Development Of Carious Lesions Research Articles

Clinical Strategies for Managing Dental Caries in Egypt: Opinions of General Practitioner Dentists

Background: To assess the approach of GPDs in Upper Egypt regarding preventive and restorative treatments for various stages of carious lesion development. Methods: A 42-item questionnaire was constructed for obtaining the GPDs opinions. Factor analyses (with Varimax rotation) were conducted to identify scales (clusters) of variables .Logistic regression analyses, with continuing professional development as dependen t variable, were conducted to test for the effect of single and scaled factors regarding indications to perform preventive or restorative treatments. Original ResearchArticle

The effect of ER: YAG laser on enamel resistance to caries during orthodontic treatment: An in vitro study

Background: One common undesirable side effect of orthodontic treatment with fixed appliances is the development of incipient caries lesions around brackets, particularly in patients with poor oral hygiene. Different methods have been used to prevent demineralization; the recent effort to improve the resistance against the demineralization is by the application of lasers. Materials and method: Thirty human premolars extracted for orthodontic purposes were used to test the effect of two energy level of ER-YAG laser on enamel resistance to demineralization. The brackets were bonded on the teeth and all the labial surface excluding 2 mm area gingival to the brackets were painted with acid resistance varnish. Three groups were generated. The first group was the control group (A), with no treatment was performed. In group II (B)and groups III (C); teeth were irradiated by ER-YAG laser of 200, 60 mj energy respectively. All the teeth were individually subjected to acid challenge cycle for 30 days. After debonding longitudinal sections were taken and examined under stereomicroscope. The enamel demineralization evaluation was done by taking the average of three depths at the centre of the artificial lesion. Also the enamel surface was classified by an experienced investigator according to acid etch pattern. Comparisons of the average depth values of the groups were performed with ANOVA and LSD tests. The statistical significance level was set at p ≤ 0.05. Results: The results revealed that average lesion depth was significantly deeper at the control group than the laser groups, and its significantly deeper in group (B) 200 mj than in group (C) 60 mj, enamel surfaces showed deeper pits and craters than in control group. Conclusions: the decrease in artificial caries lesion depth associated with use of the two laser energy level support the ER-YAG laser as a tool to increase enamel resistance to demineralization and white spot lesion prevention. Key words: Demineralization, ER-YAG, laser.

A Comparative Study of Two High-Viscosity Ionomeric Cements for the Sealing of Newly Erupted Permanent Molars

Objective: To compare the retention and preventive aspects of two different types of high-viscosity glass ionomer cements for newly erupted permanent molars, considering the cost-benefit ratio in relation to public health. Material and Methods: fifty-four children (5-12 years) with erupted molars were selected. One hundred and fifty-four teeth were sealed, 75 with Ketac Molar (KM) and 79 with Vitro Molar (VM). Before and after sealant application, photos were taken and condensation silicone casts were produced in order to better classify tooth eruption stage and to assess the sealant retention rate. Results: Fifty-six percent of teeth sealed with KM showed fully retained material (FR) after the 5-month follow-up period; 18.4 % showed KM in two-thirds of the occlusal surface (partial retention 2- PP2); 23.7 % in one third of the occlusal surface (partial retention 1-PP1); and only 1.3 % of sealed teeth showed total loss (TL). Among teeth sealed with VM, 28.8 % showed total retention (TR) of the sealant after 5 months; 7.5 % of sealants were present in two-thirds of the occlusal surface (PP2); 10% were present in one third of the occlusal surface (PP1), and 53.7 % showed total loss of the sealant (TL). The development of only one active white spot caries lesion after total sealant loss was observed in the VM group. Conclusion: Occlusal surfaces of newly erupted permanent molars sealed with high-viscosity KM glass ionomer cement exhibited higher retention when compared to VM after a 5-the development of carious lesions in sealed teeth was similar in both materials, which confirms the good clinical performance of glass ionomer cement sealants in the evaluation period, being highly significant when considering the cost-benefit ratio in relation to public health (KM cost is 4 times higher than VM cost).

Erythritol May Reduce Dental Caries in High-Risk School Children

Article Title and Bibliographic Information Effect of erythritol and xylitol on dental caries prevention in children. Honkala S, Runnel R, Saag M, Olak J, Nommela R, Russak S, Makinen PL, Vahlberg T, Falony G, Makinen K, Honkala E. Caries Res 2014;48(5):482-90. Reviewer Jaana Gold, DDS, PhD Purpose/Question To determine the efficacy of daily consumption of erythritol, xylitol, and sorbitol candies by first- and second-graders on the development of enamel and dentin caries lesions. Source of Funding Cargill R&D Center Europe (Vilvoorde, Belgium), manufacturer of sweeteners Type of Study/Design Double-blind, cluster randomized clinical trial Level of Evidence Level 2: Limited-quality, patient-oriented evidence Strength of Recommendation Grade Not Applicable

Enamel Carious Lesion Development in Response to Sucrose and Fluoride Concentrations and to Time of Biofilm Formation: An Artificial-Mouth Study.

The aim of this study was to evaluate both sucrose and fluoride concentrations and time of biofilm formation on enamel carious lesions induced by an in vitro artificial-mouth caries model. For Study 1, biofilms formed by streptococci and lactobacilli were grown on the surface of human enamel slabs and exposed to artificial saliva containing 0.50 or 0.75 ppmF (22.5 h/d) and broth containing 3 or 5% sucrose (30 min; 3x/d) over 5 d. In Study 2, biofilms were grown in the presence of 0.75 ppmF and 3% sucrose over 3 and 9 days. Counts of viable cells on biofilms, lesion depth (LD), and the integrated mineral loss (IML) on enamel specimens were assessed at the end of the tested conditions. Counts of total viable cells and L. casei were affected by sucrose and fluoride concentrations as well as by time of biofilm formation. Enamel carious lesions were shallower and IML was lower in the presence of 0.75 ppmF than in the presence of 0.50 ppmF (P < 0.005). No significant effect of sucrose concentrations was found with respect to LD and IML (P > 0.25). Additionally, deeper lesions and higher IML were found after 9 d of biofilm formation (P < 0.005). Distinct sucrose concentrations did not affect enamel carious lesion development. The severity of enamel demineralization was reduced by the presence of the higher fluoride concentration. Additionally, an increase in the time of biofilm formation produced greater demineralization. Our results also suggest that the present model is suitable for studying aspects related to caries lesion development.

English

Periodontal disease and dental caries are infectious diseases resulting from the interactions of oral bacteria residing dental plaque and the host. The indigenous bacteria residing dental plaque are thought to be a relatively stable community of high species diversity, which may vary from site to site throughout the mouth. When this stability is disturbed, due to many host-specific and environmental factors, in addition to oral hygiene and dietary habits which the subjects can regulate, other less benign bacteria may colonize the oral cavity and the bacteria that are normally present in very low number may increase to cause oral diseases. The aim of this review paper is to highlight the oral microbial ecosystems in oral health and disease and to investigate the ecological changes that shift the indigenous bacteria residing dental plaque to be increased in number and cause oral diseases. The paper reviews the different oral ecosystems involving a variety of microbes and the balance between the growth of those microbes and the host health. In addition, the paper discusses the development of periodontal disease and dental caries according to plaque hypotheses. Relatively specific microfloras are associated with various types of periodontal conditions including Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia. The genera Streptococcus and Actinomyces are main indicators of periodontal health. The development of caries lesions appears to involve different bacterial succession. Mutans streptococci are implicated more with caries initiation, while lactobacilli appear to be related to progression of enamel and dentine lesions. Key words: Plaque hypotheses, periodontal disease, dental caries, bacterial interactions.

Effect of Erythritol and Xylitol on Dental Caries Prevention in Children

Objective: The aim of this study was to test the efficacy of long-term, daily intake of erythritol and xylitol candy, compared with sorbitol candy, on the development of enamel and dentin caries lesions. Methods: The study was a double-blind randomized controlled prospective clinical trial. Altogether 485 primary school children, first- and second-graders at baseline, from southeastern Estonia participated in this 3-year intervention. Each child consumed four erythritol, xylitol or sorbitol (control) candies three times per school day. The daily intake of polyol was about 7.5 g. The International Caries Detection and Assessment System (ICDAS) was used in the clinical examinations by four calibrated examiners at baseline and at 12, 24 and 36 months. Results: The annual examination analyses and the follow-up analyses confirmed that the number of dentin caries teeth and surfaces at 24 months follow-up and surfaces at 36 months follow-up was significantly lower in the mixed dentition in the erythritol group than in the xylitol or control group. Time of enamel/dentin caries lesions to develop and of dentin caries lesions to progress was significantly longer in the erythritol group compared to the sorbitol and xylitol groups. Also the increase in caries score was lower in the erythritol group than in the other groups. Conclusions: In the follow-up examinations, a lower number of dentin caries teeth and surfaces was found in the erythritol group than in the xylitol or control groups. Time to the development of caries lesions was longest in the erythritol group. Trial registration: ClinicalTrials.gov Identifier NCT01062633.

The state-of-the-art of ART sealants.

Sealing caries-prone pits and fissure systems is an effective caries-preventive measure. There are basically two types of sealant materials: glass-ionomer and resin-based materials. Low- and medium-viscosity glass-ionomers were initially used and showed a low level of retention. With the advent of the ART approach in the mid-nineties, high-viscosity glass-ionomers were introduced as sealant material and the retention rate of ART sealants increased substantially. As the effectiveness of a sealant is measured by its capacity to prevent (dentine) carious lesion development, sealant retention is considered a surrogate endpoint. The ART sealant protocol is described. Systematic reviews and meta-analysis covering low- medium- and high-viscosity glass-ionomer (ART) sealants have concluded that there is no evidence that either glass-ionomer or resin-based sealants prevent dentine carious lesions better. The annual dentine carious lesion development in teeth with high-viscosity glass-ionomer ART sealants over the first three years is 1%. These ART sealants have a high capacity of preventing carious lesion development. Because no electricity and running water is required, ART sealants can be placed both inside and outside the dental surgery. High-viscosity glass-ionomer ART sealants can be used alongside resin-based sealants.41:119-124

The effects of ionizing radiation on the development of human caries lesions in vitro

A radioterapia é associada a diversos efeitos colaterais, entre eles a cárie de radiação. O objetivo desse estudo foi avaliar o efeito da radiação ionizante no desenvolvimento de lesões cariosas utilizando um sistema bacteriano in vitro. Foram selecionados quinze terceiros molares humanos inclusos que foram seccionados em fragmentos vestibular (A, controle) e lingual (B, irradiado), e foram mantidos pareados até o término do estudo. O grupo B foi submetido à radioterapia de acordo com protocolo utilizado no tratamento radioterápico de cabeça e pescoço. Ambos os grupos foram expostos a um desafi o cariogênico utilizando um sistema bacteriano com S. mutans por 10, 20 e 30 dias (n = 5). As variáveis de profundidade, extensão e área das lesões formadas no limite amelo-dentinário foram medidas por um software acoplado ao microscópio de luz. A Tomografi a de coerência óptica (TCO) foi utilizada para visualizar as características morfológicas das lesões. Os resultados da microscopia de luz mostraram que, no período de 20 dias de desafi o bacteriano, ocorreu um resultado signifi cante, comparando a profundidade das lesões formadas entre os grupos A e B (p = 0.013). A análise de TCO não permitiu visualizar as camadas de cárie das lesões. Podemos concluir, dentro das limitações do estudo, que o tratamento radioterápico pode levar à formação de lesões de cárie mais profundas do que aquelas que se desenvolvem em dentes sem exposição à radiação ionizante.

Effect of Preventive Oral Hygiene Measures on the Development of New Carious lesions.

To evaluate the effect of preventive oral hygiene measures on the development of new carious lesions. Children regularly and irregularly attending recall appointments in a paediatric dental clinic were interviewed regarding their preventive measures performance. Newly developed carious lesions were also recorded. The files of 651 children were analysed. A significant negative correlation was found between newly developed carious lesions and total number (P < 0.001) and frequency (interval in months to the next dental examination) of recall appointments (P = 0.021), regular toothbrushing twice a day (P < 0.0001), regular brushing in the evening (P < 0.001), high fluoride concentration in toothpaste (P < 0.0001) and drinking water between meals (P = 0.015), but not with regular brushing in the morning or eating more than 6 times a day. Multivariate analysis revealed three of the variables independently correlated with the development of new carious lesions: brushing regularly twice a day, concentration of fluoride in the toothpaste greater than 1100 ppm and frequency of follow-ups. Regular toothbrushing twice a day is of high importance for caries prevention. Fluoride concentration of > 1100 ppm in toothpaste should be recommended for children (considering the child's age) in order to maximise the fluoride protective effect. The importance of attending periodic recall appointments in order to maintain long term oral health should be emphasised.

Use of ICDAS-II Criteria in the Detection of Caries Lesion in Cleft Lip and Palate Patients

Objective: To use the International Caries Detection and Assessment System (ICDAS-II) to evaluate the scores of different stages of caries lesion development in cleft lip and palate children. Material and Methods: Fifty cleft lip and palate children aged6-10 years at mixed dentition were selected. Two examiners, one after the other, performed the visual examination of dental surfaces. Firstly, the teeth were cleaned with the aid of pumice and water paste. The examination was carried out under the dental chair reflector, after air drying for 5 seconds with air-water syringe, and with the aid of a WHO probe. The sites comprising the sample were classified according to criteria proposed by ICDAS-II. Results: Ten children met the inclusion criteria. Twenty-five anterior teeth at the cleft area and 93 posterior teeth were assessed, totalizing 590 surfaces classified by ICDAS-II. Four hundred and ninety-four surfaces were scored as sound (code 0-0) regarding the Caries Lesion Condition. Only one surface was scored as partial sealant (code 1), according to the Tooth Surface Condition, but classified as sound regarding the Caries Lesion Condition (code 1-0). No surface exhibited stainless steel; porcelain, gold or porcelain fused to metal crowner veneer; lost or broken restoration; and temporary restoration (codes 5, 6, 7, and 8, respectively). Conclusion: ICDAS-II shows good performance in analyzing caries lesions through more specific assessment and more accurate examination, enabling the detection of caries lesion development at several stages.

INCIDENCE OF LOSS OF ANTERIOR TEETH DUE TO CARIES IN SOUTH INDIAN POPULATION IN 2009

Abstract Aim: To evaluate the incidence of loss of anterior teeth due to caries in 2000 patients randomly selected from the South Indian population in 2009. Material and Methods: 2000 patients were examined for incidence of loss of anterior teeth due to caries and the recorded data was statistically analysed using Pearson Chi-Square test. Results:Incidence of loss of anterior teeth due to caries in the population of South Canara district was found to be 16.3 %. It was observed that there was increased incidence of loss of anterior teeth in age group above 65 years. No difference in incidence of anterior tooth loss was observed between urban and rural patients and also between males and females. There was high rate of replacement for the missing lost anterior teeth. Conclusion: This study showed that less than one fourth population of South Canara district had missing anterior tooth due to caries. Since anterior teeth occupies a strategic position in the dental arch, it is necessary to know the caries prevalence in this tooth and take adequate measures to prevent its progression and/or development of new carious lesions.

Caries risk assessment models in caries prediction

The aim of this research was to assess the efficiency of different multifactor models in caries prediction. Data from the questionnaire and objective examination of 109 examinees was entered into the Cariogram, Previser and Caries-Risk Assessment Tool (CAT) multifactor risk assessment models. Caries risk was assessed with the help of all three models for each patient, classifying them as low, medium or high-risk patients. The development of new caries lesions over a period of three years [Decay Missing Filled Tooth (DMFT) increment = difference between Decay Missing Filled Tooth Surface (DMFTS) index at baseline and follow up], provided for examination of the predictive capacity concerning different multifactor models. The data gathered showed that different multifactor risk assessment models give significantly different results (Friedman test: Chi square = 100.073, p=0.000). Cariogram is the model which identified the majority of examinees as medium risk patients (70%). The other two models were more radical in risk assessment, giving more unfavorable risk -profiles for patients. In only 12% of the patients did the three multifactor models assess the risk in the same way. Previser and CAT gave the same results in 63% of cases - the Wilcoxon test showed that there is no statistically significant difference in caries risk assessment between these two models (Z = -1.805, p=0.071). Evaluation of three different multifactor caries risk assessment models (Cariogram, PreViser and CAT) showed that only the Cariogram can successfully predict new caries development in 12-year-old Bosnian children.

Effect of neovestitol–vestitol containing Brazilian red propolis on accumulation of biofilm in vitro and development of dental caries in vivo

The present study examined the influences of the neovestitol–vestitol (NV) containing fraction isolated from Brazilian red propolis on the development of biofilm and expression of virulence factors by Streptococcus mutans using saliva-coated surfaces of hydroxyapatite. In addition, NV was tested in a rodent model of dental caries to assess its potential effectiveness in vivo. Topical applications of NV (800 μg ml−1) significantly impaired the accumulation of biofilms of S. mutans by largely disrupting the synthesis of glucosyltransferase-derived exopolysaccharides and the expression of genes associated with the adaptive stress response, such as copYAZ and sloA. Of even greater impact, NV was as effective as fluoride (positive control) in reducing the development of carious lesions in vivo. NV is a promising natural anti-biofilm agent that targets essential virulence traits in S. mutans, which are associated with the formation of cariogenic biofilm and the subsequent onset of dental caries disease.

The atraumatic restorative treatment (ART) strategy in Mexico: two-years follow up of ART sealants and restorations

BackgroundThe massive use of preventive measures in Mexico has resulted in a large decline in dental caries over the past two decades. There does however remain a largely unmet need for restorative treatment. This paper describes the steps leading up to the adoption of a strategy, as part of general health policy, to use Atraumatic Restorative Treatment (ART) within the Mexican public health service as a means of addressing this. The objective was to evaluate ART restorations and sealants placed in primary and permanent teeth in schoolchildren from deprived areas over a period of 2 years.Methods18 Dentists from 13 municipalities in 6 states with the lowest human development index treated 304, 6- to 13-year-old schoolchildren with ART sealants and ART restorations (single-surfaces) on the school compounds. Ketac Molar Easymix was the filling material used. ART procedures were evaluated according to the ART assessment criteria after 1 and 2 years, by 7 calibrated evaluators. Survival rates were estimated, using the PHREG Model with frailty correction.ResultsThe 2-year cumulative survival rates of fully and partially retained ART sealants were 73.1% (primary teeth) and 48.8% (permanent teeth). The dentine carious lesion failure rates of ART sealants in primary and permanent teeth over the 2-year period were 0% and 2.5%, respectively. The 2-year cumulative survival rates of single-surface ART restorations in primary and permanent teeth were 74% and 80.9%, respectively. Secondary carious lesion development occurred in 6 restored primary teeth (2.1%) and in one restored permanent tooth (1.3%). All restorations placed in primary teeth in one state survived, whilst those in one of the 5 remaining states failed statistically significantly more than those in the other 4.ConclusionsThe ART procedures were of substantial quality and had prevented to a large extent the development of new dentine carious lesions in these children from socio-economically deprived areas.

Fluoride releasing and enamel demineralization around orthodontic brackets by fluoride-releasing composite containing nanoparticles

Fluoride-containing materials have been suggested to control enamel demineralization around orthodontic brackets during the treatment with fixed appliances. The improvement of their properties has been made through innovations, such as the application of nanotechnology by incorporation of nanofillers. This in vitro study evaluated the capacity of fluoride releasing and enamel demineralization inhibition of fluoride-releasing nanofilled cement around orthodontic brackets using an artificial caries biofilm model. Forty bovine enamel discs were selected by evaluating surface microhardness and randomized into four groups (n = 10): non-fluoride-releasing microfilled composite, fluoride-releasing microfilled composite, resin-modified glass ionomer cement (RMGI), and fluoride-releasing nanofilled composite (FN). After brackets bonding in each disc, the specimens were subjected to a cariogenic challenge through a Streptococcus mutans biofilm model. After the experimental period, the biofilm formed around the brackets was collected for fluoride analysis and the mineral loss around the brackets was determined by integrated demineralization via cross-sectional microhardness measurement at 20 and 70 μm from the bracket margin. Additionally, samples of each group were subjected to energy-dispersive X-ray spectroscopy (EDX) analysis examined under a scanning electron microscopy (SEM). ANOVA followed by Tukey test were applied for fluoride concentration and mineral loss data, respectively. At both distances, only RMGI statistically differed from the other groups presenting the lowest demineralization, although there was a trend to a lower demineralization of enamel around brackets in FN group. Similar condition was found to fluoride concentration and EDX/SEM analysis. Under the cariogenic exposure condition of this study, the fluoride-releasing nanofilled material had similar performance to fluoride-releasing microfilled materials. The presence of nanofillers in the fluoride-releasing materials studied did not promote further benefits against caries lesion development around brackets and presented inferior demineralization inhibition than the resin-modified glass ionomer material.

The Use of Probiotic Strains in Caries Prevention: A Systematic Review

This paper aims to provide a systematic review of the caries-prevention effect of probiotics in human. The hypothesis was that the administration of probiotic strains might play a role in caries lesion prevention and in the control of caries-related risk factors. The main relevant databases (Medline, Embase) were searched. Quality of the Randomized Clinical Trials (RCTs) was classified using the “Consolidated Standards of Reporting Trials” (CONSORT) checklist and the Impact Factor (IF) value of each journal was recorded. Sixty-six papers were identified, and 23 fulfilled the inclusion criteria. Only three studies had caries lesion development as outcome, all the others reported caries risk factors as interim evaluation. Using the CONSORT Score, the papers were coded as 4 excellent, 9 good and 10 poor. The mean IF value recorded was 1.438. Probiotics may play a role as antagonistic agent on mutans streptococci (MS), acidogenic/aciduric bacteria that contributes to the caries process. In two-thirds of the selected papers, probiotics have demonstrated the capacity to reduce MS counts in saliva and/or plaque in short-term. The effect of probiotics on the development of caries lesion seems encouraging, but to date, RCTs on this topic are insufficient to provide scientific clinical evidence.

Influence of CO2 (10.6 μm) and Nd:YAG laser irradiation on the prevention of enamel caries around orthodontic brackets

One possible undesirable consequence of orthodontic therapy is the development of incipient caries lesions of enamel around brackets. The aim of this study was to compare the effects of CO2 (λ = 10.6 μm) and Nd:YAG (λ = 1,064 nm) lasers associated or not with topical fluoride application on the prevention of caries lesions around brackets. Brackets were bonded to the enamel of 65 premolars. The experimental groups (n = 13) were: G1--application of 1.23% acidulated fluoride phosphate gel (AFP, control); G2--Nd:YAG laser irradiation (0.6 W, 84.9 J/cm(2), 10 Hz, 110 μs, contact mode); G3--Nd:YAG laser irradiation associated with AFP; G4--CO2 laser irradiation (0.5 W, 28.6 J/cm(2), 50 Hz, 5 μs, and 10 mm focal distance); and G5--CO2 laser irradiation associated with AFP. Quantitative light-induced fluorescence was used to assess enamel demineralization. The data were statistically compared (α = 5%). The highest demineralization occurred in the Nd:YAG laser group (G2, 26.15% ± 1.94). The demineralization of all other groups was similar to that of the control group. In conclusion, CO2 laser alone was able to control enamel demineralization around brackets at the same level as that obtained with topical fluoride application.

Laser application in prevention of demineralization in orthodontic treatment.

One common negative side effect of orthodontic treatment with fixed appliances is the development of incipient caries lesions around brackets, particularly in patients with poor oral hygiene. Different methods have been used to prevent demineralization such as fluoride therapy and application of sealant to prevent caries. The recent effort to improve the resistance against the demineralization is by the application of different types of lasers. The purpose of this review article is discussing the effects of laser in prevention of demineralization in orthodontic patients.

Hydrodynamic Flow through Loading and in vitro Secondary Caries Development

This in vitro study investigated the effect of hydrodynamic flow through mechanical loading on development of secondary caries lesions. Forty-eight bovine tooth specimens (enamel and dentin; sizes 3.2 x 3.2 x 2.0 mm) were restored with resin-composite on polystyrene bars; 18 samples were bonded, and 30 were not bonded. Specimens were suspended in a lactic acid solution (pH = 5; 14 days) in a modified brushing machine, and artificial caries lesions were formed. During caries development, specimens were mechanically loaded at the surface of the polystyrene bar, bent so that the tooth- composite interfaces were subjected to opening forces (16x/min). Loads applied were either none (Control Bonded, CB, n = 6; and Control Non-bonded, CNB, n = 6), 200 gr (NB200, n = 12), or 350 gr (NB350 and B350, both n = 12). Before and after caries development, specimens were imaged with transverse wavelength-independent microradiography (T-WIM), and lesion depth (LD) and mineral loss (ML) were calculated at 4 different locations. An independent t test was used to compare the LD and ML at the 4 different locations. A statistically significant effect of the level of loading (comparing groups NB200 and NB350) and of bonding (comparing groups NB350 and B350) could be observed, with a higher load and absence of bonding leading to more advanced lesions.