Varnish Application Research Articles

Assessment of Enamel Demineralization Adjacent to Orthodontic Brackets Using a Polarized Microscope

Background and Objectives: This study was conducted to assess the effect of light-curable fluoride varnish on enamel demineralization adjacent to orthodontic brackets using polarized light microscopy and to compare the depth of demineralization at different time periods. Method: In 15 patients, the first premolars were allocated into 2 groups. In the experimental group light-curable fluoride varnish was applied. At the end of each time period (60, 90, and 120 days), first premolar brackets were debonded and premolars were extracted. Buccolingual sections were evaluated under a polarized light microscope and depth of demineralization was assessed. Results: The depth of demineralization in the control group increased from 60 to 120 days, and the experimental group did not show any significant difference during the time period. Conclusion: Single application of light-curable fluoride varnish, Clinpro XT can be effective in reducing enamel demineralization during fixed orthodontic mechanotherapy, especially in noncompliant patients.

THE EFFECT OF COMBINED TREATMENT BY LASER AND FLUORIDE ON THE ACID RESISTANCE OF ENAMEL IN PRIMARY TEETH (IN-VITRO STUDY)

Introduction: Er: YAG laser is contemplated as a preventive dental caries strategy when combined with topical fluoride varnish. Information regarding their combined effect on the enamel of primary teeth is still not established. Objectives: The present study aimed to evaluate the effect of combined treatment by Er: YAG laser irradiation prior to topical fluoride varnish application on the acid resistance of enamel in primary teeth compared to fluoride varnish by elemental analysis. Materials and Methods: Twenty caries-free exfoliated human primary molars were painted with nail varnish, leaving one window 4 x 4 mm on the buccal surface. The samples were assigned to 2 groups (10 each), according to the surface treatment: (G I) 5% sodium fluoride varnish (Enamel Pro® Varnish) only and (G II) Er: YAG laser irradiation followed by sodium fluoride varnish. The baseline value for each specimen was recorded before the test procedure. The enamel specimens underwent pH changes over 14 days. EDX was used to assess the mineral content of the specimens after pH challenge. Results: A significant increase occurred in the mean values of the Ca at%, P at%, and Ca/P ratio in the enamel in both groups compared to the baseline values (p≤0.001). No significant difference was found in the mean percent change (p ≥ 0.05) of the mineral content between the study groups. Conclusions: The combined treatment by laser and fluoride is as efficient as fluoride varnish alone for increasing the acid resistance of enamel in primary teeth.

An educational experience

The National Examining Board for Dental Nurses (NEBDN) announces the launch of its new Fluoride Varnish Application

Comparative Effects of CPP-ACP and Xylitol F-Varnishes on the Reduction of Tooth Erosion and Its Progression.

Evaluated the effect of CPP-ACP/NaF and xylitol/NaF varnishes in reduce erosion and progression of erosion. Forty enamel blocks were divided into four groups (n=10): G1=CPP-ACP/NaF varnish (MI varnishTM); G2=xylitol/NaF varnish (Profluorid®); G3=NaF varnish (Duraphat®, positive control) and G4=deionized water (MilliQ®, negative control). Samples were immersed in Sprite ZeroTM (pH 2.58, 4x/day, 3 days), in between immersions, the specimens stayed in artificial saliva. After 3 days of erosion, the eroded area was divided in two (half of one received an additional varnish layer while the other half repeated the same 3-day erosion cycle). The 3D, non-contact profilometry technique was used to determinate tooth structure loss (TSL) and surface roughness (SR). Scanning electron microscopy (SEM) and 3D images were utilized to evaluate the topography of the samples. Mann-Whitney, one-way ANOVA and Tukey tests were used (significance level of 0.05%). SEM and 3D images were descriptively evaluated. After 3 or 6 days of erosion, all tested varnishes were better than G4 (p<0.05) for TSL and SR. In addition, G1 had lower values for TSL than G3 (p<0.05) after 3 days of erosion. Under SEM and 3D images observation, all groups presented porosity, irregularities and depressions on the surface enamel after 3 and 6 days of erosion, more pronounced in G4. An application of topical NaF varnishes was effective in reducing TSL and enamel roughness after erosion challenges, being the CCP-ACP/NaF varnish more effective than NaF varnish and water after 3 days of erosion.

Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland

ObjectivesChild dental caries is a global public health challenge with high prevalence and wide inequalities. A complex public health programme (Childsmile) was established. We aimed to evaluate the reach of...

Clinical and economic analysis of caries prevention programs by mathematic modeling

Relevance. Underestimating the importance of economic analysis is the barrier to the implementation of cariesprevention programs.The aim is to study with use of mathematic modeling method the clinical and economic effectiveness of dental caries prevention programs provided for schoolchildren.Materials and methods. The method of mathematic modeling was used to evaluate the clinical and economic efficiency of the caries prevention programs (educational, fissure sealing, fluoride varnish). The cost of prevention program implementation and the expenses for caries treatment without prevention were calculated according to the rate of Volgograd territorial mandatory medical insurance Fund for 2018 year. The differences between the caries prevention program’s cost and the expenses needed for the treatment of “prevented caries” were considered as saving.Results. It was revealed that the Educational Dental Program for the first grade schoolchildren has short duration (2 years) of clinical-economic efficiency. The Continuous Educational Dental Program applied for 6 years by dental hygienists or dentists led to saving (per 100 children) of 99.5-115.0 or 84.0-99.6 thousand roubles respectively. The economic effect of The First Permanent Molar Fissure Sealing Program was revealed after 2 years only when The Program was implemented by dental hygienists. After 6 years of working with this Program the saving were 181.3 or 146.2 thousand roubles per 100 children depending on who implemented the Program, dental hygienists or dentists. The cost of Fluoride Varnish Program implementation was higher than the treatment of “prevented caries”. However, the number of “prevented caries” after fluoride varnish application is higher than after the implementation of the Educational Dental Programs. Moreover, fluoride varnish, in contrast to fissure sealing, prevents caries of smooth surfaces of permanent teeth. Conclusions. The method of mathematic modeling can be used for the development of the caries prevention programs in various regions considering the availability of personnel and financial resources, and for evaluation of the clinical and economic effectiveness of preventive programs implementation.

Fluoride varnish for white spot lesion prevention during orthodontic treatment: results of a randomized controlled trial 1 year after debonding.

Topical fluorides are commonly recommended to prevent the development of white spot lesion (WSL) during treatment with fixed orthodontic appliances (FOAs), but the certainty of evidence is low, and long-term effects of fluoride preventive methods to reduce lesions seem to be rare. To evaluate the long-term effectiveness of professional applications of a fluoride varnish containing 1.5% ammonium fluoride in preventing WSL development in adolescents undergoing multi-bracket orthodontic treatment. We performed a randomized controlled trial in which 166 healthy adolescents (12-18 years) from three different clinics were enrolled and randomly allocated to a test or a placebo group. The randomization was performed by a computer program, generating sequence numbers in blocks of 15. The fluoride varnish or the non-fluoride placebo varnish was applied in a thin layer around the bracket base every sixth week during the course of the orthodontic treatment (mean duration 1.7 years). We scored the prevalence of WSL on the labial surfaces of the maxillary incisors, canines and premolars immediately after debonding (baseline) and approximately 1 year after debonding, from digital photos with aid of a four-step score. The examiners were not involved in the treatment of the patients and blinded for the group assignment. One hundred and forty-eight patients were available at debonding and 142 of them could be re-examined after 1 year (71 in the test and 71 in the placebo group). The 1-year attrition rate was 4.0%. On patient level, the prevalence of post-orthodontic WSLs (score ≥ 2) dropped by over 50% during the follow-up with no significant difference between the groups. On surface level, there were significantly fewer remaining WSLs in the test group compared with the placebo group (4.5% versus 10.4%; relative risk 0.44, 95% confidence interval 0.28-0.68). The compliance with fluoride toothpaste was not checked, and the patients' general dentists may have instigated additional risk-based preventive measures. No cost-benefit analysis was carried out. This follow-up study displayed a small beneficial long-term effect of fluoride varnish in reducing WSL development during treatment with FOA. NCT03725020. The protocol was not published before trial commencement.

Antibacterial effect of amorphous calcium phosphate-casein phosphopeptide varnish against Streptococcus mutans: An exploratory in vivo randomized controlled trial

Background: Nowadays, amorphous calcium phosphate-casein phosphopeptide and tricalcium phosphate are being incorporated into fluoride varnishes to enhance remineralization potential which might interfere with antibacterial effect of fluoride in varnishes. Aim of study was to evaluate and compare the antimicrobial property of sodium fluoride varnish reinforced with amorphous calcium phosphate-casein phosphopeptide and tricalcium phosphate against streptococcus mutans.Methods: In the clinical setting, trial was conducted involving 18, 14-15 year old school children, randomly allocated into three interventional groups, Group A (5% Sodium fluoride varnish, Fluoritop-SR varnish), Group B (5% Sodium fluoride - Tricalcium phosphate varnish, Clinpro White varnish) and Group C (5% Sodium fluoride- amorphous calcium phosphate-casein phosphopeptide varnish, MI Varnish) to receive the varnish application. Saliva samples were collected at the end of one hour after varnish application for S Mutans count estimation. Student’s paired ‘t’ test and One way-ANOVA tests were used for statistical analyses.Results: Significant reductions in salivary streptococcus mutans count at one hour was achieved with application of B & C varnishes compared to varnish A. Conclusion: amorphous calcium phosphate-casein phosphopeptide and tricalcium phosphate varnish groups exhibited better antimicrobial property against streptococcus mutans compared to Sodium fluoride varnish at one-hour post intervention.

A Resident-Led QI Project to Improve Dental Health at a Primary Care Pediatric Practice.

Dental caries are the most common chronic condition of childhood and have significant medical, psychological, and financial consequences. The American Academy of Pediatrics (AAP) recommends primary care physicians apply fluoride varnish (FV) every 3 to 6 months from tooth emergence through age 5. Through a resident-led quality improvement (QI) project, we aimed to provide FV to 50% of patients ages 1 through 5 who did not have a dental visit in the preceding 6 months or receive FV elsewhere in the past month. From May 2017 through April 2018, we conducted 7 monthly plan-do-study-act cycles to improve our primary outcome measure (FV application), secondary outcome measure (percentage of patients who had routine dental care), and process measure (percentage of dental referrals). Balancing measures included time taken away from other clinical priorities and reimbursement rates. Fluoride varnish application improved from 3.6% to 44% with a 54% peak. The percentage of patients under 6 who had seen a dentist in the past 6 months increased from 30% to 47%. The percentage of dental referrals increased from 17% to 33%. Application of FV is a quick, cost-effective way for primary care providers to improve dental health. This resident-led QI project increased rates of FV application, dental referrals, and dental visits while meeting ACGME guidelines for experiential learning in QI. By adapting to state-specific guidelines and workflows of each clinic, this QI project could be nationally reproduced to improve adherence to AAP and United States Preventive Services Task Force guidelines.

Визначення часу запалювання деревної сировини при дії високої температури радіаційної панелі

Reducing the fire prevention of timber is not only an economic task, but also has a social and environmental focus. From economic, technological and environmental perspective, an important problem in ensuring the viability and safe operation of construction sites is the development of fire-retardant coatings for wooden structures. The construction is increasingly looking for new highly effective means of fire protection of wood and wood products which should not only ensure the standardized fire resistance of wood, but also to maintain its operational parameters to solve environmental safety and durability. Studies of the effect of the radiation panel on the ignition of the wood sample have set the parameters of the flame ignition, which makes it possible to influence this process. It is proved that they consist in the formation of a layer of organic material on the surface, which provides heating to a critical temperature, when the intensive decomposition of the material begins with the release of the required amount of combustible gases and their ignition. This makes it possible to determine the effect of fire protection and the properties of protective compositions on the process of slowing down the rate of burning of wood. Experimental studies have confirmed that the untreated sample of wood, under the thermal action of the radiation panel has taken up, the flames spread over the entire surface, which led to its combustion. The application of a fire retardant varnish under the influence of temperature leads to a layer of foam coke and inhibition of heat transfer of high-temperature flame to the material and its ignition. Thanks to this, it became possible to determine the conditions for changing the parameters of combustion and braking during fire protection of wood, by forming a barrier for thermal conductivity. Thus, there is reason to argue for the possibility of directional control of the processes of fire protection of wood by the use of fireproof coatings that can form a protective layer on the surface of the material, which slows down the rate of burning of wood.

Motivational interviewing for preventing early childhood caries: A systematic review and meta-analysis.

This systematic review with meta-analysis was performed to assess whether motivational interviewing (MI) is effective in the prevention of early childhood caries (ECC) and to examine potential sources of heterogeneity. Interventions based on motivational interviewing were considered eligible. The main outcome was new caries lesions (some studies included white-spot lesions in total count), and secondary outcomes included caregivers' oral health knowledge, home-care behaviours, plaque index, gingival index and fluoride varnish applications. Controls were any type of oral health education or negative controls without any specific intervention. From a total of 1498 studies identified in the databases search, 1078 were assessed for eligibility by reading titles and abstracts, after removal of duplicates. Full-text screening was performed in 61 articles, with 18 reporting on 14 different studies included in the qualitative synthesis and 8 in the quantitative synthesis (four studies included new white-spot lesions in total count). Subgroup analysis was performed by the control group dmft/dmfs and the test for subgroup differences suggests that there is a subgroup effect (P=.06), so population caries experience modifies the effect of MI-based intervention. In populations with high caries experience, the MI-based approach proved preventing an average of 3.15 (95% CI: -6.14, -0.17) dmfs in young children. In samples with low caries experience, differences were smaller, since the caries levels were already lower (-0.31; 95% CI: -0.63, 0.00). Motivational interviewing has the potential to modify knowledge and behaviours and reduce ECC with a more significant impact on children with high caries experience.

Aboriginal dental assistants can safely apply fluoride varnish in regional, rural and remote primary schools in New South Wales, Australia.

There are significant inequalities in oral health status between Aboriginal and non-Aboriginal children in Australia, particularly where the children have insufficient access to various forms of fluoride. There has been a growing interest in seeing fluoride varnish programs used more widely for Aboriginal children due to proven effectiveness. Despite this, there has been limited scale-up of these programs in Australia. This study investigates the feasibility of using Aboriginal dental assistants to provide regular fluoride varnish applications for Aboriginal children in the primary school setting. A mixed-methods approach including auditing the number of Aboriginal dental assistants were trained and then approved by the NSW Chief Health Officer to apply fluoride varnish, and collection and reporting of participant data on the each of the fluoride varnish days in the local patient management system. Six Aboriginal Community Controlled Health Services from regional NSW were invited to participate in the study. They also nominated a primary school and an Aboriginal dental assistant to participate in the study. Data were obtained from four 'fluoride varnish days' held at the schools over a 12-month period between December 2017 and December 2018. The number of Aboriginal dental assistants were trained and then approved by the NSW Chief Health Officer to apply fluoride varnish is also reported. In total, 8 Aboriginal dental assistants were trained to apply fluoride varnish during the study. Overall, students participating in the study received three or more fluoride varnish applications. Results showed that Aboriginal dental assistants are able to safely and effectively apply fluoride varnish in a school setting with remote supervision. This program can be scaled at the state level in NSW, and this could provide the basis for a nationally consistent program. Initial discussions have been held with several jurisdictions to lead this process via the Australian Health Ministers Advisory Council (AHMAC) based on the results of this study and the support of key stakeholders. The Poche Centre as part of its scale-up planning for the Fluoride Varnish Program is examining the feasibility of including the apply fluoride varnish skillset in its existing Aboriginal Dental Assistant Scholarship Program.

Impact of self-assembling peptides in remineralisation of artificial early enamel lesions adjacent to orthodontic brackets

Enamel demineralisation can occur as a side effect during orthodontic treatment with fixed appliances. This study aimed to evaluate the efficacy of the self-assembling peptide P11-4 for remineralisation combined with fluorides, compared to application of fluoride varnish alone. De- and remineralisation was assessed by Quantitative light-induced fluorescence (QLF). Orthodontic brackets were bonded on 108 human enamel samples and white spot lesions were created. The samples were allocated randomly into three groups: Group I received no treatment, group II had a single application of fluoride varnish (22,600 ppm), and group III was treated with P11-4 following a single application of fluoride varnish. Quantitative light-induced fluorescence (QLF) measurements were performed at baseline, after demineralisation and after storage in remineralisation solution for 7 and 30 days. Non-parametric tests (Kruskal–Wallis test and Friedman test) were used for further analysis. After demineralisation, all samples showed a median ΔF -9.38% ± 2.79. After 30 days median ΔF values were as followed: group I = -9.04% ± 2.51, group II = -7.89 ± 2.07, group III = -6.08% ± 2.79). The median ΔF values differed significantly between all groups at all investigation times (p < 0.00001). Application of P11-4 with fluoride varnish was superior to the use of fluorides alone for remineralisation of enamel adjacent to brackets.

Fluoride Varnish Application in Preschoolers Have a Modest Effectiveness in Reducing the Incidence of Dentinal Caries

Fluoride Varnish and Dental Caries in Preschoolers: A Systematic Review and Meta-Analysis. de Sousa FSO, Dos Santos APP, Nadanovsky P, Hujoel P, Cunha-Cruz J, de Oliveira BH. Caries Res. 2019;53(5):502-513. Government. Systematic review with meta-analysis of data.

Fluoride Varnish in Nursery Schools: A Randomised Controlled Trial – Protecting Teeth @3

Studies suggest that fluoride varnish (FV) application can reduce dental caries in child populations. The multiple-component national child oral health improvement programme in Scotland (Childsmile) includes nursery-based universal supervised toothbrushing and deprivation-targeted FV applications, together with community and dental practice prevention interventions. This trial, a double-blind, two-arm randomised control trial, aimed to assess the effectiveness and cost-effectiveness of the nursery-based FV applications plus treatment-as-usual (TAU) Childsmile programme interventions, compared to TAU Childsmile interventions alone, in children not targeted to receive nursery FV as part of the programme. Participating children in the first year of nursery (aged three), with or without existing caries, were randomised to either FV or TAU and followed up for 24 months until the first year of primary school. Treatments were administered at six-monthly intervals. The primary endpoint was “worsening of d3mft” from baseline to 24 months. Secondary endpoints were worsening of d3mfs, d3t, mt, and ft. Individual record-linkage captured wider programme activities and tertiary endpoints. A total of 1,284 children were randomised, leading to 1,150 evaluable children (n = 577 FV, n = 573 TAU, 10% dropouts). Mean age was 3.5 years, 50% were female (n = 576), 17% had caries at baseline (n = 195), all balanced between the groups. Most children received three/four treatments. Overall, 26.9% (n = 155) had worsened d3mft in the FV group, and 31.6% (n = 181) in the TAU group, with an odds ratio (OR) of 0.80 (0.62–1.03), p = 0.078. The results for worsening of the secondary endpoints were: d3mfs 0.79 (0.61–1.01) p = 0.063, d3t 0.75 (0.57–0.99) p = 0.043, mt 1.34 (0.75–2.39) p = 0.319, and ft 0.77 (0.53–1.14) p = 0.191. We calculated a number needed to treat of 21 and a cost of GBP 686 to prevent a single worsening of d3mft. There was a modest non-significant reduction in the worsening of d3mft in the nursery FV group compared to TAU, suggesting that this intervention is unlikely to represent an effective or cost-effective addition to the population oral health improvement programme.

Protective factors for caries of a school-based oral health program in Bangkok, Thailand: a retrospective cohort study

ObjectivesThe aim of the study was to assess protective factors of a school-based oral health preventive program on caries in permanent teeth in students and to identify other risk and protective factors associated with caries in this group. Study designThis is a retrospective cohort study. MethodsA total of 433 students were examined in the 1st grade and followed up until the 6th grade. Each student was annually assessed for caries as per the World Health Organization index. Binary simple and multiple logistic regressions were performed to assess risk or protective factors with a P-value ≤0.05. ResultsIn 1st graders, the caries prevalence in deciduous teeth was 87.2%, and the mean decayed, missing and filled teeth (dmft) index was 6.44 (±4.4); in 6th graders, the caries prevalence in permanent teeth was 51.7%, and the mean DMFT was 1.37 (±1.84). Protective factors for caries in permanent teeth were complete participation in the program, receiving fluoride varnish >4 times, and sealant applications on all first molars. Risk factors were female sex and caries prevalence in deciduous teeth. After multiple logistic regression, sealant application only remained significant, with an odds ratio (OR) of 0.19 (95% confidence interval [CI] = 0.06–0.63, P = 0.007), and for risk factor, caries prevalence in deciduous teeth only remained significant, with an OR of 5.44 (95% CI = 2.23–13.27, P < 0.001). ConclusionsThere is an association between deciduous dentition caries and permanent dentition caries. Early prevention in school settings by applying fluoride varnish and dental sealants onto molars is protective and feasible. The study suggests that regular fluoride varnish and sealant applications should be extended to similar low-income area schools.

LASER THERAPY: DENTINARY HYPERSENSITIVITY THERAPEUTIC APPROACH IN A PATIENT WITH ENAMEL HYPOPLASIA FROM ACUTE LEUKEMIA

A 12-year-old male patient came to the pediatric dentistry clinic complaining of sensitivity to cold. The patient was affected by acute leukemia before the age of 2 and underwent chemotherapy. Clinically, permanent teeth were almost always affected by enamel hypoplasia, chemotherapy effect, with consequent dental sensitivity, which made it impossible for the patient to eat frozen foods and to withstand any refrigeration necessary for dental treatment. Radiographic examinations confirmed poor enamel formation. Topical applications of varnish were performed for desensitization, with no success. A low-intensity laser therapy approach was performed: 6 weekly sessions, with a wavelength of 808 nm, 100 mW of power, 1 J at a single point in the cervical margin of each tooth for 10 seconds. At each session the patient indicated a number on the pain scale: before the first session he indicated 6, and after the last session he indicated 1.

42. HEALTHY SMILE HAPPY START

Background Dental caries is the most common chronic disease in childhood in the US and they are the single greatest risk factor for caries in permanent dentition. Caries and cavities are largely preventable and fluoride varnish has been proven effective for combating the disease. Only 1.5% of one-year-olds have been to a dentist in comparison to 89% who have been seen by a pediatrician. Given the low prevalence of children with a dental medical home, AAP, Bright Futures and USPSTF released a statement in 2014 addressing oral healthcare, recommending fluoride varnish in the primary care setting beginning at first tooth emergence. Aim Statement Increase the percentage of at least one fluoride varnish application in 9 to 36-month old children to 50% and oral health documentation in the electronic health record (EHR) by 80% by June 2020. Interventions Population and setting included patients presenting to our general pediatrics clinics (ACC and Kendall UHealth) for their 9, 18, 24, 30, 36-month well child visits, after their first tooth eruption. The first cycle took place from Sept-Dec 2019 and involved applying fluoride varnish to eligible patients. The second cycle is planned for Jan-Mar 2020 and includes distributing a FAQ sheet about fluoride and using a trackable smart phrase for oral health documentation. The final cycle will include another change to increase application and documentation from Mar-June 2020. Measures A questionnaire was used to collect baseline and post-intervention data to determine the % of eligible patients who received fluoride varnish application. Chart review was done for the eligible patients to determine % of dental assessments documented in the EHR. Results After the first cycle, fluoride varnish application increased from 17.2% to 79.5% at ACC and from 9.1% to 38.8% at Kendall; dental assessment documentation increased from 40.3% to 50.6% at ACC and from 62.5% to 98.6% at Kendall. Conclusions and Next Steps Our clinics did not previously apply fluoride varnish at routine well child visits, which created a gap in preventative medicine. Knowing that dental caries account for the most common chronic disease in childhood, we have made strides to prevent this disease by increasing application significantly, which we will continue to do through added changes. While dental assessment documentation increased as well, there is still room to improve to ensure it is as compressive as possible, which will be closely tracked in coming months.

Aesthetic restoration of hypo-plastic maxillary young permanent central incisors: A clinical approach

Brief background:This case reportdiscusses injuriesto primary maxillary anterior teeth and theirsubsequent effects on the succedaneous teeth.The consequencesof the injuries leadto development of hypo-plastic enamel. Materials and methods:Enamel hypo-plasia in young children was treated with direct light cureradiopaque composite resin (Restofill R Anabond Stedman) followed by incremental layering of Tetric N-Ceram A2 shade (Ivoclar Vivadent co.) along with fluoride varnish application (Fluor-protector, Ivoclar Vivadent co.) to prevent secondary caries development at the interface of tooth and restored resins. Discussion:Hypo-plastic enamel favorus accumulation of plaque and food staining and unaesthetic appearance of permanent central incisors. Unaesthetic appearance may adversely affect the self-esteem and confidence of the child when the child is interactive with their peer groups. Summery and conclusion:Self-esteem of the child can be restored and good aesthetic results can be achieved by proper diagnosis, treatment planning and good knowledge of advanced restorative materials and techniques when applied to restore the affected abutment. Key Words: Hypo-plastic enamel, maxillary central incisors, aesthetic restoration.

Remineralization and fluoride uptake of white spot lesions under dental varnishes.

The aim of this study was to evaluate white spot lesion (WSL) remineralization and fluoride uptake by the application of fluoride varnishes directly onto artificial WSLs in vitro. MI varnish containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and 2.26% fluoride and Duraphat varnish containing 2.26% fluoride (no added calcium) were compared with a placebo varnish (no added calcium or fluoride). Two WSLs were prepared in enamel slabs and varnish applied to cover one of the two lesions. Each slab was immersed in artificial saliva for 14days at 37°C. Mineral content was determined using transverse microradiography and fluoride uptake using electron probe microanalysis. The data were statistically analysed using a linear mixed model. Both MI and Duraphat varnishes significantly remineralized the covered and uncovered WSLs when compared with the placebo varnish (P<0.001). The WSLs covered with varnish showed greater remineralization than those uncovered. MI varnish produced the highest level of remineralization and significantly greater fluoride uptake (0.44±0.08 wt%) compared with Duraphat (0.24±0.03 wt%) and the placebo varnish (0.06±0.05 wt%). Varnish containing fluoride and CPP-ACP was superior to varnish containing fluoride alone in promoting WSL remineralization and fluoride uptake.