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In vivo sensitivity of human root dentin to air blast and scratching.

BACKGROUND: The present study evaluated the prevalence of radicular sensitivity to scratching as well as the effects of a common oxalate desensitizing agent on sensitivity to air blast and scratching. METHODS: Eighty-seven patients self-reporting dentin hypersensitivity, with at least two hypersensitive teeth, were included. Prior to any treatment, their sensitivity to air blast was recorded and rated as absent or present, and the force necessary to trigger pain when scratching was measured with a scratchometer in cN. For each patient one sensitive tooth was treated with an oxalate desensitizing agent and the other one with a placebo solution. The same measurements were carried out after treatment. RESULTS: Following treatment with a placebo solution, 70% of the teeth remained sensitive to air blast while only 38% of the desensitizing agent-treated teeth remained sensitive to air blast (P < 0.01). The mean force required to elicit pain prior to any treatment was 44 +/- 17 cN. This force statistically increased significantly after application of the placebo (53 +/- 17 cN) (P < 0.05). After using the desensitizing agent, the force was even higher (95 +/- 24 cN) (P < 0.01). Only 8% of the teeth treated with the desensitizing agent did not respond to treatment compared to 37% of the teeth treated with the placebo solution. CONCLUSIONS: The placebo solution had a significant effect on sensitivity to air blast and to scratching (P < 0.05). The oxalate desensitizing agent was more effective than the placebo solution at decreasing the sensitivity both to air blast and to scratching (P < 0.01). The sensitivity to air blast seems to be overestimated because, after using the desensitizing agent, 38% of the teeth remained sensitive to air blast but only 8% remained sensitive to scratching. Pulpal inflammation may be involved in those teeth that did not respond to treatment.

Adolescent↗

Polymeric sealing of dentinal tubules to control sensitivity: preliminary observations.

The purpose of this study was to evaluate the effectiveness of a hydrophilic dentin primer to eliminate dentinal hypersensitivity to thermal stimuli. Eight patients enrolled in the study, with a total of 42 teeth having cervical sensitivity caused by erosion, abrasion, or periodontal therapy. All teeth were sensitive to cold air and tactile exploration. All test sites were rinsed with water, air-dried, and rubbed with a moist cotton pledget. Several coats of a dentin primer, consisting of N-tolylglycine-glycidyl methacrylate and bisphenyl dimethacrylate, were then applied with a brush to the exposed dentin and light-cured. All patients reported a complete absence of pain when the sites were retested with thermal stimuli immediately after treatment. After a 9-month period, seven patients remained symptomless, and one patient indicated slight sensitivity to ice. It was concluded that a single application of a hydrophilic dentin primer is highly effective in reducing or eliminating dentinal hypersensitivity to thermal stimuli for at least 9 months.

Composite Resins↗

Tooth brushing, tooth wear and dentine hypersensitivity--are they associated?

Evidence suggests that patients suffer the painful symptoms of dentine hypersensitivity when dentine is exposed and the dentinal tubule system is opened to the oral cavity to allow stimuli to trigger a neural response in the pulp via a hydrodynamic mechanism. The processes needed to localise lesions of dentine hypersensitivity include loss of enamel and/or gingival recession. Whilst tooth brushing with or without toothpaste appears to cause minimal wear to enamel (in the absence of acids), circumstantial evidence implicates tooth brushing with gingival recession and exposure of dentine. Other tooth wear processes notably attrition and acid erosion cause loss of enamel and can expose dentine. Therefore sensitivity may result. How lesions of dentine hypersensitivity are initiated is a matter of conjecture and based on extrapolating data from studies, mainly in vitro, to affect in vivo. Again this circumstantial type of evidence suggests that abrasion by some toothpastes and erosion by dietary acid could open the tubule system. Little is known about the actual effect of desensitising toothpastes on lesions of dentine hypersensitivity even though they are formulated to either occlude dentinal tubules or block the neural response in the pulp. Clinical studies have produced contradictory findings for the efficacy of products and there have been extremely few evidence based reviews. In conclusion, available evidence supports a probable link of tooth brushing, with or without toothpaste and an acidic diet to both tooth wear and dentine hypersensitivity, and suggests also that dentine hypersensitivity is a tooth wear phenomenon. Although there is a need for more direct clinical and scientific evidence for these associations, it is recommended that they be taken into consideration when planning management strategies for the dentine hypersensitivity sufferer.

Dental Enamel↗

Digital subtraction radiography after stannous fluoride treatment for occlusal caries diagnosis.

The material in this study consisted of 38 fully erupted, extracted third molars without clinical cavitation in the occlusal surface. A radiograph was made of each tooth before and after 5, 10, and 20 minutes of stannous fluoride treatment. The radiographs were digitized and subtraction performed between the images obtained after stannous fluoride treatment and the pretreatment image. Two observers assessed the stannous fluoride treated radiographic and the subtraction images on a monitor: 0 = no change, 1 = intensity increase (white area interpreted as a carious lesion) in dentinoenamel area. Caries was assessed on conventional film radiographs made before treatment: 0 = no caries in dentin, 1 = caries in dentin. The presence of caries in dentin was validated histologically. Sensitivity for intensity increase as a sign of caries was overall higher for the subtraction images based on 20-minute treatment than for the radiographic images (0.025 > p > 0.01) but not significantly higher than for the conventional radiographs. However, neither observer gave false-positive scorings in the subtraction images, whereas observer 1 had five false-positive scorings on the conventional films. Observer 2 had none. The subtraction method did not provide a higher sensitivity for dentinal occlusal caries than conventional film radiography, but the intensity increase could be trusted more than the traditional radiolucency as a sign of a dentinal lesion.

Adolescent↗

Current strategies for dentist-applied treatment in the management of hypersensitive dentine.

Few of the many dentist-applied treatments for dentine hypersensitivity meet the requirements of an ideal desensitizing agent'. This paper, although not exhaustive, covers methods that may be classified from simplest to most complex. Topical methods are simple, but they are often uncomfortable and the effects usually quite short-lasting, and many fall short of the 'ideal'. Fluorides and oxalates appear to be the best topical methods. Iontophoresis of fluoride represents an intermediate stage of complexity and it meets most of the criteria of an ideal desensitizing agent. Newer restorative materials, such as glass-ionomer cements and dentine bonding agents, are the most complex. These are still under investigation, but when the tooth needs recontouring, or in difficult cases that do not respond to other treatments, the dentist may choose to use a restorative material. Resin primers alone could be promising but the effects are not permanent and investigation into their use is still under way. Finally, laser treatment has been espoused for dentine desensitization. This requires extremely expensive equipment, must be dentist applied, and might produce pulpal irritation. Much more study is needed on restorative treatments and lasers before they can be considered as effective desensitizing agents. Until that research is completed, the dentist must choose one or more of the available methods in order to have a clinical therapy that is likely to relieve the symptoms of hypersensitive dentine.

Caustics↗

Bond strength of resin to dentin treated with calcium phosphate desensitizer.

In a previous study we proposed a new method utilizing immediate precipitation of calcium phosphate (CaP) in situ for treatment of dentin hypersensitivity. Sequential application of 5% disodium phosphate followed by 10% calcium chloride on patent dentin surface resulted in instant occlusion of dentin tubules and immediate relief from the hypersensitivity. To guarantee long-lasting effectiveness of the CaP treatment, resin coverage of the treated dentin surface will be the next practical approach. However, the CaP covering the surface may possibly affect bonding of resins. This study determined the effect of the CaP treatment on tensile bond strength of adhesive resins to dentin. Independent of the type of resin used, a bond strength of 4-5 MPa was obtained; cohesive failure occurred within the resin-CaP hybridized composite layer rather than at the dentin surface. The CaP treatment produced a significant increase in the bond strength of one resin.

Animals↗

Effect of dentin desensitizers and cementing agents on retention of full crowns using standardized crown preparations.

STATEMENT OF PROBLEM: Past research has not controlled preparation surface area when examining the influence of dentin desensitizers on the retentive strength of cemented cast crowns, leading to inconsistent results. PURPOSE: This research controlled crown preparation surface area and evaluated the effect of various dentin desensitizers and conventional cementing agents on the in vitro retentive strength of cast crowns. METHODS AND MATERIAL: Freshly extracted human molars were prepared for a standardized crown preparation (26 degrees total convergence, 4 mm axial height) with a custom-made pantograph. Dentin desensitizers included none (control), a polymerizable material (All-Bond 2), and a nonpolymerizable desensitizer (Gluma Desensitizer). Cementing agents included zinc phosphate (Fleck's), glass ionomer (Ketac-Cem), resin-modified glass ionomer (Fuji II), and resin cement (Panavia 21). Twelve teeth were prepared for each test condition (144 teeth total). Individual castings were made from a base metal alloy (Rexillium III). Crowns were removed after storage at 26 degrees C for 48 hours at 100% relative humidity using a universal testing machine at a crosshead speed of 1.27 mm/min. The proportion of cement retained on the tooth and casting after debonding was quantified according to treatment. Statistical treatment included 1- and 2-way ANOVAs, followed by the Tukey-Kramer post hoc test at a preset alpha of 0.05.Results. Resin cement exhibited the highest retentive strength and all dentin treatments resulted in significantly different retentive values (All-Bond 2 (5.68 +/- 0.70 MPa) > control (4.67 +/- 0.48 MPa) > Gluma (4.12 +/- 0.37 MPa)). Retention of resin-modified glass ionomer was between the resin cement and glass ionomer groups: All-Bond 2 (3.46 +/- 0.26 MPa) > Gluma (2.81 +/- 0.15 MPa) = control (2.96 +/- 0.18 MPa). Conventional glass ionomer values were between those of Fuji Plus and zinc phosphate groups: All Bond 2 (2.23 +/- 0. 20 MPa) = control (2.36 +/- 0.20 MPa) > Gluma (1.98 +/- 0.23 MPa). Zinc phosphate had the lowest retention values: control (1.68 +/- 0. 08 MPa) > Gluma (0.81 +/- 0.11 MPa) > All-Bond 2 (0.67 +/- 0.14 MPa). The majority of cement was retained on the debonded tooth surface versus the casting, with the exception of zinc phosphate when used with dentin pretreatments. CONCLUSION: Controlled crown surface areas reduced the variation in strength values permitting high discrimination among retention values of desensitizer/cement combinations. In all but 1 combination, Gluma desensitizer significantly decreased crown retention. With resin cement and resin-modified glass ionomer, use of All-Bond 2 desensitizer significantly increased crown retention values.

Analysis of Variance↗

Alternative method of conservative esthetic treatment for gingival recession.

The health and appearance of gingival tissue play an essential role in esthetics. The esthetic function of the tissue is enhanced when it frames the restoration. With gingival recession, the effect of natural gingiva is created with pink composites or ceramics on the cervical part of the crown, as described in this clinical report. This goal depends on the absence of adverse effects on the color, shape, and health of the surrounding tissue. The new composites are more color stable and wear resistant, and the latest generation of dental bonding agents allows the bonding of composites to dentin, various metals, and porcelain. The application of soft-tissue colored composite on dentin cementum, enamel, or porcelain is a good solution for correcting gingival recessions.

Acid Etching, Dental↗

Resistance of two dentin-bonding agents and a dentin densensitizer to acid erosion in vitro.

OBJECTIVES: To determine the resistance of two dentin-bonding agents (DBAs) and a dentin desensitizer to simulated dental erosion. METHODS: Twenty teeth in each of three groups of selected premolars, with exposed cervical dentin, were treated with one of three dentin surface treatment systems: Gluma Desensitizer (Heraeus Kulzer (UK) Ltd), One Coat Bond (Whaledent (UK) Ltd), and Optibond FL (Kerr (UK) Ltd) and exposed to water (control) and an erosive challenge (Coca Cola) for 14 days. Sequential tracings of the specimens were taken, superimposed and the mean reduction in densensitizer or DBA thickness and or tooth loss determined. RESULTS: A mean loss of 77 microns (s.d. 14.6 microns) of tooth tissue over the untreated sites following 14 days exposure to Coca Cola was observed. The application of DBAs, as opposed to Gluma Desensistizer alone, over exposed dentin surfaces afforded substantial protection against erosion by Coca Cola over the period of study. The mean change in vertical profile of teeth treated with a DBA was 20 microns (s.d. 14.7 microns), almost four times less than that seen over untreated sites. SIGNIFICANCE: With the exception of Gluma Desensitizer, which was lost completely, One Coat Bond and Optibond FL demonstrated levels of acid dissolution resistance, which would be of potential value clinically.

Analysis of Variance↗

A survey of the use of dentin-bonding systems in Denmark.

OBJECTIVES: Dentin-bonding systems, which usually involve multistep procedures, are relatively new in dentistry. This study was conducted to survey dental practitioners in Denmark concerning their use of dentin-bonding systems. METHODS: A questionnaire regarding dentin-bonding systems was distributed to dentists at an annual dental conference, and 462 dentists were included in the survey. RESULTS: Dentin-bonding systems were used by 99% of the dentists. Twenty-one different dentin-bonding systems were being used, with six of the systems being used by 78% of the dentists. Of the 456 dentists who used a dentin-bonding system, 77% recalled a clinical procedure for their dentin-bonding system that was in accordance with the written instructions of the manufacturer. The degree to which the dentists complied with the instructions for use, was influenced by the number of operating steps involved for a given dentin-bonding system, by the frequency with which the dentin-bonding system was used, and by the degree to which the dentist was satisfied with the instructions for use provided by the manufacturer. The frequency with which dentin-bonding systems were used, was influenced by year of graduation, place of work, and gender of the dentist. SIGNIFICANCE: Further studies, which focus on the adherence of dental practitioners to instruction manuals are warranted as are investigations of the potential clinical consequences of incorrect use of dentin-bonding systems.

Attitude of Health Personnel↗

Effect of resins sealing of dentin on the bond strength of ceramic restorations.

OBJECTIVES: The purpose of this in vitro study was to evaluate shear bond strengths when ceramic cylinders were bonded to dentin following the use of different dentin adhesive systems as desensitizers. METHODS: Freshly extracted human molars were selected. Their buccal dentin was exposed and a standardized circular area was isolated. Dentin desensitizers included an experimental self-curing 'one-bottle' adhesive system, two light-curing 'one-bottle' bonding systems and a conventional three component adhesive system, which was selected as a control system. Ten teeth were prepared for each test group (40 teeth total). A layer of an eugenol-free temporary cement was applied on the treated surface and the specimens were stored in distilled water for 1 week. After the removal of cement, the dentin surfaces were cleaned, re-etched and a layer of the experimental self-curing 'one-bottle' adhesive was applied. Standardized cylindrical ceramic samples were luted using a resin cement. One week later, shear bond strengths were determined using a universal testing machine. The bond strength values obtained were tested for a statistical significance with Kruskall-Wallis one-way analysis of variance. The type of failure occurring on each specimen was observed and recorded by means of an optical and a scanning electron microscope. RESULTS: Mean shear bond strengths of the four groups ranged from 25.84 to 27.83 MPa and they were not significantly different. Most failures were cohesive in dentin. SIGNIFICANCE: The use of an adhesive system as a dentin desensitizing agent before cementation does not alter the retentive strength of adhesively luted ceramic restorations.

Analysis of Variance↗

Effect of desensitizers on bond strength of adhesive luting agents to dentin.

The current study investigates the influence of three dentin hypersensitivity treating agents (Gluma CPS, MS Coat and Saforide) on bond strength to dentin of two luting agents (Panavia Fluoro Cement and Super-Bond C & B). Sixty bovine dentin substrates were divided into 12 combinations of four treatment conditions (Gluma CPS, MS Coat, Saforide and control) and three adhesive systems (AD Gel sodium hypochlorite + Panavia Fluoro Cement, Panavia Fluoro Cement without AD Gel and Super-Bond C & B). After bonding the treated teeth to steel rods, 24-h tensile bond strengths were determined, and average values (n=5) were compared by analysis of variance (ANOVA). Without application of the desensitizers, bond strengths of the two groups (Super-Bond C & B, 10.2 MPa; AD Gel + Panavia, 11.5 MPa) were comparable, and they were greater than the group bonded with the Panavia material with no AD Gel conditioning (7.1 MPa). Application of the Saforide ammoniated silver fluoride desensitizer reduced bond strength of both the Super-Bond and Panavia luting agents, whereas the MS Coat polymeric agent negatively affected bond strength of the Panavia cement only. The use of the Gluma desensitizer did not affect bond strength of any of the three adhesive systems, and the bond strength of the Panavia cement with the AD Gel conditioning was not reduced by application of any of the three desensitizers. The four combinations of two desensitizers (MS Coat and Gluma CPS) and two adhesive systems (Super-Bond C & B and AD Gel + Panavia) are deemed to be applicable to fixed prosthodontic treatment.

Acid Etching, Dental↗

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.

Adult↗

Dentists' perceptions of dentine hypersensitivity and knowledge of its treatment.

The aim of the present investigation was to determine by questionnaire, UK dentists' perception of Dentine Hypersensitivity (DH) and knowledge of its treatment. A total of 403 questionnaires were sent to a selected group of UK dentists who had either inquired about further postgraduate education or had attended a course at the Eastman Dental Institute/Hospital. A total of 181 of 403 dentists (44.9%) (118M; 36F, 17 no response, mean age 38.2 years [s.d. 8.97]) returned the questionnaire. About 92.8% (n=168) of responding dentists claimed to see patients with DH in their practice. According to the dentists' replies at least one of four of their patients suffered from the complaint. About 71.8% (n=130) of dentists reported that DH was a severe problem in at least 10% of their patients and that pain from DH lasted no more than 4 weeks. Most of responding dentists claimed to be asked about DH by their patients and stated that they offered advice or treatment to their patients. Nearly 87.3% (n=158) of responding dentists provided a wide range of treatment options/advice which included both in-office and over-the-counter (OTC) products. Popular responses included desensitizing pastes/gels, Topical F(-) varnishes and toothpastes/rinses/gels, advice on atraumatic tooth brushing, dentine bonding agents (DBA), glass-ionomer cements (GIC) and other unspecified restorations. Of the various in-office treatments Duraphat was the most cited choice of varnish/primer options. Sensodyne toothpaste was the most popular of the specified OTC products. Most dentists appeared to understand the aetiological features associated with DH and provided a wide range of factors including the effects of incorrect tooth brushing, dietary acids as well as the possible influence on non-dental topics such as stress. Most responding dentists believed that their advice on DH was generally effective although they did highlight that certain aspects on the condition were lacking such as appropriate scientific information including the prevention of DH and its treatment. The results from the present study highlight several discrepancies in the perception and knowledge of the treatment of DH between dentists and their patients. The results from this study are, however, reasonably consistent with those previously reported by Dutch investigators. The results from this study also highlighted a need for guidelines on the aetiology, prevention and treatment of DH for both dentists and their patients. The reported average frequency and duration of discomfort from DH by the responding dentists appeared to be consistent with the available literature.

Adult↗

Crown retention with use of different sealing systems on prepared dentine.

The purpose of this in vitro study was to evaluate crown retention after using different sealing systems on prepared dentine. Ca(OH)2 suspension was used in comparison with three adhesive bonding systems (Gluma Desensitizer, Optibond FL, Prompt L-Pop). Extracted human premolars were uniformly prepared with the use of a special parallelometer (11 degrees taper, 4 mm axial length). Groups of 20 teeth each were treated with each sealing system. Then crowns were fabricated and temporarily cemented twice. Finally the abutments were cleaned and the crowns were cemented with a glass-ionomer cement Ketac-Cem. Subgroups of 10 crowns were removed with a universal testing machine following storage in distilled water either for 3 days or for 150 days. Prior to dislodging, the crowns of both groups were subjected to chewing simulation. The mean dislodgement stresses in MPa were between 4.9 and 6.9. A range test of Student-Newmann-Keuls revealed significant differences between Ca(OH)2 and Optibond FL (P < 0.05), while the storage time had no significant effect. The level of microleakage increased significantly with storage time (P < 0.05). It is concluded, that the use of Gluma Desensitizer and Prompt L-Pop did not affect crown retention as compared with Ca(OH)2, thus may be used in combination with glass-ionomer cement to desensitize prepared teeth.

Analysis of Variance↗