Dissertations / Theses on the topic 'Infiltrative resin'

AN INVESTIGATION OF SURFACE CHARACTERISTICS OF ENAMEL TREATED WITH INFILTRATIVE RESIN: A SCANNING ELECTRON MICROSCOPY STUDY Danielle E. Easterly, Doctorate of Dental Surgery. A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Dentistry at Virginia Commonwealth University. Virginia Commonwealth University. 2017. Director: Dr. Eser Tüfekçi D.D.S., M.S., Ph.D., M.S.H.A. Objective: To evaluate the microstructural changes of a resin infiltrant (ICON®, DMG America LLC, Englewood, NJ) after six months of simulated toothbrushing. Materials and Methods: Ten extracted third molars (n=10) were collected. Artificial white spot lesions were created and resin applied. Environmental SEM images at 250X and 500X were taken after application of Icon® (T1), and after six months of simulated toothbrushing (T2). Micrographs were evaluated for changes in surface characteristics. Results: SEM showed some changes in the surface characteristics of the resin after simulated toothbrushing. However, changes in presence of enamel rods, microcracks, or fractures were not statistically significant (p>0.05). The effects of polymerization shrinkage were noted on most samples in the form of clefts and fissures. Conclusions: Icon® resin seems to withstand challenge by toothbrush abrasion over a six-month period, with some evidence of microstructural wear.

A white spot lesion (WSL) is defined as enamel porosity, which could be due to an enamel defect or an initial carious lesion. ICON® resin is a resin infiltrant that penetrates into the enamel porosity and seals the lesion, thus inhibiting the progression of caries. This method is micro-invasive; however, the resin is radiolucent and the clinician cannot detect the material using radiographs. In order to develop a radiopaque resin, understanding the pore size and pore structure in WSLs is helpful. Therefore, the aim of this study was to characterise: (1) the pore size and structure, (2) the incorporation of radiopaque agents into ICON® resin. Brunauer-Emmett-Teller (BET) and focused ion beam-scanning electron microscopy (FIB-SEM) were used to characterise the porosity in WSLs. The data showed the enamel prisms become more pronounced in the advanced areas of the WSLs and demineralisation occurs within or/and between the enamel prisms. The pore size could be as small as an enamel crystallite, 28x48nm. Nano-strontium hydroxyapatite (non-coated and coated) and strontium bioglass were made as radiopaque fillers and characterised using different techniques including fourier transform infrared spectroscopy (FTIR), BET, transmission electron microscopy (TEM), X-ray diffraction (XRD) and particle size measurements. The radiopaque fillers had micron-sized particles, which made them unsuitable for infiltration into WSLs despite their possible ability to remineralise the WSLs. Radiopaque monomers including bromine-methacrylate and tin-methacrylate were able to make ICON® resin radiopaque and they showed a similar viscosity, wettability and biocompatibility compared to ICON® resin. The X-ray microtomography (XMT) showed that the experimental radiopaque resins were able to infiltrate into the WSLs, artificial and natural lesions, and they could be detected using image subtraction. Backscattered electron (BSE) imaging after each step of application of materials showed that the etching pattern and etchant gel could be barriers for a successful infiltration of the resins into WSLs.

A two-dimensional fmite element model for the infiltration of a dry textile preform by an injected resin has been verified. The model, which is based on the finite element/control volume technique, determines the total infiltration time and the pressure increase at the mold inlet associated with the RTM process. Important input data for the model are the compaction and permeability behavior of the preform along with the kinetic and rheological behavior of the resin.

The compaction behavior for several textile preforms was determined by experimental methods. A power law regression model was used to relate fiber volume fraction to the applied compaction pressure. Results showed a large increase in fiber volume fraction with the initial application of pressure. However, as the maximum fiber volume fraction was approached, the amount of compaction pressure required to decrease the porosity of the preform rapidly increased.

Similarly, a power law regression model was used to relate permeability to the fiber volume fraction of the preform. Two methods were used to measure the permeability of the textile preform. The first, known as the steady state method, measures the permeability of a saturated preform under constant flow rate conditions. The second, denoted the advancing front method, determines the permeability of a dry preform to an infiltrating fluid. Water, corn oil, and an epoxy resin, Epon 815, were used to determine the effect of fluid type and viscosity on the steady state permeability behavior of the preform. Permeability values measured with the different fluids showed that fluid viscosity had no influence on the permeability behavior of 162 E-glass and TTI IM7/8HS preforms.

Permeabilities measured from steady state and advancing front experiments for the warp direction of 162 E-glass fabric were similar. This behavior was noticed for tests conducted with corn oil and Epon 815. Comparable behavior was observed for the warp direction of the TTl 1M7/8HS preform and corn oil.

Fluid/fiber interaction was measured through the use of the single fiber pull-out test. The surface tension of both the corn oil and Epon 815 was determined. The contact angle between these two fluids and glass and carbon fibers was also measured. These tests indicated that the glass fiber had a lower contact angle than the carbon fiber and therefore is wet out better than the carbon fiber by both fluids. This result is attributed to the sizing commonly used on the carbon fibers.

Mold filling and flow visualization experiments were performed to verify the analytical computer model. Frequency dependent electromagnetic sensors were used to monitor the resin flow front as a function of time. For the flow visualization tests, a video camera and high resolution tape recorder were used to record the experimental flow fronts. Comparisons between experimental and model predicted flow fronts agreed well for all tests. For the mold filling tests conducted at constant flow rate injection, the model was able to accurately predict the pressure increase at the mold inlet during the infiltration process. A kinetics model developed to predict the degree of cure as a function of time for the injected resin accurately calculated the increase in the degree of cure during the subsequent cure cycle.
Master of Science

Title: The Esthetic Outcome and the Infiltration Capacity of Three Resin Composite Sealers Compared to ICON (DMG, America). Objective: The aim of these studies, including a randomized control in-vitro study and a survey study was to answer the following question: In treating initial caries lesions, is the esthetic outcome and the infiltration capacity of the three resin composite sealers; BisCover LV (Bisco Dental), Optiguard (Kerr), PermaSeal (Ultradent) similar to that of the gold standard ICON (DMG, America) resin infiltrant. Methods: A sample of 75 extracted human permanent molars were painted with an acid resistant nail varnish (Revlon, USA) to protect the tooth surface from demineralization leaving only two panels of 1x7 mm of exposed enamel on the buccal and the lingual surfaces of each tooth to be demineralized. Samples were immersed in an acidic gel (500g of Fisher G-8 Gelatin, 275 Bloom, 0.1% thymol, lactic acid, pH 4.30) for a period of 3 months to create artificial initial caries lesions. Seventy-five specimens were randomly assigned to 5 groups: I: ICON (DMG, America), B: BisCover LV (Bisco Dental), O: Optiguard (Kerr), P: PermaSeal (Ultradent) and C: control group. Specimens were hemi sectioned yielding two halves, each with a panel of 1x7 mm of initial caries lesion. One side was used to assess the esthetic following the caries lesion resin infiltration with ICON, BisCover LV, Optiguard and PermaSeal applied according to ICON manufacturer instructions. The control group (C) did not receive any treatment and was only included in the esthetic part of this study. Preoperative and postoperative photographs were taken. Two sets of photographs were taken for the control group. The preoperative, postoperative and control group photographs were installed in a PowerPoint presentation and placed side by side on a black background. A total of 17 operative faculties and residents at the department of operative dentistry at the University of Iowa (UI) participated in the survey. The esthetic improvement was assessed based on a 100-mm visual analogue scale (VAS). A value between 0 and 20 indicated slight esthetic improvement. A value between 20 and 40 indicated mild esthetic improvement. A value between 40 and 60 indicated moderate esthetic improvement. A value between 60 and 80 indicated high esthetic improvement. A value between 80 and 100 indicated outstanding esthetic improvement. A value of 100 indicated full esthetic recovery. Each subject was asked to look at the preoperative and postoperative photographs of a specimen in each slide and place a line on the respective VAS according to her/his opinion of esthetic improvement. The survey was conducted twice in two different sessions to evaluate the inter-rater and intra-rater reliability. For lesions on the opposite side, the resins: ICON, BisCover™LV, Optiguard and PermaSeal were applied according to the indirect dual fluorescence technique protocol using the red fluorophore rhodamine B isothiocyanate (RITC 0.1%; Sigma Aldrich, Steinheim, Germany) and the green sodium fluorescein (NaFl; Sigma Aldrich). Specimens were sectioned in a mesio-distal direction yielding thin sections of 200 μm and were visualized under the Confocal Laser Scanning Microscope (CLSM, Leica Microsystems, Buffalo Grove, IL.) to assess the infiltration depth percentage (ID%) and the infiltration area percentage (IA%) following the application of the different resins. Statistical analysis: The effect of treatment type on ID% and IA% was evaluated using the one-way ANOVA. The effect of treatment type on esthetic improvement measures represented by VAS scores was evaluated using the non-parametric analogue of the one-way ANOVA; Kruskal-Wallis test. All pairwise comparisons were performed using the Tukey method with an overall 0.05 level of significance. Spearman rank correlations were used to assess the relationship between esthetic improvement measures and infiltration measures. Validity of assumptions related to normality and variance homogeneity were assessed using the Shapiro-Wilk and Brown-Forsythe tests, respectively. The intra-class correlation and associated 95% confidence interval reflecting the reproducibility of the mean VAS scores and the reliability among the evaluators were obtained using the method of Shrout and Fleiss. The Wilcoxon Signed Rank procedure was used to evaluate differences between sessions for individual evaluators. The paired student’s t-test was used to detect any systematic differences between the mean VAS scores at session 1 and 2. Bonferroni adjustment for multiple testing was made for the 17 tests associated with individual raters, using an overall 0.05 level of significance. Results: the mean IA% values were significantly higher in the ICON group compared to the other three treatment groups. Optibond and Permaseal groups resulted in intermediate values that did not differ significantly from each other. Biscover group yielded the lowest mean values and were significantly lower than that of the other three treatment groups. The results of the ID% values were consistent with the results of the IA% values. the mean ID% values were significantly higher in the ICON group compared to the other three treatment groups. Optibond and Permaseal groups resulted in intermediate values that did not differ significantly from each other. Biscover group yielded the lowest mean values and were significantly lower than that of the other three treatment groups. The distribution of esthetic improvement outcomes represented by the average VAS scores for session 1 (AVGVAS1), average VAS scores for session 2 (AVGVAS2), and the combined average VAS scores (AVERAGED_VAS) for each sample obtained from the two sessions were all significantly lower in the control group than in the other four treatment groups. Biscover yielded intermediate average VAS values. ICON, Optiguard and Permaseal yielded significantly greater average VAS values than both the control and Biscover groups and were not significantly different from each other. According to the Spearman rank correlations which was used to assess the relationships between the esthetic improvement measures; AVGVAS1, AVGVAS2 and AVERAGED_VAS for each sample and the two measures of infiltration; the IA% and the ID%, all results were highly significant (p<0.0001) and indicative of a moderately large positive correlation between each of the infiltration measures and the three esthetic improvement measures. The Spearman coefficients for the six relationships evaluated were quite similar, ranging from about 0.523 to 0.548. Conclusion: The resin composite sealers BisCover LV, Optiguard and Permaseal can infiltrate artificial initial caries lesions. The esthetic outcome of artificial initial caries lesion following resin infiltration with Optiguard and Permaseal was similar to ICON and thus might be adequately used in caries resin infiltration. BisCover LV showed the least esthetic improvement and thus might not be indicated for the esthetic management of initial caries lesions but might be used for caries prevention purposes. The esthetic improvement is correlated to the resin infiltration depth to a certain extent after which the esthetic outcome will not be visually impacted.

Orientador: Americo Bortolazzo Correr
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: O objetivo neste estudo foi avaliar o efeito da adição dos solventes dimetil sulfóxico (DMSO) e tetrahidrofurano (THF) em propriedades físico-químicas de infiltrantes experimentais. Foram preparadas duas blendas resinosas, uma composta por 75%p de TEGDMA (T) e 25%p UDMA (U) e outra por 75%p de T e 25%p de BISEMA (B). Em um grupo de cada mistura não foi adicionado solvente. Os demais grupos foram formulados pela adição dos solventes DMSO ou o THF nas concentrações de 0,5% e 5%. No total foram obtidos 10 infiltrantes experimentais. Icon® foi utilizado como controle. Este estudo foi separado em 2 capítulos. No capitulo 1 o objetivo foi avaliar a influência dos solventes DMSO e THF no ângulo de contato, dureza Knoop em lesões artificiais de cárie infiltradas e a capacidade de penetração dos infiltrantes experimentais em microscópio confocal de varredura a laser. Os dados do ângulo de contato foram submetidos à analise de variância um fator e teste de Tukey, e os de dureza Knoop avaliados por analise de variância dois fatores e teste de Tukey (?=0,05). Os resultados mostraram que o Icon apresentou o menor ângulo de contato. Dentre os infiltrantes experimentais, o menor ângulo de contato foi apresentado pela mistura T + U + 5% DMSO, significativamente menor que as misturas T + U, T + U + 0,5% DMSO, T + U + 5% THF, T + B + 0,5% DMSO e T + B + 0,5% THF. Os resultados de microscopia confocal de varredura a laser mostraram que os infiltrantes apresentaram boa penetração nas lesões artificiais de cárie exceto os grupos T + B, T + B + 0,5% DMSO e T + B + 0,5% THF. As lesões infiltradas por Icon apresentaram dureza significativamente maior que dos outros materiais, exceto T + U + 0,5% DMSO (252,4) e T + U + 5% THF (239,1). Concluiu-se que o Icon apresentou os melhores resultados dentre os materiais avaliados, com menor ângulo de contato, maior dureza e boa penetração. Dentre os materiais experimentais, a incorporação de 5% de DMSO na mistura de U reduziu o ângulo de contato e apresentou dureza semelhante à infiltrada por Icon. No capitulo 2 foi verificada a influência dos solventes DMSO e THF nos infiltrantes experimentais no grau de conversão (GC) (n = 3), resistência coesiva à tração (RT) (n = 10), resistência de união a microtração (RU) (n = 10), resistência a flexão (RF) (n = 10) e módulo de elasticidade (ME) (n = 10). Os dados foram submetidos à ANOVA um fator e teste de Tukey (? = 0,05). Foi verificado que o GC dos infiltrantes com U foi significativamente maior que dos demais infiltrantes. Os infiltrantes experimentais sem solvente apresentaram RF significativamente maior que Icon e que os infiltrantes com solvente. Os infiltrantes com 5% de DMSO apresentaram RU significativamente menor que os demais; Icon apresentou RU significativamente maior que os demais infiltrantes. A RT de Icon foi significativamente maior que dos infiltrantes experimentais. Conclui-se que os solventes DMSO e THF não melhoraram a resistência de união e prejudicaram as propriedades mecânicas dos infiltrantes experimentais. Dentre os solventes, o THF na concentração de 0,5% apresentou menos efeitos deletérios nas propriedades mecânicas dos infiltrantes experimentais. Como conclusão geral, pode ser verificado que o infiltrante Icon apresentou os melhores resultados. Dentre os infiltrantes experimentais, o melhor desempenho foi obtido com a mistura T e U. A adição 0,5% do solvente DMSO na mistura T e U não reduziu o ângulo de contato e reduziu as propriedades mecânicas dos infiltrantes, mas produziu resistência de união e dureza da lesão infiltrada semelhante ao infiltrante Icon
Abstract: The aim of this study was to evaluate the effect of alternative solvents addition dimethyl sulfoxide (DMSO) and tetrahydrofuran (THF) in the chemical-physical properties of experimental infiltrants. Were prepared 2 blends: (1) 75wt% TEGDMA (T) + 25 wt% UDMA (U), (2) 75wt% T + 25wt% BISEMA (B). From each blend were added the solvents DMSO or THF in concentrations of 0.5wt% and 5wt%, totaling 10 experimental groups. Icon® was used as control. This study was divided in 2 chapters. In chapter 1 the aim was to evaluate the influence of alternative solvents (DMSO and THF) in the contact angle, Knoop hardness of artificial caries lesions infiltrated, and the capability of penetration of the experimental infiltrants. Data were analyzed by ANOVA one-way (contact angle) and two-way (Knoop hardness) and Tukey's test (?=0.05). The results showed that Icon presented the lowest contact angle. Analyzing the experimental infiltrants, T + U + 5% DMSO showed the lowest contact angle. The confocal microscopy analysis showed that the infiltrants presented satisfactory penetration into the caries-like lesions except the groups T + B, T + B + 0.5% DMSO and T + B + 0.5% THF. Lesions infiltrated with Icon exhibited hardness values significantly higher than all the experimental groups, except to T + U + 0,5% DMSO (252.4) e T + U + 5% THF (239.1). It is possible to conclude that Icon showed the best results for the tested properties. In chapter 2 was analyzed the influence of the addition of DMSO and THF solvents in experimental infiltrants in relation to degree of conversion (n=3), ultimate tensile strength (n=10), microtensile bond strength (n=10), flexural strength (n=10) and elastic modulus (n=10). Data were submitted to one-way ANOVA and Tukey's test (?=0.05). Infiltrants containing U obtained the highest degree of conversion values. The solvents-free experimental infiltrants showed the highest values of flexural strength. In relation to microtensile bond strength results, the groups with 5% DMSO presented the lowest results and Icon the highest ones. Icon group obtained the highest results of UTS. It is possible to conclude that the addition of solvents DMSO and THF did not improve the bond strength and affected negatively mechanical properties of the experimental infiltrants. THF solvent 0,5% showed less deleterious effects in mechanical properties of experimental infiltrants. Overall, Icon xi obtained the best results. Among the experimental infiltrants, the best performance was obtained by the association of T and U. The addition of 0.5% of DMSO in the blend T + U did not reduce the contact angle and affected negatively the mechanical properties, except to microtensile bond strength and hardness of the caries lesions infiltrated
Doutorado
Materiais Dentarios
Doutora em Materiais Dentários

Dans cette étude, nous avons tenté de décrypter les mécanismes reliant l’augmentation de lymphocytes infiltrant les tumeurs (LIT) T CD8+ et un pronostic clinique défavorable dans le cancer du rein à cellules claires (ccRCC). Pour cela, nous avons déterminé 1) la relation entre le pronostic associé à l'expression d’immune checkpoints et l’infiltrat de cellules dendritiques (DC) et de LT CD8+ et 2) les caractéristiques phénotypiques des LIT T CD8+. L’expression des immune checkpoints a été déterminée par immunohistochimie dans une cohorte de 135 ccRCC. Nous avons constaté que les densités des cellules exprimant CD8, PD-1 et LAG-3 sont corrélées, et associées à une diminution de PFS et OS. Egalement, les patients dont les tumeurs présentent des densités élevées de cellules PD-1+ et PD-L1 et/ou PD-L2 +, ont le taux de survie le plus faible. Des densités élevées de DC immatures isolées dans le stroma tumoral sont associées à une forte expression d’immune checkpoints et à un faible taux de survie chez ces patients. En revanche, les patients présentant un taux de survie prolongé ont une densité élevée de lymphocytes CD8+, des DC matures au sein de structures lymphoïdes tertiaires, ainsi qu’une faible expression d’immune checkpoints. Nous avons analysé les LIT T CD8+ chez 21 patients ccRCC par Cytométrie de Flux. On a trouvé un groupe de patients (8/21) dont les tumeurs sont caractérisées par la surexpression de marqueurs inhibiteurs (PD1 et TIM3) et de d'activation (CD69 et CD38), par l'expansion des cellules T CD8 + mémoires effectrices et un plus grand potentiel d’agressivité. En résumé, nous avons démontré qu’une densité élevée de LIT T CD8+ dans les ccRCC est accompagnée d’une forte expression d’immune checkpoints et d’une réponse immunitaire mal coordonnée dans un sous-groupe de tumeurs agressives
To decipher the potential mechanisms linking increased CD8+ T cell infiltration with an adverse clinical outcome in ccRCC, in this study we determined: 1) the prognosis associated with the expression of immune checkpoints and its coordination with dendritic cell (DC) and CD8+ cell infiltration, and 2) the phenotypic traits of CD8+ tumor infiltrating lymphocytes. The prognosis associated with CD8+ and DC infiltrations, in addition to the expression of immune checkpoints were investigated in a cohort of 135 ccRCC by quantitative immunohistochemistry. We found that the densities of CD8+, PD-1+ and LAG-3+ cells were closely correlated, and independently associated with decreased PFS and OS. In addition, patients whose tumors presented both high densities of PD-1+ cells and PD-L1+ and/or L2+ tumor cells, displayed the worst clinical outcome. High densities of immature DC isolated in the tumour stroma were associated with high expression of immune checkpoints and patients’ poor clinical outcome. In contrast, the presence of mature DC within Tertiary Lymphoid Structures identified, among the tumours with high CD8+-TIL densities, those with low expression of immune checkpoints and prolonged survival. We also investigated the phenotype of freshly isolated CD8+TIL in 21 ccRCC by flow cytometry. We found a group tumors (8/21) characterised by the over-expression of inhibitory (PD-1 and TIM-3) and activation markers (CD69 and CD38), the expansion of the effector memory cell subpopulation (CCR7-CD45RA-), and a trend toward more aggressive features. In summary, we demonstrated that the infiltration with CD8+ TIL in ccRCC is accompanied by the enhanced expression of immune checkpoints and a poorly coordinated immune response in a subgroup of aggressive tumors

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Este estudo avaliou a efetividade do mascaramento de manchas de fluorose utilizando a técnica da infiltração resinosa em comparação com a técnica de microabrasão. Método: Vinte pacientes, de 12 a 16 anos, apresentando manchas de fluorose no esmalte dental, foram selecionados e divididos randomicamente em dois grupos (n=10): microabrasão e infiltração resinosa. Ambas as técnicas foram executadas, segundo as orientações do fabricante. A avaliação ocorreu de três formas distintas: quantitativa, qualitativa e “Grau de satisfação do paciente/responsável”. Fotografias estandardizadas foram feitas (baseline e 1 semana após a intervenção), para serem analisadas utilizando o software Adobe Photoshop CS5, para obter os dados para o cálculo dos valores de ΔL, Δa, Δb e ΔE, nos pontos onde a mancha da fluorose era mais intensa, em cada um dos dentes tratados. Para avaliar a otimização estética obtida nas manchas fluoróticas dois avaliadores cegos e calibrados, basearam-se nas mesmas imagens pareadas (baseline e 7 dias após a intervenção) utilizadas na análise quantitativa, registrando na escala de percepção visual (VAS), os valores de ”1” (Nenhuma melhora na aparência ou lesão não removida totalmente), à “7” (Melhora excepcional da estética, ou lesão totalmente removida). Aos pacientes e/ou os pais foi solicitado que informassem o seu grau de satisfação. Para esse efeito, foi aplicada a mesma escala VAS, variando de insatisfeito até excepcionalmente satisfeito. Os dados da análise quantitativa foram submetidos à análise estatística pelo “Teste “t” de Student” e os da análise qualitativa e do “Grau de satisfação” pelo “Teste Exato de Fisher” (α = 0,05). Resultados: Não foi observada diferença significativa entre os grupos quando as medidas objetivas foram levadas em consideração (valores de ΔL, Δa, Δb e ΔE) (p> 0,49). Em relação à avaliação qualitativa, os pacientes estavam completamente satisfeitos em 88% e 100% dos casos, respectivamente, para as técnicas de microabrasão e infiltração resinosa (p=0,42). No entanto, os examinadores observaram que a infiltração resinosa mudou completamente a aparência estética dos dentes em 70% dos casos, enquanto que isso ocorreu em apenas 10% dos casos quando a microabrasão foi aplicada (p= 0,02). Conclusão: As técnicas de microabrasão e de infiltração resinosa foram capazes de remover/mascarar manchas de fluorose e promoveram um alto nível de satisfação para os pacientes, diante de uma maior preservação de estrutura dental na técnica da infiltração resinosa, ambas as técnicas tiveram melhoria na estética obtida, ainda que diferenças positivas foram observadas em favor da infiltração resinosa.
This study evaluated the masking capability of fluorosis stains using the microabrasion technique in comparison to the resin infiltration technique. Method: Twenty patients, from 12 to 16 years old, presenting fluorosis stains on dental enamel were randomly divided into two groups (n = 10): microabrasion and resin infiltration. Both techniques were performed according to the manufacturer's guidelines. The evaluation occurred in three different ways: quantitative, qualitative and "Degree of patient/responsible satisfaction". Standardized photographs were taken (baseline and 1 week after the intervention), to be analyzed using Adobe Photoshop CS5 software, to obtain the data for calculating the values of ΔL, Δa, Δb and ΔE at the points where the spot of fluorosis was more intense in each of the treated teeth. To evaluate the aesthetic optimization, by qualitative/satisfaction degree, obtained in the fluorotic stains, two blind and calibrated evaluators were based on the same paired images (baseline and 7 days after the intervention) used in the quantitative analysis, recording in a visual perception scale (VAS) values between "1" (No improvement in appearance or injury not completely removed), to "7" (Exceptional aesthetic improvement, or stain totally removed); patients and/or parents were asked to indicate their satisfaction degree, in the same VAS scale used by the evaluators, who ranged from “1” (totally dissatisfied) to “7” (exceptionally satisfied). The data of the quantitative analysis were submitted to statistical analysis by Student's “t” Test and those of the qualitative analysis Fisher's Exact Test (α = 0.05). Results: There was no significant difference between groups when the objective measurements were considered (values ΔL, Δa, and Δb ΔE) (p> 0.49). Regarding qualitative evaluation, patients were completely satisfied by 88% and 100% of the cases, respectively, to techniques and microabrasion resin infiltration (p = 0.42). However, investigators found that the resin infiltration completely changed the aesthetic appearance of teeth in 70% of cases, while it occurred in only 10% of cases when the microabrasion was applied (p = 0.02). Conclusion: The both techniques (microabrasion and resin infiltration) were able to remove/mask fluorosis stains and promoted a high level of patient satisfaction, due to a greater dental structure preservation in the resin infiltration technique, both techniques obtained aesthetics results although positive differences were observed in favor of resin infiltration.

Este ensaio clínico randomizado, cego e controlado com placebo teve como objetivo principal avaliar a eficácia do diamino fluoreto de prata (DFP) a 30% no tratamento não operatório de lesões de cárie em superfícies proximais de molares decíduos e compará-la a eficácia do infiltrante resinoso e a do controle do biofilme interproximal pelo uso do fio dental. Além disso, também avaliou a custo-eficácia e o desconforto dos tratamentos e a satisfação dos participantes quanto ao tratamento recebido. Para isso, foram selecionadas 141 crianças entre 3 e 10 anos de idade, que apresentavam pelo menos uma superfície proximal com lesão de cárie clinicamente em esmalte. A alocação dos participantes foi aleatória, de acordo com o tratamento: DFP a 30%, infiltrante resinoso de cárie e orientação para o uso diário do fio dental (controle). Todos os participantes receberam o tratamento ativo para os quais foram alocados e também o placebo dos tratamentos realizados nos outros grupos. Os custos dos materiais utilizados nos tratamentos foram registrados. Ao final da consulta de tratamento, foi aplicada aos participantes a Escala Facial de Wong-Baker para avaliação do desconforto. Os responsáveis pelos participantes, que concluíram o seguimento da pesquisa, responderam a um questionário de satisfação sobre o tratamento recebido. As crianças foram examinadas após 1 mês para avaliação de higiene bucal e também de presença de biofilme nas superfícies tratadas. Após 6, 12 e 24 meses, foram realizados exames visual e tátil para verificar a progressão das lesões tratadas, além de exame radiográfico aos 12 e 24 meses. Para avaliar a eficácia dos tratamentos, consideraram-se como desfechos: (I) qualquer progressão clínica da lesão tratada e (II) progressão para cavidade em dentina. A progressão radiográfica foi utilizada como um desfecho secundário e para comparar com o padrão clínico de progressão das lesões. Análises de regressão foram realizadas para verificar se os grupos de tratamento influenciaram os desfechos testados após 12 e 24 meses de seguimento (análise por protocolo - Poisson multinível e análise de sobrevida). Valores pontuais de custo-eficácia dos tratamentos foram calculados e, para comparar a custo-eficácia da implementação do uso do DFP em relação às outras opções testadas foi utilizada a razão de custo-eficácia incremental. Análises de regressão de Poisson foram utilizadas para verificar a associação entre o desconforto e variáveis explicativas. A satisfação dos participantes e seus responsáveis foi explorada descritivamente. Um total de 316 superfícies proximais foram incluídas, sendo a maioria classificada como escore 2 do ICDAS (Sistema Internacional de Detecção e Avaliação de Cárie) associadas à ausência de imagem radiográfica (46,8%). As perdas de seguimento foram de 15% e 24% aos 12 e 24 meses, respectivamente. Não houve associação entre o grupo de tratamento e a progressão das lesões aos 12 e 24 meses, tanta pela análise por protocolo como pela análise de sobrevida. A taxa de progressão clínica das lesões para cavidade em dentina foi de 2,5% aos 12 meses e de 5,6% aos 24 meses. As lesões que não apresentavam imagem radiográfica inicial não progrediram para o 1/3 médio de dentina ou mais. A condição clínica inicial das lesões foi associada à progressão das lesões em todas as análises. Já o risco de cárie foi associado à progressão das lesões aos 24 meses e também na análise de sobrevida. O tratamento com infiltrante resinoso apresentou o custo mais elevado, fazendo com que o tratamento com DFP apresentasse melhor relação custo-eficácia do que este primeiro. Os participantes tratados com o DFP e os que receberam orientação para o uso do fio dental relataram menor desconforto do que os tratados com o infiltrante resinoso. Os responsáveis se mostraram satisfeitos com o tratamento recebido, independentemente do grupo ao qual foram alocados. Conclui-se que o tratamento com DFP é tão eficaz quanto o infiltrante resinoso e a orientação para o uso do fio dental no controle das lesões iniciais em proximal de molares decíduos. No entanto, causa menor desconforto e apresenta custo-eficácia superior ao infiltrante resinoso, devendo ser preferível para superfícies proximais de molares decíduos, em situações nas quais o tratamento dessas lesões possa ser necessário, como por exemplo, pacientes com experiência de cárie.
This randomized, blinded and placebo-controlled clinical trial aimed to evaluate the efficacy of 30% silver diamine fluoride (SDF) as a non-operative treatment of the approximal surfaces of primary molars and to compare it with the efficacy of resin infiltration and the mechanical control of the interproximal biofilm by flossing. We also evaluated the cost-efficacy and the discomfort of the treatments as well as the parent\'s satisfaction regarding treatments. One hundred forty-one, 3-to-10-year-old, children were included. They must present at least one caries lesion clinically into enamel sited on an approximal surface of primary molar. Participants were randomly allocated to the following groups according to active treatment to be received: 30% SDF, caries resin infiltration, flossing orientation (control). All participants received the active treatment, in which they were allocated and they also received the placebo treatment corresponding to the other groups. Costs of materials used in the treatment were registered. In the end of treatment session, the Wong-Baker faces scale was applied to evaluate participants\' reported discomfort. Children were examined after 1 month to evaluation of the oral hygiene and the presence of the biofilm on the treated surfaces. After 6, 12 and 24 months, visual and tactile examinations were performed to verify the lesions progression. Radiography was taken at 12- and 24-month follow-ups. To evaluate the efficacy of non-operative treatments, two outcomes were considered: (I) any clinical progression and (II) progression to cavity into dentine. The radiographic progression was used as a secondary outcome and to evaluate with clinical standard of lesions progression. Regression analyses were used to verify if the treatment influenced on these outcomes after 12 and 24 months (per-protocol analyses - multilevel Poisson and survival analysis). Cost-efficacy ratios were calculated for the treatments. To compare the cost-efficacy of implementing the use of DFP versus other options tested, the incremental cost-efficacy ratio was used. Poisson regression analyses were used to verify the association between discomfort and explanatory variables. The parents\' satisfaction about the treatments were explored descriptively. A total of 316 approximal surfaces were included. The majority of them were classified as ICDAS (International Caries Detection and Assessment System) score 2 associated with absence of radiographic image. The dropout in the study was 15% and 24% at 12-month and 24-month follow-up, respectively. There was no association between treatment groups and lesions progression at 12 and 24 months, both for the per-protocol analysis and by survival analysis. The rate of clinical lesions progression to cavity into dentine was 2.5% at 12 months and 5.6% at 24 months. Lesions without initial radiographic image did not progress into the middle of the dentine or more. Baseline clinical condition of caries lesions was associated with lesions progression in all analyses. The caries risk was also associated to caries progression in 24-month analyses and in the survival analyses. The treatment with resin infiltration was costlier. Consequently, the treatment with SDF was more cost-effective than resin infiltration. The participants allocated to SDF and control groups reported less discomfort than those who was allocated to the resin infitrant group. The parents were satisfied with the treatment received during the study, independently of the group to which their children had been allocated. It is possible to conclude that the SDF is as efficacious as the resin infiltration and flossing orientation to control initial lesions in the approximal surfaces of primary molars. However, SDF causes less discomfort and presents superior cost-efficacy relationship than resin infiltration and could be preferable to treat approximal caries in primary molars in those situations in which the treatment could be necessary, for example, depending on patients\' caries experience.

L'expression de récepteurs inhibiteurs tels PD-1, TIM-3, LAG-3, TIGIT sur les lymphocytes T participe à l'immunosuppression dans l'environnement tumoral. Le ciblage de PD-1 par les immunothérapies anti-PD-1/PD-L1 notamment révolutionne depuis peu la prise en charge de nombreux types de cancers en particulier dans le mélanome, cancer du poumon et aussi du rein. Dans la plupart des cancers comme dans celui du poumon et le mélanome, l'infiltrat CD8 et la réponse Th-1/IFN-gamma sont associés à un meilleur pronostic, contrairement aux tumeurs du rein et aux hémopathies. Les travaux de ma thèse s'intéressent à la caractérisation de l'expression des récepteurs inhibiteurs des lymphocytes, notamment PD-1 et TIM-3 dans le carcinome rénal et dans le lymphome. Mes travaux de thèse ont été réalisés avec des outils d'exploration du microenvironnement tumoral permettant une analyse multiplexe de nombreux paramètres in situ. En théorie jusqu'à 7 protéines peuvent être mises en évidence à la fois, j'ai pu mettre au point des comarquages de 4 protéines membranaires et/ ou nucléaires + Dapi ainsi que la détection d'ARN in situ dans les tumeurs. L'utilisation d'un outil technologique de microscopie à fluorescence multispectrale a permis une étude fine de la coexpression de PD-1 et Tim-3 sur les lymphocytes T CD8 (LT-CD8) grâce à la visualisation aisée de la colocalisation de ces 3 marqueurs. De la même façon, j'ai mis en évidence de l'expression de leurs ligands PD-L1 et Galectin-9 (Gal-9) dans l'environnement des tumeurs du rein. J'ai démontré que la co-expression de Tim-3 et PD-1 sur les CD8 dans le carcinome rénal avait un rôle délétère aussi bien sur le plan (i) fonctionnel puisque les LT-CD8 sécrétaient moins d'IFN-gamma, (ii) et clinique puisque les patients présentant un infiltrat de LT-CD8 double positifs pour PD-1 et TIM-3 récidivaient plus fréquemment. La présence des ligands PD-L1 et Gal-9 a été mise en évidence dans l'environnement tumoral laissant suggérer des interactions possibles avec les récepteurs inhibiteurs exprimés par les LT. J'ai également caractérisé les LT-CD8 PD-1+ TIM-3+ dans les lymphomes en combinant un marquage CD20 (quadruple + Dapi). Selon le type de lymphome, TIM-3 était coexprimé avec PD-1 à la surface des CD8 et plus ou moins au contact avec les cellules lymphomateuses CD20+. D'autre part, lorsque TIM-3 était coexprimé, les LT-CD8 étaient plus volontiers proliférant (comarquage Ki-67) en comparaison aux PD-1+ TIM-3-. Afin de poursuivre dans la caractérisation Th-1/IFN-gamma, j'ai élaboré la mise au point de la détection d'ARN dans les lymphocytes T in situ dans la tumeur, permettant de faire des liens avec leur fonctionnalité. Au total mes travaux de thèse ont permis de mettre en évidence des biomarqueurs immunologiques composites en lien avec l'expression des récepteurs inhibiteurs PD-1 et/ou TIM-3 et la perte de fonctionnalité (IFN-gamma) des lymphocytes T intratumoraux
It has been mainly described that the inhibitory receptors coexpression (PD-1, TIM-3, LAG-3, TIGIT) by lymphocytes in the tumor microenvironment (TME) induces a local immunosuppression. Targeting these receptors particularly PD-1 and its ligand PD-L1 is of great clinical benefit in cancer many types treatment (melanoma, renal and lung cancer in particular). In the most cases of cancer, like melanoma and lung cancer, a CD8-T cell and Th-1/IFN-gamma response is of good prognosis. But this is not the case in renal cancer and in hemopathies. My PhD work attempts to characterize clinical and biological implication of PD-1 and TIM-3 expression by intra-tumor lymphocytes in the setting of renal cancer and lymphoma. My PhD work has been conducted thanks to new methods of multiplexed characterization of the TME. Multispectral immunofluorescence lead to identify 7 parameters at the same time, and in this study I elaborated the identifications of lymphocytes markers in situ within the tumor: 4 membrane and/or nuclear proteins + nuclei (Dapi counterstain) and also coupled with the RNA detection. This tool allows me to accurately study the coexpression of PD-1 and TIM-3 at the CD8-T cell surface thanks to colocalisation identification and counting of these 3 markers. With the same method, I found that PD-L1 and Gal-9, which are PD-1 and TIM-3 ligands, were also expressed in the TME of renal carcinoma. I found that the coexpression of TIM-3 together with PD-1 in the CD8-T cells had a double relevance (i) at functional level, CD8-T cells were less able to secrete gamma-IFN (ii) at clinical level, patients harboring a higher infiltrate were more likely to relapse. The presence of PD-L1 and Gal-9 suggested interactions with inhibitory receptors of T cells. I also characterized CD8-T cells expressing PD-1 and TIM-3 in lymphomas, combining a CD20 staining (quadruple staining + Dapi). TIM-3 was more or less expressed depending of the lymphoma type near to CD20+ cells. TIM-3 PD-1 CD8-T cells were more likely Ki-67+ compared to TIM-3- cells, suggesting a more proliferative capacity. In order to continue the characterization of the Th-1/gamma-IFN-gamma immune response, I elaborate a technic to detect the gamma-IFN RNA in situ, together with lymphocytes staining, allowing the exploration of functionality within the tumor. To summarize, during my PhD work I could characterize composite immune biomarkers linked to the functionality of CD8-T cell and gamma-IFN Th-1 response

Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Introduction: White spot lesion represents the first visual alteration in the enamel caused by caries. The progression of these lesions can be arrest with non-invasive treatments before cavitation. The thesis aims to analyze changes in the enamel after applying the infiltrant resin in white spot lesions, namely penetration depth, surface roughness, microhardness, and shear bond strength. Materials and Methods: The search was conducted in Medline, Pubmed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, Scholar, and LILACS until May 2021. In-vitro studies that assess depth penetration, roughness, microhardness, and shear strength before and after resin infiltration were included. Methodological quality was evaluated using the Joanna Briggs Institute Clinical Appraisal Checklist for Experimental Studies. Pairwise ratio of means meta-analyses allowed evaluating of the enamel properties, before and after resin infiltration, on enamel surfaces with and without white spot lesions. Results: From a total of 1604 articles, 48 were included for meta-analytic quantitative evaluation. In the parameter of enamel surface roughness there was an improvement by 35% in sound enamel (95% CI: 0.49-0.85, p<0.0021) and 54% (95% CI: 0.29; 0.74, 0.0012) in white spot lesions. Enamel microhardness was reduced by 24% (95% CI: 0.73; 0.80, p<0.001) and increased by 68% (95% CI: 1.51; 1.86, p<0.001) in white spot lesions. Shear strength in enamel was reduced by 25% in sound enamel (95% CI: 0.60; 0.95, p<0.001) and increased by 89% (95% CI: 1.28; 2.79, p<0.001) in white spot lesions. At penetration depth, the application of infiltrating resin led to occlusion of 65.39% (95% CI: 56.11; 74.66, p=0.01, I2=100%) of the white spot lesion. Conclusions: The application of infiltrating resin promotes recovery of enamel properties, both in healthy enamel and in white spot lesions. In the future, studies with defined protocols and appropriate controls are needed with long-term follow-ups.
Introdução: As lesões de white spot são as primeiras alterações do esmalte devido à cárie dentária e tratamentos não-invasivos têm sido sugeridos para travar a progressão da lesão. O objetivo desta tese é analisar as alterações da superfície do esmalte com e sem lesão de white spot após aplicação da resina infiltrativa, nomeadamente profundidade de penetração, rugosidade, microdureza e resistência ao cisalhamento. Materiais e Métodos: A pesquisa foi realizada no Medline, Pubmed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, Scholar, and LILACS até maio de2021. Estudos in-vitro que avaliam a profundidade de penetração, rugosidade, microdureza e resistência ao cisalhamento antes e depois da infiltração de resina foram incluídos. A qualidade metodológica foi avaliada através do Joanna Briggs Institute Clinical Appraisal Checklist for Experimental Studies. Meta-análises pairwise de rácio de médias avaliaram as alterações das propriedades do esmalte com e sem lesão white spot. Resultados: De um total de 1604 artigos, 48 foram incluídos para avaliação quantitativa meta-analítica. A rugosidade de superfície do esmalte melhorou 35% (95% CI: 0.49-0.85, p<0.0021) no esmalte saudável e 54% (95% CI: 0.29-0.74, 0.0012) nas lesões de white spot. A microdureza reduziu 24% (95% CI: 0.73-0.80, p<0.001) no esmalte saudável e aumentou 68% (95% CI: 1.51-1.86, p<0.001) nas lesões de white spot. A força de cisalhamento reduziu 25% (95% CI: 0.60-0.95, p<0.001) no esmalte saudável e aumentou 89% (95% CI: 1.28-2.79, p<0.001) em lesões de white spot. A profundidade de penetração da resina infiltrativa levou à oclusão de 65,39% (95% CI: 56.11-74.66, p=0.01, I2=100%) da lesão de white spot. Conclusões: A aplicação da resina infiltrativa promove a recuperação das propriedades do esmalte, tanto em esmalte são como em lesões de white spot. Futuramente, estudos com controlos apropriados são necessários bem como follow-ups a longo prazo.

A fluorose dentária é uma anomalia no desenvolvimento do esmalte causada por um excesso de flúor que pode alterar tanto a cor como a estrutura do esmalte, levando a uma aparência inestética dos dentes. Uma das opções de tratamento muito utilizada atualmente é a técnica de resina infiltrativa ICON®, sendo a sua ação baseada na erosão da superfície da lesão através da utilização de um ácido clorídrico e na subsequente infiltração de uma resina de baixa viscosidade nos espaços entre os cristais de esmalte. Este novo procedimento minimamente invasivo, veio trazer uma melhoria dos resultados, conseguindo uma melhor satisfação a nível tanto do paciente como do médico dentista. A realização desta revisão bibliográfica narrativa tem como principal objetivo comprovar e demonstrar a eficácia do ICON® na remoção das manchas de fluorose dentária, bem como compreender quando e de que forma este pode ser utilizado.
Dental fluorosis is an anomaly in the development of enamel caused by an excess of fluoride that can alter both the color and structure of the enamel, leading to an unsightly appearance of the teeth. One of the treatment options widely used today is the ICON® infiltrative resin technique, its action being based on the erosion of the lesion surface through the use of hydrochloric acid and the subsequent infiltration of a low viscosity resin in the spaces between the crystals of enamel. This new minimally invasive procedure made an improvement in the results, achieving a better satisfaction both for the patient and the dentist. The main objective of this narrative bibliographic review is to prove and demonstrate the effectiveness of ICON® in the removal of dental fluorosis stains, as well as to understand when and how it can be used.

碩士
國立成功大學
航空太空工程學系
105
Resin Transfer Molding (RTM) is a method for manufacturing polymer composite. The RTM process involves the resin injection into a mold cavity to infiltrate the fibers while the air is discharged from the outlet. Since the flow behavior of the resin infiltration in fibers is the key factor affecting the quality of the fabricated composite. In this thesis, we applied the Lattice Boltzmann method with single-component pseudo-potential model and single-phase free surface model to simulate the flow of resin infiltration in and between fiber bundles. This method is simpler than the traditional computational fluid dynamics method in simulating the free surface flow with surface tension. Because of the diversity of the fiber bundle shape and arrangement, we chose the circular and elliptical shapes to model fiber bundles in the simulations in order to reduce the amount of calculation. According to the fiber bundle arrangement and resin flow direction, it is divided into six models. The flow behavior of the resin injection and the possibility of bubble formation among those models were investigated by changing the factors as the resin and fiber contact angle, injection speed, fiber bundle spacing, fiber bundle arrangement, and the gaps between fibers. This method used in this thesis successfully modeled the actual surface tension of epoxy resin, and simulated the flow behavior of the resin infiltration in fibers, which was also demonstrated to predict the possibility of air bubble formation in the fiber network during the filling process.

Hipomineralização molar-incisivo (MIH) é um defeito estrutural do esmalte. Os dentes afetados apresentam opacidades isoladas, assimétricas em dentes homólogos, manchas de cor branca, amarelo ou castanha, consoante a severidade da lesão afetando como o nome sugere, os primeiros molares e incisivos da dentição permanente. A exigência estética dos pacientes é cada vez mais importante, pois as manchas coloridas do esmalte podem, dependendo de sua localização e gravidade, ter um grande impacto estético no sorriso dos nossos pacientes e prejudicar muito a sua vida social. Atualmente existem soluções simples e minimamente invasivas para lidar com estas situações, sendo uma das opções de tratamento muito utilizada, a técnica de resina infiltrativa ICON®, sendo a sua ação baseada na erosão da superfície da lesão através da utilização de um ácido e na subsequente infiltração de uma resina de baixa viscosidade. A realização desta revisão narrativa tem como principal objetivo relembrar os fatores etiológicos, diagnóstico, características clínicas e tratamento de lesões de hipomineralização molar-incisivo, assim como, demonstrar a eficácia da técnica do ICON® na remoção destas lesões.
Molar-incisor hypomineralization (MIH) is a structural defect of the enamel. Affected teeth present isolated opacities, asymmetric in homologous teeth, white, yellow or brown stains, depending on the severity of the lesion, affecting, as the name suggests, the first molars and incisors of the permanent dentition. The esthetic demands of patients are increasingly important, as the colored stains on the enamel can, depending on their location and severity, have a great aesthetic impact on our patients' smiles and greatly impair their social life. Currently, there are simple and minimally invasive solutions to deal with these situations. One of the most widely used treatment options is the infiltrative resin technique ICON®, its action based on erosion of the surface of the lesion through the use of an acid and the subsequent infiltration of a low viscosity resin. The main objective of this narrative literature review is to recall the etiological factors, diagnosis, clinical characteristics and treatment of molar-incisive hypomineralization lesions, as well as to demonstrate the effectiveness of the ICON® technique in removing these lesions.

Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
White Spot Lesions (WSLs) are a common iatrogenic finding along brackets used in orthodontic treatment. WSLs are frequently noticed as small opaque lesions with lessened radiolucency which might have a lasting unaesthetic effect. These lesions might range from small lines along bracket peripheries and less frequently might be observed as larger demineralized areas with or without cavitation. The development of WSLs is principally enhanced by the accumulated plaque around brackets due to a compromised oral hygiene that might be aggravated by the presence of dental crowding. Furthermore, The presence of fixed orthodontic apparatus leads to alteration in the oral microflora causing reduction in the PH level and increased bacterial adherence to the metal facade through electrostatic effect. There are several preferences for treatment of WSL, ranging from conservative approaches relying on remineralization to invasive techniques. The severity of lesions is a determinant of which option is most appropriate. The management of WSLs is based on remineralization strategies or in other situations on a minimal-invasive camouflage of the lesions. Although orthodontic WSLs are one of the most frequent and most visible adverse effects of comprehensive fixed appliance treatment, the efficacy of their intervention continues to be assessed in the literature and up to date there is no consensus on the best evidence-based approach to manage such lesions. Therefore, the aim of the present thesis is to review and critically appraise the contemporary evidence related to causes, diagnosis, prevention, risk evaluation and management of WSL associated with orthodontic appliances. Furthermore, clinical recommendations that might be useful for both the general dentist as well as the orthodontist. This literature review will be undertaken by searching the database engines, Pubmed, Medline, Google Scholar, B-on and Science Direct. The search will include the literature published inbetween 2005-2021.

Objetivo: O objetivo deste trabalho consistiu em avaliar a eficácia, segurança e aplicabilidade clínica da infiltração de resina Icon® no tratamento de lesões iniciais de cárie nas superfícies proximais em pacientes odontopediátricos. Metodologia: Para elaboração deste trabalho, foi realizada uma pesquisa bibliográfica nas bases de dados on-line: Pubmed e Google Scholar no período compreendido entre novembro de 2020 e maio de 2021. Foram estabelecidos critérios de inclusão e de exclusão para a seleção dos artigos. Tópico Abordado: A infiltração de resina Icon® parece ser um tratamento seguro e eficaz para controlar a evolução das lesões iniciais de cárie em ambas as dentições, desde que bem indicada e realizada conforme as orientações do fabricante. Contudo, é escassa a literatura sobre a sua aplicação em dentes permanentes no período de maturação pós-eruptiva. Apesar das considerações técnicas, o sistema Icon® parece apresentar uma boa aplicabilidade clínica na área da odontopediatria, podendo ser adicionado ao leque de opções para a abordagem destas lesões.
Objective: The aim of this study was to evaluate the efficacy, safety and clinical applicability of Icon® resin infiltration in the treatment of early caries lesions on proximal surfaces in pediatric dental patients. Methods: For the elaboration of this work, a bibliographic search was carried out in the online databases: Pubmed and Google Scholar in the period between November 2020 and May 2021. Inclusion and exclusion criteria were established for the selection of articles. Topic Covered: Icon® resin infiltration appears to be a safe and effective treatment to control the evolution of early caries lesions in both dentitions if it is well indicated and performed according to the manufacturer's guidelines. However, there is little literature on its application in permanent teeth in the post-eruptive maturation period. Despite technical considerations, the Icon® system seems to have good clinical applicability in the field of pediatric dentistry and can be added to the range of options for approaching these lesions.

AIM: The aim of this study is to compare, in a randomized clinical trial, the appearance improvement of white spot carious lesions (WSL) treated with resin infiltration (RI) – ICON®, 5% sodium fluoride (22,600 parts per million (ppm) with fluoride varnish (FV), and to assess the synergistic effect of adding Casein Phosphopeptide-Amorphous Calcium Phosphate- MI Paste® (MIP) to these treatment modalities. METHODS: Forty subjects with unrestored WSL, after debanding fixed orthodontic appliances, were recruited from the Department of Orthodontics, Henry M. Goldman School of Dental Medicine, Boston University. A randomized, split-mouth, and double-blind clinical trial design was used to allocate subjects to resin infiltration and fluoride varnish without MI Paste® (RI and FV), 20 patients, and resin infiltration and fluoride varnish with MI Paste® (RI-MIP and FV-MIP), 20 patients. Patients in the MI Paste® present treatment group given 6-weeks supply of MI Paste®. The assessment methods were: 1) patient self-assessment, 2) expert panel subjective assessment, 3) clinical caries assessment using the International Caries Detection and Assessment System (ICDAS), and 4) actual lesion size assessment. Treatment efficacy was assessed after 4-6 weeks of application. The appearance improvement was analyzed at α level of 5% and a power of 90%. RESULTS: Over 4-6 weeks, RI treatment appeared to have a higher mean difference between baseline and follow-up compared to fluoride varnish with a statistically significant difference across all assessment methods. The patient self-assessment mean difference was 1.07 (±1.49); 95% CI [0.59 - 1.55], the expert panel subjective assessment mean difference was 0.75 (±1.06); 95% CI [0.61 - 0.88], the ICDAS mean difference was 0.38 (± 0.43); 95% CI [0.24 - 0.52], and the actual size assessment mean difference was 0.07 (±0.16); 95% CI [0.01 - 0.12]. There was no statistically significant difference between the mean differences between RI and RI-MIP, nor between FV and FV-MIP across all assessment methods. CONCLUSION: The results indicate that RI is significantly better in improving the appearance of WSLs when compared to FV. There is little evidence that use of MIP adds to the improvement of the appearance of WSL in conjunction with either modality.
2019-09-26T00:00:00Z

Nos últimos anos, as exigências estéticas dos pacientes têm aumentado. As lesões de mancha branca são um problema comum na prática dentária. A hipomineralização traumática, uma das causas de lesões de mancha branca, é uma anomalia do desenvolvimento do esmalte ocorrido durante o processo de amelogénese nos dentes permanentes causada por um traumatismo nos dentes decíduos correspondentes. Uma das opções terapêuticas muito utilizada actualmente para as lesões de mancha branca é a técnica de infiltração de resina ICON®, baseada na erosão da superfície da lesão através da utilização do ácido clorídrico a 15% e na subsequente infiltração de uma resina de baixa viscosidade no interior da lesão de mancha branca. O objectivo deste trabalho, é apresentar um caso clínico demonstrativo do protocolo da aplicação da resina infiltrante ICON® na reabilitação de uma lesão de mancha branca, cuja causa foi hipomineralização traumática.
In the past few years, the aesthetic demands of patients have increased. White spot lesions are a common problem in dental practice. Traumatic hypomineralization, one of the causes of white spot lesions, is an anomaly of enamel development, occurring during the process of amelogenesis by trauma in deciduous teeth. One of the currently widely used therapeutic options for white spot lesions is the ICON® resin infiltration technique, based on the erosion of the lesion surface using a 15% hydrochloric acid and the subsequent infiltration of a low-viscosity resin inside the white spot lesion. The aim is to present a clinical case demonstrating the protocol for the application of ICON® infiltrating resin in the rehabilitation of a white spot lesion, caused by traumatic hypomineralization.

Introdução: A infiltração de resina, registada como ICON® (DMG, Hamburgo, Alemanha), permite o preenchimento, reforço, estabilização e melhoria da estética de lesões de mancha branca (LMB), sem sacrifício da estrutura dentária sã. A incorporação de pigmentos compromete a estética, podendo ser revertida com um retratamento com infiltração de resina ou um branqueamento. Não existe evidência que compare os tratamentos. Objetivos: Avaliar o método mais eficaz de reversão de lesões pigmentadas previamente tratadas com ICON (retratamento com infiltração de resina ou branqueamento) e verificar a estabilidade da cor, ao longo do tempo, destas lesões quando sujeitas a pigmentação. Materiais e Métodos: Numa amostra de setenta e cinco dentes bovinos (n=75), foram criadas artificialmente LMB. Aplicou-se a infiltração de resina (ICON®, DMG, Hamburgo, Alemanha) e os espécimes foram imersos numa solução de pigmentação. Dividiu-se a amostra em três grupos de tratamento (n=25): infiltração de resina (ICON®, DGM, Hamburgo, Alemanha); controlo e branqueamento (Perfect Bleach® peróxido de carbamida a 10%, VOCO, Alemanha). Os espécimes foram novamente sujeitos a pigmentação, sendo a sua cor avaliada em sete momentos, utilizando um espetrofotómetro. Resultados: Entre o início e o tratamento imediato, o tratamento que apresentou maior variação de cor foi o branqueamento, seguido do re-ICON e controlo (p≤0.05). Verificam-se diferenças significativas entre grupos no ΔE no período decorrido desde o tratamento imediato até aos 30 dias de pigmentação. Discussão: Os resultados obtidos demonstram que ambos os tratamentos permitem reverter as alterações de cor e de pigmentação. O branqueamento possui melhores iniciais, contudo, a longo prazo, a pigmentação aumenta mais rapidamente face ao re-ICON, aos 15 dias de pigmentação. Ao fim de 30 dias de pigmentação, o re-ICON apresenta maior suscetibilidade à pigmentação. Conclusão: As LMB tratadas previamente com ICON são suscetíveis à pigmentação, sofrendo uma alteração de cor considerável. A reversão da pigmentação com branqueamento ou retratamento com ICON permitem uma melhoria colorimétrica destas lesões.
Introduction: The resin infiltration, registered as ICON® (DMG, Hamburg, Germany), foments the filling, reinforcement, demineralized enamel stabilization and improvement of the appearance of the lesion, without sacrificing the healthy dental structure. The incorporation of pigments compromises the aesthetics and can be reversed with a re-treatment or a bleaching. There is no evidence comparing treatments. Objectives: To evaluate the most effective method of the reversion of pigmented WSL previously treated with ICON (re-treatment with ICON or bleaching) and to verify the stability of color, over time, when submitted to pigmentation. Materials and Methods: In a sample of bovine teeth (n = 75), WSL were artificially created. Resin Infiltration (ICON®, DMG, Hamburg, Germany) was applied and the specimens were immersed in a pigmentating solution. The sample was divided into three treatment groups (n = 25): resin infiltration (ICON®, DMG, Hamburg, Germany); control and bleaching (Perfect Bleach®, carbamide peroxide at 10%, VOCO, Germany). The specimens were again subjected to pigmentation, and their color was evaluated in seven moments, using a spectrophotometer. Results: Between the beginning and the immediate treatment, the treatment that presented the greatest color variation was bleaching, followed by re-ICON and control (p≤0.05). There were significant differences between groups in ΔE in the period from immediate treatment to 30 days of pigmentation. Discussion: The results show that both treatments allow reversing color and pigmentation variations. Bleaching has better initials results, but in long-term, the pigmentation increases more rapidly compared to ICON re-treatment. Conclusion: WSL previously treated with ICON are susceptible to pigmentation, undergoing a considerable color change. The reversal of the pigmentation with bleaching or retreatment with ICON allows colorimetric improvement of these lesions.

As discromias ou anomalias de cor são caracterizadas por descoloração e alteração no esmalte, que frequentemente afetam os dentes anteriores provocando um descontentamento nos pacientes. O objetivo desta revisão narrativa é recapitular as diferentes discromias, resumir e discutir as evidências sobre os tratamentos não invasivos mais comuns, sua eficácia, indicações e efeitos adversos. Para tal, foram pesquisados artigos nas bases de dados: NCBI, PubMed Advanced, Google scholar, entre 1997 e 2019. Conclui-se que as discromias podem ser classificadas como intrínsecas ou extrínsecas e o seu tratamento pode ser não invasivo como o branqueamento dentário, infiltração de resina e micro-abrasão ou ainda uma combinação destas técnicas; ou invasivos como a mega abrasão. A técnica de infiltração de resina utilizando o Icon® tem sido uma verdadeira inovação no mundo da odontologia, sendo necessários mais estudos para comprovar a sua eficácia a longo prazo.
Dyschromia or color anomalies are characterized by discoloration and enamel alteration, which often affect the anterior teeth, causing discontent in patients. The aim of this narrative review is to recapitulate the different dyschromia, summarize and discuss the evidence on the most common noninvasive treatments, their efficacy, indications and adverse events. To this end, bibliographic data were searched in the databases: NCBI, PubMed Advanced, Google scholar, between 1997 and 2019. We conclude that dyschromia can be classified as intrinsic or extrinsic and its treatment can be non-invasive such as tooth whitening, resin infiltration and microabrasion or a combination of these techniques; or invasive such as mega abrasion. The resin infiltration technique using Icon® has been a true innovation in the world of dentistry since 2009, and further studies are needed to prove its long-term effectiveness.

Tendo em conta os conceitos atuais da doença cárie dentária a necessidade de diagnóstico precoce das lesões de desmineralização que afetam o esmalte, pretendeu-se realizar uma revisão bibliográfica descritiva com os seguintes objetivos: descrever os principais conceitos acerca das lesões não cavitadas de cárie no esmalte, relacionadas com prevalência, gravidade, formas de deteção e registo; pretendeu-se ainda efetuar uma revisão da ação química dos agentes remineralizantes e infiltrantes, em lesões não cavitadas do esmalte, focando-se essencialmente na sua identificação, descrição, modos de apresentação, mecanismo de ação, modo de atuação clínica, principais evidências in vitro e in vivo sobre a ação dos remineralizantes e infiltrantes. Para tal, foi utilizada a metodologia PICO para a formulação das questões, avaliação e síntese da evidência empírica a incluir neste estudo. Os achados resultam da análise de 148 artigos, quer de perfil qualitativo, quer do perfil quantitativo, dos quais 104 são de revisões de literatura e 44 são empíricos, destes 44 artigos, 13 são relativos a infiltrantes e 31 são relativos a remineralizantes. Foram colocadas as palavras-chave: “enamel remineralization”, “ICDAS”, “white spot lesion”, “non-cavitated caries lesions”, “resin infiltration”, “infiltrants”, “dental caries detection”, “remineralizing agents”, “demineralization-remineralization” e “dental toothpaste”. Os critérios de inclusão foram: estudos observacionais, in vivo e in vitro, revisões narrativas, sistemáticas e meta-análises, escritas em nomenclatura Inglesa, sem período temporal definido, dando no entanto mais relevo clínico a publicações entre os anos de 2005 e 2016. Os critérios de exclusão foram todos os artigos que se referissem a lesões na dentina ou lesões cavitadas de esmalte, lesões odontopediátricas, lesões de cárie de raiz e materiais restauradores que não fossem infiltrantes. Foi possível concluir que ambas as técnicas (atuação por agentes remineralizantes e por infiltração resinosa) são eficazes na remineralização de lesões cariosas incipientes no esmalte. Os agentes remineralizantes apresentam uma vasta gama de formulações de acordo com as necessidades de cada paciente, enquanto os infiltrantes por serem uma técnica ainda recente apenas apresentam um composto disponível comercialmente para a sua aplicação em consultório dentário.
Given the current concepts of dental caries disease and the need for early diagnosis of enamel demineralization lesions this study intended to carry out a descriptive literature review with the following objectives: to describe the main concepts about the injuries of enamel non-cavitated carious lesions related to prevalence, severity, forms of detection and registration; it was intended also to perform a review on chemical action of remineralizing and infiltrating agents in non-cavitated enamel lesions, focusing primarily on the identification, description, presentation modes, mechanism of action, clinical performance mode and, the main evidence in vitro and in vivo regarding the action of remineralizing and infiltrating agents. For this purpose were analyzed and interpreted the studies conducted up to the present day and for that was used PICO method, evaluation and synthesis of empirical evidence to include in this study. Final findings resulted from the analysis of 148 articles (qualitative and quantitative profile) of which 104 publications were literature review and 44 were empirical, where 13 and 31 were related to infiltrants and remineralizing agents, respectively. keywords used: "enamel remineralization," "ICDAS", "white spot lesion", "non-cavitated caries lesions", "resin infiltration," "infiltrants," "dental caries detection", "remineralizing agents" "demineralization-remineralization" and "dental toothpaste." Inclusion criteria were observational studies, in vivo and in vitro, narrative reviews, systematic and meta-analysis, written in English; no time period was set on the literature research, giving however more relevance to publications between the years 2005 and 2016. As exclusion criteria was considered all publications not available in full text, and those that referred to dentin carious lesion or enamel cavitated carious lesions, odontopediatric injuries, root caries and restorative materials that were not infiltrating agents.It was possible to conclude that both techniques (actuation by remineralizing and resin infiltration agents) prove to be effective in the remineralization of enamel incipient caries. The remineralising agents present a wide range of formulations according to the needs of each patient, while infiltrating agentes showed to be a recent technical approach with only one commercially agent available for its application in the dental office.

A Dentística é uma área da Medicina Dentária que apresenta uma das maiores evoluções. O seu principal objetivo prende-se com tratamento dentário a nível estético e da promoção de saúde dentária através da restauração e tratamento de cáries. Esta revisão de literatura tem como objetivo a realização da revisão da literatura disponível no que diz respeito às possibilidades de preservação da estrutura dentária, diferenças entre reparação e/ ou substituição de restaurações definitivas a amálgama e resinas compostas, causas de cada uma delas, como realizar uma correta avaliação para a reparação/substituição e protocolos correspondentes. Foi realizada uma pesquisa baseada em artigos científicos, livros e material fornecido nas aulas de dentística cujo limite temporal recaiu entre 2000e 2019. Concluiu-se que ainda não existe evidência científica suficiente para se estabelecerem recomendações padronizadas e que a reparação tem mais vantagens em relação á substituição total da restauração, sendo um tratamento mais conservador.
Dentistry is an area of dentistry that has one of the biggest evolutions. Its main objective is aesthetic dental treatment and the promotion of dental health through the restoration and treatment of caries. This literature review aims to review the available literature regarding the possibilities of preserving the dental structure, differences between repair and / or replacement of permanent amalgam restorations and composite resins, causes of each, how to perform correct evaluation for repair / replacement and corresponding protocols. A research was conducted based on scientific articles, books and material provided in dentistry classes whose time limit fell between 2000 and 2019. It was concluded that there is not enough scientific evidence to establish standardized recommendations and that the repair has more advantages than the total replacement of the restoration, being a more conservative treatment.

Les tumeurs solides sont infiltrées par des cellules immunes (TIIC) dont la nature, la fonction et la composition varient d’un patient à l'autre. Ces cellules inflammatoires influencent l'invasion tumorale en contrôlant la croissance et le potentiel métastatique d’une tumeur. Ainsi, il est proposé d’utiliser cette infiltration comme outil diagnostic et pronostic de routine. Certaines cellules sont bien connues pour jouer un rôle important dans le contrôle de la progression tumorale, comme c’est le cas des lymphocytes T cytotoxiques CD8+ alors que d’autres possèdent un rôle contradictoire. Étant donné la dépendance des tumeurs sur l’équilibre entre ces différentes cellules, il est important d’identifier les fonctions précises des cellules immunes au sein de la tumeur. De nombreuses études sont réalisées afin d’identifier des marqueurs descriptifs du phénotype et la fonction des cellules immunes dans la tumeur. Ce projet de doctorat se divise en deux parties : 1- Identifier la méthode de désagrégation des tissus tumoraux altérant le moins la biologie des TIIC pour leur caractérisation. 2- Caractériser l’expression de la molécule d’adhérence CD146 dans les TIIC et en identifier l’origine. L’identification de marqueurs pour la caractérisation phénotypique et fonctionnelle des TIIC a été réalisée, entre autres, par la détection de protéines exprimées par la cellule. Dans la première partie de ce projet, nous avons démontré que les méthodes utilisées pour désagréger les tissus tumoraux dans le but d’isoler les TIIC induisent des changements dans la biologie de ces cellules ce qui peut fausser les conclusions qui en dérivent. Nous avons donc comparé l'impact de trois méthodes de désagrégation : une dissociation mécanique utilisant la MédimachineTM et deux digestions enzymatiques utilisant une collagénase de type I seule ou combinée à de la collagénase de type IV et de la DNase I de type II. Nous nous sommes intéressés à l'effet de ces méthodes sur des paramètres tels que la viabilité cellulaire, l’altération des protéines de surface et la capacité des cellules à proliférer. Nous avons démontré que ces méthodes affectent la viabilité des cellules de manière comparable, alors que la détection de certaines protéines de surface et la capacité de proliférer est réduite/inhibée par les traitements enzymatiques. Nous concluons qu’une méthode mécanique utilisant la MédimachineTM est mieux adaptée à la caractérisation des TIIC afin de conserver leurs propriétés. Dans la deuxième partie de notre projet, nous avons adapté cette méthode à la caractérisation des TIIC. Nous avons porté une attention particulière à la molécule d’adhérence CD146 dont l’implication dans la migration des cellules immunes à travers l’endothélium vers les sites d’inflammation est de plus en plus étudiée dans les maladies autoimmunes. Nous avons mis en évidence une augmentation des proportions de cellules immunes exprimant CD146 dans les tumeurs comparativement au sang de patients de cancers. Cette expression est induite par les cellules tumorales tout en étant accrue par la nécrose de celles-ci. Nous démontrons que ces cellules sont majoritairement des lymphocytes T CD4+ présentant un profil immunosuppressif. En conclusion, nos résultats suggèrent que CD146 participe à la mise en place du contexte immunitaire dans la tumeur et augmente la capacité de migration des lymphocytes T CD4+. L’induction par les cellules tumorales de cette molécule d’adhérence dans les cellules suppressives pourrait contribuer aux mécanismes immunorégulateurs mis en place par la tumeur. CD146 pourrait être un marqueur d’intérêt pour l’identification des cellules immunosuppressives et pour le développement de nouvelles thérapies.
Solid tumors are infiltrated by immune cells (TIIC), which vary in function and proportion from patient to patient. These inflammatory cells may contribute positively or negatively to tumor invasion, by controlling the growth and the metastatic potential of tumors. It has therefore been proposed to use infiltration as a diagnostic and prognosic tool. Certain cells play an important role in the control of tumor progression, as is the case of cytotoxic CD8+ T lymphocytes, whereas others present an ill-defined role. Since the progression of tumors depends on the balance between these cell types, it is important to identify their specific functions within the tumor. Many studies have therefore focused on identifying markers, which are suggestive of phenotype and function of immune cells in the tumor. This project is divided into two parts: 1 – The identification of a tumor tissue disaggregation method which induced minimal effects on TIIC biology. 2 – The characterization of the expression of the adhesion molecule CD146 in TIIC and understand its regulation. Marker identification for phenotypic and functional characterization of TIIC is carried out by detection of cell proteins. In the first part of this project, we showed that methods used to disaggregate tumor tissue in order to isolate TIIC induce changes in cell biology, which may alter results. We thus compared the effects of three disaggregation methods: mechanical disruption using MedimachineTM and two enzymatic digestions using a type I collagenase alone or combined with type IV collagenase and type II DNase I, on parameters such as cell viability, cell surface marker detection and cell proliferation. We showed that these methods affect cell viability in a comparable manner, whereas the detection of certain surface proteins and proliferative capacity of cells was reduced by enzymatic treatments. We concluded that a mechanical method using MedimachineTM is more suitable for the characterization of TIIC. In the second part of our project, we adapted this method to the characterization of TIIC. We focused on CD146, an adhesion molecule that was shown to be involved in immune cell migration in autoimmune disease. We demonstrated an increase of CD146+ immune cells in tumors compared to the blood of the same patients. This expression was shown to be induced by tumor cells and increased by necrosis. We showed that these cells are predominantly CD4+ T lymphocytes with an immunosuppressive profile. In conclusion, our results suggest that CD146 is involved in the establishment of the tumor immune environment and may increase the migratory capacity of CD4+ T cells toward tumors. Tumor cell induction of this adhesion molecule by suppressor cells could contribute to the immunoregulatory mechanisms established by tumors. CD146 may be a useful marker for the identification of immunosuppressive cells and development of new therapies.