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Master's Dissertation
DOI
https://doi.org/10.11606/D.23.2021.tde-28012022-115746
Document
Author
Full name
Jair Carneiro Leão Filho
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2021
Supervisor
Committee
Silva, Patricia Moreira de Freitas Costa e (President)
Eduardo, Carlos de Paula
Tedesco, Tamara Kerber
Toti, Marina Stella Bello
Title in Portuguese
Alteração da morfologia de superfície do esmalte dental e temperatura intrapulpar no descolamento de dispositivos cerâmicos com lasers de alta potência: revisão sistemática e meta-análise
Keywords in Portuguese
Braquete ortodôntico
Esmalte
Laser
Abstract in Portuguese
A alta demanda por estética trouxe um aumento na procura por materiais cerâmicos na Odontologia, resultando na predileção entre os pacientes por braquetes ortodônticos cerâmicos. A baixa resistência à fratura e alta força de união desses dispositivos cerâmicos ao esmalte pode provocar danos irreversíveis à estrutura dental sadia durante o processo de descolamento. Nesse contexto, os lasers de alta potência, devido a sua capacidade de interação com os materiais resinosos que unem o braquete ao esmalte, têm sido estudados para contornar esses possíveis danos ao tecido dental. O objetivo da presente revisão sistemática é comparar os lasers de alta potência com os alicates ortodônticos no descolamento de braquetes cerâmicos, com enfoque na alteração da morfologia de superfície do esmalte e aumento de temperatura intrapulpar. Foi realizada uma busca sistematizada nas bases de dados Pubmed, Cochrane Central, Scopus, Lilacs e Single via Open Grey até agosto de 2020 (seguindo o protocolo estabelecido pelo PRISMA) e realizado o processo de avaliação do risco de viés. 1.134 artigos foram identificados e doze deles foram incluídos para avaliação final baseados nos critérios de inclusão e exclusão. Os lasers foram divididos em dois subgrupos para melhor análise dos dados: subgrupos lasers interaction by ablation (formado pelos lasers Er:YAG, Er,Cr:YSGG e Tm:YAP) e lasers interaction by termal softening (formado pelos lasers de diodo e CO2). As análises de alteração de surperfície do esmalte envolveram os testes de Adhesive Remanant Index (ARI) e Shear Bond Strengh (SBS); além disso, foi avaliado o aumento de temperatura intrapulpar durante a irradiação dos braquetes. Para o teste de ARI, o subgrupo lasers interaction by ablation apresentou melhor resultado do que o grupo controle (p=0.005); entretanto, em uma análise geral de todos os lasers de alta potência, não houve diferença estatisticamente significante em relação ao grupo controle (p=0.12); da mesma forma, não houve diferença estatisticamente significante entre os subgrupos testados (p=0.111). Na análise de SBS todos os lasers de alta potência reduziram a força de união (8.91 MPa), com menores valores para os lasers do subgrupo lasers interaction by ablation (9.28 MPa). Adicionalmente, a análise de temperatura mostrou que nenhum laser nos estudos selecionados atingiu o limiar crítico de 5,5°C. Mesmo havendo uma tendência aos lasers do subgrupo interaction by ablation sobre os do subgrupo interaction by termal softening de melhores resultados, não é possível afirmar qual o melhor comprimento de onda e parâmetros para descolamento de braquetes ortodônticos cerâmicos devido à pouca quantidade de estudos primários.
Title in English
Alteration of dental enamel surface morphology and intrapulpal temperature in the debonding of ceramic devices with high-power lasers: systematic review and meta-analysis
Keywords in English
Enamel
Laser
Orthodontic brackets
Abstract in English
The high aesthetic demand of the population brought an increase in the demand for ceramic materials in dentistry resulting in the predilection among patients for ceramic orthodontic brackets. The low fracture resistance and the need for greater bonding strength of these ceramic devices can cause irreversible damage to the healthy dental structure during the debonding process. With this, high-power lasers have been studied during the last decades to overcome these possible damages to dental tissue due to their capacity to interact with the resin materials responsible for bonding the bracket to the enamel. The objective of this systematic review is to compare high-power lasers with orthodontic pliers in the debonding of ceramic brackets by evaluating enamel surface alteration and temperature increase. A systematic search was performed in the Pubmed, Cochrane Central, Scopus, Lilacs, and Single databases via Open Grey until August 2020, following the protocol established by Prisma and the assessment process risk of bias. 1,134 articles were identified and twelve of them were included for final evaluation based on inclusion and exclusion criteria. The lasers were divided into two subgroups for better data analysis. First subgroup lasers interaction by ablation formed by lasers Er:YAG, Er,Cr:YSGG and Tm:YAP, and the second subgroup lasers interaction by thermal softening formed by the diode and CO2 lasers. The enamel surperficial alteration analyses involved the Adhesive Remanant Index (ARI) and Shear Bond Strengh (SBS) tests, and intrapulpal temperature increase was evaluated during bracket irradiation. For the ARI test, the subgroup lasers interaction by ablation presented better than the control group (p=0.005); however, in a general analysis of all high-power lasers there was no statistically significant difference concerning the control group (p=0.12) in the same way there was no statistically significant difference between the subgroups tested (p=0.111). In the SBS analysis, all high-power lasers reduced the shear bond strength (8.91 MPa), with favoritism to lasers of the subgroup lasers interaction by ablation (9.28 MPa). Additionally, temperature analysis showed that no laser in the selected studies reached the critical threshold of 5.5°C. Even though there is a tendency to laser interaction by ablation on lasers interaction by thermal softening, we cannot affirm the best wavelength and parameters for debonding of ceramic orthodontic brackets due to the limited amount of primary studies.
 
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Publishing Date
2022-04-28
 
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