EGYPTIAN RHEUMA Oct 2015 Mar 2016 Tanta Dental Journal TOLOGY & REHABILIT Table of contents

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1 Issue 1 - Mrch

2 Originl rticle 55 Reminerliztion effect of low-level lser nd morphous sodium clcium phosphosilicte pste in teeth with fixed orthodontic pplinces Edith Lr-Crrillo, Crlos Doroteo-Chiml b, Srí López-González, Rúl A. Morles-Luckie c, Oscr F. Ole-Mejí c, Toshio Kuboder-Ito, Crlo E. Medin-Solís d Reserch Center, b Deprtment of Orthodontics, Fcultd de Odontologí, Universidd Autónom del Estdo de México, c Fcultd de Químic, Universidd Autónom del Estdo de México, d School of Dentistry, Áre Acdémic de Odontologí, Instituto de Ciencis de l Slud, Universidd Autónom del Estdo de Hidlgo, Hidlgo, México Correspondence to Edith Lr-Crrillo, PhD, Reserch Center, Fcultd de Odontologí, Universidd Autónom del Estdo de México, Pseo Tollocn esq. Jesús Crrnz, Coloni Universidd, C.P Toluc, Estdo de México, México e-mil: elrc@uemex.mx Received 02 Mrch 2016 Accepted 21 Mrch 2016 Tnt Dentl Journl 2016, 13:55 62 Purpose The im of the present study ws to evlute enmel reminerliztion with NovMin (morphous sodium clcium phosphosilicte pste) nd low-level lser (LLL) for white spot lesions fter orthodontic therpy. Mterils nd methods A totl of 20 premolrs divided into four groups were submitted to three phses: (i) plcement fixed orthodontic pplinces; (ii) deminerlizing solution; nd (iii) reminerliztion for groups (group A, control; group B, NUPRO Sensodyne with NovMin; group C, LLL; nd group D, NovMin nd LLL). In ech stge, elementl nlysis (clcium, phosphorus, nd sodium) ws mesured under scnning electron microscope; the dt were tested to find significnt differences between minerl chnges during phses by using the Bonferroni test nd Tukey s test between groups. Results Clcium nd sodium decresed nd phosphorus ions incresed in ll groups t stge 2. In stge 3, ll minerls incresed for ll the tested groups, recording greter vlues in group B. Clcium showed sttisticlly significnt difference on compring stge 1 with stge 2 (P = 0.025) nd stge 2 with stge 3 (P = 0.019). On the other hnd, using the Bonferroni nlysis, phosphorous recorded significnt difference on compring stge 1 with stge 3 (P = 0.013). Applying Tukey s test, sttisticl significnt difference between groups A nd B ws recorded s regrds the clcium level (P = 0.004) nd the phosphorus level (P = 0.003), which lso showed significnt difference between group A nd group C (P = 0.052). As regrds the sodium distribution, no significnt differences were found. Conclusion According to the results obtined in the current study, using NUPRO Sensodyne with NovMin thn using LLL proved to be the better tretment for white spot lesions, leding ion incorportion nd providing n effective lterntive for dentl deminerliztion. Keywords: lser therpy, NovMin, tooth deminerliztion Tnt Dentl Journl 13: Tnt Dentl Journl Introduction An imblnce between pthologicl nd protective fctors will result in rupture of the physiologicl processes of reminerliztion nd deminerliztion of the dentl structure, fvoring the ltter. Criogenic bcteri, fermentble crbohydrtes, nd slivry dysfunction re scientificlly ccepted s importnt pthologicl fctors. Humn sliv contins clcium nd phosphte ions in supersturted stte nd therefore hs the potentil to reminerlize enmel. However, if cid chllenges overcome this physiologicl reminerliztion process, lterntive therpeutic pproches re necessry to enhnce reminerliztion [1,2]. Declcifiction or the development of white spot lesion (WSL) on the enmel surfce is the most importnt itrogenic effect of the fixed orthodontic pplince therpy. From the time fixed orthodontic pplinces were introduced, WSLs hve become prticulr clinicl problem tht cn be ttributed to the difficulties for orl hygiene on bonded dentl rches nd the prolonged plque ccumultion on tooth surfces [3,4]. This is n open ccess rticle distributed under the terms of the Cretive Commons Attribution-NonCommercil-ShreAlike 3.0 License, which llows others to remix, twek, nd build upon the work non-commercilly, s long s the uthor is credited nd the new cretions re licensed under the identicl terms Tnt Dentl Journl Published by Wolters Kluwer - Medknow DOI: /

3 56 Tnt Dentl Journl Orthodontic pplinces physiclly lter the microbil environment. Incresed prolifertion of the fculttive bcteril popultion, including Streptococcus mutns, leds to decrese in ph, which tips the deminerliztion reminerliztion blnce towrd minerl loss (deminerliztion), which in turn cn led to WSL development nd eventully to cvittion nd cries extending into the dentin [3,5]. While postorthodontic tretment of WSLs differs from their prevention during orthodontic procedures, common interventions include fluoride nd clcium phosphte-bsed reminerlizing gents. Although fluoride still remins the cornerstone of modern noninvsive dentl cries mngement, new nd emerging methods, which cn be used s lterntives to fluoride, hve been nd re in the process of being developed. NovMin is cermic mteril consisting of morphous sodium clcium phosphosilicte, which is highly rective in wter, s fine prticle size powder cn physiclly occlude dentinl tubules. In the queous environment of the tooth, sodium ions from the NovMin prticles rpidly exchnge with hydrogen ctions (in the form of H 3 O + ). This leds to the relese of clcium nd phosphte (PO 4 3 ) ions from the mteril. A loclized, trnsient increse in ph occurs during the initil exposure of the mteril becuse of the sodium relese. This increse in ph helps to precipitte the extr clcium nd phosphte ions provided by the NovMin prticles to form precipitted clcium phosphte lyer. As these rections continue, this lyer crystllizes into hydroxycrbonte ptite, which is chemiclly nd structurlly equivlent to nturlly occurring biologicl ptite. The combintion of the residul NovMin prticles nd the newly formed hydroxycrbonte ptite lyer physiclly occludes the dentinl tubules [6 8]. Since 1960s, it hs been consistently demonstrted tht under certin conditions, high-powered lsers cn reduce the rte of subsurfce deminerliztion of enmel by ltering its crystlline structure, cid solubility, nd permebility. Nevertheless, the rel mechnisms of cries inhibition by lser remin uncler. Becuse of their high cost, high-powered lsers re not widely employed in privte prctice in developing countries. The use of low-level lsers (LLLs) ppers to be n ppeling lterntive, s reports in the literture suggest tht when used lone or with topicl fluoride they my increse tooth resistnce to dentl cries [9,10]. Compred with the evidence on the prevention of WSLs during orthodontic tretment, not much is known regrding their tretment with reminerlizing gents fter the orthodontic therpy. Therefore, the purpose of the present study ws to evlute enmel reminerliztion of NovMin (morphous sodium clcium phosphosilicte) nd LLL for the tretment of WSLs fter orthodontic tretment. Mterils nd methods Tooth selection nd smple preprtion In totl, 20 humn premolrs, extrcted for orthodontic resons, were used in the study; these were selected on the bsis of the following inclusion criteri: intct buccl enmel with no developmentl defects, restortions or fluorosis, bsence of ny pretretment chemicl gents such s hydrogen peroxide, lck of crcks cused by pressure during extrction, nd no cries or WSLs. All remining visible soft tissue ws removed from the teeth with sclpel no. 12. Teeth were stored in 0.01% thymol solution nd distilled wter t room temperture until further use [11]. Teeth were rinsed in deionized wter for 30 s to wsh off the thymol. The root of ech tooth ws perforted with crbide fissure bur 701L, using low-speed turbine. An orthodontic wire (Stinless steel ; TP Orthodontics, Scottsdle, Arizon, USA) ws plced into the root orifice. Subsequently, ech tooth ws fixed with crylic to the cp of polyethylene continer to fcilitte mnipultion of the smple. A different crylic color ws used in ech group to fcilitte comprison (Fig. 1). All tooth surfces, except buccl, were pinted with three lyers of cid-resistnt nil vrnish nd dried for 24 h. Buccl surfce ws covered with dhesive tpe (3M Trnspore Surgicl Tpe; 3M Unitek, New York, USA) leving rectngulr window t the site Figure 1 Tooth ws fixed with crylic to the cp of the continer to fcilitte mnipultion.

4 Reminerliztion effect Lr-Crrillo et l. 57 of bonding, which corresponds to the brcket size; this ensured tht cid etching ws restricted only to the exposed window. First stge Teeth were divided rndomly into four groups, with five teeth ech. Tretment groups were ssigned s follows: group A, which served s the control group or the group without tretment with reminerlizing gents; group B, which ws treted with NUPRO Sensodyne (Prophylxis Pste with NovMin; Dentsply Interntionl, USA); group C, which ws treted with LLL (Therpeutic Lser, Dentlser LV KVT-106UP; Lsertech, Dresden, Germny); nd group D, which ws treted with NovMin nd LLL. Subsequently, 20 specimens were etched, primed, nd bonded (Trnsbond Plus Self Etching Primer; 3M Unitek) for 3 s ccording to the mnufcturer s indictions. After brcket plcement (Stinless steel premolr brckets, Edgewise Stndrd Mini Uni Twin; 3M Unitek), excess composite mteril (Trnsbond XT Light Cure Adhesive Primer nd Pste; 3M Unitek) ws removed from round the brckets with n explorer, nd then were light cured (Ortholux Luminous; 3M Unitek) for 10 s for ech interproximl surfce, nd finlly, dhesive tpe ws removed. The specimens were prepred for the first evlution under scnning electron microscope (SEM) (INCA Pent FetX3; Oxford Instruments, UK), through which n enmel surfce chrcteriztion ws observed, nd the percentge nlysis of minerl contents of clcium, sodium, nd phosphorus ions were obtined. The coronl segments of ech tooth were cut with crbide discs nd low-speed dentl hndpiece to sses sty prllel to slide bse of SEM (Fig. 2). Second stge: deminerliztion Dentl crown of the smples were fixed gin with crylic to the cp of the polyethylene continer, repeting the process described bove. To crete the initil injury or deminerliztion, the four groups were immersed in deminerlizing solution. This solution contined 2.2 mmoll CCl 2, 2.2 mnol/l KH 2 PO 4, nd 0.05 M cetic cid; the ph ws djusted with 1 M KOH to 4.4 [12]. Teeth were immersed in deminerlizing solution for 96 h t 37 C [12]. This produced initil enmel lesions. The teeth were removed from the solution, wshed with deionized wter, nd dried with oil-free compressed ir. The wires were cut nd ll the smples were nlyzed under SEM, under the sme prmeters s described for the first stge. Third stge: reminerliztion The reminerlizing gents were dded to ech group by following the mnufcturer s instructions: Figure 2 Specimens were prepred for evlution under scnning electron microscope. Group A: without tretment or control. Group B: the NUPRO Sensodyne with NovMin pste ws pplied with rubber cup to ech tooth for 1 min, with oscilltory movements in clockwise direction round the brcket, nd were then llowed to stnd for 1 min before rinsing; smples were wshed with deionized wter for 30 s nd dried with oil-free compressed ir for 30 s. Group C: the LLL ws pplied by plcing the diode 2 mm to the tooth surfce (4000 Hz for 4 min/smple), with n oscilltory motion in clockwise direction. Group D: the procedure of group B ws repeted, nd before wshing, the LLL ppliction ws performed with the sme procedure s in group C. Smples were wshed with deionized wter for 30 s nd dried with oil-free compressed ir during 30 s. Then, ll groups were submitted to ph-cycling regimen for 7 dys to simulte orl environmentl conditions. Ech tooth ws individully incubted for 6 h t 37 C in 40 ml of deminerlizing solution (2.0 mmol/l clcium, 2.0 mmol/l PO4, M cette, ph 4.3) [13]. Teeth were removed from the solution nd thoroughly rinsed in deionized wter nd dried with oil-free compressed ir for 30 s. They were then incubted for 17 h t 37 C in 20 ml of reminerlizing solution (1.5 mm clcium, PO mmol/l, 0.15 mmoll KCl, nd 20 mmol/l ccodylte regultor, ph 7.0) [12]. ph-cycling regimen ws repeted every 24 h for 5 dys; for the lst 2 dys, teeth remined in the minerlizing solution. Both deminerliztion nd reminerliztion solutions were chnged every 96 h during this regimen [12]. After the completion of ph cycling, teeth were rinsed in deionized wter nd dried for 30 s with oil-free

5 58 Tnt Dentl Journl compressed ir. A second ppliction of reminerlizing gents, corresponding to ech group, ws crried out, following the process described bove. ph-cycling regimen ws repeted. Once the second cycle ws finished, smples were kept in deionized wter until their exmintion under SEM. Sttisticl nlysis Sttisticl nlyses were crried out with SPSS for 20.0 Windows (SPSS Inc., Chicgo, Illinois, USA). The normlity nd homogeneity were checked for ech vrible. The Bonferroni test ws conducted to compre minerl chnges t different tested stges, wheres Tukey s test ws crried out to compre the men vlues of minerl chnges for different studied groups. This ws estblished ccording to the smple size. Results Tble 1 shows the men vlues of minerl content obtined from elementl nlysis by using SEM for ech tested group. Comprison between first nd second stge After the second stge, the results indicted loss of clcium ions rnging from 0.54 to 2.02%, being more pronounced in group B. Phosphorus ions incresed in four groups, from 0.22 to 0.57%, being greter in group D. Sodium ion decresed in three groups except for group A, from 0.02 to 0.05%, being higher in group D. Group A showed n increse of 0.07% compred with bseline mesurements (Tble 2). Comprison between second nd third stge After the ppliction of reminerlizing gents, clcium ions gined n increse in ll groups, from 0.14 to 2.85%, with group B showing the highest gin of ions. As regrds the phosphorus ions, n increse ws observed in groups A, B, nd C, with group B showing the highest increse in group B, with 0.54%, wheres decrese of 0.02% ws observed in group D. Sodium ions incresed in groups B nd D, being higher in group D with 0.07%; group C recorded no chnge nd group A hd decrese of 0.02% (Tble 2). Comprison between first nd third stge When compring the men vlues of the control group with tht of the lst on third stge, it ws obvious tht clcium ions incresed in the three experimentl groups. Group B showed higher vlues with 0.83%; wheres in group A there ws decresed of 1.37%. The phosphorus ion incresed in ll groups, being highest in group B with 0.76% nd lest in group A with 0.34%. There ws decrese of sodium ions in group C of 0.02% nd rise in the remining three groups; the highest vlues were recorded in group A (Tble 2). According to the Bonferroni nlysis, clcium concentrtion showed sttisticlly significnt difference between stge 1 nd stge 2 (P = 0.025), nd between stges 2 nd 3 (P = 0.019) (Tble 3). On compring clcium distribution, sttisticl significnt differences between groups A nd B ws found (P = 0.004) (Tble 4 nd Fig. 3). While studying the phosphorus concentrtion, sttisticlly significnt differences between stges 1 nd 3 were observed (P = 0.013) (Tble 3). On compring the distribution of phosphorus, by using Tukey s test, sttisticlly significnt differences between group A nd B were detected (P = 0.003) (Tble 4 nd Fig. 4). According to the Bonferroni nlysis, concentrtion of sodium did not record ny sttisticl differences (Tble 3). On compring the distribution of sodium by using Tukey s test, no sttisticlly significnt differences were found (Tble 4 nd Fig. 5). Scnning electron microscope nlysis To mesure the minerls from ech smple, reference zone ws estblished with mgnifiction of 400 to hve wide rnge of evlution. The chrcteristic description of the surfce smples is shown for ech stge. In the first stge, vriety of chrcteristics ws observed on the surfces of the Tble 1 Minerl men vlues Groups First stge Second stge Third stge C P N C P N C P N A (2.14) (0.80) 0.38 (0.11) (2.64) (0.97) 0.45 (0.08) (2.21) (0.83) 0.43 (0.05) B (1.72) (0.54) 0.40 (0.08) (1.61) (0.52) 0.36 (0.06) (1.22) (0.24) 0.37 (0.16) C (1.00) (0.51) 0.43 (0.01) (1.71) (0.51) 0.41 (0.04) (2.51) (0.59) 0.41 (0.19) D (1.21) (0.29) 0.40 (0.08) (1.56) (0.55) 0.35 (0.07) (2.46) (0.59) 0.42 (0.08) Dt presented s men (SD). Groups: A, control; B, NovMin; C, lser; C, clcium; D, NovMin nd lser; N, sodium; P, phosphorus.

6 Reminerliztion effect Lr-Crrillo et l. 59 smples in some, the enmel prisms were brely visible, nd scrtches exhibited elements tht my represent crbon surfce contmintion (Fig. 6). In Fig. 7 the surfce ws observed with crbon remnnts nd enmel prisms in rough surfce with disordered nd ordered res. At the deminerliztion stge, remrkble chnge ws observed in the enmel surfce: crbon residues, which indicted contmintion of the surfce, were removed by the exposure to deminerlizing solution; enmel prisms becme more visible becuse of erosion; some smples lso presented microfrctures on the surfce (Fig. 8). At the reminerliztion stge, it ws observed tht the enmel surfce prisms were visible, more uniform, nd more compct especilly in the imges of group B nd group C (Fig. 9). Discussion During orthodontic tretment, tooth enmel is t higher risk for cries due to food stgntion cused by the pplinces nd indequte orl hygiene [14]. Tody, there re mny wys to stop or reverse the progression of WSLs: good orl hygiene with fluoride toothpste [15], fluoride-relesing orthodontic mterils [16], products such s those contining csein phosphopeptide morphous clcium phosphte (CPP ACP) [17], nnocomplexes such s crbonte hydroxyptite nnocrystls, nd clcium sodium phosphosilicte (NovMin) [14]. observed deminerliztion of the smples round the fixed pplinces is observed s milky white opque re on smooth surfces [3]. To evlute the smples under SEM with mgnifiction of 400, fter immersing in the deminerlizing solution for 96 h, surfce erosion ws observed in 100% of the smples, which ws more visible in some smples thn in others, which is in contrst to study by Queiroz et l. [18], who evluted minerl loss fter 32 h without erosion of the surfce, but with loss of minerls. O Reilly nd Fetherstone [19] concluded tht significnt nd mesurble minerl loss round fixed pplinces cn occur only 1 month fter beginning the orthodontic tretment, emphsizing tht deminerliztion could not be observed cliniclly yet, suggesting tht the loss of minerl my go undetected by the clinicin. In the current study, it ws observed tht the tested products my significntly reminerlize WSLs. However, this effective reminerliztion is vrible depending on the conditions in which they re pplied. NUPRO Sensodyne dded with NovMin (group B) showed better results, chieving reminerliztion up to 2.85% in clcium, nd significnt increse of phosphorus nd sodium ions; this corrobortes the findings in respect to Vhid Golpyegni et l. [8], who evluted the effectiveness of NovMin with respect to Figure 3 Artificil cries-like lesions of enmel re more homogeneously reproducible thn re nturl lesions, nd thus provide relible experimentl model [14]. When we rtificilly crete the lesion, cliniclly Tble 2 Comprison between stges Groups First/second stge Second/third stge First/third stge C P N C P N C P N A B C D Groups: A, control; B, NovMin; C, lser; C, clcium; D, NovMin nd lser; N, sodium; P, phosphorus. Clcium vlues t different stges of the study. Tble 3 Concentrtion chnge of minerls in ech stge of the study First/second P Second/third P First/third P C (1.92) (2.14) 0.025* (2.14) (2.87) 0.019* (1.92) (2.87) 1.00 P (0.67) (0.75) (0.75) (0.80) (0.67) (0.80) 0.013* N 0.40 (0.07) 0.39 (0.07) (0.07) 0.41 (0.12) (0.07) 0.41 (0.12) 1.00 Dt presented s men (SD). C, clcium; N, sodium; P, phosphorus. *P 0.05 with Bonferroni nlysis.

7 60 Tnt Dentl Journl Figure 4 Figure 5 Phosphorus vlues t different stges of the study. Sodium vlues t different stges of the study. Figure 6 Figure 7 b () Smple 5 (M5) in group A with scrtches on the surfce; (b) smple 4 (M4) in group D with highly visible prisms nd contminted surfce. 400 mgnifiction. Tble 4 Comprison between overll verge of ech group Study groups C P N B 0.004* 0.003* A C * D A 0.004* 0.003* B C D A * C B D A D B C C, clcium; N, sodium; P, phosphorus. P vlues re presented for ech group compred. *P 0.05 with Tukey s test. sodium fluoride (1.1%) nd found tht the NovMin hd gret effect on reminerliztion of WSLs in permnent teeth. The evlution of SEM microgrphs llowed us to observe chnges in the enmel structure; visible, b c () Smple 4 (M4) of the group B; (b) smple 2 (M2) in group C hve rough surfce nd visible prisms; (c) smple 3 (M3) in group C hs ordered nd clen surfce, nd visible enmel prisms without erosion. 400 mgnifiction. remrkble regenertion ws observed in most smples of this group, finding tht coincided with those reported by Burwell et l. [7], who observed the chnges mde in the dmntine structure, which refers greter regenertion of the enmel prisms fter the ppliction of NovMin. Another similr study ws conducted by Gjorgievsk nd Nicholson [20], which compred the effectiveness of NovMin with Recldent (CPP ACP); gin, the results fvored NovMin, proving its greter efficcy in enmel prisms regenertion, s shown in the current reserch. In their study on the effects of 960 nm lser diode on the solubility of clcium in tooth enmel, Kto et l. [21] summrized tht clcium by itself cn lter the enmel surfce, but it does not increses the cid resistnce, which mens tht it does not mke the dentl surfce less susceptible to deminerliztion, unless fluoride gent is dded.

8 Reminerliztion effect Lr-Crrillo et l. 61 Figure 8 Figure 9 b c b c d e () M5 group A; (b) M4 group B; (c) M2 group C; (d) M3 group C; (e) M4 group D fter being subjected to deminerlizing solution. 400 mgnifiction. d e () M5 group A; (b) M4 group B; (c) M2 group C; (d) M3 group C; (e) M4 group D fter being treted with reminerlizing gents nd cyclic ph. 400 mgnifiction. The results obtined in the third stge of this reserch were reltively unexpected. This study demonstrted tht therpeutic lser by itself is cpble of chieving fvorble results, obtining up to 1.02% reminerliztion of the enmel surfce with respect to clcium ion, nd minimum but significnt increse in phosphorus nd sodium ions. When both reminerlizing gents were used, the result ws not s expected; lthough the results were fvorble, they were lower thn those obtined for the individul ppliction of ech minerlizing gent; this is in contrst to the studies by Vhid Golpyegni et l. [8] nd Nryn et l. [22], who evluted the combintion of 5% NovMin with fluoride t concentrtion of 1100 ppm nd obtined good results s the composition of the gents ws not ffected with regrd to the other. However, it is noted tht the ppliction of NUPRO Sensodyne dded with NovMin ws crried out ccording to the mnufcturer s instructions, using rubber cup of undiluted pste into wter. The ction of this mteril results from the interction with queous solutions; when it is introduced in n orl environment, the mteril releses sodium, clcium, nd phosphorus ions; it intercts with the fluid, resulting in the formtion of hydroxyptite crystls in the surfce. It is lso importnt to remember tht the ppliction of lser releses certin mount of het in the treted surfce from 1 to 6 C [10]; this leds to some degree of drying nd, consequently, the elimintion of moisture from the pste. Conclusion On the bsis of the results of this study in vitro nd scientific bses tht provide ech of the products used, we cn conclude tht the effect of NUPRO Sensodyne dded with NovMin s minerlizing gent in WSLs increses the reminerliztion effect by itself compred with the combintion with therpeutic lser. Moreover, the therpeutic use of lsers to tret WSLs helps to reminerlize the surfce by itself, but in lower percentge. Finncil support nd sponsorship Nil. Conflicts of interest There re no conflicts of interest. References 1 Fetherstone JD. Cries prevention nd reversl bsed on the cries blnce. Peditr Dent 2006; 28(2): Oliveir GM, Ritter AV, Heymnn HO, Swift E Jr, Donovn T, Brock G, Wright T. Reminerliztion effect of CPP-ACP nd fluoride for white spot lesions in vitro. J Dent 2014; 42(12): Chen H, Liu X, Di J, Jing Z, Guo T, Ding Y. Effect of reminerlizing gents on white spot lesions fter orthodontic tretment: systemtic review. Am J Orthod Dentofcil Orthop 2013; 143(3): e3. 4 Hess E, Cmpbell PM, Honeymn AL, Buschng PH. Determinnts of enmel declcifiction during simulted orthodontic tretment. Angle Orthod 2011; 81(5): Lr-Crrillo E, Montiel-Bstid NM, Sánchez-Pérez L, Alnís-Tvir J. Effect of orthodontic tretment on sliv, plque nd the levels of Streptococcus mutns nd Lctobcillus. Med Orl Ptol Orl Cir Bucl 2010; 15(6):e924 e Chen C, Proli A, Pu A, Celerino de Mores Porto I. Comprtive evlution of the effectiveness of desensitizing gents in dentine tubule occlusion using scnning electron microcopy. Aust Dent J 2015; 60: Burwell AK, Litkowski LJ, Greenspn DC. Clcium sodium phosphosilicte (NovMin ): reminerliztion potentil. Adv Dent Res 2009; 22: Vhid Golpyegni M, Sohrbi A, Biri M, Ansri G. Reminerliztion effect of topicl NovMin versus sodium fluoride (1.1%) on cries-like lesions in permnent teeth. J Dent (Tehrn) 2012; 9(1): de Snt nn GR, dos Sntos EA, Sores LE, do Espírito Snto AM, Mrtin AA, Durte DA, et l. Dentl enmel irrdited with infrred diode lser nd photobsorbing crem: Prt 1 FT-Rmn Study. Photomed Lser Surg 2009; 27(3):

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