Evaluation of Five Different Desensitizers: A Comparative Dentin Permeability and SEM Investigation In Vitro

Comparison of the Effects of Gluma Gel, Sensodyne Repair and Protect Toothpaste, and an 810 nm Low Power Diode Laser on the Closure of Dentinal Tubules: An In Vitro Study

Introduction: One of the common problems among dental patients is tooth hypersensitivity. There are various treatments for hypersensitivity, such as gels, solutions, toothpaste, and laser treatments. This report examined the effect of three treatments, namely 810 nm wavelength diode laser, Gluma gel, and Sensodyne Repair and Protect toothpaste, on tooth hypersensitivity. Methods: This experimental survey selected 40 premolars free of caries, fractures, restorations, root canal therapy, or wear. The enamel of the midline in the cervical part of the buccal surface was removed by a bur (the area was 2*2 mm and the depth was 2 mm), and the samples were then prepared and divided into four groups. Sensodyne Repair and Protect toothpaste, Gluma gel, and an 810 nm diode laser with 0.5 W power were applied to three groups of teeth. The samples were analyzed by using a field emission scanning electron microscope (FE-SEM). The data from the occluded dentinal tubules, partially occluded tubules, and open tubules were analyzed by using the Tamhane test. Results: The amount of occluded dentinal tubules was 83.2±9% in the laser group, 74.4±11.62% in the Gluma group, 67.1±18% in the Sensodyne group, and 15.03±3.39% in the control group. The difference between the treatment groups and the control group was meaningful (P<0.05). However, the difference between the Gluma group, the Sensodyne group, and the 810 nm laser group was not significant (P>0.05). Conclusion: The three treatments (810 nm diode laser, Gluma, and Sensodyne) were all effective in occluding dentinal tubules compared to the control group. However, there was no significant difference between these three treatment methods (P>0.05).

A novel mussel-inspired desensitizer based on radial mesoporous bioactive nanoglass for the treatment of dentin exposure: An in vitro study

OBJECTIVES

The dentin exposure always leads to dentin hypersensitivity and the acid-resistant/abrasion-resistant stability of current therapeutic approaches remain unsatisfatory. Inspired by the excellent self-polymerization/adherence activity of mussels and the superior mineralization ability of bioactive glass, a novel radial mesoporous bioactive nanoglass coated with polydopamine (RMBG@PDA) was developed for prevention and management of dentin hypersensitivity.

METHODS

Radial mesoporous bioactive nanoglass (RMBG) was synthesized by the sol-gel process combined with the cetylpyridine bromide template self-assembly technique. RMBG@PDA was synthesized by a self-polymerization process involving dopamine and RMBG in an alkaline environment. Then, the nanoscale morphology, chemical structure, crystalline phase and Zeta potential of RMBG and RMBG@PDA were characterized. Subsequently, the ion release ability, bioactivity, and cytotoxicity of RMBG and RMBG@PDA in vitro were investigated. Moreover, an in vitro experimental model of dentin hypersensitivity was constructed to evaluate the effectiveness of RMBG@PDA on dentinal tubule occlusion, including resistances against acid and abrasion. Finally, the Young's modulus and nanohardness of acid-etched dentin were also detected after RMBG@PDA treatment.

RESULTS

RMBG@PDA showed a typical nanoscale morphology and noncrystalline structure. The use of RMBG@PDA on the dentin surface could effectively occlude dentinal tubules, reduce dentin permeability and achieve excellent acid- and abrasion-resistant stability. Furthermore, RMBG@PDA with excellent cytocompatibility held the capability to recover the Young's modulus and nanohardness of acid-etched dentin.

CONCLUSION

The application of RMBG@PDA with superior dentin tubule occlusion ability and acid/abrasion-resistant stability can provide a therapeutic strategy for the prevention and the management of dentin hypersensitivity.

Dentine tubule occlusion effect of hydrolyzed casein in a bioactive glass-based dental desensitizing gel

OBJECTIVES

The effectiveness of three different groups of polyethylene glycol (PEG)-based gels containing powders on dentin hypersensitivity (DH) treatment were assessed and compared with Actimins® as commercial reference group.

METHODS

Hydroxyapatite nanorods (nHA) and sol-gel-derived 45S5 bioglass (SGD 45S5) powders were synthesized through hydrothermal and sol-gel methods, respectively. First, 25 demineralized dentin disks were divided into five groups. Then, the prepared gels based on 45S5 bioglass with and without hydrolyzed casein (HC) as experimental, nHA gel and Actimins® as positive and commercial reference groups were applied twice a day on disks by a micro applicator. To mimic the oral environment, treated disks were immersed in artificial saliva in a water bath at 37 °C for 7 days. However, in the negative control group, no agent was applied on the samples. FE-SEM, EDS, AFM, and XRD were performed to assess tubule occlusion. One-way ANOVA test was used for statistical analysis and p*<0.05 was set as the significance level.

RESULTS

The nHA with an average aspect ratio of 2.77 and the SGD 45S5 powders with a polygonal morphology and the average size of 48.64±11.38 µm were synthesized. After treatment, tubule occlusion in HC-SGD 45S5 and nHA gels were shown to be higher than other groups. The root mean square roughness (Rrms) of the above-mentioned gels showed to be 121.54±9.25 nm, and 312.6 ± 9 nm, respectively.

CONCLUSION

The nHA containing group exhibited the highest tubule occlusion efficiency (i.e., tubule diameter of 0.92±0.32 µm) with a superior mineral precipitation. HC as a novel material demonstrates to be potentially beneficial in DH treatment.

CLINICAL SIGNIFICANCE

DH as a common issue may be reduced or eliminated by occlusion of patent dentinal tubules. There are various types of desensitizing agents capable of controlling the DH by the occlusion of patent dentinal tubules. The desensitizing gels developed in this study showed to be promising for clinical and home-use applications.

A novel rapidly mineralized biphasic calcium phosphate with high acid-resistance stability for long-term treatment of dentin hypersensitivity

OBJECTIVES

Treating dental hypersensitivity (DH) rapidly and maintaining long-term effectiveness remains challenging. We aimed to address this problem by fabricating a novel rapidly mineralized biphasic calcium phosphate (RMBCP), which could rapidly elicit mineralization to form hydroxyapatite (HA) and perform excellent acid-resistant stability, thus effectively blocking the exposed dental tubules and protecting them from acid attack.

METHODS

RMBCP was firstly synthesized by precisely adjusting the molar ratio of acetic acid and calcium hydroxide and characterized by X-ray diffraction (XRD), X-ray fluorescence microprobe (XRF), Fourier-transform infrared (FTIR) spectrometer, scanning electron microscope (SEM), and transmission electron microscope (TEM). Subsequently, using a commercialized desensitizing agent, 45S5 bioglass (BG), as the control group, the mineralization performance of RMBCP was investigated in simulated body fluid (SBF), Dulbecco's modified eagle medium (DMEM), and even slightly acidic artificial saliva (pH=6.6). Moreover, the biocompatibility of RMBCP was studied. Finally, the tubule occlusion effect and acid-resistant stability of RMBCP were evaluated in vitro and in vivo.

RESULTS

The rapid mineralization behavior of RMBCP could easily adhere to the dentin surface and block the dentinal tubules completely in vitro and in vivo within 7days. RMBCP performed high acid-resistant stability to maintain the long-term therapeutic effect of DH treatment.

SIGNIFICANCE

Developing novel bioactive calcium phosphate materials with the ability to trigger mineralization for HA formation rapidly will be an effective strategy for the long-term treatment of dentin hypersensitivity.

Dentinal tubule occlusion using Er:YAG Laser: an in vitro study

OBJECTIVES

We analyzed the effects of the Er:YAG laser used with different parameters on dentinal tubule (DT) occlusion, intrapulpal temperature and pulp tissue morphology in order to determine the optimal parameters for treating dentin hypersensitivity.

METHODOLOGY

Dentin specimens prepared from 36 extracted human third molars were randomized into six groups according to the treatment method (n=6 each): control (A); Gluma desensitizer (B); and Er:YAG laser treatment at 0.5 W , 167 J/cm2 (50 mJ, 10 Hz) (C), 1 W , 334 J/cm2 (50 mJ, 20 Hz) (D), 2 W , 668 J/cm2 (100 mJ, 20 Hz) (E), and 4 W and 1336 J/cm2 (200 mJ, 20 Hz) (F). Treatment-induced morphological changes of the dentin surfaces were assessed using scanning electron microscopy (SEM) to find parameters showing optimal dentin tubule occluding efficacy. To further verify the safety of these parameters (0.5 W, 167 J/cm2), intrapulpal temperature changes were recorded during laser irradiation, and morphological alterations of the dental pulp tissue were observed with an upright microscope.

RESULTS

Er:YAG laser irradiation at 0.5 W (167 J/cm2) were found to be superior in DT occlusion, with an exposure rate significantly lower than those in the other groups (P<0.05). Intrapulpal temperature changes induced by Er:YAG laser irradiation at 0.5 W (167 J/cm2) with (G) and without (H) water and air cooling were demonstrated to be below the threshold. Also, no significant morphological alterations of the pulp and odontoblasts were observed after irradiation.

CONCLUSION

Therefore, 0.5 W (167 J/cm2) is a suitable parameter for Er:YAG laser to occlude DTs, and it is safe to the pulp tissue.

Bioactive glass versus Arginine dentifrices on the reduction of dentin permeability and acid tolerance

Objectives

To compare the efficacy of calcium sodium phosphosilicate (CSPS) and arginine dentifrices on dentin permeability and acid tolerance.

Material and Methods

Sixty dentin discs were randomly assigned into 3 groups, then brushed for 1 min with CSPS, arginine, or fluoride (control) dentifrices. To test acid tolerance, each disc was soaked in 6% citric acid for 1 min. Dentin permeability was measured before, following brushing, and acid challenge. Ten discs per group were similarly treated and evaluated for tubule occlusion following a single dentifrice application, while other five discs per group were employed in an acid tolerance assay.

Results

The percentage reduction in dentin permeability was 39.26%, 32.27%, and 21.71% in the arginine, CSPS, and control groups, respectively. The differences in dentin permeability reduction between the arginine and CSPS groups following brushing and acid challenge were not significant (p = 0.398 and p = 0.211, respectively). The arginine dentifrice demonstrated a significant reduction in permeability compared with the control (p = 0.011). In addition, the occlusion exhibited by the arginine and CSPS dentifrices was more resistant to acid challenge compared with that of the control (p < 0.001). From SEM analysis, dentinal tubule occlusion was observed after a single application in all groups. Some open dentinal tubules were detected in the test groups, while almost all of the orifices were open in the fluoride group following acid challenge.

Conclusions

There is no significant difference between arginine and CSPS dentifrices in reducing dentin permeability following a single application and acid challenge. Following acid challenge, the reduced permeability generated by arginine and CSPS was more stable compared with the fluoride dentifrice.

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.

Evaluation and Comparison of Efficacy of Gluma® and D/Sense® Desensitizer in the Treatment of Root Sensitivity Induced by Non-Surgical Periodontal Therapy

BACKGROUND:

Dentinal hypersensitivity is one of the most common sequels of non-surgical periodontal therapy. Resulted discomfort may restrain patients from oral hygiene maintenance, thus affects the long-term success of periodontal therapy. So, it becomes a prime concern of the clinician to manage the post-operative hypersensitivity.

AIM:

This clinical investigation aimed to evaluate and compare the efficacy of D/Sense^® and Gluma^® in preventing post-operative sensitivity after non-surgical periodontal therapy.

MATERIAL AND METHODS:

The present randomised, double-blind, split-mouth study was conducted on forty-five (22 male, 23 female) systemically healthy patients, with the mean age of 40 ± 17.5 years. Visual Analogue scale was used to evaluate root sensitivity after application of tactile and cold stimuli at baseline, 1, 2, 4 and 6 weeks after scaling and root planing. After scaling and root planning, the sites were randomly divided into different groups for the application of desensitising agents. Collected data were analysed by using, analysis of variance (ANOVA) for inter-group and paired t-test for intra-group comparisons.

RESULTS:

No adverse or side effects were reported by any of the patients throughout the study period. Gluma^® showed a statistically significant reduction in the VAS score for root sensitivity as compared to D/Sense^®, at 1, 2- and 4-weeks follow-up period (p < 0.05). Whereas, at 6th-week follow-up, both the solution showed almost similar score for root hypersensitivity. Intragroup comparison for D/Sense^® revealed a significant difference in scores from baseline to all intervals (p < 0.05), except baseline to 6 weeks (p > 0.05). Whereas Gluma^® showed a significant difference in scores from baseline to 2nd-week follow-up (p < 0.05).

CONCLUSION:

The result of the present investigation revealed that application of Gluma® resulted in better control on iatrogenic root hypersensitivity as compared to the D/Sense^® during the initial follow-up period.

Performance of a bioglass-based dentine desensitizer under lactid acid exposition: an in-vitro study

Background

Dentine hypersensitivity is especially frequent in patients with pronounced periodontal attachment loss. Aim of the treatment is an obstruction of the dentine tubules in order to inhibit liquid or osmotic motion, which is considered as trigger for pain sensations. Novel approaches aim for obstruction by calcium phosphate compounds in order to rely on biocompatible compounds. It was the aim of the study to optically investigate the morphology and to assess the fluid permeability of treated dentine surfaces.

Methods

Dentine discs were pretreated in an ultrasonic bath with 17% EDTA to clean the lumina of the dentine tubules. Samples of group A remained untreated while Seal&Protect® as a conventional desensitizer was applied for group B and DentinoCer in group C. Discs were mounted into a pulp fluid simulator (PFS) with a methylene blue solution in order to create a flow pressure of 0.5 bar. Over 12 d, discs were exposed three times per day to 0.1 M nonsaturated lactic acid. At baseline and after 2, 8 and 12 d samples were removed from PFS and prepared for SEM analysis. Tubule obstruction was assessed quantitatively using Olley scores and by qualitative description of the surface. Absorption spectrometry was used to assess the concentration of leaked methylene blue outside the samples in order to estimate dentine permeability.

Results

Untreated discs showed clean lumina of all tubules at all time points and magnifications. From day 2 onwards dentine showed exposed collagene fibers due to acid exposition. Seal&Protect® initially showed homogenous dentine surface coverage that got a more granulomatous aspect in the course of treatment time. Few samples showed sporadic tubules with open lumen at day 8 and 12. Group C showed samples with a homogeneous, even surface. Narrow slits in the superficial layer are visible from day 4 on, but the dentine surface remained invisible and dentine tubules were closed till the end of the investigation period.

Conclusion

Over 12 d of lactid acid exposure, samples showed complete coverage of the dentine tubules in the chosen in-vitro-model when treated with Seal&Protect® or DentinoCer.

Evaluation of the effects of Er:YAG laser, Nd:YAG laser, and two different desensitizers on dentin permeability: in vitro study

The purpose of this in vitro study was to evaluate and compare the efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser, neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, PrevDent nano-hydroxyapatite toothpaste plus Repairing Serum Kit (PNH), and NUPRO Sensodyne Prophylaxis Paste with NovaMin (NPP) on dentin permeability reduction. Forty dentin discs obtained from bovine incisors were divided into four study groups: Er:YAG laser-treated (2940 nm; 0.2 W, 80 mJ/pulse, 3 Hz); Nd:YAG laser-treated (1064 nm; 1 W, 10 Hz); PNH-treated; and NPP-treated groups. The quantitative changes in permeability of each dentin disc were measured using a computerized fluid filtration method (CFFM) before and after desensitizer treatments. The data were analyzed using the Wilcoxon, paired-samples t, Kruskal-Wallis, and Mann-Whitney U tests. The dentin surfaces and tubules were also morphologically detected by scanning electron microscopy (SEM). In all groups, dentin permeability was significantly reduced after the desensitizer and laser treatments (p < 0.05). Among the groups, we detected a significant difference in only when comparing the Er:YAG laser- and NPP-treated groups (p = 0.034). SEM analysis revealed physical changes in the dentin surface in all groups. This in vitro study shows that all tested desensitizers and laser treatments reduced dentin permeability. Also, surface changes, such as complete or partial occlusion or shrinkage of dentin tubules, were observed in all groups. Although the laser groups performed best, the PNH protocol can be considered as an alternative therapeutic product. In addition, clinical and laboratory studies should be performed for this product, and their efficacy should be assessed by combined therapy with lasers.