Effect of different treatments on dentin hypersensitivity: evaluation of cytotoxicity and randomized clinical study
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2023-07-31
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Universidade Estadual Paulista (Unesp)
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Objetivos: O objetivo deste estudo foi investigar os efeitos de diferentes categorias de tratamentos para hipersensibilidade dentinária em relação ao desgaste e citotoxicidade usando os seguintes protocolos: verniz placebo (PLA), verniz fluoretado (FLU), verniz de fluoreto de sódio (NaF) + Trimetafosfato de sódio (TMP), verniz adesivo universal (SBU), verniz S-PRG (SPRG), biosilicato (BIOS) e solução de amelotina (AMTN). Adicionalmente, FLU, SBU, SPRG e BIOS tiveram sua longevidade clínica avaliada. Metodologia: Setenta blocos de dentina radicular bovina foram seccionados. Metade da superfície de cada espécime não foi tratada (controle) e a outra metade foi imersa em EDTA e tratada com os materiais dessensibilizantes. Após a aplicação, os corpos de prova foram submetidos a um desafio erosivo-abrasivo e o desgaste foi analisado por perfilômetro óptico. Diluições seriadas de extratos obtidos a partir do meio de cultura contendo discos impregnados com esses dessensibilizantes foram aplicadas em culturas de fibroblastos e células odontoblásticas. A citotoxicidade e a produção de proteína total (PT) por ensaios colorimétricos foram determinadas após 24h. Em relação ao ensaio clínico, 192 exposições radiculares não cavitadas foram analisadas usando escala visual analógica (VAS) e visual computadorizada (CoVAS), antes dos tratamentos (baseline) e após 7, 15, 30 dias, 6 e 12 meses. Os dados foram analisados usando Kruskal-Wallis, Dunn's para desgaste, One-way ANOVA, Tukey e modelo de regressão linear com efeitos fixos e pós-teste usando contrastes ortogonais (p ≤ 0.05). Resultados: O SBU foi o único material que não apresentou desgaste. O menor desgaste foi observado para AMTN, sendo estatisticamente semelhante ao TMP. A viabilidade celular foi significativamente reduzida para PLA, FLU, TMP e SBU em a fibroblastos e TMP e SBU em células semelhantes a odontoblastos considerando o extrato não diluído. PT mostraram níveis variados de concentrações de proteína sem diferença entre os grupos para fibroblastos. No estudo clínico, todos os dessensibilizantes foram eficazes na redução da HD, em comparação com os dados iniciais para ambas as escalas. Na escala VAS, observou-se redução significativa de HD a partir de 7 dias para BIOS e SBU, e a partir de 15 dias para FLU e SPRG. Para a escala CoVAS, todos os dessensibilizantes foram capazes de reduzir significativamente a HD após 7 dias, exceto o SPRG, que apresentou essa redução após 15 dias. Nenhum dessensibilizante retornou ao nível de sensibilidade inicial após 12 meses para ambas as escalas. Não foram encontradas diferenças estatísticas entre os dessensibilizantes para todos os momentos de avaliação, para ambas as escalas. Conclusão: O adesivo universal protegeu a superfície dentinária após o desafio erosivo-abrasivo. Extratos não diluídos de adesivos universais e vernizes fluoretados apresentam citotoxicidade, principalmente para fibroblastos. Todos os tratamentos em consultório foram eficazes na redução da HD ao longo de 12 meses, com níveis de dor semelhantes.
Objectives: The aim of this study was to investigate the effects of different categories of treatments for dentin hypersensitivity in relation to wear and cytotoxicity using the following protocols: placebo varnish (PLA), fluoride varnish (FLU), sodium fluoride varnish (NaF) + sodium trimetaphosphate (TMP), universal adhesive (SBU), S-PRG varnish (SPRG), biosilicate (BIOS) and amelotin solution (AMTN). Additionally, FLU, SBU, SPRG and BIOS had their clinical longevity evaluated. Methods: Seventy bovine root dentin blocks were sectioned. Half of the surface of each specimen was untreated (control) and the other half was immersed in EDTA and treated with the desensitizing materials. After application, the specimens underwent an erosive-abrasive challenge and the wear was analyzed by optical profilometer. Serial dilutions of extracts obtained from the culture medium containing discs impregnated with those desensitizers were applied on fibroblasts and odontoblasts-like cells cultures. Cytotoxicity and production of total protein (TP) by colorimetric assays were determined after 24h. Regarding clinical trial, 192 non-cavitated root exposures were analyzed using visual analogue (VAS) and computerized visual scales (CoVAS), before treatments (baseline) and after 7, 15, 30 days, 6 and 12 months. Data were analyzed using Kruskal-Wallis, Dunn’s for wear, One-way ANOVA, Tukey, and linear regression model with fixed effects and post-test using orthogonal contrasts for clinical (p ≤ 0.05). Results: SBU was the only material that did not show wear. The lowest wear was observed for AMTN, being statistically similar to TMP. Cell viability was significantly reduced for PLA, FLU, TMP and SBU in fibroblasts-like cell and TMP and SBU in odontoblast-like cell considering undiluted extract. PT showed varied levels of protein concentrations with no difference between groups at 24h for fibroblasts-cell. For clinical study, all desensitizers were effective in reducing DH, compared with baseline data for both scales. On the VAS scale, a significant reduction in DH was observed after 7 days for BIOS and SBU, and after 15 days for FLU and SPRG. For the CoVAS scale, all desensitizers were able to significantly reduce DH after 7 days, except for SPRG, which showed this reduction after 15 days. No desensitizer returned to initial sensitivity level after 12-months for both scales. No statistical differences were found among desensitizers for all times of evaluation, for both scales. Conclusion: Universal adhesive protected the wear of DH after challenge. Undiluted extracts of universal adhesives and fluoride varnishes show cytotoxicity, mainly for fibroblasts. All in-office treatments were effective for reducing DH over 12 months, with similarity levels of pain.
Objectives: The aim of this study was to investigate the effects of different categories of treatments for dentin hypersensitivity in relation to wear and cytotoxicity using the following protocols: placebo varnish (PLA), fluoride varnish (FLU), sodium fluoride varnish (NaF) + sodium trimetaphosphate (TMP), universal adhesive (SBU), S-PRG varnish (SPRG), biosilicate (BIOS) and amelotin solution (AMTN). Additionally, FLU, SBU, SPRG and BIOS had their clinical longevity evaluated. Methods: Seventy bovine root dentin blocks were sectioned. Half of the surface of each specimen was untreated (control) and the other half was immersed in EDTA and treated with the desensitizing materials. After application, the specimens underwent an erosive-abrasive challenge and the wear was analyzed by optical profilometer. Serial dilutions of extracts obtained from the culture medium containing discs impregnated with those desensitizers were applied on fibroblasts and odontoblasts-like cells cultures. Cytotoxicity and production of total protein (TP) by colorimetric assays were determined after 24h. Regarding clinical trial, 192 non-cavitated root exposures were analyzed using visual analogue (VAS) and computerized visual scales (CoVAS), before treatments (baseline) and after 7, 15, 30 days, 6 and 12 months. Data were analyzed using Kruskal-Wallis, Dunn’s for wear, One-way ANOVA, Tukey, and linear regression model with fixed effects and post-test using orthogonal contrasts for clinical (p ≤ 0.05). Results: SBU was the only material that did not show wear. The lowest wear was observed for AMTN, being statistically similar to TMP. Cell viability was significantly reduced for PLA, FLU, TMP and SBU in fibroblasts-like cell and TMP and SBU in odontoblast-like cell considering undiluted extract. PT showed varied levels of protein concentrations with no difference between groups at 24h for fibroblasts-cell. For clinical study, all desensitizers were effective in reducing DH, compared with baseline data for both scales. On the VAS scale, a significant reduction in DH was observed after 7 days for BIOS and SBU, and after 15 days for FLU and SPRG. For the CoVAS scale, all desensitizers were able to significantly reduce DH after 7 days, except for SPRG, which showed this reduction after 15 days. No desensitizer returned to initial sensitivity level after 12-months for both scales. No statistical differences were found among desensitizers for all times of evaluation, for both scales. Conclusion: Universal adhesive protected the wear of DH after challenge. Undiluted extracts of universal adhesives and fluoride varnishes show cytotoxicity, mainly for fibroblasts. All in-office treatments were effective for reducing DH over 12 months, with similarity levels of pain.
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Abrasão dentária, Citologia, Dessensibilizantes dentinários, Ensaios clínicos, Erosão dentária, Sensibilidade da dentina, Dentin sensitivity