Artificial White Spot Lesions Research Articles

Development of an Artificial White Spot Lesion Creation Protocol: A Preliminary Study

Development of an Artificial White Spot Lesion Creation Protocol: A Preliminary Study

Comparative Analysis of the Effectiveness of Four Distinct Remineralizing Agents in Artificial White Spot Lesions Following Chitosan Nanoparticle Pretreatment: An In Vitro Study

Comparative Analysis of the Effectiveness of Four Distinct Remineralizing Agents in Artificial White Spot Lesions Following Chitosan Nanoparticle Pretreatment: An In Vitro Study

The Effect of Non-Invasive Treatment Techniques on the Color Masking Ability and Surface Roughness of Induced Enamel Lesions (An in vitro Study)

ABSTRACT Aim of the Study: The aim of this in vitro study was to evaluate the effect of the resin infiltration technique and remineralization of induced enamel caries with fluoride solution on the color masking of white spot lesions and surface roughness. Materials and Methods: A total of 45 sound teeth were used in this study. All the teeth were sectioned along the long axes into two halves, lingual and buccal to get 90 specimens. All specimens were immersed in a demineralized solution for 7 days. The specimens were divided randomly into three equal groups (n = 30) according to the type of treatment; Group 1 (n = 30) was treated with fluoride varnish (Clinpro); Group 2 (n = 30) was treated by resin infiltration (Icon); and Group 3 (n = 30) was used as a control group with no treatment. The color and surface roughness were measured three times at baseline (T1), directly after induction of artificial white spot lesions (WSLs) (T2), and directly after application of the treatment options (T3). The colors were measured using a portable reflective spectrophotometer and the 3D surface roughness was measured using a Light Sectioning Vision System. Data were collected and statistically analyzed using T test and Mann–Whitney U test. The Results: Surface roughness was almost equal in the study groups with no statistically significant differences reported. Icon showed slightly higher color scores than that of ClinPro. Conclusions: The Icon produced favorable esthetic results compared to the fluoride therapy while no significant differences were reported regarding the surface roughness.

Evaluation of resin infiltration for inhibiting initial caries progression: An in vitro study using Micro-Computed Tomographic analysis

ObjectiveTo evaluate the changes in lesion depth and mineral density of resin infiltration-treated white spot lesions against asimulated oral environment using thermal and acidic challenges in vitro. Materials and methodsTwo enamel slabs were prepared from each buccal surface of permanent human premolars, for a total of 56 slabs. Artificial white spot lesions were induced. One specimen was treated with resin infiltration, while the other was used as an untreated control. A micro-CT was used to assess the lesion depth and mineral density of each specimen. Subsequently, all specimens were subjected to 10,000 cycles of thermocycling and pH cycling for 10 days before being re-evaluated using the micro-CT. Lesion depth and mineral density were examined and compared between before and after aging procedures within each group by the paired sample t-test. The independent samples t-test was utilized to compare lesion depth progression and percentage change of mineral density between groups. ResultsAfter aging, there was both a significant lesion depth progression and a mineral loss in the control and resin infiltration groups. Mean lesion depth progression was 132.88 ± 4.18 µm for the control group and 52.31 ± 4.16 µm for resin infiltration group. Percentage mineral density loss as a percentage for the control and resin infiltration groups were 16.1 ± 0.64 % and 8.83 ± 0.30 %, respectively. The resin infiltration group demonstrated a significantly lower mean lesion depth progression and percentage changes in mineral loss compared to the control group. ConclusionsThe lesion depth and mineral density changes in the resin infiltrated-treated group were lower than untreated white spot lesions after aging procedures using thermal and acidic challenges. Clinical significanceResin infiltration is a promising approach to inhibit the progression of white spot lesions related to the initial stage of dental caries.

An in vitro evaluation of the effects of fluoride, CPP-ACP, or resin infiltration on discoloration caused by pediatric supplements.

White spot lesions are more susceptible to staining agents due to their porous structure. This study examines the impact of white spot lesion treatments on discoloration caused by pediatric supplements. Three treatments (fluoride, casein phosphopeptide-amorphous calcium phosphate [CPP-ACP], resin infiltration), a control, and their respective syrup-based subgroups (iron and black elderberry syrups) were established, each with eight teeth. Artificial white spot lesions were induced, and weekly applications of fluoride varnish, daily applications of CPP-ACP paste, or a single resin infiltration procedure were performed on the white spot lesions within the treatment groups over 4 weeks. Simultaneously, samples were exposed daily to iron or black elderberry syrups. Spectrophotometer measurements were taken at baseline, after demineralization (T0), and after 1 (T1), 2 (T2), and 4 weeks (T4). ΔE00 values were calculated. Statistical analysis was conducted using a three-way mixed-design ANOVA, with the significance level set at P = .05. At T4, ΔE00 values from all groups exceeded the clinical acceptability limit of 1.8. At T2 and T4, the ΔE00 values obtained from the black elderberry syrup subgroups were significantly higher (P < .001). At T4, the highest ΔE00 values were seen in the CPP-ACP groups (P < .001). The lowest ΔE00 values at T2 and T4 were observed in the resin infiltration groups (P < .05). Supplements containing ferrous sulfate and black elderberry extract caused color changes in white spot lesions that exceeded the clinical acceptability limit. Resin infiltration of white spot lesions provides advantages over remineralization treatments, particularly in minimizing discoloration induced by pediatric supplements.

Treatment of shallow and deep white spot lesions with three different mouthwashes evaluated by laser fluorescence (an in vitro study)

This research aims to find how three different types of mouthwashes affect the depth of artificial white spot lesions. Teeth with various depths of white spot lesions were immersed in either splat mouthwash, Biorepair mouthwash, Sensodyne mouthwash, or artificial saliva (control)twice daily for one minute for 4 weeks and 8 weeks at 37°C. After this immersion procedure, lesion depth was measured using a diagnosed pen score. A one-way analysis of variance, Dunnett T3 and Tukey's post hoc α = .05 were used to analyze the testing data. Splat mouthwash enhanced the WSL remineralization and made the lowest ΔF compared with other mouthwashes in shallow and deep enamel after 4 and 8 weeks of treatment. In the repair groups, after 4 weeks of treatment, significant recovery was observed in shallow enamel. Further improvement in shallow WSL after 8 weeks of treatment with biorepair mouthwash was observed compared to Sensodyne and the control group. Splat mouthwash is more effective than other mouthwashes in remineralizing two depths of WSLs at different time points. Keywords: DIAGNOdent pen, Shallow enamel, Deep enamel, white spot lesion.

Impact of Various Remineralizing Agents on Artificial White Spot Lesion on Primary Teeth-A Comparative Study.

The aim of the current research was to assess the effectiveness of different remineralizing substances on artificial white spot lesions on deciduous teeth. 45 deciduous teeth without dental caries constituted the study group for this in vitro research. A 3 mm by 3 mm window of enamel was uncovered at the occluso-gingival midpoint of the coronal labial surface; an acid-resistant nail varnish was coated alongside the uncovered enamel surface of all specimens, employing vertical strokes. Demineralization was executed for the tenure of 72 hours at 37°C temperature in an incubator. The forty-five specimens, fifteen in each group, were assigned to the investigational groups plus a control group as: Group A: Control, Group B: Calcium sucrose phosphate (CaSP), Group C: Casein phosphopeptide-amorphous calcium phosphate-fluoride (CPP-ACPF). Microhardness tester was employed for testing the microhardness of the enamel surface using a Vickers diamond indenter laden with twenty-five milligrams for approximately ten seconds. Vickers hardness number (VHN) calculations for the microhardness were performed at baseline and on the fourteenth day. The CPP-ACPF group exhibited greater mean microhardness value at 236.14 ± 2.12, in pursuit by CaSP group with a score of 231.98 ± 3.16 and then the control group at 220.22 ± 5.08. An extremely statistically significant difference was seen amid the groups. The current research arrived at a conclusion that both the remineralizing substances were certainly efficient in handling early dental caries, and additionally, casein phosphopeptide-amorphous calcium phosphate-fluoride (CPP-ACPF) was found highly efficient as a remineralizing substance, in pursuit by calcium sucrose phosphate (CaSP).

Surface roughness and microhardness of enamel white spot lesions treated with different treatment methods

ObjectiveTo analyse the surface roughness and microhardness of artificial enamel white spot lesions before and after WSL formation, after treatment (Opalsutre™ microabrasion, Sylc® bioactive glass, and ICON® resin infiltration), and after pH cycling with the help of the profilometer surface roughness tester and the digital Vickers microhardness tester. Materials and methodsSeventy-five extracted molars were used to acquire one hundred specimens. 50 specimens were randomly assigned to five groups (n = 10) for the surface roughness study: 1) Sound group, 2) WSL group, 3) micro abrasion (MA; Opalustre, Ultradent, South Jordan, UT, USA), 4) bioactive glass 45S5 Sylc powder (Sylc; Denfotex Research Ltd, Inverkeithing, UK), and 5) ICON resin infiltration (ICON; DMG, Hamburg, Germany). An additional 25 specimens were used to obtain 50 enamel slabs for the surface microhardness study, which were also assigned to the same groups. All groups underwent a final stage of pH cycling. Surface roughness and surface microhardness measurements were performed at different stages for all groups. ResultsRegarding surface roughness, ICON significantly reduced the surface roughness compared to Opalustre and Sylc, with no significant difference between Opalustre and Sylc. In terms of surface microhardness, ICON showed the highest improvement, followed by Sylc and then Opalustre. Both surface roughness and microhardness were significantly affected by demineralization, partially improved after treatment, and then regressed significantly after pH cycling. ConclusionICON resin infiltrant can be considered as a superior treatment option for improving surface roughness and microhardness, while Opalustre demonstrated relatively the poorest performance compared to the other treatment options. It is noteworthy that the pH cycling procedure had an adverse impact irrespective of the treatment option used.

Comparative evaluation of prevention of demineralization of artificial enamel caries treated with two fluoride varnishes and 38% SDF in primary teeth: an in vitro study

BackgroundThis study aimed to compare the effect of Clinpro™ White varnish containing 5% sodium fluoride (NaF) and functionalized tricalcium phosphate, MI varnish containing 5% NaF and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and 38% Silver diamine fluoride (SDF) in preventing demineralization of treated white spot lesions (WSLs) in enamel of primary teeth.MethodsForty-eight primary molars with artificial WSLs were allocated into four groups as follows: Group 1: Clinpro white varnish, Group 2: MI varnish, Group 3: SDF, and Group 4: control (no treatment). The three surface treatments were applied for 24 h and then enamel specimens were subjected to pH cycling. Thereafter, the mineral content of specimens was evaluated by Energy Dispersive X-ray Spectrometer and the lesion depth was assessed via Polarized Light Microscope. One-way ANOVA followed by Tukey’s post hoc test were used at p ≤ 0.05 to identify significant differences.ResultsInsignificant difference in mineral content was observed among treatment groups. Treatment groups exhibited significantly higher mineral content compared to control except for Fluoride (F). MI varnish showed the highest mean calcium (Ca) ion content (66.57 ± 0.63), and Ca/P (2.19 ± 0.11), followed by Clinpro white varnish, and SDF. MI varnish also displayed the highest phosphate (P) ion content (31.46 ± 0.56), followed by SDF (30.93 ± 1.02), and Clinpro white varnish (30.53 ± 2.19). Fluoride content was highest in SDF (0.93 ± 1.18), followed by MI (0.89 ± 0.34) and Clinpro (0.66 ± 0.68) varnishes. Significant difference in lesion depth was observed among all groups (p < 0.001). The lowest mean lesion depth (µm) was found in MI varnish (226.23 ± 44.25) which was significantly lower than Clinpro white varnish (285.43 ± 44.70), SDF (293.32 ± 46.82), and control (576.69 ± 42.66). Insignificant difference in lesion depth was found between SDF and Clinpro varnish.ConclusionsIn primary teeth, WSLs treated with MI varnish displayed better resistance to demineralization compared to WSLs treated with Clinpro white varnish and SDF.

Remineralization and Aesthetic Effect of Three Agents on Artificial White Spot Lesions: An in vitro study

Remineralization and Aesthetic Effect of Three Agents on Artificial White Spot Lesions: An in vitro study

Methylene Blue Penetration of Resin Infiltration and Resin Sealant in Artificial White-Spot Lesions.

This study determined the potency of resin infiltrations and resin sealant in impeding microleakage on artificial white-spot lesions (AWL) by methylene blue penetration. Eighty AWL specimens were randomly separated into two groups for water storage for 24 hours (groups 1-4) and 20,000 cycles of thermocycling (TC) (groups 5-8). Each group was then separated into four subgroups (n = 10) based on the AWL surface treatments: (1) no Tx, (2) treated with resin infiltration (ICON, DMG, Hamburg, Germany), (3) treated with resin infiltration (Surface pre-reacted glass-ionomer (S-PRG) barrier coat, SHOFU, Kyoto, Japan), (4) treated with resin sealant (Clinpro sealant, 3M ESPE, Minnesota, United States). Nail varnish was covered to all samples, with the exception of a 4 × 4 mm2 patch on the buccal measurement region, which was subsequently submerged in a 2% methylene blue solution and cut into buccolingual sections. Stereomicroscope measurements were used to calculate methylene blue penetration scores. The Kruskal-Wallis test and the Bonferroni post-hoc correction were performed to evaluate the data. Application of resin infiltrants and resin sealant reduced microleakage in AWL by methylene penetration both before and after thermal cycling. In addition, group 6 (ICON + TC) and group 7 (S-PRG + TC) had a significantly different value from group 8 (sealant + TC). Both the resin infiltration approach and the resin sealant seem to help seal AWL and might perhaps offer long-term defense against microleakage in AWL caused by methylene blue penetration. The greatest sealing and defense for microleakage in AWL were demonstrated by the resin infiltrations.

Nano-hydroxyapatite-induced remineralization of artificial white spot lesions after bleaching treatment with 10% carbamide peroxide.

To assessed in vitro the effect of nanohydroxyapatite (n-HA) to improve the aesthetic appearance and microhardness of white spot lesions (WSL) when associated with a low-concentration bleaching agent (carbamide peroxide-CP10%). Enamel/dentin specimens (n=60) of 5 × 5 × 2.2 mm were prepared, of these, 48 were submitted to pH-cycling to create artificial WSL. Subsequently, these were allocated into five groups (n=12): n-HA; n-HA + CP10%; CP10%; WSL control (WSLC ); sound control (Sound). The color was assessed at baseline, pre-treatment, and post-treatment using a spectrophotometer, and the color (ΔE/ΔE00 ) and whiteness index (ΔWID) alterations were determined. The enamel cross-sectional microhardness (CSMH) was evaluated (post-treatment) with a Knoop indenter, 25gf/5s, 20-200 μm. The data was analyzed through generalized linear models (α=5%). ΔE and ΔE00 were significantly higher for the bleached groups (n-HA + CP10% and CP10%), and the n-HA was higher than the WSLC group (p < 0.05). ΔWID was significantly higher for the bleached groups (p < 0.05). The CSMH values were significantly higher in the sound group than in the n-HA, CP10%, and WSLC groups (p < 0.05). The WSLC had lower microhardness than the n-HA + CP10% and sound groups (p < 0.05). n-HA is suitable to remineralize and recover the color of the WSL. However, its association with CP10% maintains the esthetical outcome while increasing its in-depth remineralizing effect. Considering the aesthetic and functional repercussions of the WSL persistence, treatments that tend to improve its physical appearance and reinforce its weakened substructure in a non-invasive way are ideal. For this associating low-concentration, bleaching agents to the remineralizing treatments is promising to treat this type of lesions.

Novel hybrid-glass-based material for infiltration of early caries lesions

ObjectivesTo assess the effectiveness of two experimental, hybrid-glass-based infiltrants in arresting artificial white spot lesions (WSLs) in vitro, and to compare it with resin-based infiltrant Icon. MethodsArtificial WSLs were formed on bovine enamel specimens (n = 68). Specimens were divided into four groups according to WSLs treatment: 1) no-treatment control (NTC), 2) infiltration with Icon (Icon), 3) infiltration with experimental hybrid-glass material (EXP), and 4) infiltration with experimental hybrid-glass material containing hydroxyapatite (HAp) nanoparticles (1%) (EXP-HAp). Half of the specimens from each group were subjected to cariogenic challenge using pH-cycling, consisting of a 7-day alternate incubation (37⁰C) in demineralization (4 h/day, pH=4.6) and remineralization solutions (20 h/day, pH=7.2). Another half of the specimens was incubated in distilled water (control). Caries progression was assessed by measuring surface micro-hardness (SMH), roughness (Ra) and average surface level, and by analyzing WSLs morphology. Non-cycled and pH-cycled specimens were compared with Man-Whitney U test, while different treatment groups were compared with Kruskal-Wallis test with pairwise comparisons (p < 0.05). ResultsIn all groups (NTC, Icon and EXP-HAp) except EXP, SMH decreased significantly after pH cycling. In addition, SMH increased in EXP upon pH cycling and was significantly higher than in other pH-cycled groups (<0.001). Ra increased considerably, while surface level decreased after pH cycling in all groups except in EXP. Signs of demineralization and roughness increase in NTC, Icon and EXP-HAp were also observed with the SEM. SignificanceExperimental hybrid-glass-based material without HAp-nanoparticles could completely arrest the progression of WSLs, unlike its version with HAp-nanoparticles and resin-based infiltrant Icon.

Effect of Resin Infiltration and Microabrasion on the Microhardness of the Artificial White Spot Lesions (An in Vitro Study)

Background: White spot lesion is the first visible sign of dental caries that is characterized by demineralized lesion underneath an intact surface. Several studies demonstrated that they could be treated using noninvasive techniques like the use of fluoride or casein phospho-peptide and amorphous calcium phosphate. Improvement in aesthetic outcomes by covering the demineralized enamel is one of the advantages of the use of resin infiltration and opal-ustre microabrasion, which are two new techniques that had been used for treatment of white spot lesion. The purpose of this study was to evaluate the impact of resin infiltration and microabrasion in the microhardness of the artificial white spot lesions at various depths. Material and method: Forty-eight artificially white spot lesions were divided into three groups (n=16) according to the depth of the lesion (shallow enamel, deep enamel, shallow dentine). Then, each of the main groups was divided into two subgroups (n = 8), the first group was treated with resin infiltration, while the second one was treated with Opalustre microabrasion. Assessment of the microhardness was done using Vickers hardness at the baseline, after demineralization (formation of the white spot lesion) and after the treatment with the resin infiltration and the microabrasion. Results: There was a significant difference in the microhardness of all the layers after demineralization. Although the hardness values that found among the icon group in the inner enamel and the outer dentine were higher than that of the opalustre, statistically there was no significant difference between the two mate-rials in all the layers of the white spot lesion. Conclusion: Microhardness values decrease as the depth of the white spot lesion increase. There was an increase in the microhardness values after the treatment with the resin infiltration and the microabrasion.

Effect of CPP-ACPF, resin infiltration, and colloidal silica infiltration on surface microhardness of artificial white spot lesions in primary teeth: An in vitro study

Remineralizing agents such as fluoride and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) are popular treatment choices for incipient enamel lesions. Recently introduced resin infiltration enhances the esthetics of teeth affected by these enamel lesions. Furthermore, few studies reported the utilization of colloidal silica infiltration for the white spot lesions. However, the potency of these materials for treatment in primary teeth necessitates investigation.Thus, this study evaluated and compared the effectiveness of CPP-ACP fluoride (CPP-ACPF), resin infiltration, and colloidal silica infiltration on surface microhardness in artificial white spot lesions in primary incisors using the Vickers microhardness testing machine. In this in vitro study, on the labial surface of 45 primary incisors, artificial white spot lesions were created by immersing them in a demineralizing solution. According to the evaluation method, random distribution of specimens into three groups: Group 1: CPP-ACPF, Group 2: resin infiltration, and Group 3: colloidal silica infiltration. Specimens after treatment were stored in artificial saliva, followed by microhardness evaluation using Vickers microhardness. Microhardness readings at baseline, post demineralization, and after treating them with different materials were taken. The level of significance was 0.01. Enamel specimens treated with resin infiltration showed a high microhardness mean value compared to CPP-ACPF and colloidal silica infiltration. Resin infiltration is a promising and effective treatment option for incipient enamel lesions followed by CPP-ACPF compared to colloidal silica infiltration in primary teeth.

Comparison of the efficacy of Icon resin infiltration and Clinpro XT varnish on remineralization of white spot lesions: An in-vitro study.

OBJECTIVE:To compare the efficacy of Icon resin infiltration and Clinpro XT varnish on remineralization of white spot lesions using a polarized light microscope (PLM).MATERIALS & METHODS:Artificial white spot lesions were created on a sample of 40 extracted human premolar teeth by immersing in a demineralizing solution. All samples were randomly allocated to two groups of 20 each; Group A: Icon resin infiltration and Group B: Clinpro XT varnish. Teeth were sectioned along the buccolingual plane using a diamond disc. Specimens were observed under the PLM (4× magnification) at three deepest measurements and their averages were calculated to obtain the mean penetration depth. The data obtained were analyzed using SPSS software (version 22.0). Independent samples t-test and group statistics were used to compare the two groups. In all statistical tests, the significance level was set at 5% (P < 0.05).RESULTS:Both Icon resin infiltration and Clinpro XT groups showed a statistically significant difference (P = 0.00) in the penetration depth. Icon resin infiltration group showed a significantly higher penetration depth (24.46 μm) compared to the Clinpro XT group (12.34 μm). Group A showed a greater mean penetration depth (17.07 ± 4.35 μm) when compared to group B (7.68 ± 1.81 μm).CONCLUSION:Icon resin infiltration showed a significantly higher penetration depth and is more effective on remineralization of white spot lesions when compared to Clinpro XT varnish.

Efficacy of Three Commercially Available Fluoride Releasing Varnishes in Remineralization of Artificial White Spot Lesions Evaluated by Laser Fluorescence: An In Vitro Study

Introduction This study aimed to assess the remineralization of shallow and deep artificial white spot lesion (WSL) by the application of three fluoride releasing varnishes. Methods Sixty-four extracted premolars were subjected to acid attack inducing two depths of WSLs. Using a DIAGNOdent pen, teeth were divided into two groups according to the WSL depth: shallow enamel (SE) and deep enamel (DE). Then each was subdivided into four intervention groups of eight teeth each: MI varnish, Clinpro White varnish, Clinpro XT, or control (artificial saliva). Laser fluorescence were measured via DIAGNOdent pen at baseline, demineralization stage, 24 h, 4 weeks, and 8 weeks after intervention. Results For each lesion depth, there were statistically significant differences among the agents after intervention (P < 0.01) and among time intervals for each group (P < 0.01). Conclusion MI varnish is more effective than Clinpro White varnish or Clinpro XT in remineralizing two depths of WSLs at different time points.

Characterization of white spot lesions formed on human enamel under microcosm biofilm for different experimental periods.

The initial characteristics of white spot lesion (WSLs), such as the degree of integrated mineral loss (ΔZ), depth and pattern of mineral distribution, have an impact on further demineralization and remineralization. However, these lesion parameters have not been evaluated in WSLs produced from microcosm biofilms.Objective:This study characterized artificial white spot lesions produced on human enamel under microcosm biofilm for different experimental periods.Methodology:In total, 100 human enamel specimens (4x4mm) were assigned to 5 distinct groups (n=20/group) differing according to the period of biofilm formation (2, 4, 6, 8 or 10 days). Microcosm biofilm was produced on the specimens from a mixture of human and McBain saliva at the first 8h. Enamel samples were then exposed to McBain saliva containing 0.2% sucrose. WSLs formed were characterized by quantitative light-induced fluorescence (QLF) and transverse microradiography (TMR). Data were analyzed by ANOVA/Tukey or Kruskal-Wallis/Dunn tests (p<0.05).Results:A clear time-response pattern was observed for both analyses, but TMR was able to better discriminate among the lesions. Regarding QLF analysis, median (95%CI; %) changes in fluorescence ∆Z were -7.74(-7.74:-6.45)a, -8.52(-8.75:-8.00)ab, -9.17(-10.00:-8.71)bc, -9.58(-10.53:-8.99)bc and -10.01(-11.44:-9.72)c for 2, 4, 6, 8, and 10 days, respectively. For TMR, median (95%CI; vol%.µm) ∆Z were 1410(1299-1479)a, 2420(2327-2604)ab, 2775(2573-2899)bc, 3305(3192-3406)cd and 4330(3972-4465)d, whereas mean (SD; µm) lesion depth were 53.7(12.3)a, 71.4(12.0)a, 103.8(24.8)b, 130.5(27.2)bc, 167.2(39.3)c for 2, 4, 6, 8 and 10 days, respectively.Conclusion:The progression of WSLs formed on human enamel under microcosm biofilm can be characterized over 2-10 days, both by QLF and TMR analyses, although the latter provides better discrimination among the lesions.

Spectrophotometric Evaluation of the Color Change of Artificial White Spot Lesions Treated with Three Different Commercially Available Remineralizing Agents: An In Vitro Study

Introduction: This study evaluated the color changes induced by the treatment of intact and demineralized enamel surfaces with casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and sodium fluoride. Material and Methods: Ninety-six sound teeth were collected. The samples were divided into “intact” and “demineralized” groups and then subjected to different treatments (CPP-ACFP, sodium fluoride, and CPP-ACP). After the treatment phase, the colors of samples were evaluated and compared with the pretreatment values. Results: Both demineralized and intact enamel samples underwent increased whiteness (L*) and reduced yellowness (b*) upon treatment with any of the agents (P < 0.001). More pronounced results were achieved with CPP-ACP. Conclusion: These treatments generally make the teeth look whiter, brighter, and clearer with a more natural appearance.

Effect of Er:YAG Laser Irradiation and Acidulated Phosphate Fluoride Therapy on Re-Mineralization of White Spot Lesions.

Statement of the Problem: Studies on the efficacy of erbium laser for enhancement of enamel resistance to acid attacks and its effects on fluoride uptake by the enamel are limited.Purpose: This study sought to assess and compare the effects of erbium-doped yttrium aluminum garnet (Er:YAG) laser irradiation and application of acidulated phosphate fluoride (APF) gel (alone and in combination) on remineralization of artificial white spot lesions (WSLs).Materials and Method: This in vitro, experimental study evaluated 90 buccal and lingual slabs of extracted human premolars. The specimens underwent pH cycling to induce WSLs. They were then randomly divided into 6 groups of caries-free positive control (c+), negative control with WSLs (ws), 1.23% APF gel applied on the enamel (F), Er:YAG laser irradiation (80 mJ, 10 Hz, and 8 J/cm2) of enamel (L), APF gel application followed by laser irradiation (FL), and laser irradiation followed by fluoride gel application (LF). The fluoride ion content of specimens was measured before and after the intervention using a potentiometer. Data were analyzed by ANOVA (p< 0.05).Results: APF gel application before/after laser irradiation maximally increased the fluoride uptake by the enamel (p= 0.000). Application of APF gel in group F and laser irradiation in group L increased fluoride uptake by the enamel, compared with groups 1 and 2 (p= 0.000). Laser- treated (L) and APF-treated (F) groups had no significant difference in this respect (p= 0.945). Maximum fluoride concentration was noted in combined laser and fluoride groups (FL=332.07ppm and LF=341.27ppm) with no significant difference between the two (p= 1.000).Conclusion: Er:YAG laser irradiation changes the chemical composition of enamel and probably promote its remineralization, especially when combined with APF gel application, which highlights its cariostatic potential.