Thesis (doctoral)--Ludwig Maximilians-Universität zu München, 1978.

Background: Chlorhexidine (CHX) is the most effective antiseptic mouthwash known and yet, side effects such as tooth discolorations and bitter taste exist. A new product of CHX with an anti-discoloration system (ADS) was supposed to minimize these side effects while maintaining the antiseptic effects. The aim of this clinical trial was to evaluate the effectiveness of the CHX with and without an ADS on stains, plaque accumulation and gingivitis development. Material and Methods This double blinded RCCT included 26 healthy dental students. After a preparatory period (3 weeks) of professional prophylaxis and optimal tooth brushing, the participants were randomly assigned to one of three groups: Group P (Placebo), Group T1 (0.12% CHX without ADS) and Group T2 (0.12% CHX with ADS). During 3 weeks of abolished oral hygiene, the participants were asked to rinse with a mouthwash twice daily. Allocation was concealed until after the baseline examination. The clinical parameters were assessed on Days 0, 7, 14 and 21 and included the Discoloration Index (DI), the Plaque Index (PII) and Gingival Index (GI). Results All 26 participants completed the study with good compliance. At baseline, there were no significant differences for any parameters between any of the groups. Throughout the study, there were no significant differences in mean DI, PII or GI between group T2 and group P. However, significant differences in mean DI between group T2 and group T1 on Day 14 (0.19±0.15 vs. 0.87±0.56, p=0.007) and on Day 21 (0.21±0.17 vs. 1.13±0.59, p=0.001) were noted. Also, the mean PII between group T2 and group T1 on Day 7 (0.89±0.40 vs. 0.13±0.09, p<0.001), Day 14 (1.32±0.46 vs. 0.25±0.12, p<0.001) and on Day 21 (1.45±0.39 vs. 0.25±0.19, p<0.001) differed significantly. Likewise, significant differences were found in mean GI between group T2 and group T1 on Day 14 (0.71±0.39 vs. 0.14±0.10, p=0.002) and on Day 21 (1.12±0.41 vs. 0.18±0.19, p<0.001). Conclusions CHX with ADS appeared to be effective in preventing stain on teeth. However, the efficacy of preventing plaque accumulation and gingivitis development was greatly hampered by the addition of ADS. In fact, CHX mouthwash with ADS showed no superior effect over placebo on maintenance of oral hygiene or prevention of gingivitis. / published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

Mémoire DES : Pharmacie hospitalière et des collectivités : Université de Nantes : 2005. Thèse d'exercice : Pharmacie : Université de Nantes : 2005. / Bibliogr. f. 88-92 [86 réf.].

Orientadores: Sergio de Toledo, Antonio Wilson Sallum / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-04T03:45:17Z (GMT). No. of bitstreams: 1 Rodrigues_IvanaFerreiraGomes_M.pdf: 1979982 bytes, checksum: 9156f761fe75412d468296b2a79275be (MD5) Previous issue date: 2005 / Resumo: O objetivo deste estudo foi avaliar clinicamente a utilização de um dispositivo de liberação lenta de clorexidina (PerioChip®) em pacientes engajados na Terapia Periodontal de Suporte (TPS) que ainda apresentavam áreas com sangramento à sondagem e profundidade de sondagem > 5mm e < 8mm em dentes anteriores. Foram utilizados 42 pacientes com boa saúde geral, sendo 21 pacientes no grupo teste (PerioChip®) e 21 no grupo controle (raspagem e alisamento radicular) distribuídos aleatoriamente. Os parâmetros Índice de Placa (IP), Índice Gengival (IG), Sangramento à Sondagem (SS), Profundidade de Sondagem (PS), Recessão Gengival (RG) e Nível de Inserção Clínica (NIC) foram avaliados nos períodos inicial, 6, 12 e 24 semanas. Ao término das 24 semanas, a profundidade de sondagem reduziu 2,64 + 0,02mm no grupo teste e 2,12 + 0,02mm no grupo controle (p > 0,05); o ganho de inserção clínica foi de 2,19 + 0,87mm no grupo teste e 2,07 + 1,53mm no grupo controle (p > 0,05); ambos os tratamentos mostraram diferenças intragrupo estatisticamente significantes. Com as limitações do presente estudo, pode-se concluir que os tratamentos avaliados foram igualmente efetivos em proporcionar ganho de inserção clínica em pacientes na terapia de suporte periodontal. Entretanto, considerando as bolsas periodontais profundas, o dispositivo de liberação lenta de clorexidina foi mais eficiente do que a raspagem e alisamento radicular quanto à redução na profundidade de sondagem / Abstract: The aim of this study was to clinically evaluated the use of PerioChip® in sites showing bleeding on probing and pocket depth ranging from 5mm to 8mm (anterior teeth) in maintenance patients. Forty two patients that consented to participate in the study were randomly assigned to two groups test, treated with PerioChip® and control, treated by scaling and root planing. Patients were assessed for plaque index (PI), gingival index (GI), bleeding on probing (BOP), pocket depth (PD), clinical attachment level (CAL) and gingival recession (GR) at baseline, 6, 12 and 24 weeks. After 24 weeks, a reduction of 2,64 + 0,02mm and 2,12 + 0,02mm in PD was observed for the test and control group (p > 0,05), respectively. The observed gain in CAL was 2,19 + 0,87mm and 2,07 + 1,53mm for the test and control group (p > 0,05), respectively. In both treatments, the intragroup comparisons showed statistically significant differences in the parameters evaluated. Within the limits of this study, it can be concluded that both treatments were equally effective in the reestablishment of periodontal health in inflamed sites of maintenance patients. However, considering the deep periodontal pocket, the PerioChip® was more efficient than the scaling and root planing as for the reduction in the probing depth / Mestrado / Periodontia / Mestre em Clínica Odontológica

Indiana University-Purdue University Indianapolis (IUPUI) / The study compared pulp reactions to a synthetic hydroxyapatite and to calcium hydroxide with either one percent chlorhexidine or distilled water as a mixing vehicle. Forty-seven permanent teeth of two monkeys were mechanically exposed under aseptic conditions. The pulps were then capped with one of the following: synthetic hydroxyapatite mixed with chlorhexidine; synthetic hydroxyapatite mixed with water; calcium hydroxide mixed with chlorhexidine; calcium hydroxide mixed with water. Small square sheets of gold foil were then placed over the capping material. A base of IRM was placed and the cavities were restored with amalgam. The teeth were extracted at 14 and 90 days after pulp capping. The specimens were fixed in 10% formalin and decalcified in 5% formic acid. Serial sections 7 microns thick were prepared and stained with hematoxylin and eosin. The synthetic hydroxyapatite mixed with one percent chlorhexidine or water was well tolerated by the dental pulp. Complete bridging occurred infrequently in the specimens capped with the hydroxyapatite, compared to those capped with calcium hydroxide, which usually showed complete bridging of the exposure.

Indiana University-Purdue University Indianapolis (IUPUI) / This study investigated the effectiveness of chlorhexidine and a cavity varnish in reducing the incidence of recurrent caries around amalgam restorations in vitro. This was accomplished by: (1) inserting amalgam restorations into Class V preparations to which a varnish (Copalite), a 1 percent chlorhcxidine gluconate solution, or chlorhexidine followed by the varnish were applied; (2) exposing the teeth with the restorations to a severe ciogenic challenge; and (3) measuring with the television microscope instrumentation the changes which occurred in the width of the gap between the amalgam and the cavity wall. Four groups of 12 intact bicuspids, previously extracted for orthodontic purposes and mounted in squares of self-curing resin, were used. Upon completion of the Class V Cavity preparations, the three treatments performed, and the cavity restored with amalgam, the teeth were exposed to a cariogenic challenge for six weeks, with a weekly change in the "artificial plaque" created by Streptococcus mutans. A group of teeth which received no treatment before the restoration was inserted served as controls. The television microscope measurement instrumentation which allowed a magnification of 250 X and measurements as small as one micron were used to identify and measure the width of the gap between the amalgam and the cavity wall before and after the teeth were exposed to the cariogenic challenge. The conclusions of this study were: (1) The use of chlorhexidine or a varnish or a combination of both produced a significantly smaller enlargement of the amalgam-cavity wall gap width when no treatment was performed before the insertion of the restoration. (2) Chlorhcxidine by itself or in combination with the varnish did not prove to be more effective in preventing the enlargement of the gap than the varnish. (3) The experimental model in which a cariogenic challenge was developed produced decalcifications that closely resembled those produced in the mouth situation. (4) The television microscope measurement instrumentation accurately measured the amalgam-cavity wall gap widths. (5) The evaluation did not permit a correlation between the increase in gap width and the carious process. It is the author's suggestion that for this purpose, future studies should be performed with histologic evaluations of enamel ground sections as one of the evaluation methods. (6) Before recommending the clinical use of chlorhcxidine as a recurrent marginal caries inhibitor, further research is necessary.

Thesis (M.S.)--University of Michigan, 1989.

Orientador: Carlos Alberto de Souza Costa / Banca: Elisa Maria Aparecida Giro / Banca: Denise Madalena Palomari Spolidorio / Banca: Maria Cristina Borsatto / Banca: Mario Fernando de Góes / Resumo: O objetivo da presente pesquisa foi avaliar o efeito citotóxico direto e transdentinário de diferentes concentrações de clorexidina (CHX), bem como sua atividade antibacteriana. Para isto, concentrações de 0,06%; 0,12%; 0,2%; 1% e 2% de CHX foram aplicadas sobre células odontoblastóides MDPC-23 em cultura (teste direto). Além disto, as concentrações de CHX também foram aplicadas sobre a superfície oclusal de discos de dentina de 0,5mm ou 0,2mm de espessura, os quais apresentavam células MDPC-23 cultivadas sobre sua superfície pulpar (teste indireto). O metabolismo e morfologia celular foram avaliados pelo teste de MTT e pela análise em MEV, respectivamente. O potencial antibacteriano da CHX foi avaliado sobre S.mutans com e sem interposição de discos de dentina. Os dados numéricos obtidos dos experimentos realizados foram submetidos à análise estatística. A redução do metabolismo celular provocado pela CHX mostrou-se dose e tempo dependentes. Foi demonstrado ainda que quanto menor a espessura do disco de dentina e maior a concentração da CHX, mais intensos são os efeitos tóxicos deste agente químico sobre as células pulpares em cultura, e mais efetiva é a atividade antibacteriana da CHX sobre S.mutans. Foi possível concluir que o intenso efeito tóxico direto observado para a CHX é notavelmente reduzido pela interposição de barreiras de dentina, cuja espessura interfere no metabolismo das células pulpares MDPC-23. Além disso, a CHX difunde através dos túbulos dentinários exercendo efeito antibacteriano contra S.mutans. / Abstract: The aim of this in vitro study was to evaluate the direct and transdentinal cytotoxicity of different concentrations of chlorhexidine (CHX) and its antibacterial activity. The following concentrations of CHX: 0.06%; 0.12%; 0.2%; 1%; and 2% were applied directly on odontoblast-cell line MDPC-23 or on the occlusal surface of dentin discs (0.5mm or 0.2mm thick) which presented pulp cells seeded on their pulpal surface. Cell metabolic activity and morphology were evaluated by MTT assay and SEM, respectively. The influence of dentin thickness on the antibacterial activity of CHX against S. mutans was also assessed. The data were submitted to the statistical analysis of Mann-Whitney. Reduction in the cell metabolism from 42% to 78% was observed according to the concentration of CHX and its period of application on the cells. Therefore, the direct cytotoxicity of CHX is dose and time dependent. It was also observed that the most intense toxic effects occurred as thicker was the dentin disc and as higher was the concentration of CHX. Antibacterial activity against S. mutans was observed to the highest concentration of CHX. It was concluded that the intense cytotoxicity of all concentrations of CHX applied directly on the MDPC-23 cells is notably reduced by the presence of dentin discs interposed between this chemical agent and the cultured cells. In addition, the transdentinal diffusion of CHX causes antibacterial activity against S. mutans. / Doutor

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / O sucesso do tratamento endodÃntico depende de muitos fatores, sendo a reduÃÃo ou eliminaÃÃo da infecÃÃo bacteriana o mais importante desses fatores. Portanto, o uso de substÃncias capazes de agir nesses microorganismos e em seus subprodutos torna-se uma etapa importantÃssima no tratamento. O objetivo deste ensaio clÃnico âsplit-mouthâ foi comparar a eficÃcia da clorexidina gel 1% e do hidrÃxido de cÃlcio associado ao paramonoclorofenol canforado (Callen PMCCÂ), como medicaÃÃo intracanal, e do tratamento executado em sessÃo Ãnica (grupo controle), contra Estreptococos do grupo mutans (EGM) e bactÃrias anaerÃbias presentes no interior dos canais radiculares de molares decÃduos com necrose pulpar. Um total de 21 crianÃas (37 dentes) participou do estudo. Amostras iniciais (prÃ-tratamento) e finais (apÃs a permanÃncia das substÃncias por 14 dias no interior dos canais) foram coletadas para anÃlise microbiolÃgica e incubadas em placas de Mitis Salivarius Bacitracina, em aerofilia, para a observaÃÃo dos nÃveis de EGM, assim como em placas de Brucella Ãgar, em anaerobiose, para verificaÃÃo de bactÃrias anaerÃbias. Os nÃveis de sucesso da pulpectomia apÃs um perÃodo de acompanhamento de atà 12 meses foram analisados baseados em parÃmetros clÃnicos e radiogrÃficos. A clorexidina gel a 1% reduziu significantemente os nÃveis de EGM (p= 0,010, teste de Wilcoxon) e o Callen PMCC reduziu significantemente os nÃveis de bactÃrias anaerÃbias (p=0,002, teste de Wilcoxon). Observou-se diferenÃa significativa na comparaÃÃo da reduÃÃo dos nÃveis de EGM obtidos pelo grupo da clorexidina e pelo controle (p=0,032, Mann-Whitney). A taxa de sucesso do tratamento foi de 81,71% no grupo do Callen PMCCÂ, 78,57% para o grupo da clorexidina gel 1% e 77,77% no grupo controle. Concluiu-se que a clorexidina gel a 1%, assim como o hidrÃxido de cÃlcio associado ao paramonoclorofenol canforado, possui eficÃcia limitada na reduÃÃo de bactÃrias dos canais radiculares decÃduos infectados. Os presentes resultados sugerem que uma possÃvel associaÃÃo entre as medicaÃÃes testadas em estudos futuros pode eliminar de maneira mais eficaz estas bactÃrias. / The success of endodontic treatment depends on many factors, and the reduction or elimination of bacterial infection is the most important one. Therefore, the use of substances that act against these microorganisms and their products becomes an important stage in treatment. The aim of this in vivo split-mouth study was to compare the efficacy of a 1% chlorhexidine gel, calcium hydroxide/camphorated paramonochlorophenol (Callen PMCCÂ) as intracanal medications, and a Control group (1-visit endodontic treatment) against mutans streptococci (EGM) and anaerobic bacteria found in primary molars with necrotic pulps. A total of 21 children (37 teeth) participated in this study. Initial (pre-treatment) and final (14 days post-treatment) intra-canal samples were collected for microbiological analysis and were incubated in Mitis Salivarius Bacitracin plates under microaerophilic conditions for EGM counting; as well as in Brucella-agar plates, anaerobically, to allow growth of anaerobic bacteria. The success rate of the pulpectomies after a 12 months follow-up were also evaluated based on clinical and radiographic parameters. Chlorhexidine gel significantly reduced EGM levels (p=0,010, Wilcoxon test), whereas Callen PMCC significantly reduced anaerobic bacteria levels (p=0,002). Significant difference was observed when comparing EGM reduction levels between the Chlorhexidine and Control groups (p=0,032, Mann-Whitney test). The success rate was 81,71% in the Callen PMCC group, 78.57% in the Chlorhexidine group and 77.77% in the control group. We concluded that 1% chlorhexidine gel, as well as calcium hydroxide/camphorated paramonochlorophenol, has limited efficacy in the reduction of bacteria from deciduous infected root canals. The present results suggest that a possible association between these two medications in future studies may eliminate more efficiently these bacteria.

Este estudo avaliou o efeito da carbodiimida (EDC) e da clorexidina (CLX) na longevidade da resistência de união (RU) de cimento resino à dentina radicular e na composição química e estrutura do colágeno de dentes submetidos à radioterapia. 120 caninos superiores foram selecionados e distribuídos em 2 grupos: não irradiados (n=60) e irradiados (30 ciclos de 2Gy, totalizando 60Gy) (n=60). Os dentes foram seccionados, sendo as raízes destinadas à análise da RU e os remanescentes coronários à análise química. 40 fragmentos coronários remanescentes, 20 irradiados e 20 não irradiados, foram seccionados, lixados e polidos para obtenção de blocos de dentina intraradicular (3x3x2mm), distribuídos de acordo com o tratamento da dentina (n=10): CLX 2% e EDC 0,5M. A análise foi realizada em espectroscopia no infravermelho com transformada de Fourier (FTIR) no tempo zero (T0) e após 1(T1), 3(T3) e 5(T5) min de imersão nas soluções para análise das bandas de carbonato (C), amida I (AI) e razão entre as bandas amida III e prolina e hidroxiprolina (AIII/PH). As raízes (16mm) foram instrumentadas com Reciproc (R50) e obturadas com AH Plus. Em seguida, as raízes foram preparadas para pino e redistribuídas de acordo com o tratamento da dentina (n=20): soro fisiológico (SF); CLX 2%; e EDC 0,5M. Após secagem do canal, pinos de fibra de vidro foram cimentados com RelyX U200. Em seguida, obteve-se os slices e, em metade dos espécimes de cada subgrupo (n=10), as análises foram realizadas imediatamente; as demais (n=10) foram armazenadas por 10 meses, para análise da longevidade. O slice mais cervical de cada terço foi submetido ao push-out e padrão de falha (n=10), e o slice mais apical submetido à análise da interface adesiva em microscopia eletrônica de varredura (MEV) (n=5). Os dados de área das bandas e de RU foram submetidos à análise estatística pelos testes de ANOVA e Tukey, já a adaptação da interface adesiva foi submetida aos testes de Kruskal-Wallis e Duns, e o teste qui-quadrado foi utilizado para avaliar o tipo de falha. Não houve diferença estatística para as áreas das bandas de C; para AI houve diferenças entre os tempos experimentais (P<0,0001) independentemente dos fatores radioterapia e tratamento, em que T3 e T5 apresentaram valores maiores que T0 e T1 (P<0,05); já a razão AIII/PH foi reduzida pela radioterapia (P<0,05), sendo que o EDC aumentou os valores de AIII/PH em T1, T3 e T5 em dentes irradiados (P<0,05), sendo esses valores semelhantes aos dentes não irradiados (P>0,05); já para a CLX os valores de AIII/PH foram menores para todos os tempos experimentais tanto em dentes irradiados como não irradiados (P<0,05). Os dentes irradiados apresentaram menores valores de RU (13,8±4,3) comparados aos não irradiados (18,1±3,1)(P<0,001). Para os dentes irradiados, os valores de RU foram menores para o SF e CLX (P<0,001), sendo que o EDC mostrou valores de RU similares aos dentes não irradiados (P=0,215). Para os dentes não irradiados, os valores de RU foram similares para os dentes tratados com SF, CLX e EDC (P>0,05). Ainda, a RU reduziu após 10 meses para o grupo tratado com SF e CLX (P<0,001), sendo que o EDC manteve os valores (P=0,236), de forma que após 10 meses, o EDC apresentou maior RU que a CLX (P<0,001), sendo a CLX superior ao SF (P<0,001). O terço cervical apresentou maior RU quando comparado ao terço médio (P<0,001), que por sua vez foi maior que no terço apical (P<0,001). O padrão de falhas mostrou ocorrência de falhas coesivas na dentina para os espécimes irradiados, e a análise da interface adesiva em MEV mostrou maior desadaptação nos dentes submetidos à radioterapia, além de fraturas e microfraturas na dentina. Em relação aos tratamentos da dentina, observou-se maior adaptação para o EDC. A radioterapia altera a estrutura secundária do colágeno, resultando na redução da RU e maior desadaptação da interface, sendo que o tratamento da dentina com EDC devolveu a integridade do colágeno, se apresentando como melhor alternativa para tratamento da dentina previamente à cimentação de pinos de fibra de vidro em dentes irradiados e não irradiados, uma vez que contribui para a longevidade da interface adesiva / This study evaluated the effect of carbodiimide (EDC) and chlorhexidine (CHX) on the bond strength (BS) of resin cement to root dentin and on the chemical composition and structure of dentin collagen of teeth submitted to radiotherapy. 120 maxillary canines were selected and distributed in 2 groups: non-irradiated (n=60) and irradiated (30 cycles of 2Gy, total 60Gy) (n=60). The teeth were sectioned, and the roots were used for BS analysis while the remaining coronary was subjected to chemical analysis. 40 remaining coronal fragments, 20 non irradiated and 20 irradiated, were sectioned and polished to obtain 40 intraradicular dentin blocks (3x3x2mm), distributed according to the dentin treatment (n=10): CHX and EDC. The analysis was carried out in Fourier Transform Infrared Spectroscopy (FTIR) before treatment (T0) and after 1 (T1), 3 (T3) and 5 (T5) minute immersion in solutions for the analysis of carbonate bands (C), amide I (AI), and ratio between the amide III and proline and hydroxyproline (AIII/PH) bands. The roots (16mm) were instrumented with Reciproc (R50) and filled with AH Plus. The post space was prepared and the samples were redistributed according to dentin treatment (n=20): saline solution (SF); CHX 2%; and EDC 0.5M. After drying the post space, fiberglass posts were cemented with RelyX U200. Then, slices were obtained and, in half of the specimens of each subgroup (n=10) the analyses were performed immediately; the others (n=10) were stored for 10 months before analysis. The most cervical slice of each third was subjected to push-out and failure pattern analysis (n=10), and the most apical slice submitted to the analysis of the adhesive interface in scanning electron microscopy (SEM) (n=5). The band areas and BS data were submitted to statistical analysis by the ANOVA and Tukey tests, the adhesive interface adaptation was submitted to the Kruskal-Wallis and Duns tests, and the chi-square test was used to evaluate the type of failure. There was no statistical difference for the areas of the C bands; for AI, there were differences between the experimental times (P<0.0001) independent of the radiotherapy and treatment factors, in which T3 and T5 presented higher values than T0 and T1 (P<0.05); the AIII/PH ratio was reduced by radiotherapy (P<0.05), and the EDC increased the AIII/PH values in T1, T3 and T5 in irradiated teeth (P<0.05), with similar values in non-irradiated teeth (P>0.05); for CHX, AIII/PH values were lower for all experimental times in both irradiated and non-irradiated (P<0.05) teeth. The irradiated specimens presented lower BS values (13.8±4.3) than non-irradiated specimens (18.1±3.1) (P<0.001). For the irradiated teeth, the BS values were lower for the SF and CHX (P<0.001), while EDC showed similar BS values to the non-irradiated teeth (P=0.215). For non-irradiated teeth, BS values were similar for teeth treated with SF, CHX, and EDC (P>0.05). Also, the BS reduced after 10 months for the group treated with SF and CHX (P<0.001), while EDC maintained the BS values (P=0.236), wherein EDC presented higher BS values than CHX (P<0.001), and CHX presented higher values than SF (P<0.001). The cervical third showed higher BS values when compared to the middle third (P<0.001), which in turn was higher than in the apical third (P<0.001). The failure pattern showed the occurrence of cohesive failures in dentin for the irradiated specimens, and the analysis of the adhesive interface in SEM revealed worse adaptation in teeth submitted to radiotherapy, in addition to fractures and microfractures in dentin. Regarding the dentin treatments, a better adaptation of the adhesive interface was observed with EDC treatment. Radiotherapy alters the secondary structure of collagen, resulting in the reduction of BS values and worse adaptation of the adhesive interface; and the dentin treatment with EDC returned the collagen integrity, and was the best alternative for surface treatment prior to the cementation of glass fiber posts in non-irradiated and irradiated teeth, since it contributed to the longevity of the adhesive interface