Abstract There are many suitable strategies for addressing caries, which is an ongoing worldwide problem. Although white spot lesions (WSLs) can be either remineralized naturally or treated with non- or micro-invasive strategies, their whitish and opaque appearance may persist. Objective To evaluate the effects of tooth bleaching as a complement to fluoride-enhanced remineralization or resin infiltration in masking WSLs, as well as in enamel surface roughness relative to that of the adjacent enamel. Methodology Flattened rectangular bovine enamel fragments (6×3×~2.9 mm length, width and thickness) were divided into six groups (L/N, F/N, F.BL/BL, I/N, I.BL/BL, N/N; n=15). Treatments applied to the 3×3 mm left half included: L (Lesion) - WSL simulation with 50 mM acetate buffer, 96 hours, 37ºC; F (Fluoride) - WSL treatment with 2% NaF neutral gel, 1x/week, 8 weeks; I (Infiltration) - WSL treatment with H3PO4 37%/10 s; Icon®-Dry/30 s; Icon®-Infiltrant/3 min+1 min; N (Nothing) - sound enamel/control. Treatments applied to both halves after F and I included: BL (Bleaching) - Opalescence Boost 40%, 3×/20 min each; N (Nothing) - control. The differences in color (ΔE00, ΔL, Δa, Δb) and surface roughness (ΔRa) between the left and right halves were measured. Kruskal-Wallis/post-hoc tests were applied to ΔE00, ΔL, Δa and ΔRa, and 1-way ANOVA/Tukey tests to Δb (α=0.05). Results The factor under study significantly influenced ΔE00 (p=0.0001), ΔL (p=0.0024), Δb (p=0.0015), and ΔRa (p<0.001), but not Δa (p=0.1592). Both fluoride-enhanced remineralization and resin infiltration were able to mask WSL, regardless of subsequent bleaching. However, when bleaching was performed, ΔE00 median values did not exceed the acceptability threshold for color difference. Only resin infiltration reduced ΔRa between WSL and the adjacent enamel. Conclusions Both remineralization and infiltration, particularly if complemented by bleaching, fostered satisfactory esthetic results. Only infiltration without bleaching led to really good results in surface roughness. caries problem WSLs (WSLs non microinvasive micro invasive persist fluorideenhanced fluoride enhanced 6×3×~2.9 6329 6 3 2 9 (6×3×~2. length thickness L/N, LN (L/N FN F/N FBLBL F.BL/BL IN I/N IBLBL I.BL/BL N/N NN n=15. n15 n n=15 . 15 n=15) 33 3× included Lesion (Lesion 5 buffer hours 37ºC ºC Fluoride (Fluoride gel 1xweek xweek 1x week x 1x/week weeks Infiltration (Infiltration HPO H PO H3PO 3710 37 10 37%/1 s Icon®Dry/30 IconDry30 IconDry Icon® Dry/30 Icon Dry 30 Icon®-Dry/3 Icon®Infiltrant/3 IconInfiltrant3 IconInfiltrant Infiltrant/3 Infiltrant Icon®-Infiltrant/ min1 1 min+ Nothing (Nothing enamelcontrol control enamel/control Bleaching (Bleaching 40 40% 320 20 3×/2 each ΔE (ΔE00 (ΔRa measured KruskalWallis/posthoc KruskalWallisposthoc Kruskal Wallis/post hoc Wallis post 1way way ANOVATukey ANOVA Tukey α=0.05. α005 α α=0.05 0 05 (α=0.05) ΔE0 p=0.0001, p00001 p p=0.0001 , 0001 (p=0.0001) p=0.0024, p00024 p=0.0024 0024 (p=0.0024) p=0.0015, p00015 p=0.0015 0015 (p=0.0015) p<0.001, p0001 p<0.001 001 (p<0.001) p=0.1592. p01592 p=0.1592 1592 (p=0.1592) However performed difference 6×3×~2. 632 (6×3×~2 L/N n1 n=1 371 37%/ Icon®Dry/3 IconDry3 Dry30 Dry/3 Icon®-Dry/ Icon®Infiltrant/ Infiltrant3 Infiltrant/ Icon®-Infiltrant 4 32 3×/ (ΔE0 KruskalWallis posthoc Wallispost α00 α=0.0 (α=0.05 p0000 p=0.000 000 (p=0.0001 p0002 p=0.002 002 (p=0.0024 p=0.001 (p=0.0015 p000 p<0.00 00 (p<0.001 p0159 p=0.159 159 (p=0.1592 6×3×~2 63 (6×3×~ n= 37% Icon®Dry/ Dry3 Dry/ Icon®-Dry Icon®Infiltrant (ΔE α0 α=0. (α=0.0 p=0.00 (p=0.000 (p=0.002 (p=0.001 p00 p<0.0 (p<0.00 p015 p=0.15 (p=0.159 6×3×~ (6×3× Icon®Dry α=0 (α=0. p=0.0 (p=0.00 p0 p<0. (p<0.0 p01 p=0.1 (p=0.15 6×3× (6×3 α= (α=0 p=0. (p=0.0 p<0 (p<0. (p=0.1 6×3 (6× (α= p=0 (p=0. p< (p<0 6× (6 (α p= (p=0 (p< ( (p= (p

RESUMO Objetivo: demonstrar a viabilidade do uso da análise acústica dos sons da deglutição como método conjugado à avaliação clínica em pacientes traqueostomizados acometidos por traumatismo cranioencefálico. Métodos: estudo observacional do tipo transversal. Participaram deste estudo 10 pacientes adultos, com idade média de 43,6 anos internados em leito hospitalar, unidades de terapias intensivas ou semi-intensivas, no período de maio a julho de 2016. O critério para inclusão foi ser acometido por traumatismo cranioencefálico, confirmado por tomografia axial computadorizada. Foi aplicado o Protocolo Fonoaudiológico de Decanulação Traqueal para a avaliação clínica e a ausculta cervical por meio do Sonar Doppler. Foi aplicado o Test Fischer e não foi encontrada relação significante (p>0,05), entre as variáveis analisadas nas duas consistências e na decanulação. Resultados: foi observada a presença de sinal acústico de elevação laríngea, presença de ruído entre as deglutições, presença de sinal acústico sugestivo de resíduo em 50% dos pacientes, para as consistências testadas. Quando correlacionados a relação entre frequência de pico, tempo médio da onda, presença de resíduo entre as deglutições, sinal acústico sugestivo de resíduos e decanulação (Tabela 5), verificou-se que não existe correlação significante (p>0,05) entre as variáveis analisadas nas duas consistências e a decanulação. Conclusão: o estudo sugere que o uso do Sonar Doppler é viável como método conjugado na avaliação clínica das disfagias para a decanulação de pacientes acometidos por traumatismo cranioencefálico.

ABSTRACT Purpose: to demonstrate the feasibility of using the acoustic analysis of swallowing sounds as a combined method in the clinical assessment of tracheostomized patients affected by traumatic brain injury. Methods: an observational, cross-sectional study. A total of 10 adult patients, in the mean age of 43.6 years, participated. They were hospitalized in wards, semi-intensive, or intensive care units, from May to July 2016. The inclusion criterion involved being affected by traumatic brain injury, confirmed with a CT scan. The Speech Therapy Tracheal Decannulation Protocol was used in the clinical assessment, as well as the cervical auscultation with the Doppler sonar. Fisher’s test was used, resulting in no significant relationship (p > 0.05) between the variables analyzed in the two consistencies and decannulation. Results: the presence of an acoustic signal of laryngeal elevation was observed, as well as noise between the swallowings, and acoustic signal suggestive of residue in 50% of the patients for the consistencies tested. When the peak frequency, mean wave time, presence of residue in between swallowings, and acoustic signal suggestive of residues were correlated with decannulation (Table 5), no significant correlation was verified (p > 0.05) between the variables analyzed in the two consistencies and the decannulation. Conclusion: the study suggests that it is feasible to use the Doppler sonar as a combined method in the clinical assessment of dysphagia for the decannulation of patients affected by traumatic brain injury.