Orientadores: Monica Campos Serra, Leonor de Castro Monteiro Loffredo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-07-28T08:37:40Z (GMT). No. of bitstreams: 1 Pinelli_Camila_D.pdf: 3436834 bytes, checksum: 2866910ab5e9e39232f71400818f21be (MD5) Previous issue date: 2001 / Resumo: O diagnóstico de cárie tem assumido uma importância particular, desde que a habilidade em se detectar lesões reversíveis oferece diversas vantagens para o paciente, em termos de tratamento e cuidados preventivos. A inspeção visual das superfícies é um dos métodos diagnósticos mais utilizados e os critérios: cor, brilho, textura e distância das lesões em relação à margem gengival precisam ser considerados para a determinação da atividade de cárie no esmalte não-cavitado. Um aparelho laser fluorescente, KaVo DIAGNOdent@, foi proposto para quantificar a perda mineral de lesões de cárie e, a validade e reprodutibilidade de seus resultados têm sido investigadas in vitro. Devido a dificuldade em se determinar clinicamente a atividade ou inatividade de lesões de cárie incipientes e, frente à possibilidade de utilização do laser fluorescente como um auxiliar diagnóstico na quantificação da perda mineral, o recente trabalho teve como objetivos: 1. promover a difusão de conhecimentos e de critérios clínicos para o diagnóstico de lesões de cárie ativas e paralisadas; 2. determinar, in vivo, a reprodutibilidade de duas escalas de classificação dos resultados do laser DIAGNOdent@, propondo uma escala para o diagnóstico de cárie em superficies lisas livres; 3. pesquisar a reprodutibilidade e a validade do laser DIAGNOdent@, em lesões de cárie de superflcies lisas livres, quando comparado com o critério clínico de validação, in vivo. Dentro das condições experimentais deste trabalho, observou-se que: 1. através da divulgação de casos clínicos, os critérios de atividade e inatividade das lesões de cárie foram ilustrados, incentivando o diagnóstico diferencial e precoce; 2. a escala de classificação dos valores do laser DIAGNOdent@ que mostrou melhor desempenho no diagnóstico de cárie, em superfícies lisas livres, foi a escala de LUSSI et al., 1999 adaptada por PINELLI et al., 2001 (unpublished data), sendo proposta para o diagnóstico de lesões incipientes em superfícies lisas livres; 3. o laser DIAGNOdent@ mostrou-se reprodutível e válido no diagnóstico de cárie in vivo, e a associação dos métodos clínico e laser pode aprimorar a eficácia do diagnóstico / Abstract: Caries diagnosis has assumed a particular importance, since the ability to detect earlier the reversible lesions offers several advantages for the patients, in terms of treatment and preventive measures. The visual inspection of the surfaces remains the method of first choice and clinical criteria such as color, shininess, roughness, and distance from the lesion to the gingival margin must be considered when determining caries activity on non-cavitated enamel. A laser fluorescent system, Ka V o DIAGNOdent@, was proposed to quantify mineral loss of caries lesions, and the validity and the reproducibility of the laser results has been investigated in vitro. Due to difficulty at determining clinical caries activity or inactivity, and due to possibilities of applying the laser fluorescence device as an auxiliary method to quantify mineral loss, the present work was aimed to: 1. disclose some clinical criteria for detecting active or arrested caries lesions; 2. verify, in vivo, the reproducibility of two scales of classification for DIAGNOdent@, and to propose a scale for the diagnosis of caries on free smooth surfaces; 3. test the reproducibility and validity of DIAGNOdent@, on caries lesions of free smooth surfaces, when the validation criterion was the visual examination, in vivo. Under the experimental conditions, it was verified: 1. afier the publication of clinical cases, the clinical criteria related to caries activity or inactivity were illustrated, aiming at differential and earlier diagnoses; 2. the scale which showed a better performance in caries diagnosis of free smooth surfaces was the scale proposed by LUSSI et al., 1999, modified by PINELLI et al., 2001 (unpublished data), and _it was suggested to diagnose incipient caries on free smooth surfaces; 3. the laser DIAGNOdent@ was reproducible and valid for caries diagnosis in vivo, and the utilization of both methods can improve caries diagnostic efficacy / Doutorado / Dentística / Doutor em Clínica Odontológica

Indiana University-Purdue University Indianapolis (IUPUI) / Etching of enamel caries lesions has been demonstrated to enhance remineralization. However, this effect reaches a plateau after a period of time. This study aimed at investigating the effectiveness of additional acid etching on remineralization. Forty 1 mm × 2 mm human enamel blocks with chemically induced artificial incipient lesions were used. Ten specimens were randomly selected at the end of demineralization for transverse microradiography (TMR) analysis. The remaining specimens were then divided into three groups (n = 10). Group A was remineralized by a pH cycling system with 1100 ppm sodium fluoride for 20 days. In group B, the specimens were etched with 35-percent phosphoric acid for 30 s and then remineralized. Group C was remineralized by same procedure as group B plus and given an additional acid etch after 10 days of remineralization. Mineral density was measured by x-ray microtomography (µ-CT). The volumetric mineral content [VM (µm3×105)] was determined between 91 and 0-wt%. The µ-CT % mineral recovery (%) was calculated using the formula 100×(remineralize VM - demineralization VM) / (sound VM - demineralization VM). One-hundred-μm sections of demineralized and remineralized specimens were used to assess the mineral loss (IML: vol%×µm) and lesion depth (µm) using TMR. The three groups showed no significant difference in mineral change or mineral content for µ-CT or TMR lesion depth. The TMR IML showed a significant difference between the demineralized specimens and the three remineralized groups. The correlation between TMR IML and TMR lesion depth was 0.66 (p < 0.0001). The µ-CT percent mineral recovery from demineralization was correlated with neither TMR IML nor TMR lesion depth. When evaluated with µ-CT, the twice-acid-etched group presented lower mineral gain values than the group etched only once with acid. Also, the twice-etched group presented lower mineral gain and greater TMR IML compared with the non-acid etch group. TMR images revealed reduction of surface layer in the acid-etched groups, especially in the twice-etched group, in which significant reduction or loss of surface layer occurred. Based on these results, we conclude that additional acid etching with 35-percent phosphoric acid does not enhance remineralization compared with a single application of acid etching. We believe that the viable existence of the surface layer is essential for remineralization of the lesion. Further investigations into the accuracy of µ-CT to detect minute mineral changes in incipient caries lesions are probably needed.