Métodos de prevenção de danos à superfície dental e manutenção da saúde bucal durante o tratamento ortodôntico

Abstract

The objective of this work was to systematically check the literature on the use of probiotics against the main microorganisms that cause caries (Streptococcus mutans and Lactobacillus), as well as to propose and test the use of scalpel blades (SB) as a new system for removing orthodontic cement. to avoid irreversible damage to the teeth surface. Materials and methods: Study 1 - Four databases were searched until December 2019. Clinical trials were included, involving patients undergoing fixed orthodontic treatment who received any probiotic intervention compared to placebo. The risk of bias was assessed with the RoB 2 Cochrane tool and the GRADE system. Meta-analyzes were performed considering the salivary bacterial counts before and after treatment, using odds ratios. Study 2 - Fifty enamel discs were cut and polished. Surface roughness was assessed. Metal brackets (Edgewise Standard; Morelli, Sorocaba, SP, Brazil) were glued to the enamel surface using Transbond XT (3M Unitek, Monrovia, CA, USA) and stored in distilled water at 37 ° C for 24 hours. The brackets were removed with specific pliers. The adhesive remnant was removed using four systems (TCB: tungsten carbide drill; DHpro: aluminum oxide polisher; MO: zirconia drill for removing resin and SB: scalpel blade) and surface roughness using Atomic Force Microscopy has been evaluated again. After final polishing, with a specific polishing system, the surface roughness, the measurement of the enamel surface gloss (using the Glossmeter) and the Enamel Damage Index were evaluated. Results: Study 1 - In total, 35 studies were identified, of which 8 were included. Low risk of bias was determined for most studies. The evidence supporting probiotic therapy was classified as very low to moderate. The results showed no statistical difference in the comparison between probiotics and placebo for salivary Streptococcus mutans or Lactobacillus count. Study 2 - For supercial roughness, there was no difference between the removal systems in the different stages. Differences were obtained within the groups of the removal systems, at different times. All groups showed increased surface roughness after removing the resin, but Dhpro and SB were able to reduce it after polishing. Regarding brightness, all groups showed lower values than polished enamel. Among the groups tested, Dhpro and SB had the highest brightness values. In EDI, DHpro presented the largest number of samples with a score of 0, that is, a surface with a similar aspect to the initial surface. Conclusions: Study 1 - There were no differences in the use of probiotics in orthodontic patients to decrease Streptococcus mutans and Lactobacillus. Study 2 - According to data obtained and images from AFM, we can conclude that DHPro obtained adequate results and the system proposed by the study (SB) was statistically similar to this one.