Analytical strategies for clinical studies on dental erosive wear

K R Stenhagen,B Holme,A B Tveit,T S Carvalho,A Lussi

doi:10.1186/s12903-019-0834-1

Abstract

BackgroundThere is a need for analytical techniques for measuring Erosive Tooth Wear (ETW) on natural surfaces in clinical studies. The purpose was to investigate the use of two instruments aimed to assess initial to more advanced stages of ETW.MethodsHuman premolar enamel samples (2x3mm) (n = 24), were polished flat and mounted in resin cylinders (4 cylinders, 6 samples in each). Part 1: Baseline analyses by White Light Interferometer (WLI), Surface Reflection Intensity (SRI: TableTop and OptiPen) and Surface Hardness (SH). Erosion (1% citric acid (pH 3.6) for 1, 2, 4, 6, 8, 10 min. SRI and SH analyses after every erosion episode and by WLI after 10 min. New indentations were made and enamel loss; was measured by change in indentation depths from toothbrush abrasion (200 g, 60 strokes, 30 s). Another series of 2 × 5 min erosion (totally15 min and 20 min) was analysed with SH and SRI after each erosion, and by WLI (on samples and impressions of samples) after 20 min. Part 2 investigated WLI performance in the interface where initial erosion increases in severity and substance loss occurs. The samples were repolished. Baseline analyses by WLI, SRI (TableTop and OptiPen) and SH. Four cylinders were etched for 1, 2, 4, 8 min respectively and analysed by SRI, SH on samples, and WLI on samples and impressions).ResultsPart1: SRI decreased from baseline to ~ 6 min etch and increased slightly after abrasion, the two devices correlated well (ICC 0.98 p < 0.001, Spearmans rs 0.91 p < 0.001). SH decreased nearly linearly to 10 min etch, but increased distinctly after abrasion. Mean enamel loss from abrasion alone was 0.2 μm (change in indentation depths). After 10 min etch, it was 0.27 μm (WLI) and after 20 min etch, it was 2.2 μm measured on samples vs 2.4 μm on impressions of samples (7% higher). Part 2: From baseline to 8 min etch; SRI and SH decreased whereas WLI presented increasing etch depths.ConclusionsWith some adjustments, the use of SRI and WLI in combination seems to be a promising strategy for monitoring ETW in clinical studies.

Highlights

There is a need for analytical techniques for measuring Erosive Tooth Wear (ETW) on natural surfaces in clinical studies
The amalgam filling serves as reference surface during the analyses of enamel loss by the White Light Interferometer (WLI) since it has proven to be undisturbed by acid etching [5]
Part 1 Surface Reflection Intensity (SRI) and Surface Hardness (SH) Average (SD) surface reflection intensity measured by SRI TableTop and OptiPen agreed very well ICC = 0.98, p < 0.001, Spearmans rs = 0.91, p < 0.001

Summary

Introduction

There is a need for analytical techniques for measuring Erosive Tooth Wear (ETW) on natural surfaces in clinical studies. Longitudinal studies on incidence and progression of erosive lesions in individuals normally use erosion indexes to assess the severity of the lesions Such indexes do not detect changes on Stenhagen et al BMC Oral Health (2019) 19:167 impressions or casts [3,4,5,6,7,8]. Analyses of erosive enamel loss by a White Light Interferometer was previously validated, and shown to be accurate and precise, when measuring both flat and naturally curved surfaces [5, 9, 10] It gives reliable measurements on impressions of enamel surfaces [7], so this technique may be suitable for use in clinical studies (in vivo). This implies that this technique is relevant for advanced erosive lesions, and not the initial ones with loss of hardness due to superficial mineral loss only

Objectives

Methods

Results

Conclusion