The rôle of a dentine-bonding agent in reducing cervical dentine sensitivity

Comparison of the Effectiveness of Combined Diode Laser and GLUMA Bonding Therapy With Combined Diode Laser and 5% Sodium Fluoride Varnish in Patients With Dentin Hypersensitivity

Introduction: Dentin hypersensitivity (DH) is one of the most common complaints of patients referred to a dental office, so this study aimed to compare the effectiveness of combined diode laser and GLUMA bonding therapy with combined diode laser and 5% sodium fluoride varnish in patients with DH. Methods: Sixty patients were divided into three groups (bonding, laser-bonding, laser-varnish), and before the intervention, the amount of DH was measured with the visual analogue scale (VAS) scale. In the bonding group, GLUMA Desensitizer solution was applied and then air-dried. In the bonding-laser group, first bonding was used, and then the affected tooth was irradiated with a diode laser. In the varnish-laser group, 5% sodium fluoride varnish was coated and then the laser was irradiated with the said method. DH was measured immediately after the treatment and then 2, 7 and 30 days after the treatment. Results: Laser-varnish treatment was not different from laser-bonding treatment at all measurement times (P=1). Laser-varnish and bonding treatment were not significantly different up to one week after the intervention, but on the 30th day after the intervention, the difference in pain was significant (P=0.01). There was no significant difference in laser-bonding treatment up to one week after the intervention, but on the 30th day after the intervention, the difference in pain was significant (P=0.003). Conclusion: The combined treatment with GLUMA bonding and the 660 nm diode laser is effective in reducing DH and this is more effective than GLUMA bonding alone in the long term. However, it does not have a significant advantage over the combined varnish-laser method, but it seems that due to its ease of use, it can be a suitable alternative to the varnish-laser method.

Effect of erosive and abrasive stress on sealing ability of different desensitizers: In-vitro study

This in vitro study examined the sealing ability of different desensitizing agents under a chemo-mechanical stress condition. For the study, a total of 144 extracted, caries-free human third molars were used to produce 1 mm-thick dentin discs. The specimens were divided randomly into four groups: Superseal (SS), Gluma (GL), Gluma Self-etch (GS), and Tooth Coat (TC). For each group, the permeability was measured before and after applying the desensitizer, after being exposed to Coca Cola for 5 minutes, and after 3150 strokes of a brushing abrasion. The decrease in permeability after the erosive and abrasive stress was analyzed by ANOVA and Tukey post hoc test. As a result, the dentin permeability decreased significantly for all desensitizers immediately after application (p < 0.05). SS and GS showed a significant difference in permeability reduction observed immediately after application and after acid action with Coca Cola (p < 0.05). After brushing abrasion, the permeability reduction decreased significantly for all desensitizers tested in this study (p < 0.05). TC showed the largest decrease in dentinal permeability compared to that of the other desensitizers and the differences were significant after brushing abrasion (p < 0.05). All tested desensitizers were effective in reducing dentin permeability. The behavioral characteristics under erosive and abrasive stress varied according to the products used. TC exhibited excellent sealing ability among the other desensitizers.

Comparing the effect of a desensitizing material and a self-etch adhesive on dentin sensitivity after periodontal surgery: a randomized clinical trial

Objectives

This double-blind randomized placebo-controlled clinical trial evaluated the ability of a desensitizing agent and a self-etch adhesive on cervical dentin sensitivity (CDS) after periodontal surgery.

Materials and Methods

Ninety hypersensitive teeth of 13 subjects were included in the study. After periodontal surgery, the teeth of each posterior sextant treated with one of the following materials: G1: Clearfil S³ Bond (Kuraray Dental), G2: Gluma Desensitizer (Heraeus Kulzer), and G3: placebo (water). The sensitivity was assessed using evaporative stimuli before treatment (baseline, T0), 1 day after treatment (T1), after 1 week (T2), and after 1 month (T3) according to visual analog scale (VAS).

Results

Following the treatment, all the 3 groups showed significant reduction of CDS in T1 compared to T0. Reduction of CDS between T1 and T2 was observed only in G1 but there was no significant difference between T2 and T3 in this group. Although we observed a significant difference in T3 compared to T1 and T2 in G2 and G3, comparison of treatment groups in each assessment time showed a significant difference only in T3. According to paired comparison, this was due to the difference between G2 and G3.

Conclusions

Dentin sensitivity following periodontal surgery will decrease spontaneously over time, but treating the sensitive teeth with Gluma Desensitizer and Clearfil S³ Bond can have some benefits.

Ability of three desensitizing agents in dentinal tubule obliteration and durability: An in vitro study

Aim:

The purpose of this study was to evaluate the effectiveness of three desensitizing agents on dentinal tubule obliteration and their durability in use on the dentinal tubules.

Materials and Methods:

Sixty specimens were obtained from 30 extracted sound human maxillary first premolars. Each tooth was mesiodistally sectioned to obtain 30 buccal and 30 lingual surfaces, and enamel was removed in order to simulate hypersensitive dentin. Specimens were divided into four groups with 15 specimens each. Group 1 samples were immersed in artificial saliva, Group 2 samples were coated with Vivasens, Group 3 samples were coated with VOCO Admira Protect, and Group 4 samples were coated with Neo Active Apatite suspension. These specimens were examined under scanning electron microscope (SEM) to find out the occluding ability of the respective products. The specimens were brushed to find out their durability for 1 week and 1 month and were examined under SEM.

Statistical Analysis:

The results were statistically analyzed by analysis of variance (ANOVA) and Tukey's test.

Results:

Group 1 differed significantly from the Vivasens, Admira, and Neo Active Apatite groups at 5% level of significance (P < 0.05). The Vivasens group differed significantly from the Admira and Neo Active Apatite groups at 5% level of significance (P < 0.05).

Conclusion:

The Ormocer-based Admira Protect showed the best results.

Prevalence of dentinal hypersensitivity and study of associated factors: a cross-sectional study based on the general dental population of Davangere, Karnataka, India

BACKGROUND

Dentin hypersensitivity (DH) is a common clinical finding with a wide variation in prevalence and aetiological factors. The aim of this cross-sectional study was to determine the prevalence and examine some associated aetiological factors of DH in a study of an Indian population residing in and around Davangere district of Karnataka.

MATERIAL AND METHODS

A total of 404 patients (3,859 teeth) were examined for the presence of DH by means of a questionnaire and intraoral tests (air and tactile stimuli). Plaque, gingival recession, abrasion/erosion, labioversion and toothbrushing habits were noted.

RESULTS

A total of 795 teeth, in 404 patients, were diagnosed as having DH, giving an overall prevalence figure for DH of 20.6%. The chi-square test and the Z-test values for proportions were used to evaluate statistical correlations. The 36-45 years' age group was the cohort with the highest number of subjects with DH, and female subjects had greater predilection for DH compared with male subjects. Incisors were the tooth type most affected. DH was significantly correlated with gingival recession, labioversion and abrasion/erosion (P<0.05). Both gingival recession and abrasion/erosion were significantly correlated with brushing once daily in a horizontal direction and use of a toothbrush with medium-hardness bristles (P<0.05).

CONCLUSION

The prevalence of DH in the Indian population is 20.6%, with a higher predilection for DH in the age cohort 36-45 years and in female subjects. DH is a multifactorial entity with several aetiological factors, making its diagnosis and treatment a challenge for the clinician.

Making sense of sensitivity

Our professional understanding of the causes and treatment options for dentine hypersensitivity should now allow the dental profession to manage this condition reliably. This paper reviews the aetiology and explains the scientific basis for what has become a confusing number of products and methods available to patients and dental clinicians.

CLINICAL RELEVANCE

Dentine hypersensitivity appears to be an increasing problem for patients and the dental profession alike. Clinicians need to have up-to-date knowledge of this condition and the products available to treat patients presenting with this troublesome complaint.

Dentinal tubules sealing by means of diode lasers (810 and 980 nm): a preliminary in vitro study

OBJECTIVE

The aim of this study was to evaluate the effect on dentinal surfaces of diode lasers (810 and 980 nm) at different parameters.

MATERIALS AND METHODS

Twenty-four caries-free human impacted wisdom teeth were used. The crowns were sectioned transversely in order to expose the dentin. The smear layer was removed by a 1 min application of ethylenediaminetetraacetic acid (EDTA). Each surface was divided into four quadrants irradiated at a different output power setting for each kind of laser: 0.8, 1, 1.6, and 2 W (energy densities: 2547, 3184, 5092, and 6366 J/cm(2), irradiation speed 1 mm/sec; optical fiber diameter: 200 μm; continuous and noncontact mode). Half of the samples were stained with a graphite paste. All specimens were sent for scanning electron microscopic (SEM) analysis. Pulp temperature increases in additional 20 teeth were measured by a thermocouple.

RESULTS

Diode laser irradiations at 0.8 and 1 W led to occlusion or narrowing of dentin tubules without provoking fissures or cracks. The application of graphite paste increased the thermal effects in dentin. Measurements of pulp temperature showed that irradiations at 0.8 and 1 W for a period of 10 sec in continuous mode increased pulp temperature (T ≤2°C).

CONCLUSIONS

Diode lasers (810 and 980 nm) used at 0.8 and 1 W for 10 sec in continuous mode were able to seal the dentin tubules. These parameters can be considered harmless for pulp vitality, and may be effective in the treatment of dentinal hypersensitivity.

Oxalic Acid Under Adhesive Restorations as a Means to Reduce Dentin Sensitivity: A Four-Month Clinical Trial

Oxalic acid may offer a novel approach to improve the reduction of dentin postoperative sensitivity after placement of resin-bonded restorations.

Dentine sealing provided by smear layer/smear plugs vs. adhesive resins/resin tags

The aim of this study was to evaluate the ability of five experimental resins, which ranged from hydrophobic to hydrophilic blends, to seal acid-etched dentine saturated with water or ethanol. The experimental resins (R1, R2, R3, R4, and R5) were evaluated as neat bonding agents (100% resin) or as solutions solvated with absolute ethanol (70% resin/30% ethanol). Fluid conductance was measured at 20 cm H(2)O hydrostatic pressure after sound dentine surfaces were: (i) covered with a smear layer; (ii) acid-etched; or (iii) bonded with neat or solvated resins, which were applied to acid-etched dentine saturated with water or ethanol. In general, the fluid conductance of resin-bonded dentine was significantly higher than that of smear layer-covered dentine. However, when the most hydrophobic neat resins (R1 and R2) were applied to acid-etched dentine saturated with ethanol, the fluid conductance was as low as that produced by smear layers. The fluid conductance of resin-bonded dentine saturated with ethanol was significantly lower than for resin bonded to water-saturated dentine, except for resin R4. Application of more hydrophobic resins may provide better sealing of acid-etched dentine if the substrate is saturated with ethanol instead of with water.

Sealing Ability of Dentin Adhesives/Desensitizer

Depending on the application of the individual adhesives used, dentin adhesives seal dentin surfaces and reduce dentinal permeability. Dentin adhesives possessing a high sealing ability for dentin surfaces are suggested for the treatment of dentin hypersensitivity.

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.

Water uptake of bonding systems applied on root dentin surfaces: a SEM and confocal microscopic study

OBJECTIVES

Dentin adhesives have been proposed as desensitizing agents to seal exposed root dentin surfaces. Simplified 'one-step' dentin adhesives are highly permeable to water. The authors hypothesized that a lactic acid challenge may increase permeability of simplified adhesives and may induce fast degradation of bonding. This phenomenon adversely affects their durability as long term desensitizing agents. The aim of this in vitro study was to evaluate the ability of four dentin adhesives to seal root dentin surfaces that were exposed to water and lactic acid challenges.

METHODS

Four commercially-available dentin adhesives were applied with a small sponge to the root dentin of extracted human molars as de-sensitizing agents. Impression replicas of the adhesive-covered root dentin were fabricated after water immersion, as a control, and after lactic acid challenge. The replicas were examined with SEM for quantitative comparison of fluid droplet formation on the surfaces. The bonded specimens were also examined using reflected light confocal microscopy.

RESULTS

Replicas of water droplets were observed on the adhesive surfaces, by SEM which corresponded with direct confocal observation of blisters and voids from the surface of the bonded specimens. There were significantly more water droplets from samples that were subjected to lactic acid challenge than water only immersion.

SIGNIFICANCE

Although the dentin adhesives examined were able to cover exposed root dentin, they all exhibited fluid transudation through the polymerized adhesives. Dentin adhesives were also susceptible to surface degradation after lactic acid challenge. As simplified self-etch adhesives were highly water permeable and exhibited the most extensive surface damage, they may not be the best adhesives to be used for long-term dentin desensitization. These preliminary in vitro findings warrant validation in vivo.

A three-year clinical evaluation of two-bottle versus one-bottle dentin adhesives

BACKGROUND

The authors conducted an in vivo investigation to compare the clinical performance of two commercial one-bottle adhesives and a two-bottle adhesive for restoration of noncarious cervical lesions (NCCLs).

METHOD

The patient pool consisted of 57 patients and 171 teeth (three teeth per patient), with one NCCL per tooth. Each patient received three resin-based composite restorations, each with a different adhesive: one tooth with a two-bottle, water-based adhesive as the control; another tooth with a one-bottle, ethanol-based adhesive; and a third tooth with a one-bottle, solvent-free adhesive. The authors assessed restorations in terms of retention, marginal integrity, margin discoloration and air sensitivity at baseline, six months, one year, two years and three years after initial placement.

RESULTS

The retention rates at 36 months were 88 percent for the first adhesive, 81 percent for the second adhesive and 90 percent for the third adhesive. No statistically significant differences in retention rates could be shown, with 86 percent of restorations retained overall. Measures of marginal integrity, marginal discoloration and sensitivity also had no statistically significant differences between the three adhesives (P > .05).

CONCLUSIONS

All three adhesives performed with acceptable outcomes after a 36-month period, with small differences between the one- and two-bottle systems and between the various solvents. Retention rate was moderately high and air sensitivity was markedly reduced; however, superficial marginal discoloration and marginal degradation was notable. Certain lesion, tooth and patient characteristics may predispose restorations to retention failure.

CLINICAL IMPLICATIONS

The type of solvent may not be a major factor in retention of Class V restorations in NCCLs. Both single-bottle adhesives and conventional two-bottle adhesives performed acceptably.

Influence of a self-etching primer on compound nerve action potentials

The aim of this study was to evaluate the effect of self-etching primers on nerve conductance. A self-etching primer (One Up Bond F) which combines etching and bonding in one step, and a fifth-generation bonding agent (Prime&Bond NT ) were tested. Isolated rat sciatic nerves were placed between two platinum electrodes in a bath containing Tyrode solution. The bonding agents were brought into contact with the nerves and the evoked compound action potentials (CAP) were recorded before and after contact with the materials. One Up Bond F caused total inhibition of the CAP within an average time of 7 min. All CAPs in this group were blocked irreversibly. As with Prime&Bond NT, the reduction in CAP was 45.9% after an application time of 15 min, after which readings were terminated. Recovery of the CAP in this group were maintained after rinsing with fresh tyrode solution. One Up Bond F elicited faster blocking of nerve conductance under the conditions of this model. In the context of dentin desensitization with bonding agents, the self-etching primer may be more effective, clinically.

The reproducibility of methods of assessment for cervical dentine hypersensitivity

BACKGROUND

Many agents and toothpaste formulations have been proposed for treatment of dentine hypersensitivity. However, studies have reported equivocal or contradictory results, potentially related to a lack of clinical efficacy for agents being tested, poor study design or the use of assessment techniques which are unable to distinguish longitudinal changes in dentine hypersensitivity.

AIM

To investigate the reproducibility of commonly used measurement protocols for dentine hypersensitivity on single or multiple teeth. In addition, newly-developed controlled air and cold fluid stimuli were investigated.

METHODS AND MATERIALS

Standardised pain stimulation techniques were used in 2 investigations with 63 and 42 subjects, respectively. The reproducibility of perceived hypersensitivity before and following stimulation was recorded over time periods of 14 and 2 days, respectively, using visual analogue scales and threshold techniques.

RESULTS

Subject demographics resembled those reported in other hypersensitivity investigations. Analysis using several measures of reproducibility indicated that subject-based reproducibility was limited, even when the stimuli were standardised. However, the data are consistent with the findings of investigations on pain assessment in other fields.

CONCLUSIONS

The reproducibility of subjects in clinical trials of dentine hypersensitivity may therefore contribute to difficulties in establishing treatment efficacy of agents in clinical trials.

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.