A 6-month clinical evaluation of a high frequency
sonic toothbrush
Jing Lv, mm, Bing Guo, mm & Junqi Ling, dds
Abstract: Purpose: To compare the 6-month clinical efficacy of a novel high
frequency sonic power toothbrush (A) with an oscillating-rotating (O-R) power
toothbrush (B) and a traditional sonic toothbrush (C) in reducing plaque and
gingivitis. Methods: This was a
single-center, randomized, examiner-blind, parallel group design consisting of
two two-treatment sub-trials. Gingivitis was assessed using the Modified
Gingival Index (MGI) and Gingival Bleeding Index (GBI). Plaque was assessed
using the Rustogi Modified Navy Plaque Index (RMNPI)
at Baseline, Month 3, and Month 6. Statistical analysis between A versus B and
A versus C were evaluated. Data were analyzed using an ANCOVA with the baseline
score as the covariate. Results: In
total, 120 subjects (40 per group) were randomized to treatments and 119
subjects completed the study. All power toothbrushes provided statistically
significant reductions in gingivitis and plaque relative to Baseline (P<
0.001). Reductions in MGI and GBI scores were not statistically significantly
different between A and B at Months 3 and 6. While A had statistically
significant 20.1% and 29.0% greater reductions in total RMNPI and interproximal RMNPI respectively, compared to B at Month 6
(P< 0.05). Reductions in gingivitis and plaque indices were not
statistically significantly different between A (41,000 oscillations/minute)
and C (31,000 oscillations/minute) at Month 3. Compared to C,
A demonstrated 14.0% and 14.5% greater reductions in MGI and GBI respectively,
and 26.0% greater reduction in interproximal RMNPI
versus baseline at Month 6 (P< 0.05). No adverse events were reported
for the power toothbrushes. (Am J Dent 2018;31:171-176).
Clinical significance: The new high frequency sonic
power toothbrush was not significantly different from the oscillating-rotating
power toothbrush in gingivitis reduction while it demonstrated statistically
significantly greater reductions in plaque. The new high frequency sonic power
toothbrush was significantly more efficacious than the traditional sonic
toothbrush in reducing plaque and gingivitis after long term use.
Mail: Junqi Ling, Department of Operative Dentistry and Endodontics, Guanghua School and Hospital of Stomatology and Institute of Stomatological Research, Sun Yat-sen University. 56 Lingyuanxi Rd., Guangzhou 510055, China. E-mail:
lingjq@mail.sysu.edu.cn
Effect of desensitizing toothpastes on dentin
erosive wear
Raquel Marianna Lopes, dds, msc, Tais Scaramucci, dds, phd & Ana Cecilia
Corrêa Aranha, dds, msc, phd
Abstract: Purpose: To evaluate the effect of desensitizing dentifrices on
dentin wear and tubule occlusion using a three-phase, single blind, crossover
in situ trial. Methods: The
dentifrices containing Arginine and calcium carbonate
(1,450 ppmF) and Novamin,
(~1,426 ppmF) were tested in two conditions: A:
abrasion and B: erosion/abrasion. A dentifrice without desensitizing agents was
used as control (1,450 ppmF). In each study phase, 10
volunteers used intra-oral appliances containing dentin specimens (pre-treated
with EDTA, to simulate hypersensitive dentin), which were either submitted to
erosion with a cola-like drink (pH 2.6), 4×/day (2 minutes), followed by toothbrushing, using electric toothbrushes, with standard
pressure (2×/day, 5 seconds), or toothbrushing only.
Dentin surface loss (SL, in µm) was determined with optical profilometry at the 3rd and 5th days of cycling. Dentin surface was analyzed with
environmental scanning electron microscopy (ESEM), post EDTA and post cycling,
and the dentin tubules were counted using Image J software. Data were
statistically analyzed (α= 0.05). Results: For condition A and B, there were no significant differences in SL among
toothpastes in both experimental times. There were also no significant
differences between times within groups. For ESEM, in A, Toothpaste with Novamin was the only dentifrice that showed significantly
less opened tubules post cycling than post EDTA. In B, Toothpaste with Novamin and control toothpaste presented less opened
tubules post cycling. In conclusion, toothbrushing with
the tested dentifrices promoted similar levels of dentin loss; however, for
tubule occlusion, the toothpaste with Novamin was the
only toothpaste effective for both conditions,
abrasion and erosion/abrasion. (Am J Dent 2018;31:177-183).
Clinical significance: Ideally, desensitizing
dentifrices should promote obliteration of the dentin tubules or nerve
desensitization, without further contributing to the progression of dentin
wear.
Mail: Prof. Dr. Ana Cecilia
Corrêa Aranha, Department of Restorative Dentistry, School of Dentistry,
University of São Paulo, Prof. Lineu Prestes, 2227 Cidade Universitária, São Paulo, 05508-000, SP, Brazil. E-mail:
acca@usp.br
Subgingival uptake and retention of stannous fluoride from
dentifrice:
Malgorzata A. Klukowska, phd, dds, Niranjan Ramji, phd, Chelsea Combs, ms, Jeffery L. Milleman, dds, mpa,
Abstract: Purpose: To examine the delivery of stannous fluoride to subgingival sulci following toothpaste use in a clinical
population. Methods: This was a
controlled, single-site study. 23 subjects with at least 20 dental pockets, 2-4
mm with bleeding, who had not used a stannous fluoride dentifrice in the last 3 months were enrolled. After a 2-week washout period,
20 subjects returned for a baseline visit. They were instructed to refrain from
brushing the night before the baseline visit. GCF samples were taken from up to
10 sites identified as sampling sites. Subjects were then given a 0.454%
stannous fluoride dentifrice and soft manual toothbrush and asked to brush for
1 minute. 30 minutes after brushing, GCF was re-sampled. Subjects continued
using the stannous fluoride dentifrice and soft manual toothbrush at home,
twice daily for 2 weeks, in place of their usual hygiene products. At Days 1
and 14, subjects returned to the site, and 12 hours post-brushing GCF samples
were taken. The samples were analyzed by ICP-MS (inductively coupled plasma
mass spectrometry). A Wilcoxon signed-rank test was
performed to determine the difference between post-baseline visits and
baseline. Statistical tests were 2-sided using a 5% significance level. Results: 20 subjects completed the
trial. Significant levels of tin, a marker for stannous fluoride, were detected
30 minutes after brushing at sampling sites of 2-4 mm. The median tin level in
gingival crevicular fluid (GCF) was 24.59 ng/µl, which was highly
significant versus baseline (P< 0.0001). Tin levels sampled in GCF 12 hours
after brushing on Days 1 and 14 were highly significant versus Baseline (P<
0.0001), showing an increasing trend with continued use. (Am J Dent 2018;31:184-188).
Clinical significance: Stannous fluoride was found to
penetrate sampling sites from 2-4 mm and was retained for 12 hours. Subgingival uptake and retention of stannous fluoride
following toothbrushing may play a role in
detoxification effects on microbial biofilms and may
contribute to the therapeutic efficacy of stannous fluoride dentifrices in
promoting gingival health.
Mail: Dr. Donald J. White, 5567
Lakeside Drive, Fairfield, OH 45014. E-mail: lamadental@outlook.com
Randomized clinical trial
to determine if changes in dentin tubule occlusion
Joon Seong, bds, phd, Maria
Davies, bsc, phd, Emma L.
Macdonald, bsc, phd, Nicholas
C.A. Claydon, bds, mscd, phd
Abstract: Purpose: To quantify dentin tubule
occlusion and correlate this with pain reduction in vivo. Methods: This was a single-center, randomized two treatment,
examiner-blind, parallel study. 20 participants with confirmed dentin
hypersensitivity (DH) were evaluated by Schiff Air Blast, VAS Air Blast and
replica impression of the tooth surface to visualize tubule occlusion at
baseline and following 4-week twice daily use of either an occluding toothpaste
(8% strontium acetate, 1,040 ppm fluoride) or a
non-occluding toothpaste (1,450 ppm fluoride). Results: Both treatments increased
tubule occlusion significantly from baseline to 4 weeks (P= 0.01) with
significant decreases in pain score only seen with the occluding toothpaste
(Schiff, P= 0.01; VAS, P= 0.01). Schiff pain score after 4 weeks was markedly
reduced following treatment with the occluding toothpaste as compared to the
non-occluding toothpaste, (P= 0.05) with no significant differences between the
pastes for occlusion score or patient reported VAS, although the scores favored
the occluding toothpaste. (Am J Dent 2018;31:189-194).
Clinical significance: Occlusion scores as obtained by
replica impression techniques with SEM imaging correlate significantly with DH
pain scores confirming proof of concept. With further refinement, this
technique could be used to accurately quantify tubule occlusion in vivo and the
associated pain reduction achieved by occluding toothpastes.
Mail: Prof. Nicola X. West, Periodontology, Clinical Trials Unit, Bristol Dental
School, Lower Maudlin Street, Bristol, BS1 2LY, United Kingdom. E-mail:
n.x.west@bristol.ac.uk
Efficacy of ibuprofen and codeine + paracetamol to reduce immediate
Samila Neres de Oliveira, dds, Isauremi Vieira de Assunção, dds, msc, phd
Abstract: Purpose: To evaluate (1) the efficacy of Ibuprofen and codeine + paracetamol to control immediate bleaching
sensitivity caused by in-office tooth bleaching performed with 35% hydrogen
peroxide, and (2) tooth shade change caused by 35% hydrogen peroxide. Methods: In this randomized, controlled
and double blind clinical trial, 60 volunteers were divided into three treatment
groups: 400 mg placebo (PL)(n=20), 400 mg ibuprofen
(IB)(n=20), or 30 mg codeine + 500 mg paracetamol (CP)(n=20).
The volunteers were submitted to two bleaching sessions with 35% hydrogen
peroxide in 2 applications of 20 minutes each. In both sessions, the medication
was given to the volunteers 1 hour before the bleaching procedure. The
sensitivity values were obtained with the analogic visual pain scale. Tooth shade was assessed before and after bleaching.
Statistical analysis was done through the one-way ANOVA and Tukey post-hoc tests. Results: For
bleaching sensitivity, there were statistically significant differences among
the medications (P< 0.01). The lowest sensitivity means were found in the CP
group (PL:4.7 = IB:4.8 > CP:1.0). In regards to
tooth shade, participant’s teeth were statistically significantly lighter after
bleaching than before bleaching (P< 0.01), with no statistically significant
difference between the medications (P< 0.05). (Am J Dent 2018;31:195-198).
Clinical significance: The use of codeine + paracetamol 1 hour before in-office tooth bleaching can
drastically reduce immediate sensitivity.
Mail: Dr.
Boniek Castillo Dutra Borges, Av. Senador
Salgado Filho 1787, Lagoa Nova, Natal, RN, 59151-250 Brazil. E-mail:
boniek.castillo@gmail.com
Surface treatments to improve the repair
of acrylic and bis-acryl
Thais Marques Simek Vega Gonçalves, dds, phd, Karla Nunes Teixeira, dds, phd, Julia Meller Dias
de Oliveira, dds, Lorena Tavares Gama, dds, Sergio Bortolini, ds, phd & Analucia Gebler Philippi, dds, phd
Abstract: Purpose: To evaluate
the in vitro effects of the Composite Primer and different surface treatments
on the shear bond strength (SBS) of acrylic and bis-acryl
repairs with resin composite (RC). Methods: Acrylic (Alike) and bis-acryl (Protemp 4) blocks were prepared. Surface roughness was standardized (0.16 µm) and grit
blasting was applied to half of the samples. Blocks were divided randomly into
groups according to surface treatment [methyl methacrylate monomer (MMA) for 180 seconds or bonding agents (Composite Primer and Scotchbond Multi Purpose), applied alone or following MMA].
Two consistencies of RC [regular (Filtek Z350XT and Solare composite) or flowable (Filtek Z350XT flowable and G-aenial flowable composite)] were
used to test bond repair. Cylinders (2 mm diameter) of each RC (n= 10/group)
were attached to the block surface, and SBS was measured using a universal
testing machine at 0.5 mm/minute. Failure (adhesive, cohesive or mixed) was
assessed under ×3.5 magnification. SBS data were analyzed using factorial
ANOVA, followed by Tukey post-hoc, and Weibull moduli estimation (α
= 0.05). Results: The highest SBS, Weibull modulus (m) and scale parameter (σ0) were
found in combined use of MMA and bonding agents (P< 0.001), regardless of
the substrate, RC consistency or brand. The use of the Composite Primer and flowable RC also increased SBS (P< 0.001). Significant
interaction between surface treatment and RC consistency was observed for the
PMMA substrate (P< 0.001). Sandblasting did not influence SBS (P> 0.05).
Adhesive failure was most prevalent (93.5%) and SBS values were significantly
higher in mixed fractures (19.2 ± 3.8 MPa) compared
to the adhesive ones (9.7 ± 6.0 MPa) (P< 0.001).
No cohesive fracture was observed. (Am J
Dent 2018;31:199-204).
Clinical
significance: Composite Primer improved the adhesion of acrylic and bis-acryl
repairs, especially when a flowable composite was
used. When such product is not available, the combined use of MMA and a bonding
agent is necessary, increasing the number of clinical steps, cost, and time
required.
Mail: Dr. Thais Marques Simek Vega Gonçalves, Department of Dentistry, Federal
University of Santa Catarina, University Campus, R. Eng. Agronômico Andrei Cristian Ferreira, s/n Mailbox 476, Trindade, 88040900, Florianópolis, SC,
Brazil. E-mail: thaisgonc@gmail.com
Effect of thermal cycling on fracture toughness of
CAD/CAM materials
Thiago Soares Porto, dds, msc, phd, Renato Cassio Roperto, dds, msc, phd, Anna Akkus, msc, phd,
Abstract: Purpose: To compare the fracture toughness of four different
CAD/CAM materials, (VM) Vitablocs Mark II, (IP) IPS
e.max CAD, (LU) LAVA Ultimate, and (VE) Vita Enamic under long thermocycling conditions. Methods: Each type of ceramic block was
sectioned into beams (n=9) with dimensions of 14×3×2.5 mm (L × W × H). All four
ceramics were submitted to different conditions: the desiccator or distilled water, each for 7 days. The third and fourth conditions involved
the specimens being submitted to 60,000 and 120,000 thermocycles in water respectively. The dwelling time was 52 seconds at 5° and 55°C. A
three-point bend test with a universal loading machine on notched samples was
per-formed. Furthermore, a fractographic analyses was
made by scanning electron microscopy (SEM) to determine if any of these
conditions influenced the type of fracture. Data were analyzed by two-way ANOVA
(α= 0.05). Results: A
significant difference in fracture toughness (P< 0.05) was found among the
groups; IP (4.20±1.23) had the highest value followed by VE (2.02±0.39), which
did not have a statistically significant difference from LU (1.96±0.42). The
lower value and statistical difference for VM was 1.52±0.35. The ceramics
performed better after they were hydrated, while the polymer-based materials
had the fracture toughness means decreased after the thermocycles.
(Am J Dent 2018;31:205-210).
Clinical significance: A significant difference in fracture toughness (P<0.05) was found
among the groups; IP had the highest value followed by VE, which was not
statistically significantly different from LU. The ceramics performed better
after they were hydrated, while the polymer-based materials had fracture
toughness means decreased after thermocycling.
Mail: Dr Thiago S. Porto, Department
of Comprehensive Care, CWRU School of Dental Medicine, 2124 Cornell Rd,
Cleveland, OH 44106, USA. E-mail:
txp209@case.edu
Effect of different mouthwashes on discoloration of
plaque-free
Mustafa Hayati Atala, dds, phd, Gülbahar Ustaoğlu, dds, dclindent, Nagehan Atala, dds
Abstract: Purpose: To evaluate the tooth discoloration effect of the daily
use protocol of six different mouthrinses. Methods: 70 extracted caries-free
central incisors were divided into seven groups (n=10/per group): Group 1: Curasept Anti Discoloration System; Group 2: CB12; Group 3:
Listerine Zero; Group 4: Listerine Cool Mint; Group 5: Colgate Plax; Group 6: Kloroben. The teeth were exposed to the mouthrinse for 2 minutes daily for 3 weeks. Color measurement was performed four times: at
the beginning of the study, and after 1, 2 and 3 weeks, with a digital
spectrophotometer (Vita Easyshade Advanced).
Color changes (∆E) were calculated and ANOVA and post hoc Tukey’s test were used for statistical analysis. Results: Although there was no
statistically significant difference between the Colgate Plax and control
groups, both groups had a significant difference from the other groups within
all ∆E1, ΔE2 and ∆E3 values. (Am J Dent 2018;31:211-214).
Clinical significance: Among the mouthrinses tested, Listerine Cool Mint group exhibited the most tooth discoloration, while
Colgate Plax demonstrated the least noticeable color change.
Mail: Dr. Elif Yeğin, Department of Prosthodontics,
Faculty of Dentistry, Biruni University, Zeytinburnu-Istanbul, Turkey. E-mail: dtelifyegin@gmail.com
Clinical effects of
stannous fluoride dentifrice in reducing plaque microbial
Sancai Xie, phd, John Christian Haught, phd, Cheryl S. Tansky,
ms, Malgorzata Klukowska, dds, phd,
Abstract: Purpose: This study expanded the analysis of subgingival dental plaques from previous research to include the evaluation of cohort, site
and treatment effects on chemically measured endotoxin and activation of Toll-like receptor (TLR) based gene expression in two
additional reporter cell lines: a TLR2 specific cell line and a THP-1 (multi
TLR reporter) cell line. Methods: Participants from high and low bleeding cohorts were sampled at baseline for
both supra and subgingival dental plaque at both
healthy as well as clinically diseased sites and then provided with
intervention hygiene products including a stabilized SnF2 dentifrice
and a new soft bristle manual toothbrush. Following 2 and 4 weeks of assigned
dentifrice use, participants returned for a re-evaluation of gingival
inflammation and bleeding and repeat samplings of dental plaque. Subgingival sampled plaques were chemically analyzed for endotoxin concentration using a Thermo Scientific Pierce
LAL chromogenic endotoxin quantitation kit. Samples were also used for inoculation of
two reporter cell assays (an HEK293 TLR2 reporter cell line and a THP-1 monocyte cell line). Reporter cell activation was analyzed
via luminescence changes of secreted embryonic alkaline phosphatase. Results: The endotoxin content of subgingival plaque could be measured directly with dye
assays and plaque isolates activated gene expression in both TLR reporter cell
lines. Higher disease cohorts and sites with gingival inflammation generally
showed more endotoxins and higher levels of plaque
virulence as compared to low disease cohorts or plaque sampled from clinically
healthy sites. SnF2 dentifrice treatment was associated with broad
scale reductions in endotoxin content and virulence potentiation properties of dental plaque samples collected subgingivally from patients. (Am J Dent 2018;31:215-224).
Clinical significance: These results collectively
support the use of dye or various reporter cell lines in the characterization
of plaque virulence in diseased populations and as a potential route for
analysis in clinical evaluations of treatment interventions. Subgingival plaque ‘detoxification’ including effects on
microbial pathogenicity as well as metabolic activity
may be considered important mechanisms contributing to clinical benefits of SnF2 dentifrice.
Mail: Dr. Donald J. White, 5567
Lakeside Drive, Fairfield, OH 45014, USA. E-mail: lamadental@outlook.com