Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : April | Volume : 16 | Issue : 4 | Page : ZC51 - ZC54 Full Version

Efficacy of Biosilicate Glass-Ceramic and Gluma in the Treatment of Cervical Dentin Hypersensitivity: An Interim Results of Randomised Control Trial


Published: April 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52874.16269
Maria Luiza Lima Santana, Ana Isis Cesário, Danilo Rocha Dias, Edgar Dutra Zanotto, Oscar Peitl Filho, Carlos Estrela, Virgílio Moreira Roriz

1. Undergraduate Student, School of Dentistry, Universidade Federal de Goias, Goiânia, Goiás, Brazil. 2. Undergraduate Student, School of Dentistry, Universidade Federal de Goias, Goiânia, Goiás, Brazil. 3. Adjunct Professor, Department of Restorative Dentistry, School of Dentistry, Universidade, Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. 4. Full Professor, Department of Materials Engineering, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil. 5. Full Professor, Department of Materials Engineering, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil. 6. Full Professor, School of Dentistry, Universidade Federal de Goias, Goiânia, Goias, Brazil. 7. Adjunct Professor, School of Dentistry, Universidade Federal de Goias, Goiânia, Goias, Brazil.

Correspondence Address :
Dr. Danilo Rocha Dias,
Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte-31.270-901, Minas Gerais, Brazil.
E-mail: danilorocdias@gmail.com

Abstract

Introduction: Dentin Hypersensitivity (DH) is known to be a relatively common condition that affects a considerable portion of the population, and manifests itself in the form of acute pain, due to the exposure of dentin and open dentinal tubules, after the removal of enamel or root cement. It has a multifactorial aetiology.

Aim: To compare the efficacy in DH treatment using Biosilicate and Gluma Desensitiser.

Materials and Methods: This randomised clinical trial pilot study with a split-mouth design included seven participants. Two teeth presenting Gingival Recession (GR)-related DH were selected in each participant and allocated to treatment groups by simple randomisation. Gluma® desensitiser (GD) and Biosilicate® (BIO) were applied once a week for four weeks. The pain intensity under a volatile stimulus was measured using a Visual Analogue Scale (VAS) at baseline and after treatment, at 15 days and 6 months follow-up. Data analysis were performed by means of descriptive statistics, Paired t-test for inter-group comparison and Friedman test for intra-group comparison (p-value <0.05).

Results: The mean age of seven participants were 19.9 years, from which five were women (71.4%). The GD and BIO groups presented initial mean VAS values of 4.86±2.55 and 6.14±1.57, respectively. Fifteen days after treatment, both groups showed a significant improvement (GD group p-value=0.03 and BIO group p-value=0.02, Wilcoxon test) in pain intensity, with 71.4% teeth without sensitivity (VAS=0).

Conclusion: Both treatments resulted in a reduction in painful sensitivity under volatile stimuli 15 days after treatment. BIO group presented a better outcome regarding reduction in DH, without recurrence at the 6th month evaluation, when compared to GD group.

Keywords

Dentin desensitising agents, Dentin sensitivity, Pain intensity

The DH is characterised by short, sharp pain, initiated after exposure of dentin to different stimuli- thermal, tactile, osmotic, or chemical and which cannot be explained by any dental defect or disease (1). The pain remains as long as the stimulus is applied, being initially severe, but decreases after removal of the stimulus. Despite the heterogeneity in study methods and populations, the mean DH worldwide prevalence is 33.5%, with a higher incidence in young adults (2).

Cervical DH usually occurs as result of dentin exposure following GR or loss of enamel/cementum due to Non Carious Cervical Lesions (NCCL). DH, GR and NCCL are correlated and share some risk factors: age, gender, gastric disease and occlusal trauma. The depth and morphology of GR and NCCL contribute to high levels of dentin sensitivity. Pain induced in exposed dentine may be explained by the hydrodynamic theory, according to which the stimuli induce a rapid outward movement of fluid in the dentinal tubules sufficient to activate the sensory nerve fibres in the underlying pulp/dentin border zone (3).

Treatment strategies for DH aimed to address both aetiological factors and symptom relief. They may include instructions regarding brushing technique and the use of a less abrasive dentifrice, anxiety control, the use of a desensitiser and periodontal surgery (4). The different desensitiser products available to treat DH aim to interrupt the pain neural answer by means of occlusion of the opened dentin tubules, thus blocking the hydrodynamic flow within them (5). The ideal desensitiser treatment for DH should act quickly, be effective in the long-term be easy to apply, and should not be aggressive to the pulp, cause pain and or cause dental staining (6).

Gluma® desensitiser (Heraeus Kulzer, Hanau, Germany) is a well-accepted product by dentists. It was developed from Gluma Bond Original® and has glutaraldehyde as its active component, which promotes the precipitation of serum albumin present in the fluid of dentinal tubules and reacts by coagulation, counteracting the hydrodynamic mechanism of DH through tubule obliteration (7).

Biosilicate® (LaMaV, Federal University of São Carlos, São Paulo, Brazil) is a bioactive glass-ceramic developed by a multidisciplinary team for the treatment of DH (8). It reacts with saliva leading to the formation and deposition of hydroxyapatite carbonate on the dentin surface, promoting the obliteration of open dentin tubules. Biosilicate® has two advantages, the particles can be safely added to various types of formulation used in the oral cavity and these particles may be produced in different granulations, allowing their insertion into dentine tubules with some ease (9). According to an in-vitro study, 24 hours after the application of the product to specimens kept in artificial saliva, total obliteration of the dentinal tubules was observed, indicating that a mineralised layer had formed on the dentin surface (9). The results of a clinical study using Biosilicate® for the treatment of DH proved that it was quite effective at reducing DH in patients with GR during a 6 month follow-up (10). It has also been shown to be effective at reducing the sensitivity generated after tooth bleaching with hydrogen peroxide (11).

Although these two desensitisers are effective in reducing DH, they have different characteristics and mechanisms of action, and their comparative efficacy has not yet been tested. There is a hypothesis that the bioactive glass-ceramic may be more effective in reducing DH than Gluma® desensitiser.

Thus, the present study aimed to further compare the effectiveness of Biosilicate® in the treatment of DH by comparison with the well-known Gluma® desensitiser.

Material and Methods

This pilot study for a split-mouth randomised clinical trial was performed in the School of Dentistry, Universidade Federal de Goias, Goiânia, Goiás, Brazil, between September 2019 and April 2020, and was approved by the Ethics Committee of the Universidade Federal de Goiás, (protocol n.1.974.598). Patients were informed about the purpose and the design of the study, and they signed an informed consent form and related consent forms. This study was performed according to the Declaration of Helsinki and registered in the Registry of Brazilian Studies for Clinical Trials (RBR-67645p).

Inclusion criteria: The sample included dentistry students over 18-year-old, presenting at least two teeth with GR-related DH without history of DH treatment or root scaling in the past 6 months.

Exclusion criteria: Subjects being pregnant or lactating; having received periodontal treatment in the last six months; receiving orthodontic treatment; consuming an acid diet and chronic use of painkillers or anti-inflammatories; having prostheses that were using the sensitive teeth as pillars were excluded from the study.

Sample size calculation: The sample size for the RCT was estimated in 38, considering a power of 80% and a level of significance of 5% (two sided), for detecting a mean of the differences of 0.61 between pairs (10), assuming the standard deviation of the differences to be 1.3. Considering the risk of participants’ drop out, this sample size estimation was increased in 10%, totalising 42 participants. For this pilot study, the sample size was estimated at 20% of the RCT sample.

Simple randomisation was performed to allocate sensitive teeth to two treatment groups:

• Gluma® Desensitiser (GD group)
• Biosilicate® (BIO group)

The DH intensity was assessed after exposure to a volatile stimulus using a VAS, which consisted of a numerical 100 mm scale, graded from 0-10. The extreme left (0) represented the absence of pain and the extreme right (100) represented excruciating pain. The participants indicated their answer by marking a position on the line, between these two extremes.

Study Procedure

All participants were instructed to use the modified Bass technique for teeth brushing during the study. A volatile stimulus was provided by means of local air application using a professional triple syringe, totally free of water and oil. An air jet was applied perpendicularly to the dentin surface, from a distance of 1 cm, for 3 seconds.

Treatment began after baseline pain assessment and was performed by the same researcher in all patients. It involved mechanical cleaning of the surface, using a flexible cotton stick, followed by relative isolation and desensitiser application. Each product was applied once a week, for 4 weeks (10).

Biosilicate®: This is made from Silicon Dioxide (SiO2), Sodium Oxide (Na2O), Calcium Oxide (CaO) and Phosphorus Pentaoxide (P2O5), and is produced by the Vitreous Materials Laboratory (LaMaV), in the Universidade Federal de São Carlos (Brazil). A mixture of 0.2 g of powder and 1 mL of water was placed in eppendorf tubes. This solution was lightly rubbed on the cervical region of the tooth with a microbrush, for 30 seconds, and left to rest for 2 minutes. Then, the excess was removed with water from a triple syringe.

Gluma®: This desensitiser was applied according to the manufacturer’s recommendations: dentin cleaning, relative isolation, product application, 30 seconds resting, careful surface drying with an air jet and abundant washing.
The DH was measured before treatment, immediately after each session of treatment, and 15 days and 6 months later, verifying pain interruption and durability of pain remission. A different evaluator performed all DH assessment, blinded to the product applied.

Statistical Analysis

Descriptive statistics, paired t-test, Wilcoxon and Friedman tests were used for data analysis. Statistical significance was set at p-value <0.05. The Statistical Package for Social Sciences (SPSS Inc. Chicago, IL, USA) for windows software version 25.0 was used for all data analysis.

Results

Twenty-four volunteers complaining of DH were screened, and seven fulfilled the inclusion criteria (mean age was 19.9 years, SD 0.9), from which five were women (71.4%). A researcher performed the two treatment protocols on seven teeth per group, in a split-mouth design. All the treated teeth were premolars or canines.

(Table/Fig 1) describes the volatile sensitivity measured by the VAS before and after treatment. Both treatments were effective at reducing pain intensity, and only three participants presented DH 15 days after treatment, including two teeth treated with Gluma® Desensitiser and two teeth treated with Biosilicate®. Both groups showed a significant improvement in pain intensity, with 10 teeth (71.4%) without sensitivity (VAS=0) at 15th day after treatment (GD group p-value=0.03 and BIO group p-value=0.02, Wilcoxon test). The teeth treated in BIO group presented better results. At six months after treatment, only one case treated in BIO group remained sensitive, at the same intensity, while three teeth treated in GD group presented DH, including two recurrences.

The mean sensitivity of groups in each session, measured by the VAS, is presented in (Table/Fig 2), (Table/Fig 3). The two groups presented similar DH intensity at baseline (p=0.233), and a significant reduction of pain after treatment (GD group p-value=0.006 and BIO group p-value <0.001). There was no significant difference between DH at 15 days and 6 months follow-up, irrespective of treatment. Inter-group comparison revealed no significant difference at 15 days follow-up (p=0.415) or after 6 months (p=0.593). Data from the baseline and follow-up periods are represented by a boxplot in (Table/Fig 4).

During or immediately after Gluma® application, six patients reported a bitter taste or burning sensation.

Discussion

This pilot study showed the effectiveness of both treatments at reducing DH, but BIO group presented superior results in both follow-up periods (15 days and 6 months). Furthermore, no patient reported a different or bad taste, or other side-effects, after Biosilicate® application, unlike with Gluma® desensitiser.

Several techniques and protocols for DH treatment are available and have been described in the literature and several studies have reported a significant reduction in pain after treating DH with several types of desensitising agents. However, there is no established treatment protocol for DH or a gold standard desensitising agent for use at home or in-office (12),(13),(14),(15),(16).

Biosilicate® is a biocompatible material that can induce osteogenesis and has been suggested for use as an adjuvant to treat teeth fissures and cracks, due to its generation in-situ hydroxyapatite (17). In-vitro studies have attributed the effect of bioactive materials on DH reduction to the fast deposition of hydroxyapatite at the site of application, obliterating dentin tubules and contributing to enamel and dentin regeneration after bleaching treatments (18),(19). Biosilicate®, if used after bleaching treatment immediately, seemed to reduce or even demineralisation and prevent the exposure of dentin tubules (19).

Similar to our results, at least one study demonstrated the reduction of DH in the short-term by the clinical use of Biosilicate® mixed with distilled water, and this effect remained after 6 months follow-up (10).

A systematic review with meta-analysis verified that a commercial product, Nupro Sensodyne®, which is a compound of sodium and calcium phosphosilicate (likely a bioactive glass) with an active principle very similar to that of Biosilicate®, showed satisfactory results in terms of reducing DH (20). Like Biosilicate®, when this product contacts oral fluids it reacts and deposits Hydroxycarbonate Apatite (HCA), which is a compound chemically similar to dental enamel (21). Other studies found that prophylactic pastes (fluoridated or not) containing 15% Nupro® reduced DH for at least 28 days (22),(23). In another study, a single in-office application of the paste after scaling and root planning provided significant immediate hypersensitivity reduction for the whole six week (24).

A previous study compared the efficacy of Gluma® desensitiser with that of the biomimetic mineralisation system (BIMIN). Forty patients showed favourable DH reduction for 12 months, with no significant difference between the two products. However, dentin surface evaluation using a scanning electron microscopy revealed that a mineral layer concealed the dentinal tubules in the BIMIN group, while numerous dentinal tubules remained visible in the cervical defects that were treated with Gluma® (25). Although Biosilicate® was not evaluated in that study, this bioactive glass-ceramic also promotes sealing of the dentinal tubules by the deposition of hydroxyapatite, as previously mentioned (9).

Two similar studies, one with six months follow-up (26) and the other with 18 months follow-up (27), assessed the application of Gluma® desensitiser by itself or associated with different protocols of low and high-power laser treatments, and reported favourable results in terms of DH-related pain reduction. Furthermore, in a recent study, the authors found that a group of patients treated with Gluma® desensitiser was the only set that presented no increase in pain over the course of time, meaning that it can be considered an effective and non invasive treatment option (27).

Another in-vitro study assessed the efficacy of five desensitisers in relation to dentin permeability, including Gluma® desensitiser and Nupro®, and the conclusion was that both were effective in the treatment of DH. The authors were unable to compare the effectiveness of one in relation to the other due to differences in protocols for use (28).

Limitation(s)

The results observed from this pilot study must be assessed carefully, considering the small sample size. The degrees of dentin exposure were not assessed, which may represent a limitation and will be reconsidered for performing the clinical trial. Another issue to be discussed in future studies is the method for assessing DH, which may include tactile, thermal, osmotic, and electric stimuli.

Conclusion

The preliminary results presented in this study suggest that both biomaterials are effective in the treatment of DH, with a relevant reduction in pain sensitivity to volatile stimuli on the 15th day after the intervention. Considering the 6th month of follow-up, no recurrence was observed in the teeth treated with Biosilicate®, while two teeth treated with desensitiser Gluma® presented with recurrence. In addition, most participants reported a bitter taste or burning sensation during or immediately after the application of Gluma®, which was not observed with Biosilicate®.

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DOI and Others

DOI: 10.7860/JCDR/2022/52874.16269

Date of Submission: Oct 15, 2021
Date of Peer Review: Nov 16, 2021
Date of Acceptance: Jan 12, 2022
Date of Publishing: Apr 01, 2022

Author declaration:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 17, 2021
• Manual Googling: Jan 11, 2022
• iThenticate Software: Feb 02, 2022 (6%)

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