Avaliação de dispositivo de ultrassom associado à terapia fotodinâmica e vidros bioativos na remoção, descontaminação e remineralização de lesões artificiais de cárie em dentina
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Data
2021-12-15
Autores
Besegato, João Felipe
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O objetivo deste estudo foi avaliar a eficácia do uso de aparelho de ultrassom na remoção de tecido cariado, da terapia fotodinâmica antimicrobiana (TFDA) na descontaminação da dentina e da aplicação de materiais bioativos na remineralização dentinária, assim como as influências dessas terapias na resistência adesiva, em lesões artificiais de cárie induzidas por modelo biológico. Espécimes de dentina bovina (4x4x2 mm) foram obtidos e aleatorizados em grupos de acordo com o método de remoção do tecido cariado: fresa (FR) ou ultrassom (ULT); método de descontaminação: com ou sem a aplicação de TFDA; e a aplicação de vidros bioativos para remineralização dentinária (45S5 ou F-18). Sendo assim, os espécimes foram aleatorizados em 14 grupos: cárie dentária (controle); dentina hígida (controle); FR; FR+TFDA; ULT; ULT+TFDA; FR+45S5, FR+F-18; ULT+45S5, ULT+F-18; FR+TFDA+45S5; FR+TFDA+F-18; ULT+TFDA+45S5; ULT+TFDA+F-18. Após os tratamentos, os espécimes foram avaliados por meio de microradiografia transversal, microdureza longitudinal, FT-Raman e microscopia confocal. Os dados foram submetidos à avaliação dos pressupostos de normalidade e homoscedasticidade. Para comparação entre os grupos, ANOVA dois fatores seguido de pós-teste de Tukey foram utilizados em nível de significância de 5%. A análise das imagens de microscopia confocal foi realizada qualitativamente. De acordo com os resultados, a média da microdureza superficial dos espécimes foi de 40,86 ± 8,74 KHN. A microradiografia transversal revelou que a profundidade média das lesões foi de 213,9 ± 49,5 μm. Já a porcentagem de perda mineral foi de 4929,3 %vol.μm. A microdureza longitudinal evidenciou uma tendência geral em que a microdureza de um mesmo grupo aumenta em função da profundidade, independentemente do grupo avaliado (p < 0,05). Os grupos removidos com FR (24,40 – 63,03 KHN) apresentam dureza maior em comparação aos removidos com ULT (20,01 – 47,53 KHN), independentemente da profundidade (p < 0,05). Em geral, a TFDA não promoveu efeito significativo na microdureza (p > 0,05). Não houve diferença entre FR associada com 45S5 ou F-18 (p > 0,05). No entanto, na associação entre ULT e os vidros bioativos, diferenças mostram que F-18 apresentou valores maiores em relação ao 45S5. Os dados de FT-Raman mostram que para o componente fosfato não foi observado nenhuma diferença estatística significante (p > 0,05). Já para o componente carbonato, na profundidade de 200 μm houve diferença entre os grupos FR+TFDA e ULT+TFDA+45S5 (0,0355 e 0,0003 respectivamente (p < 0,05). Quanto às ligações C-H, diferença significante foi observada entre os grupos FR e ULT+TFDA (0,1869 e 0,0457 respectivamente (p < 0,05), na profundidade de 40 μm. A microscopia confocal revelou a eficácia da TFDA em inativar bactérias residuais. Os resultados de resistência adesiva evidenciaram que não houve diferença entre os grupos experimentais (p > 0,05). Falha do tipo adesiva foi predominante para a maioria dos grupos. Pôde-se concluir que a remoção com ULT é mais conservadora em relação a FR e a TFDA é eficaz como estratégia de descontaminação. Ambos os vidros mostraram resultados similares, embora alguns grupos tenham evidenciado melhores resultados para o F-18. Nenhuma das terapias influenciaram negativamente a adesão de materiais resinosos à dentina. Sendo assim, a abordagem combinada das diferentes estratégias parece ser promissora e minimamente invasiva no tratamento da lesão de cárie em dentina.
This study aimed to evaluate the efficacy of an ultrasound device to remove caries dentin, antimicrobial photodynamic therapy (TFDA) to decontaminate dentin and the application of bioactive materials to remineralize the dentin, as well as the influences of these therapies on bonding strength in artificial caries lesions. Bovine dentin specimens (4x4x2 mm) were obtained and randomized into groups according to the removal methods of caries dentin: bur (FR) or ultrasound (ULT); decontamination method: with or without the application of TFDA; and the application of bioactive glasses for dentin remineralization (45S5 or F-18). Thus, specimens were randomized into 14 groups: dental caries (control); sound dentin (control); FR; FR + TFDA; ULT; ULT + TFDA; FR + 45S5, FR + F-18; ULT + 45S5, ULT + F-18; FR + TFDA + 45S5; FR + TFDA + F-18; ULT + TFDA + 45S5; ULT + TFDA + F-18. After treatments, the specimens were evaluated by transverse microradiography, cross-sectional microhardness, FT-Raman and confocal microscopy. Data were submitted to the assessment of the assumptions of normality and homoscedasticity. For comparison between groups, two-way ANOVA followed by Tukey's post-test were used at a significance level of 5%. The analysis of confocal microscopy was performed qualitatively. According to the results, the surface microhardness mean was 40.86 ± 8.74 KHN. Transverse microradiography revealed that the average depth of the lesions was 213.9 ± 49.5 μm. The percentage of mineral loss was 4929.3% vol.μm. Cross-sectional microhardness showed a trend in which the microhardness of the same group increases as a function of depth, regardless of the group (p < 0.05). Groups removed with FR (24.40 - 63.03 KHN) have greater hardness compared to those removed with ULT (20.01 - 47.53 KHN), regardless of depth (p < 0.05). In general, TFDA did not have a significant effect on microhardness (p > 0.05). There was no difference between RF associated with 45S5 or F-18 (p > 0.05). However, in the association between ULT and bioactive glasses, F-18 showed higher values compared to 45S5. FT-Raman data show that for the phosphate component, no statistically significant difference was observed (p> 0.05). For the carbonate component, at 200 μm depth there was a difference between FR+TFDA and ULT+TFDA+45S5 groups (0.0355 and 0.0003 respectively (p < 0.05). The C-H bonding revealed a difference between FR and ULT+TFDA groups (0.1869 and 0.0457 respectively (p < 0.05), at 40 μm depth. Confocal microscopy images showed the effectiveness of TFDA in inactivating residual bacteria. No differences among the experimental groups were observed after microshear bond strength test (p > 0,05). Adhesive failure was the most predominant failure mode. It can be concluded that ULT removal is conservative, preserving caries-affected dentin. TFDA is effective as a decontamination strategy prior restoration. Both bioactive glasses showed similar results, although some groups have shown better results for F-18. Any of the experimental treatments negatively affected the adhesion to dentin. In conclusion, the combing approach using ultrasound, TFDA and bioactive glasses is promising to provide a minimally invasive treatment.
This study aimed to evaluate the efficacy of an ultrasound device to remove caries dentin, antimicrobial photodynamic therapy (TFDA) to decontaminate dentin and the application of bioactive materials to remineralize the dentin, as well as the influences of these therapies on bonding strength in artificial caries lesions. Bovine dentin specimens (4x4x2 mm) were obtained and randomized into groups according to the removal methods of caries dentin: bur (FR) or ultrasound (ULT); decontamination method: with or without the application of TFDA; and the application of bioactive glasses for dentin remineralization (45S5 or F-18). Thus, specimens were randomized into 14 groups: dental caries (control); sound dentin (control); FR; FR + TFDA; ULT; ULT + TFDA; FR + 45S5, FR + F-18; ULT + 45S5, ULT + F-18; FR + TFDA + 45S5; FR + TFDA + F-18; ULT + TFDA + 45S5; ULT + TFDA + F-18. After treatments, the specimens were evaluated by transverse microradiography, cross-sectional microhardness, FT-Raman and confocal microscopy. Data were submitted to the assessment of the assumptions of normality and homoscedasticity. For comparison between groups, two-way ANOVA followed by Tukey's post-test were used at a significance level of 5%. The analysis of confocal microscopy was performed qualitatively. According to the results, the surface microhardness mean was 40.86 ± 8.74 KHN. Transverse microradiography revealed that the average depth of the lesions was 213.9 ± 49.5 μm. The percentage of mineral loss was 4929.3% vol.μm. Cross-sectional microhardness showed a trend in which the microhardness of the same group increases as a function of depth, regardless of the group (p < 0.05). Groups removed with FR (24.40 - 63.03 KHN) have greater hardness compared to those removed with ULT (20.01 - 47.53 KHN), regardless of depth (p < 0.05). In general, TFDA did not have a significant effect on microhardness (p > 0.05). There was no difference between RF associated with 45S5 or F-18 (p > 0.05). However, in the association between ULT and bioactive glasses, F-18 showed higher values compared to 45S5. FT-Raman data show that for the phosphate component, no statistically significant difference was observed (p> 0.05). For the carbonate component, at 200 μm depth there was a difference between FR+TFDA and ULT+TFDA+45S5 groups (0.0355 and 0.0003 respectively (p < 0.05). The C-H bonding revealed a difference between FR and ULT+TFDA groups (0.1869 and 0.0457 respectively (p < 0.05), at 40 μm depth. Confocal microscopy images showed the effectiveness of TFDA in inactivating residual bacteria. No differences among the experimental groups were observed after microshear bond strength test (p > 0,05). Adhesive failure was the most predominant failure mode. It can be concluded that ULT removal is conservative, preserving caries-affected dentin. TFDA is effective as a decontamination strategy prior restoration. Both bioactive glasses showed similar results, although some groups have shown better results for F-18. Any of the experimental treatments negatively affected the adhesion to dentin. In conclusion, the combing approach using ultrasound, TFDA and bioactive glasses is promising to provide a minimally invasive treatment.
Descrição
Palavras-chave
Ultrassom, Fotoquimioterapia, Cárie dentária, Ultrasonics, Photodynamic therapy, Dental caries