Análise da ação de catequinas derivadas do chá verde em dentina humana erosivamente desmineralizada: estudos in vitro e in situ
| Ano de defesa: | 2016 |
|---|---|
| Autor(a) principal: | |
| Orientador(a): | |
| Banca de defesa: | |
| Tipo de documento: | Tese |
| Tipo de acesso: | Acesso aberto |
| Idioma: | por |
| Instituição de defesa: |
Não Informado pela instituição
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| Programa de Pós-Graduação: |
Não Informado pela instituição
|
| Departamento: |
Não Informado pela instituição
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| País: |
Não Informado pela instituição
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| Palavras-chave em Português: | |
| Link de acesso: | http://www.repositorio.ufc.br/handle/riufc/22023 |
Resumo: | The objective of this study was to evaluate and compare the action of different enzyme inhibitors on human dentin in cyclical erosion challenging situation. To this were carried out 3 projects that yielded the following chapters: In the chapter 1 and 2, coronary or root human (n=10) dentin blocks (4x4x2 mm) were submitted cyclically (3x/ day/3 days) to erosive challenge by immersion in acid [dehydrated citric acid (C6H8O7), pH 3.75, 60 s] followed by treatments depending on the group: G1-distilled water; G2- 0.12% Chlorhexidine digluconate (CHX); G3- Green tea infusion (GT). The blocks were analyzed daily by surface profilometry and hardness. In the chapter 3, a randomized, blinded, crossover, in situ study in which 20 volunteers used palatal intra oral device for three phases of 5 days each, containing 4 blocks of human dentin. They were immersed in human saliva for 2 hours to acquired pellicle formation. The erosive challenge was performed by the device immersion in 50 mL of Coke™ (pH 2.6, 4x/ day /1 min, extraorally) followed by treatment (4x/ day) by dropping on blocks 1 mL of the following solutions: G1- 0.05% Sodium fluoride, G2- 0.1% Epigallocatechin-3-gallate (EGCG), G3- Green tea infusion. At each phase the volunteer used only one substance. Quantitative analyzes were performed, such as percentage loss of surface hardness, roughness and wear, as well as qualitative analysis by scanning electron microscopy. Complementing the studies to analysis of enzyme inhibition, human dentin blocks were milled, subjected to erosion by citric acid and subjected to extraction of soluble proteins. Electrophoresis was performed and then the gel was incubated for 3 h in renaturation buffer modified according to the groups G1: without modification, G2- 0.12% chlorhexidine digluconate, G3- 0.05% NaF, G4- Green tea and G5- 0.1% EGCG. Gels were stained in a solution containing 0.025% Coomassie blue and destained with acetic acid 10% solution to verify the possible inhibitory action of the substances evaluated on the collagenolytic enzymes. Then were subjected to colorimetric enzyme inhibition test, in which the absorbance was measured. After extraction of dentin proteins, protein quantification by Bradford’s method was performed, which showed 0.15 µg soluble proteins. The results were analyzed using the Kolmogorov-Smirnov test to evaluate the normal range of results, followed by analysis of variance (ANOVA) and Tukey test, using a significance level of 5%. Results: A significant reduction in the dentin hardness loss in coronary dentin in vitro with the use of CHX and GT in comparison to the control (p <0.05). Treatment with GT significantly reduced wear and roughness of dentin in vitro (p <0.05). In relation to in vitro study on root dentin, the treatment with GT reduced the wear and roughness (p <0.05). There was no statistically significant difference between the groups regarding the loss of surface hardness of root dentin in vitro (p> 0.05). As for the in situ study, treatment with EGCG and GT reduced the loss of dentin hardness significantly (p <0.05). On the other hand, there was no significant difference in relation to wear and roughness values (p> 0.05). For zymography analysis, 0.12% CHX, green tea and 0.1% EGCG showed inhibitory action on the extracted metalloproteinases dentin and, the colorimetric assay green tea has enzimatic inhibition similar to standard inhibitor. Conclusion: Green tea solution reduces in vitro wear and roughness of coronary and root dentin erosively demineralized. The 0.1% EGCG and green tea reduce erosion damage on coronal dentin in situ and contribute to inactivate MMPs extracted dentin. |
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Bezerra, Maria Denise Rodrigues de MoraesSantiago, Sérgio Lima2017-02-15T15:30:04Z2017-02-15T15:30:04Z2016-12-12BEZERRA, M. D. R. M. Análise da ação de catequinas derivadas do chá verde em dentina humana erosivamente desmineralizada: estudos in vitro e in situ. 2016. 96 f. Tese (Doutorado em Odontologia) - Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará, Fortaleza, 2016.http://www.repositorio.ufc.br/handle/riufc/22023The objective of this study was to evaluate and compare the action of different enzyme inhibitors on human dentin in cyclical erosion challenging situation. To this were carried out 3 projects that yielded the following chapters: In the chapter 1 and 2, coronary or root human (n=10) dentin blocks (4x4x2 mm) were submitted cyclically (3x/ day/3 days) to erosive challenge by immersion in acid [dehydrated citric acid (C6H8O7), pH 3.75, 60 s] followed by treatments depending on the group: G1-distilled water; G2- 0.12% Chlorhexidine digluconate (CHX); G3- Green tea infusion (GT). The blocks were analyzed daily by surface profilometry and hardness. In the chapter 3, a randomized, blinded, crossover, in situ study in which 20 volunteers used palatal intra oral device for three phases of 5 days each, containing 4 blocks of human dentin. They were immersed in human saliva for 2 hours to acquired pellicle formation. The erosive challenge was performed by the device immersion in 50 mL of Coke™ (pH 2.6, 4x/ day /1 min, extraorally) followed by treatment (4x/ day) by dropping on blocks 1 mL of the following solutions: G1- 0.05% Sodium fluoride, G2- 0.1% Epigallocatechin-3-gallate (EGCG), G3- Green tea infusion. At each phase the volunteer used only one substance. Quantitative analyzes were performed, such as percentage loss of surface hardness, roughness and wear, as well as qualitative analysis by scanning electron microscopy. Complementing the studies to analysis of enzyme inhibition, human dentin blocks were milled, subjected to erosion by citric acid and subjected to extraction of soluble proteins. Electrophoresis was performed and then the gel was incubated for 3 h in renaturation buffer modified according to the groups G1: without modification, G2- 0.12% chlorhexidine digluconate, G3- 0.05% NaF, G4- Green tea and G5- 0.1% EGCG. Gels were stained in a solution containing 0.025% Coomassie blue and destained with acetic acid 10% solution to verify the possible inhibitory action of the substances evaluated on the collagenolytic enzymes. Then were subjected to colorimetric enzyme inhibition test, in which the absorbance was measured. After extraction of dentin proteins, protein quantification by Bradford’s method was performed, which showed 0.15 µg soluble proteins. The results were analyzed using the Kolmogorov-Smirnov test to evaluate the normal range of results, followed by analysis of variance (ANOVA) and Tukey test, using a significance level of 5%. Results: A significant reduction in the dentin hardness loss in coronary dentin in vitro with the use of CHX and GT in comparison to the control (p <0.05). Treatment with GT significantly reduced wear and roughness of dentin in vitro (p <0.05). In relation to in vitro study on root dentin, the treatment with GT reduced the wear and roughness (p <0.05). There was no statistically significant difference between the groups regarding the loss of surface hardness of root dentin in vitro (p> 0.05). As for the in situ study, treatment with EGCG and GT reduced the loss of dentin hardness significantly (p <0.05). On the other hand, there was no significant difference in relation to wear and roughness values (p> 0.05). For zymography analysis, 0.12% CHX, green tea and 0.1% EGCG showed inhibitory action on the extracted metalloproteinases dentin and, the colorimetric assay green tea has enzimatic inhibition similar to standard inhibitor. Conclusion: Green tea solution reduces in vitro wear and roughness of coronary and root dentin erosively demineralized. The 0.1% EGCG and green tea reduce erosion damage on coronal dentin in situ and contribute to inactivate MMPs extracted dentin.O presente estudo avaliou a ação de catequinas do chá verde em dentina humana sob situação de desafio erosivo e originou três capítulos. Nos dois primeiros, blocos de dentina humana (n=10) coronária ou radicular (4x4x2mm) foram imersos em saliva (2h) para formação de película adquirida. Foram submetidos de forma cíclica (3x/dia-3 dias) ao desafio erosivo pela imersão em ácido cítrico (60s), seguido pelos tratamentos: G1-Água destilada (AD), G2-Solução de gluconato de clorexidina 0,12% (CLX), G3-Infusão de chá verde (CV). Os espécimens permaneciam em saliva artificial entre os desafios e sob agitação (37ºC). A microdureza de superfície e perfilometria dos blocos foram analisadas diariamente. O estudo in situ foi randomizado, cego, cruzado e 20 voluntários utilizaram dispositivo intra-oral, contendo 4 blocos de dentina humana, por três fases de 5 dias cada. Foi realizada imersão extra-oral do dispositivo em 50 mL de Coca-Cola® (4x/dia-1min), seguida por gotejamento (1mL, 4x/dia) sobre os blocos: G1-solução de fluoreto de sódio (NaF) 0,05%, G2-epigalocatequina-3-galato (EGCG) 0,1%, G3-CV. Foram realizadas análises de microdureza de superfície, perfilometria e microscopia eletrônica de varredura. Para análise da inibição enzimática, blocos de dentina humana foram congelados, moídos, submetidos à erosão por ácido cítrico (24h) e extração de proteínas solúveis. O pool de proteínas extraído foi utilizado como fonte de metaloproteinases (MMPs), foi tratado: G1-sem tratamento, G2-CLX 0,12%, G3-NaF 0,05%, G4-CV, G5-EGCG 0,1% e foi submetido ao ensaio colorimétrico de inibição enzimática. Foi realizada a eletroforese das enzimas extraídas em gel de acrilamida sob condições não redutoras. O gel foi encubado por 3h em tampão de renaturação modificado pelo acréscimo das soluções: G1-sem modificação, G2-CLX 0,12%, G3-NaF 0,05%, G4-CV e G5-EGCG 0,1%, e corado em solução contendo 0,025% Comassie blue e descorado com solução de ácido acético (10%). O padrão de normalidade dos dados foi analisado pelo teste de Kolmogorov-Smirnov, seguido por Análise de variância e teste de Tukey (α=5%). Foi observada redução na perda de dureza da dentina coronária in vitro com o uso de CLX e CV em comparação com o controle. O tratamento com CV reduziu significativamente o desgaste e a rugosidade da dentina coronária in vitro. O tratamento in vitro com CV reduziu estatisticamente o desgaste e a rugosidade da dentina radicular quando comparado ao controle e à CLX. Não houve diferença estatisticamente significante entre os grupos em relação à perda de dureza de superfície de dentina radicular in vitro. Quanto ao estudo in situ, os tratamentos com EGCG e CV reduziram a perda de dureza da dentina significativamente. Por outro lado, não houve diferença estatística nos valores de desgaste e rugosidade. A zimografia demonstrou que a CLX 0,12%, o CV e o EGCG 0,1% apresentaram ação inibitória sobre as MMPs, enquanto que no ensaio colorimétrico o CV apresentou inibição enzimática. A solução de CV reduz in vitro o desgaste e a rugosidade da dentina coronária e radicular erosivamente desmineralizada. O CV e a EGCG 0,1% reduzem os danos causados pela erosão em dentina coronária in situ e contribuem para inativação de MMPs extraídas da dentina.EletroforeseErosão DentáriaInibidores Teciduais de MetaloproteinasesMetaloproteinases da MatrizDesgaste dos DentesAnálise da ação de catequinas derivadas do chá verde em dentina humana erosivamente desmineralizada: estudos in vitro e in situAnalysis of the action of catechins derived from green tea in erosively demineralized human dentine: in vitro and in situ studiesinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisporreponame:Repositório Institucional da Universidade Federal do Ceará (UFC)instname:Universidade Federal do Ceará (UFC)instacron:UFCinfo:eu-repo/semantics/openAccessORIGINAL2016_tese_mdrmbezerra.pdf2016_tese_mdrmbezerra.pdfapplication/pdf10780082http://repositorio.ufc.br/bitstream/riufc/22023/1/2016_tese_mdrmbezerra.pdf512cdb0ee2d834a34a184328888c8e24MD51LICENSElicense.txtlicense.txttext/plain; charset=utf-81748http://repositorio.ufc.br/bitstream/riufc/22023/2/license.txt8a4605be74aa9ea9d79846c1fba20a33MD52riufc/220232019-01-30 13:21:17.41oai:repositorio.ufc.br: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Repositório InstitucionalPUBhttp://www.repositorio.ufc.br/ri-oai/requestbu@ufc.br || repositorio@ufc.bropendoar:2019-01-30T16:21:17Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC)false |
| dc.title.pt_BR.fl_str_mv |
Análise da ação de catequinas derivadas do chá verde em dentina humana erosivamente desmineralizada: estudos in vitro e in situ |
| dc.title.en.pt_BR.fl_str_mv |
Analysis of the action of catechins derived from green tea in erosively demineralized human dentine: in vitro and in situ studies |
| title |
Análise da ação de catequinas derivadas do chá verde em dentina humana erosivamente desmineralizada: estudos in vitro e in situ |
| spellingShingle |
Análise da ação de catequinas derivadas do chá verde em dentina humana erosivamente desmineralizada: estudos in vitro e in situ Bezerra, Maria Denise Rodrigues de Moraes Eletroforese Erosão Dentária Inibidores Teciduais de Metaloproteinases Metaloproteinases da Matriz Desgaste dos Dentes |
| title_short |
Análise da ação de catequinas derivadas do chá verde em dentina humana erosivamente desmineralizada: estudos in vitro e in situ |
| title_full |
Análise da ação de catequinas derivadas do chá verde em dentina humana erosivamente desmineralizada: estudos in vitro e in situ |
| title_fullStr |
Análise da ação de catequinas derivadas do chá verde em dentina humana erosivamente desmineralizada: estudos in vitro e in situ |
| title_full_unstemmed |
Análise da ação de catequinas derivadas do chá verde em dentina humana erosivamente desmineralizada: estudos in vitro e in situ |
| title_sort |
Análise da ação de catequinas derivadas do chá verde em dentina humana erosivamente desmineralizada: estudos in vitro e in situ |
| author |
Bezerra, Maria Denise Rodrigues de Moraes |
| author_facet |
Bezerra, Maria Denise Rodrigues de Moraes |
| author_role |
author |
| dc.contributor.author.fl_str_mv |
Bezerra, Maria Denise Rodrigues de Moraes |
| dc.contributor.advisor1.fl_str_mv |
Santiago, Sérgio Lima |
| contributor_str_mv |
Santiago, Sérgio Lima |
| dc.subject.por.fl_str_mv |
Eletroforese Erosão Dentária Inibidores Teciduais de Metaloproteinases Metaloproteinases da Matriz Desgaste dos Dentes |
| topic |
Eletroforese Erosão Dentária Inibidores Teciduais de Metaloproteinases Metaloproteinases da Matriz Desgaste dos Dentes |
| description |
The objective of this study was to evaluate and compare the action of different enzyme inhibitors on human dentin in cyclical erosion challenging situation. To this were carried out 3 projects that yielded the following chapters: In the chapter 1 and 2, coronary or root human (n=10) dentin blocks (4x4x2 mm) were submitted cyclically (3x/ day/3 days) to erosive challenge by immersion in acid [dehydrated citric acid (C6H8O7), pH 3.75, 60 s] followed by treatments depending on the group: G1-distilled water; G2- 0.12% Chlorhexidine digluconate (CHX); G3- Green tea infusion (GT). The blocks were analyzed daily by surface profilometry and hardness. In the chapter 3, a randomized, blinded, crossover, in situ study in which 20 volunteers used palatal intra oral device for three phases of 5 days each, containing 4 blocks of human dentin. They were immersed in human saliva for 2 hours to acquired pellicle formation. The erosive challenge was performed by the device immersion in 50 mL of Coke™ (pH 2.6, 4x/ day /1 min, extraorally) followed by treatment (4x/ day) by dropping on blocks 1 mL of the following solutions: G1- 0.05% Sodium fluoride, G2- 0.1% Epigallocatechin-3-gallate (EGCG), G3- Green tea infusion. At each phase the volunteer used only one substance. Quantitative analyzes were performed, such as percentage loss of surface hardness, roughness and wear, as well as qualitative analysis by scanning electron microscopy. Complementing the studies to analysis of enzyme inhibition, human dentin blocks were milled, subjected to erosion by citric acid and subjected to extraction of soluble proteins. Electrophoresis was performed and then the gel was incubated for 3 h in renaturation buffer modified according to the groups G1: without modification, G2- 0.12% chlorhexidine digluconate, G3- 0.05% NaF, G4- Green tea and G5- 0.1% EGCG. Gels were stained in a solution containing 0.025% Coomassie blue and destained with acetic acid 10% solution to verify the possible inhibitory action of the substances evaluated on the collagenolytic enzymes. Then were subjected to colorimetric enzyme inhibition test, in which the absorbance was measured. After extraction of dentin proteins, protein quantification by Bradford’s method was performed, which showed 0.15 µg soluble proteins. The results were analyzed using the Kolmogorov-Smirnov test to evaluate the normal range of results, followed by analysis of variance (ANOVA) and Tukey test, using a significance level of 5%. Results: A significant reduction in the dentin hardness loss in coronary dentin in vitro with the use of CHX and GT in comparison to the control (p <0.05). Treatment with GT significantly reduced wear and roughness of dentin in vitro (p <0.05). In relation to in vitro study on root dentin, the treatment with GT reduced the wear and roughness (p <0.05). There was no statistically significant difference between the groups regarding the loss of surface hardness of root dentin in vitro (p> 0.05). As for the in situ study, treatment with EGCG and GT reduced the loss of dentin hardness significantly (p <0.05). On the other hand, there was no significant difference in relation to wear and roughness values (p> 0.05). For zymography analysis, 0.12% CHX, green tea and 0.1% EGCG showed inhibitory action on the extracted metalloproteinases dentin and, the colorimetric assay green tea has enzimatic inhibition similar to standard inhibitor. Conclusion: Green tea solution reduces in vitro wear and roughness of coronary and root dentin erosively demineralized. The 0.1% EGCG and green tea reduce erosion damage on coronal dentin in situ and contribute to inactivate MMPs extracted dentin. |
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2016 |
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2016-12-12 |
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2017-02-15T15:30:04Z |
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2017-02-15T15:30:04Z |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/doctoralThesis |
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BEZERRA, M. D. R. M. Análise da ação de catequinas derivadas do chá verde em dentina humana erosivamente desmineralizada: estudos in vitro e in situ. 2016. 96 f. Tese (Doutorado em Odontologia) - Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará, Fortaleza, 2016. |
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http://www.repositorio.ufc.br/handle/riufc/22023 |
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BEZERRA, M. D. R. M. Análise da ação de catequinas derivadas do chá verde em dentina humana erosivamente desmineralizada: estudos in vitro e in situ. 2016. 96 f. Tese (Doutorado em Odontologia) - Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará, Fortaleza, 2016. |
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Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC) |
| repository.mail.fl_str_mv |
bu@ufc.br || repositorio@ufc.br |
| _version_ |
1847793348933320704 |