Artificial Enamel Lesions Research Articles

A comparison between in vitro and randomized in situ models for remineralization of artificial enamel lesions

The randomized study aimed to evaluate the comparability of in situ (iS) and in vitro (iV) study protocols regarding remineralization of artificial enamel lesions. Two toothpastes (group A: 1450 ppm sodium fluoride, group B: placebo 0 ppm F-), were investigated. IV, a pH-cycling model with toothpaste slurry treatment was applied for 10d. IS, remineralization was performed in 9 participants wearing splints with embedded enamel samples for 10 and 21d, randomly allocated to groups A and B. Samples were scanned by X-ray micro-computed tomography (μCT) and grayscale value line profiles corresponding to mineral density (rel.ΔZ) were analyzed. Statistical analyses were performed using MedCalc Statistical Software, v22.021. T-Test for dependent and independent data and analysis of variance (ANOVA) were used for further analyses (α = 0.05). Rel.ΔZ of fluoride treated samples (A) were iV = 40.2%, iS 10d = 11.5% and iS 21d = 46.1% (p > 0.05). Rel.ΔZ of placebo treated samples (B) were: iV = − 6.2%, iS 10d = 25.2% and iS 21d = 11.0% (p > 0.05). Remineralization potential of both toothpastes was significantly different regarding iV (p < 0.001) and iS after 21d (p = 0.034), while in case of iS 10d no significant difference was detected (p = 0.4). Despite different study protocols the μCT results after remineralization were comparable between iV and iS. The results suggest that selected studies can be carried out in faster, simplified iV studies using pH-cycling instead of iS studies.

Evaluation of the effect of self-assembling peptide and fluoride varnish, alone or in combination with laser irradiation, on artificial enamel caries: a SEM/EDS and Micro-CT study.

The aim of this study was to investigate the effect of remineralization agents such as fluoride varnish and P11-4, alone and in combination with Er: YAG laser, on in-vitro hard tissue repair in artificial enamel lesions. A total of sixty enamel surfaces of 4 × 5mm in size were created on both the buccal and lingual sides of thirty extracted wisdom teeth. Remineralization agents were applied to the specimens that were grouped as follows: Group 1, control; Group 2, fluoride varnish (FV); Group 3, P11-4; Group 4, laser; Group 5, laser + FV; and Group 6, laser + P11-4. The fluorescence level was determined with DiagnoDent. The enamel mineral density, area and volume, and caries lesion area and volume were determined with micro-computed tomography (µCT), surface features were evaluated using scanning electron microscopy (SEM), and elemental analysis was performed using energy dispersive x-ray spectroscopy (EDS) . For specimens treated only with self-assembling peptide P11-4, the caries lesion area (mm2) values were 38.19 and 21.62, and the caries lesion volume (mm3) values were 6.27 and 2.99, respectively for pre- and post-treatment. In combination usage of self-assembling peptide P11-4 and laser, the caries lesion area (mm2) values were 38.39 and 16.91, and the caries lesion volume (mm3) values were 11.15 and 3.64, respectively for pre- and post-treatment. In the application of the P11-4 alone and in combination with laser, there was a statistically significant decrease in DiagnoDent values, an increase in enamel volume(mm3),enamel area(mm2) and mineral density(g/cm3) values and a decrease in caries lesion volume(mm3) and area(mm2) obtained by µCT, and an increase in %Ca and %F values obtained by SEM/EDS analysis (p < 0.05). It was discovered that the samples treated with P11-4 had a considerably higher rise in the Ca/P ratio than the samples treated with FV (p < 0.05). The calcium content increased significantly more when P11-4 application was combined with laser irradiation (p < 0.05). The combined use of self-assembling peptide P11-4 and laser accelerated the remineralization process and increased the remineralization capacity. FV and P11-4, alone or in combination with laser, can be successfully used as remineralization agents in initial enamel caries.

Evaluating the Remineralizing Effects of Calcium Sucrose Phosphate and Casein Phosphopeptide-Amorphous Calcium Phosphate Toothpastes on Artificial Carious Lesions Using Micro-computed Tomography: An In Vitro Investigation.

Background White spot lesions (WSLs) are common early indicators of enamel demineralization, particularly in pediatric orthodontic patients. Effective remineralization of these lesions is crucial for preventing further dental decay. This study aimed to evaluate the three-dimensional remineralization efficacy of two commercial toothpastes, calcium sucrose phosphate (CaSP) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), using micro-computed tomography (micro-CT). Objectives To compare the remineralization efficacy of CaSP and CPP-ACP on artificially created WSLs in human premolar enamel using micro-CT assessment. Materials and methods Freshly extracted, caries-free human premolars were used for the purpose of the study. Teeth with any defects, including caries, non-carious lesions, fractures, or hypocalcifications, were excluded. Teeth were stored in a saline solution with 0.1% thymol at +4°C until experimentation. Enamel slabs (N = 18) of 3 x 3 x 1.5 mm were prepared from the buccal surfaces of the premolars and polished to a mirror-like finish. The slabs were divided into three groups (n=6 each): control, CaSP, and CPP-ACP. Specimens were demineralized in a demineralization solution for 72 hours and then treated with the respective toothpastes or remineralizing solutions for 13 days. Micro-CT scanning was performed to assess changes in enamel volume and mineral density. Statistical analysis included Shapiro-Wilk tests, paired t-tests, and one-way ANOVA with post-hoc Tukey's HSD tests. Results Enamel volume changes were significant between groups (p<0.01), with the CaSP group showing the largest remineralization effect. Enamel mineral density changes were also significant (p=0.004), with the CPP-ACP group showing the greatest improvement in mineral density. Conclusions CaSPand CPP-ACPare both effective in remineralizing artificial enamel lesions. While CaSP shows comparable efficacy to CPP-ACP, further research is needed to confirm these findings in clinical settings. CaSP pastecan be considered a viable, cost-effective alternative for enamel remineralization.

Remineralization efficiency of three different agents on artificially produced enamel lesions: A micro-CT study.

This study aimed to assess the remineralization efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), silver diamine fluoride/potassium iodide (SDF/KI), and sodium fluoride with functionalized tricalcium phosphate (NaF/fTCP) on artificial early enamel lesion using laser fluorescence and micro-CT analysis. On extracted impacted third molars, artificial enamel lesions were prepared. Twenty-eight specimens were randomly assigned to four groups (n = 7 per group): a control group (artificial saliva), CPP-ACP (GC Tooth Mousse), SDF/KI (Riva Star), and NaF/fTCP (Clinpro White varnish). Following the manufacturer's instructions, the remineralization agents were applied to demineralized surfaces. Laser fluorescence and micro-CT were used to evaluate the remineralization efficacy of the agents and analyzes were performed during four stages: before demineralization, after demineralization, 1st day of remineralization and 30th day of remineralization. Shapiro-Wilk test, repeated measures two-way ANOVA, and Spearman correlation tests were used for statistical analysis. A significant level of p < 0.05 was established. SDF/KI significantly reduced the lesion area and lesion volume on the demineralized enamel surface after 30 days of remineralization. In the T3 period, SDF/KI increased the mineral density statistically significantly compared to the T1 period. The laser fluorescence values for all three remineralizing agents exhibited a linear decrease. A significant correlation between the fluorescence values and the mineral density was found (p = 0.01). All three investigated agents were showed positive remineralization efficacy on artificial enamel lesion. However, SDF/KI, containing silver diamine fluoride and potassium iodide exhibited superior than other agents in promoting remineralization. Although all three remineralization agents showed positive remineralization efficacy on artificial enamel lesions, SDF had higher remineralization performance over the other two agents. SDF has potential to prevent progression of demineralization in treating children with high caries risk in the long-term.

The Potential of QP3VH-Chitosan Peptide as Biomimetic Remineralization in Early Dental Caries Treatment: An In Vitro Study.

The development of remineralization biomimetics using organic peptide molecules is expected to resemble the hydroxyapatite (HA) mineralization process in tooth enamel. The development of an amelogenin derivative peptide combined with antimicrobial peptide was designed, resulting in QP3VH. This combination then was mixed with chitosan as a carrier. This study aimed to evaluate the biomimetic efficacy of QP3VH as a remineralizing agent combined with chitosan. Fifty deciduous mandibular incisor enamel samples were used in this study. The artificial enamel lesions were created on a buccal surface and were randomly assigned to five groups of 10 each according to the remineralizing agent used: QP3VH, NaF, QP3VH + NaF, QP3VH + CS (QP3VH + chitosan), and saline distilled water (SDW). Each group was performed pH cycling for seven days. Enamel surface morphology and evaluation of mineral content Ca/P (calcium and phosphate) using scanning electron microscopy and energy dispersive X-ray analysis. The assessment was carried out, after demineralization, and after application with remineralization agents. Data were analyzed using a one-way analysis of variance followed by least significance difference post-hoc test. The paired t-test was utilized to compare the demineralization and remineralization results. The significance level used was 95%. The remineralized group exhibited a significant increase in calcium and phosphate content on the enamel surface (p <0.05), and QP3VH + CS produced the maximum Ca/P mass percent after remineralization. Combining QP3VH with chitosan produces greatest remineralization than QP3VH, QP3VH + NaF, Naf, and SDW; therefore, QP3VH peptide has potential as a remineralizing agent, in the future.

Biomimetic Remineralization of Artificial Caries Lesions with a Calcium Coacervate, Its Components and Self-Assembling Peptide P11-4 In Vitro.

The application of calcium coacervates (CCs) may hold promise for dental hard tissue remineralization. The aim of this study was to evaluate the effect of the infiltration of artificial enamel lesions with a CC and its single components including polyacrylic acid (PAA) compared to that of the self-assembling peptide P11-4 in a pH-cycling (pHC) model. Enamel specimens were prepared from bovine incisors, partly varnished, and stored in demineralizing solution (DS; pH 4.95; 17 d) to create two enamel lesions per sample. The specimens were randomly allocated to six groups (n = 15). While one lesion per specimen served as the no-treatment control (NTC), another lesion (treatment, T) was etched (H3PO4, 5 s), air-dried and subsequently infiltrated for 10 min with either a CC (10 mg/mL PAA, 50 mM CaCl2 (Ca) and 1 M K2HPO4 (PO4)) (groups CC and CC + DS) or its components PAA, Ca or PO4. As a commercial control, the self-assembling peptide P11-4 (CurodontTM Repair, Credentis, Switzerland) was tested. The specimens were cut perpendicularly to the lesions, with half serving as the baseline (BL) while the other half was exposed to either a demineralization solution for 20 d (pH 4.95; group CC + DS) or pHC for 28 d (pH 4.95, 3 h; pH 7, 21 h; all five of the other groups). The difference in integrated mineral loss between the lesions at BL and after the DS or pHC, respectively, was analyzed using transversal microradiography (ΔΔZ = ΔZpHC - ΔZbaseline). Compared to the NTC, the mineral gain in the T group was significantly higher in the CC + DS, CC and PAA (p < 0.05, Wilcoxon). In all of the other groups, no significant differences between treated and untreated lesions were detected (p > 0.05). Infiltration with the CC and PAA resulted in a consistent mineral gain throughout the lesion body. The CC as well as its component PAA alone promoted the remineralization of artificial caries lesions in the tested pHC model. Infiltration with PAA further resulted in mineral gain in deeper areas of the lesion body.

Assessment of Remineralization Ability of Different Fluoride Varnishes on Artificial Enamel Lesion of Primary Teeth - A Comparative Study.

The current study's aim was to evaluate the potential of various fluoride varnishes to remineralize artificial enamel lesions on primary teeth. For the study, 90 deciduous molar teeth that were implicated for extraction were taken. A window region with a size of 3 × 3 mm was located in the middle of the tooth's coronal surface. The remaining portion was given a coat of nail polish and given time to dry. A demineralizing solution was used to create the artificial enamel lesion. The samples were randomized into three experimental groups at random, with 30 samples in each group. Group 1: Application of Clinpro White Varnish, Group 2: Application of Duraphat Varnish, and Group 3: Application of MI Varnish. After 14 days, samples from each group were examined under scanning electron microscopy at a magnification of 1000× to determine whether remineralization had occurred. Microhardness was also determined using a microhardness tester. Before the intervention, the mean demineralized enamel lesion in the Clinpro White Varnish group was 134.44 ± 0.04, in the Duraphat Varnish group was 133.76 ± 0.12, and in the MI Varnish group was 133.89 ± 0.08. After intervention, the maximum remineralized area was found in the MI Varnish group (82.74 ± 0.18) followed by the Clinpro White Varnish group (101.43 ± 0.16) and the Duraphat Varnish group (104.11 ± 0.10). After the intervention, there was a statistically significant difference found between the groups. After the intervention, the maximum microhardness mean value improved in the MI Varnish group (257.03 ± 1.09 to 261.18 ± 1.20) followed by Clinpro White Varnish (258.78 ± 1.64 to 260.10 ± 1.22) and Duraphat Varnish group (255.24 ± 1.51 to 258.02 ± 0.89). According to the findings of the current investigation, all of the varnishes utilized in this in vitro experiment are capable of correcting early enamel defects on primary teeth. However, MI Varnish group was very effective compared to the Clinpro White Varnish group and the Duraphat Varnish group.

Evaluation of the Remineralization Capacity of Water-based Silver Fluoride

Silver diamine fluoride, which can arrest dental caries, is alkaline and may cause mild soft tissue irritation. Water-based silver fluoride has a neutral pH, which is closer to the physiological range, and is biocompatible for use in the oral environment. This study aimed to evaluate the effect of water-based silver fluoride on remineralizing early enamel lesions by comparing it with other fluoride agents through microhardness and quantitative light-induced fluorescence measurements. An in vitro study with intact bovine incisors was performed. Artificial enamel lesions were induced and subjected to microhardness and quantitative light-induced fluorescence testing. Specimens were randomly divided into 4 groups for treatment. The specimens in group I were treated with water-based silver fluoride and potassium iodide, group II with silver diamine fluoride and potassium iodide, group III with sodium fluoride varnish, and group IV with distilled water. After 8 days of pH cycling, the specimens were subjected to microhardness and quantitative light-induced fluorescence testing. Water-based silver fluoride and silver diamine fluoride showed the greatest increases in microhardness and quantitative light-induced fluorescence, with no significant differences between the two. Sodium fluoride varnish also exhibited a significant increase in microhardness and quantitative light-induced fluorescence, but the differences were smaller than those for water-based silver fluoride and silver diamine fluoride. Water-based silver fluoride is considered useful in a clinical setting for remineralizing enamel lesions, with the advantages of no risk of tissue burn and improved taste and smell.

Remineralization potential of a novel varnish: an in vitro comparative evaluation.

Despite fluoride's widespread use in preventing dental caries, it remains a significant oral disease with some drawbacks. Consequently, new preventative agents have emerged that can function independently of fluoride. Our aim is to demonstrate the efficacy of newly developed varnishes, 3% Rennou (theobromine calcium and phosphate) and 1% Rennou, in remineralizing initial caries. In our experiment, 40 human enamel samples were randomly allocated into four groups of 10 samples each as: Group 1 (G1): 5% NaF (Colgate PreviDent®), Group 2 (G2): 1% Rennou®, Group 3 (G3): 3% Rennou® and Group 4 (G4): Casein Phosphopeptide-Amorphous Calcium Phosphate + Fluoride (MI VarnishTM GC). To produce an artificial carious lesion in the enamel, the samples were kept in a demineralizing solution for 72 hours. Samples underwent pH cycling for 6 days in order to induce remineralization. The means of the three measurements were compared, and the percentage of Surface Microhardness Recovery in (SMHR%) was calculated. Scanning Electron Microscopy (SEM) was used for qualitative assessment of surface changes. G1 had the highest SMHR% value, followed by G3, G2 and G4. The One-way ANOVA (Analysis of Variance) showed significant differences in the SMHR% values among the groups after six days of cycling (p < 0.001). In pairwise comparisons, groups did not show differences in means of SMHR% except for G1 and G4 (p = 0.006). In the SEM Images, after treatment within the NaF group, many flaky sediments were found on the enamel surface. Similarly, the maximum mineral gain was seen in the NaF and Rennou groups. SEM images of both varnish surfaces revealed a uniform layer interspersed with shapeless precipitates. All varnishes treated artificial enamel lesions to varying degrees. However, both concentrations of Rennou showed remineralization potential comparable to 5% NaF in acceptable statistical measurements. Thus, it could be used as a potentially effective preventive measure for pediatric patients.

Xylitol associated or not with fluoride: Is the action the same on de- and remineralization?

ObjectivesThis study evaluated the effect of xylitol combined or not with fluoride (F) on reduction of demineralization and increase of remineralization of shallow and deep artificial enamel lesions. MethodsBovine enamel samples were allocated to the following solutions groups: no xylitol (negative control), 5% xylitol, 10% xylitol, 20% xylitol, 500 ppm F (as NaF), 5% xylitol+F, 10% xylitol+F or 20% xylitol+F (n = 12–15). For the demin study, a pH-cycling model (demineralization-6 h, pH 4.7/remineralization 18 h, pH 7.0) was employed for 7 days. Treatments were applied 2 × 1 min. In the remin study, specimens were pre-demineralized for 2, 5 or 10 days. Afterwards, a pH-cycling protocol was conducted (2 h demineralizing and 22 h remineralizing solution/day for 8 days) and the same treatments were done. The response variables were percentage surface hardness loss (%SHL) and transverse microradiography. Data were analyzed by RM ANOVA/Tukey or Kruskal-Wallis/Dunn (p < 0.05) ResultsF and Xylitol combined with F reduced the %SHL (23–30%) compared to the negative control (61.5%). The integrated mineral loss and the lesion depth were not reduced by any treatment. Surface hardness recovery was seen only for shallow lesions in case of 20% xylitol+F compared to negative control. No lesion depth recovery, but significant mineral recovery was seen for F (2-days and 10-days lesion). ConclusionsAll concentrations of xylitol+F reduced enamel surface demineralization, while only 20% xylitol+F improved surface remineralization of shallow lesions in vitro. Clinical significanceOur results suggest that while F or any concentration of xylitol + F reduces surface demineralization, only 20% xylitol+F improves surface remineralization of shallow lesions in vitro. Therefore, xylitol may be added into oral products, combined to F, to control dental caries.

Comparative Evaluation of Remineralization and Antimicrobial Efficacy of Maximum Fluoride Containing Toothpastes Available in India - In-Vivo Study

Background: Early childhood caries (ECC) is a common type of dental caries with an overall prevalence of 49.6% in India. Dentifrices- containing 1000-1500ppm concentration of fluorides and certain remineralizing agents are known to be effective in reversal of early enamel lesions and reduction of dental caries prevalence. However, in India, the mean fluoride content of dentifrices available for children is only 449.5 ± 26.1 ppm. Only very few toothpastes with the recommended concentration of fluoride is available in the Indian market, for children below the age of 6 years. Aims: To compare and evaluate the remineralization potential and antimicrobial efficacy of toothpaste with highest amount of fluoride, available in India for children below 6years of age, with non-fluoridated remineralizing children’s toothpaste. To assess the Total Soluble Fluoride (TSF) concentration of fluoridated toothpastes. Methodology: 95 extracted or naturally exfoliated human primary teeth were decoronated and sectioned mesiodistally. Specimens were demineralized and randomly divided into six groups (3 fluoridated and 3 non-fluoridated remineralising toothpaste groups): group 1: Omnident®- 917ppm, group 2: AquaFresh®™ little teeth- 1450ppm, group 3: Colgate kids®- 1000ppm, group 4: Enafix® (Ca. orthophosphate + Ca. Sucrose phosphate), group 5: Aclaim® (Nano HAP) and group 6: Shy-NM® (Novamin). The samples were placed in the demineralizing solution for 48h and subjected to Vickers hardness test (VHT) and SEM to obtain the baseline values. Then the samples were remineralized using the respective toothpastes and were subjected to SEM and VHT at 21days, 3months and 6months intervals. Antimicrobial activity of all the dentifrices was determined by agar well diffusion method and selective ion electrode analysis was used to evaluate the Total Fluoride (TF) and Total Soluble Fluoride (TSF) concentrations among the three fluoridated toothpastes. The data obtained were statistically analysed. Results: SEM images showed mineral deposition in all the groups obliterating the defects caused due to demineralization at various intervals. Remineralising agents showed significantly higher remineralisation especially SHY-NM when compared to Fluoridated toothpastes. However they did not show any antimicrobial efficacy. Fluoridated toothpastes showed antimicrobial efficacy against S. mutans and the highest antimicrobial efficacy was seen with Aquafresh followed by Omnident and Colgate Kids which was directly proportional to the TSF concentration of the toothpastes. Conclusions: Highest remineralisation of artificial enamel lesions was shown by non- fluoridated remineralising toothpaste, however, the fluoridated dentifrices displayed both antimicrobial and remineralising properties. The Total Soluble Fluoride (TSF) concentration of fluoride toothpastes were generally slightly less than the Total Fluoride (TF) concentration (TSF/F (%): 97%- AquaFresh®TM, 61.1%-Colgate kids® and 96.5% in Omnident®), which can be correlated to the dose-dependant antimicrobial efficacy as well as remineralisation of the fluoridated toothpastes. Keywords: remineralization potential, antimicrobial efficacy, toothpaste with highest amount of fluoride, dental caries.

Laser – fluorescence based evaluation of remineralization in artificial enamel lesions using three commercially available re-mineralizing agents – An invitro study

The objective of this in-vitro study is evaluation of remineralization potential of three remineralization agents- Tricalcium phosphate flouride(TCP-F), Calcium sucrose phosphate(CaSP), Casein phosphopeptide- amorphous calcium phosphate(CPP-ACP) in artificial enamel lesion using laser fluorescence based DIAGNOdent(KaVo). 30 single rooted premolars were selected. Samples were randomly divided into 3 groups with 10 samples each. Baseline values were recorded before any intervention. A 4mmx4mm window was prepared on the buccal surface which was then subjected to demineralization for 96 hr at 37°C. DIAGNOdent values were recorded after demineralization. Remineralization was done using Group I TCP-F, Group II CaSP, Group III CPP-ACP remineralizing agents. The samples were subjected to DIAGNOdent analysis after 72hrs, 7days, 14 days. The data was analyzed with analysis of variance (ANOVA) and Post Hoc test. All three groups showed significant difference in DIAGNOdent values at baseline, post demineralization and post remineralization. TCP-F group showed maximum remineralization followed by CaSP and CPP-ACP groups. DIAGNOdent is a reliable non-invasive caries detecting device to measure early demineralization. TCP-F, CaSP, CPP-ACP are proven to possess remineralization properties.

Assessment of the Remineralizing Efficacy of Grape Seed Extract vs Sodium Fluoride on Surface and Subsurface Enamel Lesions: An In Vitro Study.

The aim of this study was to evaluate the efficacy of grape seed extract (GSE) on remineralization of surface and subsurface enamel lesions compared to that of sodium fluoride (NaF). A total of 20 intact bovine incisor crowns were separated from their roots and immersed in a demineralizing solution for 96 hours at 37°C to create artificial enamel lesions. The specimens were randomly divided into two groups (n = 10): 6.5% GSE solution and 1000 ppm NaF solution. The specimens were subjected to six daily pH cycles for 8 days. The microhardness test was carried out at three different stages: baseline, after artificial caries formation, and after pH cycling. Raman spectroscopy was used to evaluate the depth of enamel remineralization. Surface morphology and elemental analysis were assessed using a scanning electron microscope (SEM) and an energy dispersive X-ray (EDX) spectroscope, respectively. Statistical analysis was performed using SPSS 22.0 at a significance level of p ≤ 0.05. There was a significant increase in the mean values of enamel surface microhardness after pH cycles in the two groups compared to after artificial caries formation, but there was no significant difference between both groups. The B-type carbonate/phosphate (Ca/P) ratio at 10 and 40 µm depth revealed no significant difference between the two groups. Scanning electron microscope micrograph revealed occlusion of porosities and particle precipitation on the enamel surface of the two groups, while EDX results for the Ca/P ratio of the GSE and NaF groups were 1.59 and 1.60, respectively. Grape seed extract and NaF are equally effective in remineralizing surface and subsurface artificial enamel lesions. Grape seed extract can be considered a promising herbal material and a safe alternative to traditional NaF for the noninvasive treatment of enamel lesions.

Remineralization activities of toothpastes with and without aloe vera with different ratios of fluoride on demineralized enamel: An In-vitro study.

The aim of this in-vitro study was to evaluate and compare the efficacy of both pure aloe vera and commercially available toothpastes with different fluoride compounds and different fluoride amounts on artificial initial enamel lesions by Vicker's microhardness values. In the study, 72 extracted human molar teeth were divided into mesiodistal and 144 specimens were prepared using the vestibule and palatal/lingual surfaces of the teeth. After the surface treatments and initial microhardness measurements, all the specimens were placed in a demineralizing solution (pH: 4.5) for 7 days, resulting in artificial initial enamel lesion, and were randomly assigned to eight groups (n = 18). After the teeth were subjected to pH cycle for 14 days, microhardness measurements were repeated and the data were recorded. Statistical analyzes were performed using MedCalc Statistical Software version 12.7.7. The significance level was determined to be 0.05. In the statistical results, when the microhardness values after demineralization and post-cycle were compared, Groups B1 and A2 showed the lowest values, while Groups A3 and B3 did not show a significant difference in terms of microhardness values after demineralization and post-cycle, and only Group B4 showed statistically significantly higher values. This study emphasized the remineralization effects of fluoride on initial enamel lesions. It can be said that toothpaste containing 1450 ppm fluoride and aloe vera provides an effective remineralization and sodium monofluorophosphate formulation may have a synergistic effect with aloe vera.

Remineralization Efficacy of Four Remineralizing Agents on Artificial Enamel Lesions: SEM-EDS Investigation.

Dental remineralization represents the process of depositing calcium and phosphate ions into crystal voids in demineralized enamel, producing net mineral gain and preventing early enamel lesions progression. The aim of the present study was to qualitatively and quantitatively compare the remineralizing effectiveness of four commercially available agents on enamel artificial lesions using Scanning Electron Microscopy (SEM) combined with Energy Dispersive Spectroscopy (EDS) techniques. Thirty-six extracted third molars were collected and randomly assigned to six groups (n = 6), five of which were suspended in demineralizing solution for 72 h to create enamel artificial lesions, and one serving as control: G1, treated with a mousse of casein phosphopeptide and amorphous calcium–phosphate (CPP-ACP); G2, treated with a gel containing nano-hydroxyapatite; G3, treated with a 5% SF varnish; G4, treated with a toothpaste containing ACP functionalized with fluoride and carbonate-coated with citrate; G5, not-treated artificial enamel lesions; G6, not demineralized and not treated sound enamel. G1–G4 were subjected to pH cycling over a period of seven days. Analyses of the specimens’ enamel surfaces morphology were performed by SEM and EDS. Data were statistically analyzed for multiple group comparison by one-way ANOVA/Tukey’s test (p < 0.05). The results show that the Ca/P ratio of the G5 (2.00 ± 0.07) was statistically different (p < 0.05) from G1 (1.73 ± 0.05), G2 (1.76 ± 0.01), G3 (1.88 ± 0.06) and G6 (1.74 ± 0.04), while there were no differences (p > 0.05) between G1, G2 and G6 and between G4 (2.01 ± 0.06) and G5. We concluded that G1 and G2 showed better surface remineralization than G3 and G4, after 7 days of treatment.

Remineralization of early enamel lesions with a novel prepared tricalcium silicate paste

To evaluate the remineralization potential of prepared tricalcium silicate (TCS) paste compared to silver diamine fluoride-potassium iodide (SDF-KI) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on artificial enamel lesions. Thirty permanent sound molars were collected for the study. After cleaning, root cutting, and applying acid-resistant nail varnish, leaving a 4 × 4 mm buccal window, the teeth were subjected to demineralization process. The teeth were divided into three treatment groups (n = 10). In each group, the teeth were sectioned buccolingually to obtain two halves (30 self-control and 30 experimental halves). The self-control halves were subjected to cross-sectional microhardness (CSMH), energy-dispersive X-ray spectroscopy at 50, 100, and 150 µm from the external enamel surface, and micromorphological analysis at the superficial enamel surface. The experimental halves were subjected to the same tests after 30 days of remineralization. Three-way analysis of variance (ANOVA) outcomes showed no significant difference in CSMH after treatment among the three different groups at the different levels (p > 0.05). Meanwhile, three-way ANOVA outcomes showed a significant difference in calcium/ phosphate ratio after treatment among the three different groups at the different levels. (p < 0.05). The tricalcium silicate paste used in this study showed potential remineralization in subsurface enamel lesions.

Remineralisation capability of silver diamine fluoride in artificial enamel lesions on smooth surfaces using quantitative light-induced fluorescence measurements in-vitro

Enamel demineralisation can develop on smooth surfaces as an undesirable side effect during orthodontic treatment with fixed appliances. This study aimed to evaluate the ability of 38% silver diamine fluoride in remineralisation (as estimated by fluorescence gain) of artificial initial lesions in smooth surfaces of human enamel. The smooth surfaces of 50 human tooth samples were artificially demineralised and 45 samples were allocated randomly into three groups receiving a single treatment with a varnish: group I: Riva Star (silver diamine fluoride, SDF), group II: Bifluorid 12 (NaF, CaF2), and group III: Cervitec F (CHX, CPC, NH4F). Five samples were assigned as a negative control group without treatment. All samples were exposed to pH-cycling for 28 days. Fluorescence behavior was measured using Quantitative light-induced fluorescence before and after demineralisation and up to four weeks on a weekly basis. Analysis of variance (ANOVA) with Tukey–Kramer post-hoc tests and repeated measures ANOVA were used for statistical evaluation (α = 0.05). After demineralisation, all samples showed mean ΔF of − 16.22% ± 4.35, without significance differences between the fluorescence behaviour of the samples (p = 0.251). After 28 days group comparison showed a statistically significant difference (p = 0.034) for ΔF values: the lowest fluorescence values were found in group I (SDF, mean ΔF − 16.47 ± 6.08) with a significant difference compared to group III (Cervitec F, mean ΔF − 11.71 ± 4.83). In group II (Bifluorid 12) mean ΔF value was − 15.55 ± 2.15) without statistically significant differences to groups I and III. The fluorescence behaviour of SDF varnish on smooth surfaces with artificial initial enamel lesions was significantly lower compared to Cervitec F varnish after short time use.

Comparison of Remineralization Potential of Casein Phosphopeptide: Amorphous Calcium Phosphate, Nano-hydroxyapatite and Calcium Sucrose Phosphate on Artificial Enamel Lesions: An In Vitro Study.

Aim and objectiveTo evaluate and compare the remineralization potential of CPP-ACP, nano-hydroxyapatite, and calcium sucrose phosphate toothpaste on artificial enamel caries lesions by means of microhardness testing.Materials and methodsTwenty sound human primary molars, extracted for therapeutic reasons were selected for this study. From each tooth, two enamel specimens were prepared and embedded in acrylic resin blocks, and each block contains five tooth samples. After polishing, the baseline hardness of the enamel surface (KHN) was determined by Knoop microhardness testing. Then the specimens were randomly assigned into four groups (n = 10), according to the remineralizing agent used: group I: Control, group II: GC Tooth MousseTM (CCP-ACP), group III: AcclaimTM (nano-HAP), and group IV: EnaFix (CaSP). The specimens were then immersed in a demineralizing solution and post-lesion KHN values were obtained as baseline measurements. Later remineralizing agent was applied and after 7 days of remineralization, posttreatment KHN tests were conducted.ResultsData were analyzed using paired t- test, analysis of variance, and Tukey HSD test. Mean enamel surface microhardness (KHN) values after remineralization shows that group IV (EnaFixTM) had maximum hardness number (114.71 ± 12.27) followed by group III (Acclaim) (85.14 ± 22.82) and group II (GC Tooth Mousse) (56.42 ± 19.90). The difference was statistically significant (p < 0.001). Similarly the %SMHR was also highest in group IV (EnaFix), followed by group III (Acclaim) and group II (GC Tooth Mousse).ConclusionEnaFix (calcium sucrose phosphate) shows a maximum increase in the enamel surface microhardness followed by Acclaim (nano-HAP) and GC Tooth Mousse.Clinical significanceCalcium Sucrose Phosphate in toothpaste strengthened the enamel more than nano hydroxyapatite and CPP-ACP, and can be an alternative to the use of fluoride toothpaste in children.How to cite this articleSebastian R, Paul ST, Azher U, et al. Comparison of Remineralization Potential of Casein Phosphopeptide: Amorphous Calcium Phosphate Nano-hydroxyapatite and Calcium Sucrose Phosphate on Artificial Enamel Lesions: An In Vitro Study. Int J Clin Pediatr Dent 2022;15(1):69-73.

Effect of different surface treatments on the microhardness and colour change of artificial enamel lesions.

To investigate the effect of three different surface treatments on the microhardness and colour change of artificial enamel lesions. One hundred bovine teeth were randomly assigned into four groups. Artificial enamel lesions were created using demineralizing solution for all groups except the sound enamel group. Different surface treatments were then performed G1: resin-infiltrant; G2: Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP); G3: artificial saliva; G4: Sound Enamel. Each group was subdivided into three subgroups, where each subgroup was subjected to a different testing method. Subgroup 1: surface microhardness; subgroup 2: cross-sectional microhardness; subgroup 3: colour measurement. Statistical analysis was performed by ANOVA, followed by Tukey's post hoc test. Sound enamel group recorded the highest surface and cross-sectional microhardness results. No significant difference was found between the resin-infiltrant group and CPP-ACP regarding surface and cross-sectional microhardness at different lesion depths. Resin-infiltrant group showed the least colour change (∆E) results compared to the other groups. Resin-infiltrant can effectively enhance surface microhardness and enamel resistance to demineralization, additionally, reduces the staining susceptibility of white spot lesions (WSLs) after treatment. CPP-ACP application for 4 weeks seems to improve surface microhardness; however, has a limited effect in resisting staining of WSLs after treatment. © 2022 Australian Dental Association.

In Vitro Evaluation of the Efficacy of Three Different Remineralizing Agents on Artificial Enamel Lesions in Primary Teeth: A Comparative Study

The aim of the present study was to assess the effectiveness of three various remineralizing agents on artificial enamel lesions in deciduous teeth. Eighty primary teeth that were implicated for extraction were taken from patients of 4 to 14 years of age. Every specimen was subjected to air drying followed by the creation of 3 × 3 mm window positioned on the central surface of the coronal portion of the tooth to restrict the area of investigation. A digital pH meter was utilized to formulate a demineralizing solution by checking the pH before and following formulation of the solution. A total of 80 specimens (20 in every group) were allocated to three of the following experimental groups and one control group: group I: control, group II: tricalcium phosphate, group III: casein phosphopeptide-amorphous calcium phosphatefluoride (CPP-ACPF), and group IV: calcium sucrose phosphate (CaSP). Specimens in every group were subjected to treatment with the assigned remineralizing substance once in 24 hours for 14 days. Confocal laser scanning microscopic (CLSM) evaluation of the samples was performed to assess the baseline and posttreatment remineralization as well as demineralization. CPP-ACPF group (110.73 ± 0.11) displayed the greatest mean remineralization depth, in pursuit by the calcium orthophosphate complex (CaSP) group (122.19 ± 0.28), tricalcium phosphate group (126.87 ± 0.15) as well as the control group (158.46 ± 0.07). These differences amid the investigational groups for remineralization were significant. The greatest depth µ area of remineralization was seen in the CPP-ACPF group (50.29 ± 0.06) in pursuit by the CaSP group (36.70 ± 0.17) as well as the tricalcium phosphate group (33.29 ± 0.06). This difference amid the remineralizing agents was statistically significant. Amid the confines of the limitations of the current research, it may be concluded that the three remineralizing agents studied, exhibited a remineralization capability on the artificially induced lesions in enamel. CPP-ACPF exhibited the greatest remineralization capability in comparison with the CaSP and tricalcium phosphate groups. Dental caries is an unalterable course that leads to everlasting loss of dental hard tissues with eventual formation of a cavity. Off late, numerous techniques have centered on applying remineralizing substances to early lesions due to dental caries, aiming at arresting demineralization while encouraging remineralization. Such remineralizing substances form an atmosphere that is superconcentrated with calcium and phosphate, thereby forcing these ions to diffuse into the unoccupied areas, thereby avoiding further loss of minerals.