|Year : 2016 | Volume
| Issue : 2 | Page : 154-158
Comparative evaluation of desensitizing agent Vivasens and Laser for obliteration of dentinal tubules
Hemant M Asrani1, Deepti N Jain1, Anshul Asrani1, Pooja Deshmukh1, Abhishek Sankhla2
1 Department of Conservative Dentistry and Endodontics, Maitri College of Dentistry and Research Centre, Anjora, Durg, Chhattisgarh, India
2 CDCRI, Sundara, Rajnandgaon, Chhattisgarh, India
|Date of Web Publication||9-Dec-2016|
Deepti N Jain
D-44/1, Near Water tank, Tagore Nagar, Raipur, Chhattisgarh
Source of Support: None, Conflict of Interest: None
Introduction: The purpose of this study was to evaluate the ability of desensitizing agents VivaSens and Laser (Diode) on dentinal tubule occlusion and its effectiveness over time using scanning electron microscopy (SEM).
Materials and Methods: Twenty-two extracted human maxillary premolars were selected and grouped as follows: Group I: VivaSens (Ivoclar), Group II: Diode laser, and Group III: Control group. Teeth were embedded in plaster of Paris molds, and cavities of 2 mm depth and 3 mm width were prepared on a buccal surface at the cervical region. Ten specimens were coated with VivaSens (Ivoclar) and ten specimens were lased with Diode laser (i lase-Biolase) whereas two specimens remained as control. These specimens were examined under SEM to find the occluding ability of agents and also their efficacy with time. The statistical analysis was done using ANOVA, post hoc test, and Student's t-test.
Results: Both VivaSens and Diode laser were equally effective in the obliteration of dentinal tubules just after application as well as after 15 days of treatment. No statistically significant difference was found between VivaSens and Laser groups.
Conclusions: From the limitations of this study, it can be concluded that occlusion and narrowing of open dentinal tubules have been successfully achieved with both treatment approaches throughout the specific period.
Keywords: Desensitizing agent; laser; VivaSens; tubular obliteration.
|How to cite this article:|
Asrani HM, Jain DN, Asrani A, Deshmukh P, Sankhla A. Comparative evaluation of desensitizing agent Vivasens and Laser for obliteration of dentinal tubules. Endodontology 2016;28:154-8
|How to cite this URL:|
Asrani HM, Jain DN, Asrani A, Deshmukh P, Sankhla A. Comparative evaluation of desensitizing agent Vivasens and Laser for obliteration of dentinal tubules. Endodontology [serial online] 2016 [cited 2020 Apr 2];28:154-8. Available from: http://www.endodontologyonweb.org/text.asp?2016/28/2/154/195437
| Introduction|| |
Dentin hypersensitivity (DH) is most common unpleasant complaint of patients encountered in the dental practice. It is characterized by short, sharp pain arising from exposed dentin in response to stimuli, typically thermal, evaporative, tactile, osmotic, or chemical.
DH has been found mostly in adult population ranging from 4% to 74%, and the highest incidence is in age group of 20 to 40 years with higher incidence in females. Canines and premolars in either jaw are most frequently involved with commonly affected buccal cervical zones.
DH occurs due to loss of protective layer such as enamel and removal of cementum from root which leads to exposure of dentin (dentinal tubules). The most common clinical conditions are abrasion, attrition, erosion, abfraction, and gingival recession.
The ultimate goal of treatment of dentinal hypersensitivity ideally should be the restoration of the original impermeability of the dentinal tubules and the relief of dentinal hypersensitivity. A number of treatment regimens have been recommended over the years for the management of DH.
An ideal desensitizing agent should be nonirritating to the pulp, relatively painless on application, easy to apply, rapid in action, effective for long time, and nonstaining as proposed by Grossman (1934).
The oral environment being dynamic, the desensitizing agent has to withstand the challenges of salivary dissolution, prolonged contact with acidic foods, and/or forceful tooth brushing.
Therefore, the need of this study was to evaluate and compare the efficacy of desensitizing agents such as VivaSens and Laser for dentinal tubular obliteration.
The null hypothesis was that there was no difference in dentinal tubular obliteration between both the therapies.
| Materials and Method|| |
Twenty-two extracted sound human maxillary first premolar teeth were selected randomly from 20 to 40 age group patients for this study. Decayed teeth, fractured teeth, and teeth with malformations were excluded from this study. Plastic molds of 30 mm × 30 mm × 30 mm were made and filled with plaster of Paris. Each tooth was mounted in molds so that buccal surfaces were uncovered to prepare cavities on the cervical area. Cavities of 2 mm depth and 3 mm width were prepared by using small straight fissure bur (Dia-bur, #SF-41, Mani) on cervical areas of buccal surfaces and sectioned to obtain 5 mm × 5 mm × 3 mm blocks. These blocks were polished by an abrasive paper (600–1200 grit, SS White, Gloucester, England) to expose the dentin surface. Blocks were kept in 17% ethylenediaminetetraacetic acid for 40 min to completely open the dentinal tubules. These blocks were ultrasonicated in distilled water for 12 min to remove the residual smear layer.
All the specimens were processed and examined under the scanning electron microscope (SEM; NIT, Raipur, Chhattisgarh, India) to observe the opening of the dentinal tubules to simulate hypersensitive cervical dentin. After SEM analysis, the specimens were washed and stored in artificial saliva.
All the specimens were randomly assigned to three groups as follows:
- Group I: Ten samples were coated with VivaSens (Ivoclar)
- Group II: Ten samples were treated with Diode laser (i lase-Biolase)
- Group III: Two samples were immersed in artificial saliva (control group).
Experimental groups and their treatments
Group I – Specimens were treated with VivaSens according to the manufacturer's instructions. VivaSens was applied on the dentin surfaces with the help of a disposable brush for at least 10 s.
Group II – Specimens were treated with soft tissue laser (Diode) according to manufacturer's instructions with 940 nm; noncontact intermittent mode for 1 min; output power - 0.8–1 W.
Group III – Specimens were immersed in artificial saliva. These samples were not treated with any desensitizing agents (control).
Each specimen was mounted on a metal stub and stored in a vacuum silica gel desiccator for another 1 h; the samples were sputter-coated with 25 nm of gold for 10 min. All the specimens were examined under the SEM (× 1500) to check obliteration of the dentinal tubules. After SEM analysis, the specimens were placed in artificial saliva.
Then, each specimen was brushed twice daily for 15 days for 15 s with powered toothbrush (Oral B Vitality Precision Clean, BRAUN) with oscillations of 7600 strokes/min. Samples were stored in artificial saliva in between the procedure.
Each specimen was further examined under SEM to check the efficacy of desensitizing agent (VivaSens) and laser application over a period of time [Figure 1] and [Figure 2].
|Figure 1: Occluding ability and durability with time of Vivasens after application on exposed dentinal tubules followed by brushing (for 15 days). VivaSens group: (a) Preoperative, (b) just after application, (c) after 15 days|
Click here to view
|Figure 2: Occluding ability and durability with time of Laser after application on exposed dentinal tubules followed by brushing (for 15 days). Laser group: (a) Preoperative, (b) just after application, (c) after 15 days|
Click here to view
Scanning electron microscopy scoring
The mean scores of tubule occlusion by the two blinded observers were taken and used for analysis.
Evaluation was done as follows:
- Occluded (100% of tubules occluded)
- Mostly occluded (50%–<100% of tubules occluded)
- Partially occluded (25%–<50% of tubules occluded)
- Mostly unoccluded (<25% of tubules occluded)
- Unoccluded (0%, no tubule occlusion).
The consistency of the ranking procedure was tested by kappa statistic. The kappa value was determined to be 0.82.
| Results|| |
Statistical analysis was done using ANOVA, post hoc test, and Student's t-test [Table 1]. ANOVA showed that there was a statistically significant difference in VivaSens and Laser groups. Post hoc test showed that there was a statistically significant between both groups before application and just after Vivasens and Laser application. Statistically significant difference was also noted before application and after 15 days application. However after immediate application and after 15 days application of Vivasens and Laser, there was no statistically significant difference. Student's t-test showed that there was no statistically significant difference between VivaSens and Laser just after application and even after 15 days (P = 0.407 and 1.00). [Graph 1] and [Graph 2] shows obliteration of dentinal tubules at different time intervals for all groups.
| Discussion|| |
It is generally accepted that loss of enamel or gingival recession is the main cause for dentinal hypersensitivity. In this clinical condition, dentin tubules must be open to the oral cavity. Several reviews reported the widespread prevalence of dentinal hypersensitivity.,, To relieve dentinal hypersensitivity, various therapeutical models and agents are recommended, which could become a challenge for a practitioner when selecting appropriate therapy.
One of the best and permanent treatment options to relieve dentinal hypersensitivity is to seal and occlude dentinal tubules, thereby blocking the hydrodynamic mechanism.
The occlusion of dentinal tubules leads to the reduction of dentinal permeability which directly reduces sensitivity. The present study was aimed to evaluate the dentinal tubule occluding ability and durability of desensitizing agent using VivaSens and Diode laser by SEM.
VivaSens is an innovative protein precipitate-type desensitizer that seals exposed dentin by the precipitation of calcium ions and proteins. According to its manufacturer, the polyethylene glycol dimethacrylate triggers the precipitation of plasma proteins in the dentinal tubules. Glutaraldehyde, which is the other content, is a cross-linking reagent capable of bonding to amine groups of proteins. Potassium fluoride provides additional protection., Several studies have shown the efficacy of VivaSens as an in-office desensitizing agent.
Al-Saud et al. evaluated and compared the occluding effect of neodymium-doped yttrium aluminum garnet laser and desensitizing agents such as Gluma Desensitizer, Tenure Quick, Quell Desensitizer, and VivaSens on dentinal tubules using SEM and observed narrowing of dentinal tubules successfully with both treatment approaches.
Our findings are consistent with the findings of Al-Saud et al.
Pathan et al. evaluated the effectiveness of three desensitizing agents: Admira Protect, VivaSens, and Neo Active Apatite on dentinal tubule occlusion and their durability with time and found Admira Protect as more effective.
With the advent of laser technology and its growing utilization in dentistry, an additional therapeutic option is available for the treatment of dentinal sensitivity. The laser, by interacting with the tissue, causes different tissue reactions, according to its active medium, wavelength, and power density, and to the optical properties of the target tissue.
Sgolastra et al. state the mechanism of action of laser as follows:
- Coagulation of proteins of fluid inside the dentinal tubules; this will diminish the fluids' movements
- Occlusion of tubules through partial submelting of the denuded dentine
- Discharging of internal tubular nerve.
Diode laser has an analgesic effect by depressing nerve transmission., Laser interaction with the dental pulp causes a photobiomodulating effect, increasing the cellular metabolic activity of the odontoblasts and obliterating the dentinal tubules with the intensification of tertiary dentineproduction.
Faria et al.evaluated apical microleakage by SEM analysis with Diode laser irradiation and found ultrastructural alterations in dentin from modifying smear layer to initial melting and partial occlusion of open dentinal tubules.
Umberto et al. compared the effectiveness of Diode laser alone and with topical sodium fluoride gel (NaF) and found Diode laser to be more effective in reducing DH when used alone or in combination with NaF gel than when NaF gel used alone.
In this study, cavities were prepared on cervical third of crown to simulate the clinical condition of exposed dentin surface. All the samples were stored in artificial saliva to simulate the oral condition.
All the samples were brushed (to know the durability of desensitizing agent) with motorized toothbrush from the equidistance to standardize the brushing pressure and strokes for each sample.
Most motorized toothbrushes have the feature to stop the users whenever excessive pressure is applied while brushing by stopping the bristles' motion. Ideal brushing time is 3–4 min (180 s) for all the teeth; by considering this, we have chosen 15 s brushing time twice daily for each single tooth specimen.
SEM helps to investigate tubular openings as well as tubular occlusion with evidence.
In the present study, there is no statistically significant difference found between VivaSens and Laser groups. This indicates that both agents are equally effectivein the obliteration of dentinal tubules just after application and after 15 days of treatment.
| Conclusions|| |
From the limitations of this study, it can be concluded that occlusion and/or narrowing of open dentinal tubules have been successfully achieved with both treatment approaches throughout the specific period.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lukomsky EH. Fluorine therapy for exposed dentin and alveolar atrophy. J Dent Res 1941;20:649.
De Souza AM, Colares RC, Mendonça JS, Rodrigues LK, Santiago SL. Effect of oxalic acid pre-treatment in restorations of non-carious cervical lesions: A randomized clinical trial. J Conserv Dent 2014;17:427-31.
Braennstroem M, Astroem A. A study on the mechanism of pain elicited from the dentin. J Dent Res 1964;43:619-25.
Sharma V, Ranjana Mohan. Evaluation of the dentinal tubule occlusion ability of sodium fluoride in three different commercially available forms: A SEM study. J Dent Coll Azamgarh 2015;1:24-37.
Makkar S, Goyal M, Kaushal A, Hegde V. Effect of desensitizing treatments on bond strength of resin composites to dentin – An in vitro
study. J Conserv Dent 2014;17:458-61.
Santiago SL, Pereira JC, Martineli AC. Effect of commercially available and experimental potassium oxalate-based dentin desensitizing agents in dentin permeability: Influence of time and filtration system. Braz Dent J 2006;17:300-5.
Chen CL, Parolia A, Pau A, Celerino de Moraes Porto IC. Comparative evaluation of the effectiveness of desensitizing agents in dentine tubule occlusion using scanning electron microscopy. Aust Dent J 2015;60:65-72.
Dababneh RH, Khouri AT, Addy M. Dentine hypersensitivity – An enigma? A review of terminology, mechanisms, aetiology and management. Br Dent J 1999;187:606-11.
Addy M. Dentin hypersensitivity: Definition, prevalence, distribution and etiology. In: Addy M, Embery G, Edgar WM, Orchardson R, editors. Tooth Wear and Sensitivity Clinical Advances in Restorative Dentistry. London: Martin Dunitz; 2000. p. 239-48.
Jackson R. Potential treatment modalities for dentin hypersensitivity: Home use products. In: Addy M, Embery G, Edgar WM, Orchardson R, editors. Tooth Wear and Sensitivity in Clinical Advances in Restorative Dentistry. London: Martin Dunitz; 2000. p. 326-8.
Pashley DH. Dentin permeability and dentin sensitivity. Proc Finn Dent Soc 1992;88 Suppl 1:31-7.
Malkoç MA, Sevimay M. Evaluation of mineral content of dentin treated with desensitizing agents and neodymium yttrium-aluminium-garnet (Nd: YAG) laser. Lasers Med Sci 2012;27:743-8.
Pamir T, Dalgar H, Onal B. Clinical evaluation of three desensitizing agents in relieving dentin hypersensitivity. Oper Dent 2007;32:544-8.
Al-Saud LM, Al-Nahedh HN. Occluding effect of Nd: YAG laser and different dentin desensitizing agents on human dentinal tubules in vitro
: A scanning electron microscopy investigation. Oper Dent 2012;37:340-55.
Pathan AB, Bolla N, Kavuri SR, Sunil CR, Damaraju B, Pattan SK. Ability of three desensitizing agents in dentinal tubule obliteration and durability: An in vitro
study. J Conserv Dent 2016;19:31-6.
Pinheiro AL. Tissue interaction. In: Brugnera A Jr., Pinheiro AL, editors. Lasers in modern dentistry. São Paulo: Pancast; 1998. p. 45-62.
Sgolastra F, Petrucci A, Gatto R, Monaco A. Effectiveness of laser in dentinal hypersensitivity treatment: A systematic review. J Endod 2011;37:297-303.
Gerschman JA, Ruben J, Gerbart-Eaglemont J. Low level laser therapy for dentinal tooth hypersensitivity. Am Dent J 1994;39:353-7.
Zhang C, Matsumoto K, Kimura Y, Harashima T, Takeda FH, Zhou H. Effects of CO2 laser in treatment of cervical dentinal hypersensitivity. J Endod 1998;24:595-7.
Brugnera Júnior A, Zanin F, Pinheiro A, Pécora J, Ladalardo TC, Campos D, et al
. LLLT in Treating Dentinal Hypersensibility: A Histologic Study and Clinical Application. Second International Conference on Near-Field Optical Analysis: Photodynamic Therapy & Photobiology Effects Houston, Texas, USA, May 31 – June 1, 2001. Proceedings of the Second International Conference on NOA; 2002. p. 23-31.
Faria MI, Souza-Gabriel AE, Alfredo E, Messias DC, Silva-Sousa YT. Apical microleakage and SEM analysis of dentin surface after 980 nm diode laser irradiation. Braz Dent J 2011;22:382-7.
Umberto R, Claudia R, Gaspare P, Gianluca T, Alessandro del V. Treatment of dentine hypersensitivity by diode laser: A clinical study. Int J Dent 2012;2012:858950.
Barbakow F, Imfeld LT. Abrasives in dentifrices and prophylaxis pastes. Quintessence Int 1987;18:17-21.
[Figure 1], [Figure 2]