Objective: Toothbrushing with fluoride toothpaste followed by rinsing with mouthwash is a routine procedure to maintain good oral hygiene. It is unknown to what extent these rinses can modulate the effect of fluoride in its ability to prevent erosion/abrasion.The aim of this in-vitro study was to investigate and compare the impact of chlorhexidine (CHX), essential oils (EO) and cetylpyridinium chloride (CPC) mouthrinses on erosive tooth wear protection afforded by conventional fluoride toothpastes. Materials and Methods: The following experimental factors were considered: five rinses: CHX, EO, CPC, a fluoride rinse, and deionized water, two fluoride toothpastes: stannous fluoride (SnF2) or sodium fluoride (NaF) and two models: (erosion/ erosion+abrasion). Slabs of bovine enamel and dentin were prepared and embedded in resin blocks and generated 10 enamel and dentin testing groups (n = 8). UPVC tapes were placed on the sides of each slab leaving 1mm area exposed in the center. The blocks were subjected to a five-day cycling model. Then, the blocks were placed in a brushing machine and exposed to fluoride toothpaste slurry (one side was brushed and the other wasn’t). The blocks were then exposed to rinse treatments. Artificial saliva was used to remineralize the specimens after erosions and treatment challenges, and as storage media. After the fifth day of cycling, surface loss (in micrometers) was determined by profilometer. Data were analyzed using ANOVA (α = 0.05). Results: There was no interaction among the three factors (type of toothpaste, mouthrinse and abrasion or not (dentin p = 0.0520, enamel p = 0.4720). There were no significant two-way interactions as SL was only affected by toothpaste and mouthrinse. NaF caused less SL than SnF2 (4.60 vs. 5.83 μm; p < 0.0001) in dentin, whereas the opposite was found in enamel (5.20 vs. 3.56 μm; p < 0.0001). Toothbrushing abrasion caused comparatively more SL in enamel (6.53 vs. 2.23 μm; p < 0.0001) than in dentin (6.06 vs. 4.38 μm; p < 0.0001). None of the tested mouthrinses affected SL. Conclusion: Commonly used mouthrinses containing antimicrobial agents or additional fluoride, do not impair the erosion/abrasion protection afforded by fluoride toothpastes. Tested SnF2 dentifrice offered greater protection against enamel surface loss and NaF dentifrices showed more protection for the dentin surface. Clinical relevance: The understanding of the interaction between commonly used rinses and fluoride dentifrices will help dentists provide better recommendations to patients with erosive lesions.

Indiana University-Purdue University Indianapolis (IUPUI) / Hypothesis: The interaction between the abrasive level and fluoride concentration of dentifrice slurries modulates the surface loss (SL) and remineralization of incipient enamel caries (IEC). Methods: Three types of IEC were created and six experimental slurries with different combinations of fluoride content and abrasive level were tested. In experiment 1, the three IEC were subjected to brushing (with experimental slurries) and remineralization cycles for 5 days. Fluoride concentrations (0 and 275 ppm as NaF) and abrasive levels (Low and High) were tested. SL was determined by optical profilometry at baseline and after 1, 3, and 5 days. In experiment 2, changes in IEC mineral content (Δ(ΔZ)C) and depth (ΔLC) were investigated at baseline and after the 5-day cycling with transverse microradiography. In experiments 3 and 4, SL of MeC and CMC lesions were further studied, respectively; testing not only fluoride concentration (275 and 1250 ppm as NaF) and abrasivity (low and high) of the slurry, but also the brushing frequency (1x, 2x, and 3x/day). Brushing-remineralization cycles were performed for 7 days. Statistical analyses were performed at 5% significance level. Results: Experiment 1: overall, brushing with the high-abrasive slurry caused more SL than with the low-abrasive. For CMC and MeC lesions, 0 ppm F had more SL than 275 ppm F only after day 3. Fluoride had no effect on the SL of HEC lesions. Experiment 2: fluoride and abrasives did not have a significant effect on IEC. HEC had significantly lower Δ(ΔZ)C than CMC and MeC, with CMC and MeC not differing from each other. Lesion type had no effect on ΔLC. Experiment 3: brushing CMC lesions 3x/day with 1250 ppm F increased SL compared to 1x/day, after 5 and 7 days. Study 4: brushing MeC lesions with high abrasive slurry containing 1250 ppm F increased SL after 5 and 7 days. Conclusions: The IEC tested showed different SL and remineralization behaviors. The fluoride content and abrasive level of the toothpaste showed to be relevant modulating the SL of enamel caries lesions as well as their remineralization behavior.

O estabelecimento de interfaces adesivas no substrato dentinário artificialmente erodido, conceitualmente pobre em minerais, revestido por matriz orgânica exposta, é pouco promissor. Por ora, tornam-no similar àquele verificado para a dentina normal/hígida apenas a asperização ou, quando do uso de adesivos universais, a desproteinização com hipoclorito de sódio. Manter a camada de fibrilas colágenas, por meio do uso de inibidores de proteinases, talvez mesmo que compactada por abrasão, pode, porém, ser conveniente, já que desempenha importante papel nos processos de des e remineralização, inclusive contendo a progressão do desgaste erosivo e erosivo-abrasivo, e no estabelecimento de uma camada híbrida propriamente dita. Avaliou-se, pois, de imediato, a resistência de união do conjunto sistema adesivo condicione e lave simplificado-resina composta à dentina, considerando-se como fatores experimentais a condição desse substrato, em três níveis (N: normal; E: erodido; EA: erodido-abrasionado), e a aplicação de um gel para prevenção/controle do desgaste erosivo em três níveis (C: controle/sem aplicação; P: placebo/sem princípio ativo; CHX: digluconato de clorexidina a 0,12%). Para determinação do substrato normal, a dentina superficial oclusal de terceiros molares foi apenas submetida à ação de uma lixa de SiC (#600; 1 min; N); para a do erodido e do erodidoabrasionado, sequencialmente, de pronto, a desafio erosivo inicial (Coca-Cola®; 5 min). Aplicou-se sobre ela, então, ou não (controle/sem aplicação), um dos géis: placebo/sem princípio ativo; ou à base de CHX a 0,12%. Aquela de início desmineralizada ainda foi submetida à ciclagem de pH (Coca-Cola®; imersões de 5 min, 3x/dia, 5 dias), determinando-se, fatidicamente, o substrato erodido (E), ou a ciclagem de pH associada a escovação (escova elétrica/dentifrício com flúor diluído em água, 2,5 N, 30 s, 2x/dia, após 1º e último desafios ácidos), determinando-se o substrato erodido-abrasionado (EA). Após condicionamento (H3PO4 a 37%; 15 s; lavagem 30 s; secagem com papel absorvente), o adesivo AdperTM Single Bond 2® foi aplicado em todos os espécimes e a porção coronária, reconstruída com a resina FiltekTM Z350®. Transcorridas 24 h (água destilada / 37?C), os espécimes foram seccionados em palitos e testados (?TBS; 0,5 mm/min). Os valores de RU obtidos foram organizados considerando-se cada dente como unidade experimental e os testes de Análise de Variância a 2 critérios e de Tukey, aplicados (?=0,05). Um dente extra para cada grupo foi tratado exatamente como os outros, mas o corante fluorescente rodamina B foi previamente adicionado (0,16 mg/mL) ao sistema adesivo para permitir a avaliação qualitativa da interface adesiva por meio de Microscopia Confocal de Varredura a Laser. Diferentemente da variável aplicação de géis para prevenção/controle do desgaste erosivo (p=0,359), a variável condição do substrato dentinário exerceu influência significante sobre os resultados (p<0,001). Ademais, não houve interação entre elas (p=0,856). Os valores imediatos de RU ao substrato erodido e ao erodido-abrasionado, equivalentes entre si, foram sempre inferiores àqueles ao substrato normal, independentemente da aplicação, ou não, do gel de CHX, ou placebo, para prevenção/controle do desgaste erosivo. No tocante ao padrão de fratura dos palitos testados, as falhas adesivas e mistas foram predominantes em relação às coesivas, independentemente se em dentina ou em resina. Quanto à análise qualitativa, nota-se que tags resinosos se manifestam em maior número e comprimento nos substratos submetidos a desafio erosivo inicial, ou seja, o erodido e o erodido-abrasionado, independentemente da aplicação de qualquer estratégia para controle da progressão do desgaste. Dentre eles, para o substrato erodido, há uma identificável camada escura subjacente à de adesivo propriamente dito, entre os tags resinosos, representação da menor concentração de material marcado por rodamina B. Para o substrato erodido-abrasionado, verifica-se camada híbrida devidamente expressa por anuviado vermelho subjacente à camada de adesivo, mais e menos espessa, respectivamente, que a estabelecida no substrato normal e erodido. Destarte, conclui-se que o gel de CHX não foi capaz de determinar, por meio da preservação/controle do desgaste erosivo, ou erosivo-abrasivo, substrato tão favorável à adesão com os materiais resinosos quanto o normal, mesmo que não o tenha desajudado ainda mais. / The establishment of adhesive interfaces on artificially eroded dentin substrate, conceptually poor in minerals, coated with an exposed organic matrix, is little promising. For the time being, only diamond bur surface roughening and deproteinization with sodium hypochlorite, when universal adhesives are used, make it similar to the obtained for normal/sound dentin. Maintaining the layer of collagen fibrils, using protease inhibitors, perhaps even when compressed by abrasion, may, however, be convenient, since it plays an important role in the demineralization and remineralization processes, including the erosive and erosive-abrasive wear progression, and in establishing a hybrid layer itself. The aim of this study was to evaluate, immediately, bond strength (BS) of an etch-and-rinse adhesive system plus a composite to dentin, considering the condition of its substrate in three levels (N: normal; E: eroded; EA: eroded-abraded), and the application of a gel for the prevention/control of the erosive wear in three levels (C: control / without application, P: placebo / without an active principle, and CHX: 0.12% chlorhexidine digluconate). To determine the normal substrate, occlusal dentin from third molars was subjected solely to the action of a SiC sandpaper (# 600; 1 min; N); to determine the eroded and eroded-abraded, it was sequentially, and readily, subjected to an initial erosive challenge (Coca-Cola®, 5 min). One of the gels were applied, or not (control / without application), on it: placebo / without active principle; or containing 0.12% CHX. The initial demineralized one was still submitted to a pH cycling (Coca-Cola®, immersions of 5 min, 3x /day, 5 days), determining the eroded substrate (E), or to the pH cycling associated to brushing (electric toothbrush/fluoride toothpaste diluted in water, 2.5 N, 30 s, 2x/day, after 1st and last acid challenges), determining the eroded-abraded substrate (EA). After acid-etching (37% H3PO4, 15 sec, 30 sec washing, drying with absorbent paper), Adper(TM) Single Bond 2® adhesive was applied to all specimens and resin composite buildups constructed with Filtek(TM)Z350®. After 24 h (distilled water / 37?C), specimens were sectioned in beams and tested (?TBS, 0.5 mm/min). BS values obtained were organized considering each tooth as an experimental unit and a twoway ANOVA and Tukey test, applied (?=0.05). An extra tooth for each group was treated exactly like the others, but rhodamine B fluorescent dye was previously added (0.16 mg / mL) to the adhesive system to allow qualitative evaluation of the adhesive interface by means of Confocal Laser Scanning Microscopy. Differently from the variable application of gels for prevention/control of erosive wear (p=0.359), the condition of the dentin substrate had a significant influence on the results (p<0.001). In addition, there was no interaction between them (p=0.856). Immediate BS values to eroded and eroded-abraded substrates, equivalent to each other, were always lower than that to the sound substrate, regardless of the application, or not, of the CHX or the placebo gel for prevention/control of erosive wear. Concerning the fracture pattern of the tested beams, adhesive and mixed failures were predominant in relation to the cohesive, regardless of whether in dentin or in resin composite. As for the qualitative analysis, it is noticed that resinous tags are manifested in greater number and length in the substrates submitted to erosive initial challenge, that is, eroded and erodedabraded substrates, regardless of the application of any strategy to control progression of wear. Among them, for the eroded substrate, there is an identifiable dark layer underlying that of the adhesive itself, among the resin tags, representing the lowest concentration of material marked by rhodamine B. For the eroded-abraded substrate, hybrid layer is duly expressed by a red blur underlying the layer of adhesive, more and less thick than that established in the normal and eroded substrates, respectively. Therefore, it is concluded that the CHX gel was not able to determine, while preserving/controlling the erosive or erosive-abrasive wear, a substrate as favorable to bonding with resinous materials as a sound one, even if it has not impaired it even more.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / PURPOSE: To assess the influence of simulated oral erosive/abrasive challenges on the bond strength of an etch-and-rinse two-step bonding system to enamel using an in situ/ex vivo protocol. METHODS: Bovine enamel blocks were prepared and randomly assigned to four groups: CONT - control (no challenge), ABR - 3x/day-1 minute toothbrushing; ERO - 3x/day - 5 minutes extraoral immersion into regular Coca Cola; and ERO+ABR - erosive protocol followed by a 1-minute toothbrushing. Eight blocks were placed into an acrylic palatal appliance for each volunteer (n = 13), who wore the appliance for 5 days. Two blocks were subjected to each of the four challenges. Subsequently, all the blocks were washed with tap water and Adper Single Bond 2/Filtek Z350 were placed. After 24 hours, 1 mm2 beams were obtained from each block to be tested with the microtensile bond strength test (50 N load at 0.5 mm/minute). The data were statistically analyzed by one-way RM-ANOVA and Tukey's tests (alpha = 0.05). RESULTS: No difference was detected among the ABR, ERO, and CONT groups (P > 0.05). ERO+ABR group yielded lower bond strengths than either the ABR and ERO groups (P < 0.0113). / Revisión por pares