Eficácia estética, qualidade de vida e expressão de biomarcadores de inflamação e reabsorção determinados pela técnica walking bleach de clareamento com concentração reduzida de peroxido: estudo clinico randomizado
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Data
2016-11-16
Autores
Bersezio Miranda, Cristian Alejandro [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Estudos clinicos, randomizados, controlados, cegos e de medidas repetidas foram realizados para avaliar o efeito da técnica walking bleach de clareamento dental realizada com concentração reduzida de peroxido (PH13). O efeito de PH13 foi comparado ao obtido com peroxido de hidrogênio a 35% utilizado como controle (PH35). O desempenho clinico de PH13 e PH35 foi avaliado em função de: 1) eficácia estética, determinada por avaliação objetiva (espectroscopio) e subjetiva de cor (comparação visual) mensuradas por ΔE e ΔSGU; 2) impacto sobre fatores psicosociais de qualidade de vida, mensurados pelos indices PIDAQ e OHIP Estetico e; 3) expressão de biomarcadores de inflamação e reabsorção (IL-1β e RANK-L) no fluido crevicular. Material e Método: Um total de 50 incisivos superiores escurecidos devido ao tratamento endodontico de um total de 47 voluntários foram selecinados e randomicamente divididos nos grupos PH35 (controle) e PH13 (teste). Todos os dentes receberam 4 sessões de clareamento. A eficácia estética e a expressão dos biomarcadores foram registrados antes (baseline - T0), após cada sessão de clareamento (T1, T2, T3, T4), uma semana (T5), um mês (T6) e tres meses (T7) após o fim do tratamento clareador. Os questionarios de qualidade de vida (PIDAQ e OHIP Estético) foram aplicados no baseline, imediatamente após e fim do tratamento e após 1 mês. Resultados: foram observados aumentos significativos nos níveis de IL-1β e RANK-L, a partir do baseline (P<0.05); Não houve diferença em níveis de IL-1β entre mês com o terceiro mês pós-tratamento (p>0.05). A eficácia estética (ΔE) foi semelhante para ambas as técnicas após 1 mes de tratamento ( 16,80 ± 6,07 para PH35 e 14,09 ± 4,83) estes resultados mantiveram-se estáveis após 3 meses de acompanhamento (p>0.05). Os fatores psicosociais de qualidade de vida foram estatisticamente impactados por PH35 e PH13 mostrando diferenças signficativas a partir do baseline (p<0,05). Conclusão: Ambos agentes clareadores utilizados na tecnica WB (PH35 e PH13), são altamente eficazes para reduzir a discrepancia de cor de dentes escurecidos devido ao tratamento endodontico, impactando positivamente nos fatores psicosociais de qualidade de vida dos voluntários avaliados pelos indices PIDAQ e OHIP Estético. No entanto, também causam aumento na expressão dos marcaroes de inflamação e reabsorção (RANK-L e IL-1β) que persiste até 3 meses pós-tratamento, independente da concentração do peróxido utilizado.
Three clinical studies, randomized, controlled, blind and with repeated measurements were performed to evaluate the effect of bleaching, performed with walking bleach technique with reduced concentration of peroxide (PH13). The PH13 effect was compared to that obtained with 35% hydrogen peroxide used as control (PH35). The clinical performance of PH13 and PH35 was evaluated in terms of: 1) aesthetic efficacy, determined by objective evaluation (spectrophotometer) and subjective evaluation (visual comparison), measured in ΔE and ΔSGU respectively; 2) impact on psychosocial factors of quality of life, measured by questionnaire PIDAQ and OHIP aesthetic; 3) expression of biomarkers of inflammation and resorption (IL-1β and RANK-L) in crevicular fluid. Material and Methods: A total of 50 incisors with endodontic treatment and color change of a total of 47 selected volunteers were randomly divided into PH35 groups (control) and PH13 (test). All teeth received 4 bleaching sessions . The aesthetic effect and the expression of biomarkers were recorded before (baseline - T0), after each whitening session (T1, T2, T3, T4), one week (T5), one month (T6) and three months (T7) after the end of the bleaching treatment. The questionnaires of quality of life (OHIP PIDAQ and Esthetic) were applied at baseline, immediately after of treatment and after 1 month. Results: Significant increases were observed in IL-1β and RANK-L from baseline (P <0.05); There was no difference in IL-1β levels between month with the third month post-treatment (p> 0.05). The aesthetic efficacy (ΔE) was similar for both groups after one month of treatment (16.80 ± 6.07 to PH35 and 14.09 ± 4.83) these results remained stable after 3 months of follow-up (p>0.05). The psychosocial factors of quality of life were significantly impacted by PH35 and PH13 showing significant difference from baseline (p<0.05). Conclusion: Both bleaching agents used in the technique WB (PH35 and PH13) are highly effective in reducing the discrepancy of color of non vital discolored teeth, positive impact on psychosocial factors of quality of life of volunteers evaluated by PIDAQ and OHIP Aesthetic questionnaires . However, also cause increased expression of biomarkers of resorption and inflammation (RANKL and IL-1β) that persists for 3 months after treatment, independent of the concentration of the used peroxide.
Three clinical studies, randomized, controlled, blind and with repeated measurements were performed to evaluate the effect of bleaching, performed with walking bleach technique with reduced concentration of peroxide (PH13). The PH13 effect was compared to that obtained with 35% hydrogen peroxide used as control (PH35). The clinical performance of PH13 and PH35 was evaluated in terms of: 1) aesthetic efficacy, determined by objective evaluation (spectrophotometer) and subjective evaluation (visual comparison), measured in ΔE and ΔSGU respectively; 2) impact on psychosocial factors of quality of life, measured by questionnaire PIDAQ and OHIP aesthetic; 3) expression of biomarkers of inflammation and resorption (IL-1β and RANK-L) in crevicular fluid. Material and Methods: A total of 50 incisors with endodontic treatment and color change of a total of 47 selected volunteers were randomly divided into PH35 groups (control) and PH13 (test). All teeth received 4 bleaching sessions . The aesthetic effect and the expression of biomarkers were recorded before (baseline - T0), after each whitening session (T1, T2, T3, T4), one week (T5), one month (T6) and three months (T7) after the end of the bleaching treatment. The questionnaires of quality of life (OHIP PIDAQ and Esthetic) were applied at baseline, immediately after of treatment and after 1 month. Results: Significant increases were observed in IL-1β and RANK-L from baseline (P <0.05); There was no difference in IL-1β levels between month with the third month post-treatment (p> 0.05). The aesthetic efficacy (ΔE) was similar for both groups after one month of treatment (16.80 ± 6.07 to PH35 and 14.09 ± 4.83) these results remained stable after 3 months of follow-up (p>0.05). The psychosocial factors of quality of life were significantly impacted by PH35 and PH13 showing significant difference from baseline (p<0.05). Conclusion: Both bleaching agents used in the technique WB (PH35 and PH13) are highly effective in reducing the discrepancy of color of non vital discolored teeth, positive impact on psychosocial factors of quality of life of volunteers evaluated by PIDAQ and OHIP Aesthetic questionnaires . However, also cause increased expression of biomarkers of resorption and inflammation (RANKL and IL-1β) that persists for 3 months after treatment, independent of the concentration of the used peroxide.
Descrição
Palavras-chave
Peróxido de hidrogênio, Ligante RANK, Interleucemia-1beta, Ensaios clínicos como assunto