questions.

CONCLUSIONS

Recognition of patients who are likely to experience pain during periodontal treatment can be facilitated by the use of 2 questions on dental anxiety and the VAS response to probing during examination.

Dentine hypersensitivity in subjects recruited for clinical trials: clinical evaluation, prevalence and intra-oral distribution

Relatively few studies have reported on the frequency, distribution and severity of dentine hypersensitivity (DH) in subjects recruited for clinical trials of desensitizing agents. Potential subjects (n= 48 M, 81 F, mean age 35.1 years) for inclusion into such a study were screened to determine the extent of the problem. 117 subjects (41 M, 76 F) mean age 24.9 years were clinically examined. Evaluation by questionnaire indicated that the prevalence of DH was proportionately higher in the 20-29.9 years (34.9%), and 30-39.9 years groups (33.3%), respectively. Sensitivity to cold was the main presenting symptom. Tactile (probe) and cold air (dental air syringe) stimuli were used to clinically evaluate DH. Of the teeth eligible for evaluation 1561/3136 (49.8%) responded to either one or both of the test stimuli; 274/3136 (8.7%) responded to tactile only stimulation, 779/3136 (24.8%) to thermal only stimulation and 508/3136 (16.2%) to both tactile and thermal stimulation. Of those teeth responding to the stimuli, 477 (30.6%) were premolars, 437 (28%) incisors, 415 (26.8%) molars and 232 (14.9%) canines. The results agree with those of previously reported studies in that DH is most frequently observed on premolars and that proportionately more teeth are sensitive to evaporative than to tactile stimulation. Furthermore it would appear from the results of the study that tactile is less effective than thermal/evaporative stimulation in the evaluation of DH.

Clinical evaluation of cervical dentin sensitivity (CDS) in patients attending general dental clinics (GDC) and periodontal specialty clinics (PSC)

AIM

The objective of this study was to compare the prevalence, severity and distribution of CDS in patients attending general dental clinics (GDC) and periodontal specialty clinics (PSC) and to correlate them to possible causal factors.

MATERIAL AND METHODS

2 groups of patients aged 20-60 years recruited from GDC (144) and PSC (151) were evaluated for CDS by means of a questionnaire and intraoral clinical examinations. Furthermore, gingival recession and plaque scores were recorded at the same visit.

RESULTS

The results showed that patients referred to PSC had a significantly higher prevalence of CDS (60.3%) than those examined at GDC (42.4%) (p<0.001). Also, mean plaque scores of PSC patients (1.87 +/- 0.88) was found to be significantly higher than that of GDC (1.44 +/- 0.7) (p<0.01). The occurrence and extent of gingival recession associated with hypersensitive teeth was significantly higher in PSC than GDC patients (p<0.01), with a 5% incidence of severe recession (5 mm) in PSC only. The association of periodontal disease and periodontal treatment to the high prevalence of CDS and gingival recession in PSC patients would suggest their role in predisposition to hypersensitivity. The distribution of CDS in tooth types revealed that upper molars and lower anteriors of PSC patients were mainly affected, and followed by, to a lesser extent, lower right canine and right first molars of GDC patients.

CONCLUSION

The prevalence of CDS among our periodontal patients appears somewhat lower than that reported in periodontal specialty clinics of earlier studies but still higher than those reported in other dental populations. This indicates that periodontal disease and its treatments may increase the occurrence of hypersensitivity.

The efficiency of dentine adhesives in treating non-caries cervical lesions

The aim of this study was to prove the hypothesis that dentine adhesives can be used as therapeutic material in treating dentine hypersensitivity, regardless of aetiology. The research was conducted on 492 students of Zagreb University School of Dental Medicine (154 male, 338 female), 20-25-years-old. The defects of the tooth neck were found in 38 patients, on 133 teeth (38 of male patients, 95 of female) and dentine hypersensitivity was recorded according to the subjective sensations of patients. Therapeutic characteristics of three adhesive materials were examined simultaneously: All Bond 2, fourth generation adhesive, Syntac Single Component and One Step, fifth generation adhesives. Teeth treated with dentine lacquer Cervitec were used as a control group. Tooth necks were treated with selected materials according to instructions of a manufacturer. A completed statistical survey of the results has clearly shown that dentine adhesives can be used in symptomatic therapy of dentine hypersensitivity of the non-caries cervical lesions (NCCL). The survey has also shown that dentine adhesives of the fifth generation (Syntac Single Component and One Step) have much higher efficiency rate than dentine adhesives of the fourth generation (All Bond 2) and dentine lacquer (Cervitec). According to data complied through this study the conclusion can be brought forward that dentine adhesives are not a final solution to the problem of dentine hypersensitivity, because their efficiency decreases with time.

Potentiating potassium nitrate's desensitization with dimethyl isosorbide

Desensitization of hypersensitive teeth by the combination of dimethyl isosorbide (DMI) and potassium nitrate (KNO3) is more effective than when KNO3 is used alone. KNO3/DMI work together to desensitize hypersensitive teeth at a higher, quicker, and more profound and lasting level.

One-year retrospective clinical evaluation of hybrid composite restorations placed in United Kingdom general practices

OBJECTIVE

The purpose of this study was to assess Pertac II restorations placed in general dental practice.

METHOD AND MATERIALS

A total of 86 restorations (14 Class I, 10 Class II, 17 Class III, 5 Class IV, and 40 Class V) using a hybrid composite material (Pertac II) placed in 56 patients (mean age, 39 years) in 5 dental practices in the United Kingdom were assessed after 1 year by a trained evaluator and the dental practitioner who had placed the restoration. All the restorations were assessed for anatomic form, marginal adaptation, surface roughness, sensitivity or discomfort, gingival condition, and the presence or absence of secondary caries.

RESULTS

Thirty-five (43%) restorations were placed in load-bearing situations, 9% of which were assessed as being in "heavy" occlusion. Five (6%) of the restorations were lost (all Class V restorations), 4 from premolars and 1 from a molar. Four were in wedge-shaped cavities and 1 small restoration was actually dislodged during examination. The remaining 81 (94%) restorations were found to be intact, with no secondary caries detected. A high percentage of optimal scores were recorded for both anatomic form and surface roughness.

CONCLUSION

It is concluded that the evaluation demonstrated satisfactory clinical performance of Pertac II restorations after 1 year of clinical service in the wide variety of clinical situations seen in general dental practice. However, the potential for failure of hybrid composite materials in Class V situations appears high. It may be argued that clinicians who wish to use a resin-based material in a Class V situation should use a compomer or microfilled composite.

Tray delivery of potassium nitrate-fluoride to reduce bleaching sensitivity

OBJECTIVE

Tooth sensitivity is a common side effect associated with tooth whitening. The purpose of this study was to determine if bleaching tray delivery of potassium nitrate-fluoride reduces bleaching sensitivity enough to allow continuation of whitening treatment.

METHOD AND MATERIALS

Thirty patients were enrolled in a university-approved clinical study and had their teeth bleached at night with 10% carbamide peroxide in a custom-fitted tray. The bleaching tray was a rigid experimental design for which sensitivity was expected. If tooth sensitivity was experienced, the patient applied a gel containing 5% potassium nitrate and 1,000 ppm sodium fluoride in the bleaching tray for various time periods. Log forms were collected upon completion of bleaching, and patient interviews were used to compare effects of the gel before and after sensitivity treatment.

RESULTS

Sixteen out of 30 patients experienced tooth sensitivity. Of those 16 patients, 12 used the gel, and 11 of the 12 reported a reduction in sensitivity. Treatment times ranged from 10 minutes before bleaching to 30 minutes before and after. The number of applications ranged from one to continuous use. Some patients were able to continue bleaching after one gel application with no subsequent sensitivity. Other patients were unable to continue bleaching unless they continued using the gel. The incidence of tooth sensitivity (53%) reported in this study is consistent with sensitivity reported in studies using semi-rigid custom-fitted trays made from stone casts with a nonscalloped, nonreservoir design.

CONCLUSION

The use of a 5% potassium nitrate-fluoride gel applied in the tray as needed for tooth sensitivity associated with nightguard vital bleaching can reduce sensitivity in a majority of patients and allow most patients to continue bleaching to completion.

Cervical dentin hypersensitivity. Part I: The air indexing method

The purpose of this article is to introduce an objective method for quantifying cervical dentin hypersensitivity. Air emissions from a standard air-water syringe or a syringe with a Fluid Control Block are directed toward the cervices of teeth at a 45-degree angle to the long axis of test teeth from a distance of 0.5 cm for 0.5 to 1.0 second. An air indexing method has been developed to quantify threshold patient response values for individual teeth to this defined air stimulus. The air indexing method, using the Fluid Control Block, offers the clinician objective information to compare cervical dentin hypersensitivity before and after treatment for this common, painful condition.

Endodontic classification

Clinical and histopathologic findings are mixed in current endodontic classifications. A new system, based on symptomatology, may be more useful in clincial practice. The classifications are vital asymptomatic, hypersensitive dentin, inflamed-reversible, inflamed/dengenerating without area-irreversible, inflamed/degenerating with area-irreversible, necrotic without area, and necrotic with area.