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OBJECTIVES: To minimize the tooth sensitivity caused by in-office bleaching, many dentists use non-steroidal anti-inflammatory drugs and topical desensitizing gels containing potassium nitrate and sodium fluoride. This study aimed to evaluate the influence of these substances on inflammation and the expression of substance P and calcitonin gene-related peptide in pulp nerve fibers. MATERIALS AND METHODS: Seventy-two rats were divided into 6 groups as follows: GI, control; GII, only dental bleaching; GIII, only ibuprofen; GIV, ibuprofen administered 30 minutes before and after the bleaching treatment and every 12 hours until the analysis; GV, only topical application of a desensitizing agent; and GVI, topical application of a desensitizing agent before dental bleaching. Placebo gel was applied to the upper left jaw and the bleaching agent was applied to the upper right jaw in all groups. Subsequently, the groups were divided into 3 subgroups based on the time of analysis: 0, 24, and 48 hours after bleaching (n = 8). The rats were euthanized and the maxillae were processed and evaluated by histopathological and immunohistochemical analyses. The data were analyzed using the Kruskal-Wallis test, followed by the Dunn test (p < 0.05). RESULTS: In the bleaching groups, the inflammatory process and expression of neuropeptides decreased over time. The animals in which a desensitizing agent was applied showed better results within 24 hours. CONCLUSIONS: The use of a desensitizing agent had positive effects on inflammation and pain-related neuropeptide expression, minimizing the painful effects of dental bleaching treatment.
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Pacientes submetidos à clareação dentária relatam sensibilidade pós-operatória relacionada ao peróxido de hidrogênio (H2 O2 ) que penetra no tecido pulpar. Objetivo: Avaliar o efeito anti-inflamatório do ibuprofeno, Otosporin® e gel de curcumina na polpa dentária de ratos após procedimento clareador. Métodos: Cinquenta ratos foram divididos em GC controle (gel placebo); CLA clareação (H2 O2 35%, 30 minutos); CLA-I clareação e administração oral de ibuprofeno (duas vezes a cada 12 horas, 2 dias sucessivos); CLA-O clareação seguida da aplicação de Otosporin® nas superfícies dos molares (10 minutos); e CLA-C sessão clareadora seguida do gel de curcumina (10 minutos). Após dois dias, os ratos foram mortos para análise histológica e testes estatísticos foram realizados(p<0,05). Resultados: CLA, CLA-I e CLA-C apresentaram inflamação severa ou necrose no terço oclusal da polpa coronária (p>0,05); CLA-O apresentou inflamação leve e foi semelhante ao GC (p>0,05) e dife- rente dos outros grupos (p<0,05). No terço médio, o grupo CLA-O apresentou menor infiltrado inflamatório e permaneceu diferente do grupo CLA (p<0,05); CLA, CLA-I e CLA-C foram semelhantes (p>0,05). No terço cervical, CLA, CLA-I e CLA-C tiveram redução da inflamação, sem diferença entre os grupos clareados (p>0,05). Conclusões: O Otosporin® pode reduzir a inflamação na polpa após clareação dentária; esse resultado não foi observado utilizando ibuprofeno ou gel de curcumina. Portanto, esse estudo mostra uma nova possibilidade de pós-tratamento em dentes clareados por meio do uso de Otosporin®, que minimiza a inflamação gerada ao tecido pulpar pelo gel clareador. Consequentemente, poderá haver redução da sensibilidade pós-operatória (AU).
Introduction: Patients undergoing dental bleaching relate to postoperative sensitivity, that is linked to hydrogen peroxide (H2 O2 ) penetrating on the dental pulp. This study evaluated the anti-inflammatory effect of ibuprofen, Otosporin®, and curcumin gel on the pulp of the rats' teeth after bleaching. Methods: Fifty rats were divided into CG: controlplacebo gel; BLE: bleached (35% H2O2, 30 minutes); BLE-I: bleached and ibuprofen oral administration (twice every 12 hours in 2 successive days); BLE-O: bleached followed by Otosporin® application in the molar surfaces (10 minutes); and BLE-C: bleaching session followed curcumin gel (10 minutes). After two days, the rats were killed for histological analysis. Statistical tests were performed (P<.05). Results: BLE, BLE-I, and BLE-C had severe inflammation or necrosis in the occlusal third of coronal pulp (P>.05); BLE-O had mild inflammation and was similar from CG (P>.05) and different from other groups (P<.05). In the middle third, BLE-O group had lower inflammatory infiltration and remained different from BLE group (P<.05); BLE, BLE-I, and BLE-C were similar (P>.05). In the cervical third, BLE, BLE-I, and BLE-C had a reduction of inflammation, without difference between bleached groups (P>.05). Conclusions: Otosporin® can reduce the inflammation in the pulp after dental bleaching; this result was not observed using ibuprofen or curcumin gel. Therefore, this study shows a new teeth bleaching posttreatment possibility using Otosporin®, which minimizes the inflammation generated to the pulp tissue by the bleaching gel. This could consequently minimize the postoperative sensitivity (AU).
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Animais , Ratos , Clareamento Dental , Polpa Dentária , Peróxido de Hidrogênio , Anti-Inflamatórios , CurcuminaRESUMO
This study aimed to evaluate neuropeptide expression after bleaching treatment using histopathological and immunohistochemical analyses and the effects of hydrocortisone and acetaminophen on pulp inflammation, sine dental bleaching and inflammation first occur, and only then, the treatmentt. Sixty-three rats were divided into three groups (n = 21) according to the pain-relieving therapy used: I-control; II-topical application of Otosporin for 10 min after the bleaching treatment; III-oral administration of paracetamol 30 min before whitening and then every 12h. In all the study groups, placebo gel was applied to the left upper jaw (control) and a 35% H2O2-based whitening gel was applied to the right upper jaw for 45 min. Seven animals from each group were euthanized at different time points: 0h after treatment, 24h, and 48h. After euthanasia, the first molar on each side was analyzed by histology and immunohistochemistry to assess the degree of inflammation and verify the presence of the neuropeptides, substance P (SP) and calcitonin gene-related peptide (CGRP). The data were analyzed using the statistical nonparametric Kruskal-Wallis test followed by Dunn's test for individual comparisons. Extensive areas of necrosis were observed in the groups that received bleaching treatment only, whereas reduced damage were obtained in the group treated with Otosporin. The immunohistochemical analysis showed positive immunolabeling in all groups, including the control, but this was stronger in the groups that received bleaching treatment. The best results were obtained in the group that received treatment with Otosporin. The use of Otosporin after dental bleaching minimized the side effects of this treatment.
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Anti-Inflamatórios/uso terapêutico , Polpa Dentária/efeitos dos fármacos , Polpa Dentária/patologia , Pulpite/tratamento farmacológico , Pulpite/etiologia , Clareamento Dental/efeitos adversos , Acetaminofen/uso terapêutico , Animais , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Polpa Dentária/metabolismo , Modelos Animais de Doenças , Combinação de Medicamentos , Humanos , Hidrocortisona/uso terapêutico , Imuno-Histoquímica , Masculino , Neomicina/uso terapêutico , Polimixina B/uso terapêutico , Pulpite/patologia , Ratos , Ratos Wistar , Substância P/metabolismo , Clareadores Dentários/efeitos adversosRESUMO
Traumatic dental intrusion is a serious injury and results in significant damage to the periodontal ligament, dentin-pulp complex, and alveolar bone. This article presents a case of severe intrusion of the two upper permanent central incisors where the treatment option was the combination of the surgical and orthodontic technique. The difficulty of accessing the crowns of these teeth to bond the brackets was solved by lifting a full thickness flap. To disengage the teeth from the alveolus, a careful dislocation motion was performed. After suturing the flap, a removable orthodontic appliance was installed and an extrusive force was applied for 8 weeks. After 10 weeks, the endodontic treatment was performed and the crowns were restored. The 10-year clinical control showed normal mobility. Radiographically, minor losses of the cervical alveolar cortical bone and integrity of the periodontal ligament were observed.
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Objective The objective of this study was to evaluate dental sensitivity using visual analogue scale, a Computerized Visual Analogue Scale (CoVAS) and a neurosensory analyzer (TSA II) during at-home bleaching with 10% carbamide peroxide, with and without potassium oxalate. Materials and Methods Power Bleaching 10% containing potassium oxalate was used on one maxillary hemi-arch of the 25 volunteers, and Opalescence 10% was used on the opposite hemi-arch. Bleaching agents were used daily for 3 weeks. Analysis was performed before treatment, 24 hours later, 7, 14, and 21 days after the start of the treatment, and 7 days after its conclusion. The spontaneous tooth sensitivity was evaluated using the visual analogue scale and the sensitivity caused by a continuous 0°C stimulus was analyzed using CoVAS. The cold sensation threshold was also analyzed using the TSA II. The temperatures obtained were statistically analyzed using ANOVA and Tukey's test (α=5%). Results The data obtained with the other methods were also analyzed. 24 hours, 7 and 14 days before the beginning of the treatment, over 20% of the teeth presented spontaneous sensitivity, the normal condition was restored after the end of the treatment. Regarding the cold sensation temperatures, both products sensitized the teeth (p<0.05) and no differences were detected between the products in each period (p>0.05). In addition, when they were compared using CoVAS, Power Bleaching caused the highest levels of sensitivity in all study periods, with the exception of the 14th day of treatment. Conclusion We concluded that the bleaching treatment sensitized the teeth and the product with potassium oxalate was not able to modulate tooth sensitivity.
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Sensibilidade da Dentina/induzido quimicamente , Sensibilidade da Dentina/diagnóstico , Medição da Dor/métodos , Peróxidos/efeitos adversos , Clareadores Dentários/efeitos adversos , Clareamento Dental/efeitos adversos , Ureia/análogos & derivados , Adolescente , Adulto , Análise de Variância , Peróxido de Carbamida , Feminino , Humanos , Masculino , Ácido Orótico/uso terapêutico , Limiar da Dor , Peróxidos/química , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Ureia/efeitos adversos , Ureia/química , Escala Visual Analógica , Adulto JovemRESUMO
This study verified the occurrence of dental sensitivity in patients submitted to a 35% hydrogen peroxide based product (Whiteness HP Maxx 35% - FGM), skin cold sensation threshold (SCST) and its influence on dental sensitivity. Sixty volunteers were divided into 4 groups (n = 15), according to SCST (low: GI and GIII, and high: GII and IV) and bleaching treatment (hydrogen peroxide: GI and GII, and placebo: GIII and GIV). SCST was determined in the inner forearm for 6 different times using a neurosensory analyzer, the TSA II (Medoc Advanced Medical Systems, Ramat Yishai, Northern District, Israel). Dental sensitivity measurements were performed 10 different times using a thermal stimulus and an intraoral device attached to TSA II, positioned in the buccal surface of the upper right central incisor. Spontaneous dental sensitivity was also determined using the Visual Analogue Scale (VAS). Data were submitted to Student's t-test and Pearson's Correlation Test (α=0.05). SCST remained the same during bleaching treatment. Distinct responses of dental sensitivity were found in patients with low and high SCST during the first and third bleaching session (p≤0.05). The teeth submitted to the bleaching treatment became more sensitive to cold than those treated with placebo. Moreover, data obtained with TSA and VAS presented moderate correlation. Bleaching treatment increased dental sensitivity and skin cold sensation threshold might represent a determining factor in this occurrence, since low and high SCST patients had different responses to the thermal stimulus in the teeth.
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Sensibilidade da Dentina/induzido quimicamente , Peróxido de Hidrogênio/efeitos adversos , Temperatura Cutânea/efeitos dos fármacos , Clareadores Dentários/efeitos adversos , Clareamento Dental/efeitos adversos , Adolescente , Adulto , Temperatura Baixa , Humanos , Masculino , Medição da Dor , Efeito Placebo , Valores de Referência , Limiar Sensorial , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Abstract Objective This study verified the occurrence of dental sensitivity in patients submitted to a 35% hydrogen peroxide based product (Whiteness HP Maxx 35% - FGM), skin cold sensation threshold (SCST) and its influence on dental sensitivity. Material and Methods Sixty volunteers were divided into 4 groups (n = 15), according to SCST (low: GI and GIII, and high: GII and IV) and bleaching treatment (hydrogen peroxide: GI and GII, and placebo: GIII and GIV). SCST was determined in the inner forearm for 6 different times using a neurosensory analyzer, the TSA II (Medoc Advanced Medical Systems, Ramat Yishai, Northern District, Israel). Dental sensitivity measurements were performed 10 different times using a thermal stimulus and an intraoral device attached to TSA II, positioned in the buccal surface of the upper right central incisor. Spontaneous dental sensitivity was also determined using the Visual Analogue Scale (VAS). Data were submitted to Student's t-test and Pearson's Correlation Test (α=0.05). SCST remained the same during bleaching treatment. Results Distinct responses of dental sensitivity were found in patients with low and high SCST during the first and third bleaching session (p≤0.05). The teeth submitted to the bleaching treatment became more sensitive to cold than those treated with placebo. Moreover, data obtained with TSA and VAS presented moderate correlation. Conclusions Bleaching treatment increased dental sensitivity and skin cold sensation threshold might represent a determining factor in this occurrence, since low and high SCST patients had different responses to the thermal stimulus in the teeth.
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Humanos , Masculino , Adolescente , Adulto , Adulto Jovem , Temperatura Cutânea/efeitos dos fármacos , Clareamento Dental/efeitos adversos , Sensibilidade da Dentina/induzido quimicamente , Clareadores Dentários/efeitos adversos , Peróxido de Hidrogênio/efeitos adversos , Valores de Referência , Limiar Sensorial , Fatores de Tempo , Medição da Dor , Efeito Placebo , Resultado do Tratamento , Temperatura BaixaRESUMO
Abstract Objective The objective of this study was to evaluate dental sensitivity using visual analogue scale, a Computerized Visual Analogue Scale (CoVAS) and a neurosensory analyzer (TSA II) during at-home bleaching with 10% carbamide peroxide, with and without potassium oxalate. Materials and Methods Power Bleaching 10% containing potassium oxalate was used on one maxillary hemi-arch of the 25 volunteers, and Opalescence 10% was used on the opposite hemi-arch. Bleaching agents were used daily for 3 weeks. Analysis was performed before treatment, 24 hours later, 7, 14, and 21 days after the start of the treatment, and 7 days after its conclusion. The spontaneous tooth sensitivity was evaluated using the visual analogue scale and the sensitivity caused by a continuous 0°C stimulus was analyzed using CoVAS. The cold sensation threshold was also analyzed using the TSA II. The temperatures obtained were statistically analyzed using ANOVA and Tukey's test (α=5%). Results The data obtained with the other methods were also analyzed. 24 hours, 7 and 14 days before the beginning of the treatment, over 20% of the teeth presented spontaneous sensitivity, the normal condition was restored after the end of the treatment. Regarding the cold sensation temperatures, both products sensitized the teeth (p<0.05) and no differences were detected between the products in each period (p>0.05). In addition, when they were compared using CoVAS, Power Bleaching caused the highest levels of sensitivity in all study periods, with the exception of the 14th day of treatment. Conclusion We concluded that the bleaching treatment sensitized the teeth and the product with potassium oxalate was not able to modulate tooth sensitivity.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Peróxidos/efeitos adversos , Clareamento Dental/efeitos adversos , Ureia/análogos & derivados , Medição da Dor/métodos , Sensibilidade da Dentina/diagnóstico , Sensibilidade da Dentina/induzido quimicamente , Clareadores Dentários/efeitos adversos , Ácido Orótico/uso terapêutico , Peróxidos/química , Fatores de Tempo , Ureia/efeitos adversos , Ureia/química , Índice de Gravidade de Doença , Análise de Variância , Resultado do Tratamento , Limiar da Dor , Escala Visual Analógica , Peróxido de CarbamidaRESUMO
Atualmente, o DSD (digital smile design) tem sido utilizado como um recurso de grande destaque para a Odontologia Estética. O uso de um software pode facilitar e implementar através de simulações o tratamento reabilitador estético, fazendo com que haja maior entendimento do paciente sobre o procedimento e seus resultados, bem como evitando equívocos que possam ocorrer durante o tratamento. A técnica consiste em analisar as proporções faciais e dentárias de cada paciente e suas relações com dentes, lábios e gengivas por meio de fotografias digitais e vídeos. Com isso, são realizados desenhos seguindo métodos específicos que podem ser apresentados de maneira simples, compreensível e cativante para o paciente(AU)
Nowadays, the DSD (digital smile design) has been used as a great resource for aesthetic restorative dentistry. Through simulations, the use of a software can facilitate and implement aesthetics rehabilitation treatment, helping the patient to have a better understanding of the procedure and its outcomes, and also avoiding misunderstandings that may occur during the treatment. This technique consists in analyzing facial and dental proportions of each patient and the relations with their teeth, lips and gum through digital photograph and movies. Therefore, designs are made following specific methods that can be presented in a simple way, understandable and engaging for the patient(AU)
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Humanos , Feminino , Adulto , Sorriso , Restauração Dentária Temporária , Estética Dentária , Design de SoftwareRESUMO
Abastract This study aimed to evaluate the transenamel and transdentinal penetration of hydrogen peroxide (H202) applied to bovine teeth pigmented with black tea at different intensities. The following groups were formed DW: immersion in distilled water; BT100: immersion in an infusion of 1.6 g of black tea per 100 mL distilled water; BT10: immersion in an infusion of 1.6 g black tea per 10 mL distilled water. All groups were immersed for 6 days. To quantify the penetration of H202, the specimens were placed in artificial pulp chambers (APCs) and subjected to bleaching treatment with 38% H2O2 once per week for 3 weeks. After bleaching treatment, the acetate buffer solution of APCs with peroxidase enzyme was evaluated in a reflection spectrophotometer. The transenamel and transdentinal penetration of H2O2 and the L* values obtained at T1, T2 and T3 were subjected to Kruskal-Wallis and Friedman statistical tests. At T1, the H2O2 diffusion in DW was higher than that in BT100 and BT10. At the other evaluation times, the penetration values in BT100 and BT10 increased and remained similar. The L* values increased significantly in all groups at T1. At T2, the L* values were higher in DW, while the values in BT100 and BT10 were similar to each other. At the end of the experiment, BT10 showed the lowest L* values. The pigmentation level did not affect the penetration of H2O2 through the enamel and dentin and the bleaching agent effectively changed the color of the teeth.