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December 2013 Abstracts


Digital plaque imaging evaluation of a stabilized stannous fluoride dentifrice compared with a triclosan/copolymer dentifrice


Tao  He, dds, phd,   Matthew  L.  Barker, phd,  Aaron  R.  Biesbrock, dmd, phd, ms,  Holly Eynon,

Jeffery  L.  Milleman, dds, mpa,  Kimberly R.  Milleman, rdh, bsed,  Mark  S.  Putt, msd, phd

&  Ana  MarÍa  Wintergerst, ms, phd


Abstract: Purpose: To compare the relative plaque control efficacy of a marketed 0.454% stabilized stannous fluoride (SnF2) dentifrice relative to a triclosan/copolymer dentifrice using digital plaque imaging analysis (DPIA). Methods: This was a randomized, two-treatment, double-blind, parallel group design study that compared SnF2 and triclosan/copolymer dentifrices over a period of 3 weeks. DPIA was used to capture a digital image of the maxillary and mandibular anterior facial surfaces of 12 teeth and to calculate plaque area coverage. Overnight DPIA images were taken at a baseline visit after which subjects were randomly assigned to one of the two treatment groups and were required to brush with their assigned dentifrice according to each manufacturer’s instructions. Subjects had DPIA assessments on two separate days at the end of Week 3. Results: 96 subjects were randomized to treatment. Plaque area data for 47 subjects per treatment group were compared at Week 3 using ANCOVA. The SnF2 group demonstrated a statistically significant reduction in overnight plaque at Week 3 compared to baseline (P= 0.002). The reduction for the triclosan group at Week 3 compared to baseline was not statistically significant (P= 0.24). At Week 3, the SnF2 group demonstrated a 17% lower adjusted mean for overnight plaque relative to the triclosan group with a mean difference that was statistically significant (P< 0.05). The Week 3 adjusted mean change from baseline in overnight plaque for the SnF2 group was 3 times greater versus that of the triclosan group (P< 0.05). (Am J Dent 2013;26:303-306).




Clinical significance: This comparison between marketed dentifrices indicates that a stabilized stannous fluoride dentifrice provided significantly greater overnight plaque inhibition versus a triclosan/copolymer dentifrice.




Mail: Dr. Tao He, Procter & Gamble, Mason Business Center, 8700 Mason-Montgomery Road, Mason, OH 45040 USA. E-mail:




Effect of fluoride varnish supplemented with sodium trimetaphosphate on enamel erosion and abrasion


Michele Maurício Manarelli, dds, msc, Marcelo Juliano Moretto, dds, msc, phd,

Kikue Takebayashi Sassaki, phd, Cleide Cristina Rodrigues Martinhon, dds, msc, phd,

Juliano Pelim Pessan, dds, msc, phd  &  Alberto Carlos Botazzo Delbem, dds, msc, phd


Abstract: Purpose: To assess in vitro the effect on enamel erosion (ERO) and erosion followed by abrasion (ERO+ABR) of varnishes with different fluoride concentrations, supplemented or not with sodium trimetaphosphate (TMP). Methods: Bovine enamel blocks were randomly divided into six groups according to the type of varnish used: placebo (no F), NaF 5%, NaF 2.5%, NaF 2.5% plus TMP 3.5%, NaF 2.5% plus TMP 5%, NaF 2.5% plus TMP 10%. Varnishes were tested for ERO and ERO+ABR, separately for 3 and 5 days. ERO was done by immersion in Sprite Zero (5 minutes, 4x/day), while ERO+ABR was performed by brushing for 15 seconds after each erosive challenge. Enamel wear (µm) and cross-sectional hardness (ΔKHN) were assessed after the experimental periods. Data were analyzed by ANOVA, Tukey’s test and Pearson’s correlation coefficient (P< 0.05). Results: Varnishes supplemented with TMP promoted significantly lower wear and hardness loss when compared to the other treatments in all conditions studied (P< 0.05). Similar wear rates were observed for the placebo, NaF 2.5% and NaF 5% varnishes (P> 0.05). Greater wear was observed after 5 days of ERO and ERO+ABR when compared with 3 days (P< 0.05). Positive and significant correlations were found between enamel wear and ΔKHN. No dose-response relationship was found between TMP concentration and wear and hardness. It was concluded that fluoride varnishes supplemented with TMP had a higher protective effect against ERO and ERO+ABR, which was associated with a reduction in enamel softening. (Am J Dent 2013;26:307-312).




Clinical significance: The fluoridated varnishes supplemented with TMP were more effective against erosive challenges associated or not to abrasion when compared to conventional formulations. This enhanced effect of the TMP-supplemented varnishes was attained with half of the fluoride concentration used in the conventional formulations, which is highly desirable especially for the treatment of children.


Mail: Dr. Alberto Carlos Botazzo Delbem, Department of Pediatric Dentistry and Public Health, Araçatuba Dental School, Univ. Estadual Paulista State University (UNESP), Rua Jose Bonifacio 1193, 16015-050 Araçatuba - SP – Brazil. E-mail:




LED light attenuation through human dentin: A first step toward pulp photobiomodulation after cavity preparation


Ana Paula S. Turrioni, dds, ms, Juliana R. L. Alonso, Fernanda G. Basso, dds, phd, Lilian T. Moriyama, phd, Josimeri  Hebling, dds, phd, Vanderlei  S. Bagnato, phd  &  Carlos A. de Souza Costa, dds, phd


Abstract: Purpose: To evaluate the transdentinal light attenuation of LED at three wavelengths through different dentin thicknesses, simulating cavity preparations of different depths. Methods: Forty-two dentin discs of three thicknesses (0.2, 0.5 and 1 mm; n = 14) were prepared from the coronal dentin of extracted sound human molars. The discs were illuminated with a LED light at three wavelengths (450 ±10 nm, 630 ±10 nm and 850 ±10 nm) to determine light attenuation. Light transmittance was also measured by spectrophotometry. Results: In terms of minimum (0.2 mm) and maximum (1.0 mm) dentin thicknesses, the percentage of light attenuation varied from 49.3% to 69.9% for blue light, 42.9% to 58.5% for red light and 39.3% to 46.8% for infrared. For transmittance values, an increase was observed for all thicknesses according to greater wavelengths, and the largest variation occurred for the 0.2 mm thickness. All three wavelengths were able to pass through the dentin barrier at different thicknesses. Furthermore, the LED power loss and transmittance showed wide variations, depending on dentin thickness and wavelength. (Am J Dent 2013;26:319-323).



Clinical significance: Determining light attenuation through the dentin barrier as a function of the wavelength is a first step toward establishing the ideal window for the biostimulation of pulpal tissue previously injured by caries lesion progression and cavity preparation.



Mail: Prof. Dr. Carlos Alberto de Souza Costa, Department of Physiology and Pathology, School of Dentistry of Araraquara, Univ. Estadual Paulista, Rua Humaitá, 1680. Centro, Caixa Postal: 331 CEP: 14801903 Araraquara, SP, Brazil.  E-mail:



Post-retentive ability of new flowable resin composites


Jelena Juloski, dds, Cecilia Goracci, dds, msc, phd, Ivana Radovic, dds, msc, phd,  Nicoletta Chieffi, dds, msc, phd, Alessandro Vichi, dds, msc, phd,  Zoran R. Vulicevic, dds, msc, phd   &   Marco Ferrari, md, dds, phd


Abstract: Purpose: To investigate the applicability of flowable composites as post luting agents by assessing the push-out strength of posts. Methods: 36 intact single rooted human premolars were selected. The endodontic treatment was performed and half of the specimens were restored with light transmitting posts (DT Light Post Illusion) and the other half with opaque posts (Tech 21 X-OP). In both groups the following combinations of adhesive/cement were tested: OptiBond Solo Plus/Nexus Third Generation (NX3), XP Bond/SureFil SDR Flow (SDR), and Vertise Flow (VF). Push-out test was used to assess the retentive strength of fiber posts, which was expressed in megapascals (MPa). Specimens were analyzed under a stereomicroscope to determine failure mode (adhesive between luting agent and post, adhesive between luting agent and dentin or mixed failure). Push-out data and failure mode distribution were analyzed by two-way ANOVA and Chi-square test, respectively (P< 0.05). Results: The statistical analysis revealed that only the type of luting material significantly influenced push-out bond strength of the post (P< 0.001). SDR (9.00 ± 2.17 MPa) performed similarly to the control group NX3 (7.15 ± 1.74 MPa), while VF (4.81 ± 1.51 MPa) should significantly lower bond strength. Failure modes differed significantly among groups. (Am J Dent 2013;26:324-328).




Clinical significance: The new low-shrinkage flowable composite for bulk filling of posterior restorations (SureFil SDR Flow) may also be considered for fiber post luting, as in this investigation it provided post retention comparable to that of a dual-cure resin cement tested as a control.




Mail: Dr. Jelena Juloski, Department of Dental Materials and Fixed Prosthodontics of Siena, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy. E-mail:





Clinical investigation of oral malodor during long-term use of arginine-containing dentifrices


Deyu  Hu, dds, ms,  Xue  Li, dds, phd,  Wei  Yin, dds, phd,  William  DeVizio, dmd,  Luis  R.  Mateo, ma,

Serge  Dibart, dds  &  Yun-Po  Zhang, phd, dds (hon)


Abstract: Purpose: To investigate whether the long term use of two dentifrices containing arginine, an insoluble calcium compound, and fluoride: (1) 1.5% arginine and 1450 ppm F as sodium monofluorophosphate (NaMFP) in a dicalcium phosphate dihydrate (dical) base, and (2) 8.0% arginine and 1450 ppm F as NaMFP in a calcium carbonate base, results in an increase in oral malodor potentially associated with increased ammonia production from breakdown of arginine, as compared to a commercially available fluoride dentifrice without arginine (1450 ppm F as NaMFP in a dical base), after 6 months of product use. Methods: A 6-month clinical study, with 119 subjects, was conducted in Chengdu, China, using a double blind, randomized, parallel, three-treatment design. A panel of four expert judges used a nine-point hedonic scale to evaluate breath odor using a protocol designed in concordance with the ADA Acceptance Program Guidelines for Product Used in the Management of Oral Malodor. After a baseline evaluation, study subjects who scored above the threshold value for unpleasant breath odor were stratified by score and randomized into one of three treatment groups. Subjects were provided with a soft-bristled manual toothbrush (Colgate Classic Clean Toothbrush) and brushed their teeth thoroughly in their regular and customary manner for 1 minute with their assigned dentifrice, twice daily. Before breath-odor evaluations, the subjects refrained from eating odorigenic foods and did not use dental hygiene procedures, breath mints, or mouth rinses for 48 hours and 12 hours, respectively. Results: There was no statistically significant difference in oral malodor levels among subjects using the three dentifrices after 1, 3 and 6 months of product use. (Am J Dent 2013;26:329-334).



Clinical significance: The long term use of the two dentifrices containing arginine and fluoride did not increase oral malodor potentially associated with increased ammonia production from breakdown of arginine, as compared to the commercially available fluoride dentifrice.



Mail: Dr Yun-Po Zhang, Colgate-Palmolive Technology Center, 909 River Road, Piscataway, NJ 08855-1343, USA; E-mail:



Analysis of interfacial structure and bond strength of self-etch adhesives


Lilliam M. Pinzon, dds, ms, mph, Larry G. Watanabe, bs, ms, Andre F. Reis, dds, ms, phd, John M. Powers, phd, Sally J. Marshall, phd  &  Grayson W. Marshall, dds, mph, phd



Abstract: Purpose: To determine the bond strength, nanoleakage and interfacial morphology of four self-etch adhesives bonded to superficial dentin. Methods: Microtensile (MT) (n= 15) and single plane shear (SP) (n= 8) bond tests were performed using human dentin polished through 320-grit SiC paper. Clearfil Protect Bond (PB), Clearfil S3 Bond (S3), Prompt L-Pop (PLP) and G-Bond (GB) were used according to their manufacturers’ instructions. Composite was applied as cylinders with a thickness of 4 mm with a 1 mm diameter and stored in water at 37°C for 24 hours. Specimens were debonded with a testing machine at a cross-head speed of 1 mm/minute. Means and standard deviations of bond strength were calculated. Data were analyzed using ANOVA. Fisher’s PLSD intervals were calculated at the 0.05 level of significance. Failure modes were determined at ×100. The hybrid layer was revealed by treatment with 5N HCl/5% NaOCl or fractured perpendicular to the interface and sputter coated with gold. Specimens were viewed at ×1,000, ×2,500, and ×5,000 in a field emission SEM at 15 kV. Teeth (n=2) sectioned into 0.9 mm-thick slabs were immersed in ammoniacal silver nitrate solution for 24 hours, rinsed and immersed in photo-developing solution for 8 hours. Specimens were sectioned (90 nm-thick) and observed under TEM. Results: Means ranged from 25.0 to 73.1 MPa for MT and from 15.5 to 56.4 MPa for SP. MT values were greater than SP, but were highly correlated (R2 = 0.99, P= 0.003) and provided the same order for the systems studied. Fisher’s PLSD intervals (P< 0.05) for bond strength techniques and adhesives results were 1.7 and 2.3 MPa, respectively. Failures sites were mixed. TEM showed that hybrid layers were ~0.5 μm for PB, GB and S3 and ~5 μm for PLP. SEM showed morphologic differences among adhesives. Silver nitrate deposits were observed within the interfaces for all adhesive systems. (Am J Dent 2013;26:335-340).







Clinical significance: Simplification of application procedures appears to induce loss of adhesion capabilities. The microtensile bond strengths ranged from 25-73 MPa. None of the adhesive systems tested was able to totally prevent nanoleakage, but there were differences among systems. No relationship was observed between thickness of the hybrid layer and bond strength.






Mail: Dr. Lilliam M. Pinzon, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, 707 Parnassus Avenue, D-2244. San Francisco, CA 94143, USA. E-mail:




Adhesion to primary dentin: Microshear bond strength and scanning

electron microscopic observation


Daniele  Scaminaci  Russo, dds,  Valentina  Iuliano, dds,  Lorenzo  Franchi, dds,  Marco  Ferrari, md, dmd, phd &  Luca  Giachetti, md, dmd, msc


Abstract: Purpose: To compare the bond strength to human primary dentin of a self-adhesive light-curing resin composite, a self-etch adhesive and a glass-ionomer cement by means of microshear bond strength (µSBS) test and scanning electron microscopic (SEM) observations. Methods: 75 human primary molars were sectioned to obtain a 2 mm-thick slab of mid-coronal dentin, randomly divided into three groups (n=25). Nine conical frustum-shaped build-ups were constructed on the occlusal surface of each dentin slab using a self-adhesive light-curing resin composite (Vertise Flow; Group 1), bonding agent (Optibond All-in-One; Group 2) combined with resin composite (Premise Flow) and a glass-ionomer cement (Ketac-Fil; Group 3). After thermocycling, specimens were subjected to µSBS test. All debonded specimens were observed at SEM. Data were analyzed by a mixed model and chi-square test. Results: The bond strength measured in Group 1 (9.0±4.5 MPa) was significantly lower than that one recorded in Group 2 (20.2±12.5 MPa) although it was significantly higher than the one recorded in Group 3 (4.8±2.3 MPa). Failures were mainly adhesive in all groups. (Am J Dent 2013;26:341-346).




Clinical significance: Self-adhesive light-curing resin composites may be a viable alternative to conventional materials used for the restoration of primary teeth especially in young or noncompliant children.


Mail: Dr. Luca Giachetti, Department of Surgery and Translational Medicine, Unit of Dentistry, University of Florence, Via del Ponte di Mezzo 48, 50127 Florence, Italy. E-mail:





Plaque fluoride concentrations associated to the use of conventional

and low-fluoride dentifrices


Juliano Pelim Pessan, dds, msc, phd,  Michele Mauricio Manarelli, dds,msc, Karina Yuri Kondo, dds, msc, FlÁvia de Moraes Italiani, dds, msc, phd, ClÁudia Ayumi Nakai Kobayashi, dds, msc, phd,

Gary Milton Whitford, dmd, phd, Alberto Carlos Botazzo Delbem, dds, msc, phd

&  MarÍlia Afonso Rabelo Buzalaf, dds, msc, phd


Abstract: Purpose: This double-blind, crossover study evaluated whole plaque fluoride concentration (F), as well as whole plaque calcium concentrations (Ca) after brushing with a placebo (PD – fluoride free), low-fluoride (LFD, 513 µg F/g) and conventional (CD, 1,072 µg F/g) dentifrices. Methods: Children (n=20) were randomly assigned to brush twice daily with one of the dentifrices, during 7 days. On the 7th day, samples were collected at 1 and 12 hours after brushing. F and Ca were analyzed with an ion-selective electrode and with the Arsenazo III method, respectively. Data were analyzed by ANOVA, Tukey’s test and by Pearson correlation coefficient (P< 0.05). Results: The use of the fluoridated dentifrices significantly increased plaque [F]s 1 hour after brushing when compared to PD, returning to baseline levels 12 hours after. Positive and significant correlations were found between plaque [F] and (Ca) under most of the conditions evaluated. The mean increase in plaque [F] observed 1 hour after brushing with the CD were only about 47% higher than those obtained for the LFD. The use of a LFD promotes proportionally higher increases in plaque [F] when compared to a CD. Plaque F concentrations were also shown to be dependent on plaque Ca concentrations. (Am J Dent 2013;26:347-350).




Clinical significance: The similarity of plaque F levels 1 hour after brushing with the low-fluoride and conventional dentifrices suggest that low-fluoride dentifrices could be a valid alternative of dentifrice use, especially by caries-inactive children residents in an optimally fluoridated area.




Mail: Dr. Juliano Pelim Pessan, Department of Pediatric Dentistry and Public Health, Araçatuba Dental School, Paulista State University (UNESP), Rua Jose Bonifacio 1193, 16015-050 Araçatuba - SP – Brazil. E-mail:




Randomized clinical trial of adhesive restorations in primary molars.

18-month results


Luciano Casagrande, dds, ms, phd,  DÉbora Martini Dalpian, dds, ms,  Thiago Machado Ardenghi, dds, ms, phd, FabrÍcio  Batistin  Zanatta, dds, ms, phd,  Carlos  Eduardo  Agostini  Balbinot, dds, ms, Franklin  GarcÍa-Godoy, dds, ms, phd, phd   &   Fernando  Borba  de  Araujo, dds, ms, phd


Abstract: Purpose: To evaluate the clinical performance of adhesive restorations of resin composite and resin-modified glass-ionomer cements in primary molars. Methods: This randomized clinical trial included subjects (5-9 year-old children) selected at two university centers (UFRGS and UNIFRA). The sample consisted of 132 primary molars presenting active cavitated carious lesions (with radiographic involvement of the inner half of the dentin), located on the occlusal and occlusal-proximal surface. The sample was randomly divided into three groups, according to the restorative material: (G1) universal restorative system (Adper Single Bond 2 system and Filtek Z350); (G2): Resin-modified glass-ionomer cement (Vitremer); and (G3): Low shrink restorative system (Filtek P90). The restorations were clinically and radiographically followed every 6 months for up to 18 months using the USPHS modified criteria for clinical evaluation. Survival estimates for restoration longevity were evaluated using the Kaplan-Meier method. Log-rank test (P< 0.05) was used to compare the differences in the success rate according to the type of the restorative material. Results: The type of restorative material used did not influence the longevity of the restorations. After clinical follow-up, there was no statistical difference in the rates of success for the three materials used to restore active cavitated carious lesions in primary molars. The survival rates for the follow-up were similar regarding the number of restored surfaces and the caries removal technique (partial or complete). Mean estimated time of survival was 17.2 months (95% CI: 16.7-17.7). Estimated survival rates of the restorations were 100%, 98%, 88% and 65% at 1, 6, 12 and 18 months of clinical evaluations, respectively.(Am J Dent 2013;26:351-355).


Clinical significance: Primary molars with active cavitated carious lesion restored with resin-modified glass-ionomer cement and resin composite presented satisfactory levels of clinical success at the 18-month follow-up period.


Mail: Dr. Luciano Casagrande, Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos 2492, Porto Alegre, RS; ZIP: 90035-003, Brazil. E-mail:




Evaluation of bleaching efficacy and erosion potential of four different over-the-counter bleaching products


So Ran  Kwon, dds, ms, phd, ms,  Juan  Wang, dds, ms, phd,  Udochukwu  Oyoyo, mph  &  Yiming  Li, dds, msd, phd


Abstract: Purpose: To evaluate the bleaching efficacy and erosion potential of various over-the-counter bleaching products following a test method specified in ISO 28399. Methods: Specimens were prepared from bovine molars, stained in tea solution, embedded and randomly assigned to six groups of 10 enamel and dentin specimens each. Color was assessed at baseline, 1 day and 1 month post-bleaching with the Vita Bleachedguide 3D Master shade guide. Surface roughness changes (∆Ra), determined by baseline and post-treatment values were measured with a profilometer. The negative (NC) and positive control (PC) was treated with grade 3 water and 1.0% citric acid, respectively. Over-the-counter products were used according to manufacturer’s instructions. Brite Teeth Pro (BT), Natural White 5-Minute Whitening (NW), Luster Premium White (LP), and Crest 3D Whitestrips (WS) represented a brush-on-paint system, tray system, light-activated system and adhesive-strip system, respectively. Kruskal-Wallis procedure was used to compare surface roughness changes among groups. Color change was assessed with Friedman-test and stratified by hard tissue type with α= 0.05. Results: WS was the only group demonstrating color changes in enamel and dentin (P< 0.05). There were no differences in ∆Ra for enamel and dentin among NC, BT, LP, and WS. NW showed increase in ∆Ra in dentin (P< 0.05), while PC demonstrated an increase in ∆Ra regardless of hard tissue type (P< 0.05). (Am J Dent 2013;26:356-360).


Clinical significance: Proper selection of over-the-counter bleaching products is advised to achieve desirable bleaching efficacy without affecting surface roughness.


Mail: Dr. So Ran Kwon, Department of Operative Dentistry, University of Iowa College of Dentistry, 801 Newton Road #45, S235 DSB, Iowa City, IA 52242-1001, USA. E-mail:



Review Article


Treatment modalities for peri-implant mucositis and peri-implantitis


Stefan Renvert, dds, phd, Ioannis Polyzois, dmd, phd  &  G. Rutger Persson, dds, phd


Abstract: Purpose: To review treatment modalities used for peri-implant mucositis and peri-implantitis. Methods: A literature search was performed in PubMed for articles published until May 2013 using peri-implantitis and peri-implant mucositis and different modalities of treatment as search terms. The search was limited to the English literature. Titles and abstracts were searched in order to find studies eligible for the review. Results: The present review reported that treatment of peri-implant mucositis lesions using mechanical therapy is possible. The additional use of professionally delivered antimicrobials has commonly failed to show additional benefits as compared to mechanical debridement alone. The scientific evidence on the efficacy of non-surgical and surgical therapies in the treatment of peri-implantitis is limited. Complete resolution of peri-implantitis using mechanical, laser, or photodynamic therapy does not seem to result in a predictable outcome. Following surgical interventions around implants diagnosed with peri-implantitis, clinical improvements as judged by reductions of probing depths and bleeding on probing have been reported. Bone or bone substitutes have been used in attempts to regenerate bone loss around implants. When regenerative modalities have been employed, radiographic evidence of defect fill has been reported.  Few long term follow up studies on the treatment of peri-implantitis are available. Positive treatment results can be maintained over a period of 3-5 years. Regardless of the treatment performed, adequate plaque control by the patient is fundamental to treatment success. If the patient cannot obtain an adequate level of oral hygiene, the infection around the implants will reoccur. (Am J Dent 2013;26:313-318).




Clinical significance: Patient risk assessment and a proper maintenance program seem to be fundamental for obtaining good treatment results of peri-implantitis.






Mail: Dr. Stefan Renvert, Department of Oral Sciences, School of Health and Society, Kristianstad University, Kristianstad, Sweden. E-mail:




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