Enamel Caries Research Articles

The anti-caries effects of copper tetraamine fluoride on enamel: An in vitro study

ObjectiveTo investigate the antibacterial, remineralising, and discolouring effects of copper tetraamine fluoride (CTF) on artificial enamel caries. MethodHuman enamel blocks with artificial caries were treated with CTF, silver diamine fluoride (SDF, positive control) and water (negative control) before being challenged with Streptococcus mutans. The morphology, viability, and growth kinetics of biofilm were evaluated using scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM), and colony-forming unit (CFU) counting. The lesion depths, mineral loss, micro-hardness, and crystal characteristics were assessed using micro-computed tomography, Knoop Hardness Tester, and X-ray diffraction (XRD), respectively. The discolouring property was assessed by spectrophotometry. ResultsSEM showed that bacteria completely covered the enamel surface treated with water, but not the enamel surface treated with CTF and SDF. CLSM showed dead-to-live ratio of biofilm treated with CTF, SDF and water were 0.8 ± 0.1, 0.9 ± 0.2 and 0.5 ± 0.1 (p < 0.001, CTF, SDF>Water). Log10 CFU values of biofilm treated with CTF, SDF and water were 7.7 ± 0.2, 7.7 ± 0.1 and 8.1 ± 0.1 (p < 0.001, CTF, SDF<Water). Lesion-depths (μm) of the CTF, SDF and water groups were 93 ± 6, 92 ± 7 and 152 ± 29 (p < 0.001, CTF, SDF<Water). Mineral loss (gHApcm−3) of the CTF, SDF and water groups were 0.4 ± 0.1, 0.4 ± 0.2 and 1.0 ± 0.2 (p < 0.001, CTF, SDF<Water). Knoop hardness of the CTF, SDF and water groups were 70 ± 23, 68 ± 16 and 21 ± 10 (p < 0.05, CTF, SDF>Water). XRD revealed well-crystallised hydroxyapatite in enamel treated with CTF and SDF, but not water. Spectrophotometry showed ΔE values of the CTF, SDF and water groups were 5 ± 3, 54 ± 6 and 6 ± 2 (p < 0.001, CTF, water<SDF). ConclusionCTF inhibited Streptococcus mutans biofilm and remineralised artificial enamel caries without discolouration. Clinical significanceIf CTF is successfully translated into clinical use, it can be a simple agent for clinicians to arrest enamel caries.

Enamel hypoplasia and caries in primary dentition

Enamel hypoplasia and caries in primary dentition

A bifunctional nanocomplex with remineralizing and antibacterial activities to interrupt dental caries

Dental caries result from an imbalance between the demineralization and remineralization of dental hard tissues, primarily caused by biofilm accumulation. According to the theory of interrupting dental caries, effective anticaries materials and techniques should possess both remineralizing and antibacterial properties. However, current anticaries materials cannot replicate amelogenesis, which is crucial for remineralization and for preventing bacterial adhesion and biofilm formation. In this study, silk fibroin (SF) loaded with benzalkonium chloride (BZC) successfully formed an SF-BZC composite. This composite stabilized amorphous calcium phosphate (ACP), creating an ACP@SF-BZC dual-functional nanocomplex with both remineralizing and antibacterial properties. ACP@SF-BZC demonstrated significant anti-adhesion and biofilm inhibitory effects against Streptococcus mutans and Streptococcus sobrinus. Moreover, compared to fluoride, ACP@SF-BZC significantly enhanced the remineralization of demineralized enamel surfaces, forming a stable remineralized layer with improved mechanical properties, both in vitro and in vivo. In summary, the dual-function ACP@SF-BZC nanocomplex, with its remineralizing and antibacterial effects, offers a promising alternative for preventing and arresting enamel caries.

Quantitative assessment of early caries lesion activity using novel dye-enhanced fluorescence imaging

ObjectivesThis study aimed to evaluate the validity of the dye-enhanced quantitative light-induced fluorescence (DEQLF) method for assessing early enamel caries activity. MethodsSeventy extracted human teeth with early enamel caries on smooth surfaces were included. Two dentists evaluated the caries activity using the Nyvad system followed by the DEQLF method. The teeth were hydrated with distilled water for 60 s, dehydrated with compressed air for 10 s, and stained with 100 μM fluorescein sodium solution for 10 s. White and fluorescent images were captured using a QLF-D 2+ Billuminator. The change in fluorescence (ΔΔG) was calculated using image analysis software. Independent-sample t-tests were performed to evaluate the difference in ΔΔG between active and inactive lesions for both DEQLF and conventional quantitative light-induced fluorescence (QLF) methods. Receiver operating characteristic (ROC) curve analysis was used to assess the validity of ΔΔG for distinguishing lesion activity using the area under the ROC curve (AUROC). ResultsAmong the 70 caries lesions, 33 were active and 37 were inactive. Using the DEQLF method, the ΔΔG for active lesions (3.8 ± 5.6) was significantly higher than that for inactive lesions (1.0 ± 2.5) (P < 0.05). With the conventional QLF method, there was no significant difference in ΔΔG between active (-1.1 ± 1.7) and inactive (-1.3 ± 1.7) lesions. DEQLF-derived ΔΔG demonstrated an AUROC of 0.72, a sensitivity of 0.67, and a specificity of 0.76. ConclusionsApplying the DEQLF method to human teeth enabled the quantitative assessment of lesion activity based on dye penetration. DEQLF-derived ΔΔG values showed significant differences based on lesion activity status and demonstrated high validity in distinguishing lesion activity. Clinical significanceClinicians can use the DEQLF method, which involves applying a fluorescent dye for 10 s prior to conventional QLF, to objectively quantify and distinguish the activity status of early enamel caries, potentially replacing the traditional reliance on subjective visual assessments.

Evaluation of REFIX Technology on the Remineralization of Artificial Early Enamel Caries Lesion by Laser Speckle Tracking Analysis.

To assess the effectiveness of the REFIX technology in the remineralization process of initial caries simulated on bovine enamel. The assessment involved the analysis of backscatter intensity, which was determined from laser speckle images. Twenty-one bovine teeth were divided into three groups: G1 and G7 were submitted to treatment with the REFIX technology for 1 and 7 days, respectively. The control group was treated with deionized water. A significant difference in backscatter was found between the carious and sound areas in all groups (p = 0.0038, p < 0.0001, and p = 0.0002 for the control group, G1, and G7, respectively). The intergroup comparison revealed no significant difference among the groups studied. REFIX technology did not alter the optical properties of the samples of bovine teeth with simulated initial caries lesions after 1 and 7 days of treatment.

Remineralization Potential of Nanostrontium/Fluoride Hydroxyapatite on Artificial Enamel Caries

Objectives: This study aimed to evaluate the remineralization efficacy of nano-strontium/ fluoride hydroxyapatite paste on initial enamel caries in comparison with other remineralization products under a simulated pH-cycling model. Methods: Following the artificial caries induction, forty enamel specimens with noncavitated lesion in the same range of lesion depth were selected by mean of micro-CT evaluation. The specimens were block-randomized into four experimental groups regarding remineralizing pastes: 1500 ppm sodium fluoride paste, 10%wt nano-hydroxyapatite paste, 10%wt nano-strontium/fluoride hydroxyapatite paste and 5%wt nano-strontium/ fluoride hydroxyapatite paste. Remineralizing effect was evaluated using micro-CT, while SEM/EDS line scan mode facilitated the investigation of remineralization patterns. Changes in lesion depth (ΔLD) and changes in mineral loss (ΔΔZ) were evaluated at 7 and 14 days of treatment under the pH-cycling model. Statistical analyses were performed using 2-way ANOVA and post hoc Tukey’s test (p&lt;0.05). Results: The use of 5%wt nano-strontium/fluoride hydroxyapatite paste significantly reduced lesion depth in initial caries under experimental conditions. Meanwhile, the 10%wt nano-strontium/fluoride hydroxyapatite paste yielded the highest mineral gain, though statistically insignificant. EDS graphs indicated an increasing calcium and phosphorus deposition trend over time with nano-strontium/fluoride hydroxyapatite paste, revealing a more uniform mineral distribution compared to both sodium fluoride and nano-hydroxyapatite pastes. Nevertheless, neither fluorine nor strontium was detectable in these graphs. Conclusions: The study revealed comparable remineralization efficacy with 5%wt and 10%wt nano-strontium/fluoride hydroxyapatite pastes. The treatment durations of 7 and 14 days showed no significant difference in outcomes.

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.

Near-infrared light transillumination (NIR-LT) vs clinical-visual inspection/FOTI to detect interproximal caries lesions in vivo.

To evaluate the ability of near-infrared light transillumination (NIR-LT) to detect interproximal enamel and dentinal caries lesions compared to clinical-visual inspection (VI) aided by fibre-optic transillumination (FOTI). From 170 Finnish adolescents aged 15-17 years, 5294 interproximal surfaces of premolars and molars were examined first clinical-visually aided by FOTI (VI&#43;FOTI) using the International Caries Detection and Assessment System (ICDAS) classification. Subsequently, the surfaces were examined using NIR-LT. The extent of lesions was determined using the modified NIR-LT classification based on the Söchtig criteria. For the analyses, data on upper and lower premolars and molars were combined. Distributions of lesions were presented as frequencies. Differences between VI&#43;FOTI and NIR-LT at the tooth and tooth surface levels were analysed by Chi-square and Fisher's exact tests. Sensitivity and specificity of the NIR-LT method to detect any lesion was performed using VI&#43;FOTI as the gold standard. By VI&#43;FOTI, 92.4% surfaces were classified as sound and by NIR-LT, 88.2%. Enamel caries lesions were found on 7.0% of the surfaces by VI&#43;FOTI and on 11.6% by NIR-LT. Enamel lesions identified by NIR-LT were nearly double for all examined teeth groups, except for lower molars it was 1.3-fold. In 66% of the surfaces, the differences between NIR-LT and VI&#43;FOTI findings were statistically significant (p<0.001). The sensitivity for all teeth of NIR-LT was 48.4% and the specificity was 91.1%. Radiation-free NIR-LT method shows considerable potential as a supplementary method for early detection of caries lesions among low caries prevalence adolescents.

Effects of silver diammine fluoride with/without potassium iodide on enamel and dentin carious lesions in primary teeth.

To assess the effects of SDF and SDF+KI treatment on enamel and dentin carious lesions in primary teeth using x-ray Microtomography (XMT) and back scattered scanning electron microscopy (BSE-SEM). Artificial enamel caries of 3 caries free primary teeth were created by immersion of the samples in 50 ml demineralization solution for 72 h. Three other teeth with natural dentin caries were selected. Both groups were divided into 3 subgroups: EC-Enamel Control; ES-Enamel with SDF application; ESK-Enamel with SDF followed by KI application; DC-Dentin Control; DS-Dentin with SDF application; DSK-Dentin with SDF followed by KI application. Each tooth was imaged using XMT at 3 time points: (1) Pretreatment; (2) after immersion in remineralization solution for 120 h, with or without SDF or SDF+KI; (3) after subsequent immersion in demineralization solution for 72 h. The change of radiopacities of the lesions in these time points were assessed from the XMT images. After the XMT scans, all teeth were investigated microscopically using BSE-SEM. In EC, no change in linear attenuation coefficient (LAC) was observed after remineralization, but LAC reduction was observed after subsequent demineralization. For ES, thin layer of high LAC material was deposited on the enamel surface after remineralization, and further reduction of LAC was observed after demineralization. In ESK, the surface layer was lost after SDF+KI, and small reduction of LAC was observed after demineralization. In DC, no LAC change was observed after remineralization, but reduction of LAC was detected after demineralization. In DS, high LAC material was formed on the carious dentin surface and randomly inside the lesion. No further LAC change was found after demineralization. In DSK, thick layer of high LAC material was deposited on the carious surface and inside the dentinal tubules. No further LAC reduction was found after subsequent demineralization. SDF and SDF+KI did not protect artificial enamel under acid attack even though Ag products were deposited in the porous enamel. However, SDF and SDF+KI shows protective properties against acid challenges and Ag products are deposited in carious dentin lesion without tubular structure randomly; and within dentinal tubules when these structures are retained.

Remineralizing effect of NSF on artificial enamel caries

IntroductionNanotechnology offers new approaches and endless opportunities for remineralizing tooth decay without being toxic or causing allergies. This study aimed to determine the effect of nanosilver fluoride (NSF) on the remineralization potential of enamel caries-like lesions compared to 5% sodium fluoride varnish in permanent teeth.MethodsFifteen teeth (molars and premolars) were gathered, cleaned, and polished using a scaler. After sectioning the teeth mesiodistally and removing the roots, the thirty specimens were subjected to a demineralized solution to induce early enamel lesions and then assigned randomly into two equal groups. The test materials were applied, and then all the specimens were subjected to a pH cycling model for 30 days. DIAGNOdent and surface roughness were investigated, and an evaluation of the enamel Ca and P weight% for Ca/P ratio calculation was done using SEM-EDX to analyze the specimens at the end of the study. The data were analyzed using an independent t-test.ResultsThe mean values for the DIAGNOdent measurements for NSF and NaF at baseline and after demineralization were not significantly different (p > 0.05). After treatment, NaF varnish showed a significantly higher mean DIAGNOdent measurement (11.8 ± 5.80) than NSF (4.7 ± 1.6). The mean surface roughness of the NaF group (1.64 ± 0.39) was much higher than NSF’s mean surface roughness (1.07 ± 0.21). Specimens treated with NSF had statistically significant smoother surfaces (p < 0.001). The NSF group had a higher mean Ca/P ratio (2.9 ± 0.35) than NaF (2.2 ± 0.11). This difference was statistically significant (p = 0.012).ConclusionThe study reveals that nano silver fluoride is a more effective treatment than sodium fluoride varnish in enhancing teeth’s clinical characteristics, particularly in terms of mineral content and surface roughness, suggesting it could be an improved strategy to prevent dental caries and maintain enamel integrity.

Preventing proximal enamel caries in neighboring tooth with glass ionomer cement restoration and silver diamine fluoride pretreatment

ObjectiveTo investigate caries preventive effects of 38 % silver diamine fluoride (SDF) pretreatment on neighboring tooth proximal to glass ionomer cement (GIC), including conventional GIC (CGIC) and resin-modified GIC (RMGIC) restorations in an in vitro model. Methods: Human tooth blocks were restored withSDF+CGIC (Group 1), CGIC (Group 2), SDF+RMGIC (Group 3) or RMGIC (Group 4). Enamel specimen simulating proximal surface of neighboring tooth was placed in proximity to the restorations. The specimen underwent cariogenic challenge with cross-kingdom biofilm of Streptococcus mutans, Lacticaseibacillus casei and Candida albicans. After cariogenic challenge, the biofilm's growth kinetics, viability, and morphology were evaluated by propidium monoazide-quantitative polymerase chain reaction (PMA-qPCR), confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM), respectively. The enamel lesion depth, surface morphology and crystal characteristics were determined by micro-computed tomography (micro-CT), SEM and X-ray diffraction (XRD), respectively. ResultsPMA-qPCR demonstrated lower microbial growth in Group 1 and 3 compared with Group 2 and 4 (p < 0.05). CLSM showed the dead−to-live ratio in Groups 1–4 were 1.15±0.12, 0.53±0.13, 1.10±0.24 and 0.63±0.10, respectively (Group 1,3 > 2,4, p < 0.05). SEM revealed Groups 1 and 3 had scattered biofilm whereas Group 2 and 4 had confluent biofilm. Micro-CT showed the enamel lesion depths (µm) were 98±9, 126±7, 103±6 and 128±7 for Group 1 to 4, respectively (Group 1,3 < 2,4, p < 0.05). SEM revealed oriented and ordered enamel prismatic patterns in Group 1 and 3, not in Group 2 and 4. XRD showed the reflections of hydroxyapatite in Groups 1 and 3 were sharper than Groups 2 and 4. ConclusionSDF pretreatment enhances the preventive effect of GIC on proximal enamel surface on neighboring tooth through inhibiting cariogenic biofilm, reducing enamel demineralization and promoting enamel remineralization. Clinical significanceSDF pretreatment of GIC restorations can help prevent caries on neighboring teeth, particular for patients with high caries risk.

Microleakage Assessment of Modified Resin Infiltration With Zinc Oxide (ZnO) and Magnesium Oxide (MgO) Nanoparticles on Artificial Enamel Caries Lesion: An In Vitro Study.

Background Incorporating nanoparticles into resin infiltrant (RI) can alter its physical properties, including microleakage. This study aimed to examine the microleakage properties of RI modified with 2.5% and 5% zinc oxide (ZnO) and magnesium oxide (MgO) nanoparticles on artificially induced carious lesions (ACLs) in bovine teeth. Materials and methods Modified RIs were applied to five sound and 30 ACLs on bovine incisors. They were divided into seven groups based on the procedure (Group 1: sound enamel (SE), Group 2: artificial caries lesion only (ACL), Group 3: RI, Group 4: RI+ 2.5% ZnO, Group 5: RI + 5% ZnO, Group 6: RI + 2.5% MgO, Group 7: RI + 5% MgO). The samples were subjected to 5000 thermal cycles and then exposed to methylene blue solution for 24 hours in an incubator. The teeth were sectioned and examined with a stereomicroscope to assess the depth of methylene blue penetration (MBP), quantifying microleakage according to the following scoring: 0 = no penetration, 1 = outer half of enamel, 2 = inner half of enamel, 3 = outer half of dentin, and 4 = inner half of dentin. An ANOVA test was conducted to assess the significance of differences among the groups. Post-hoc tests, including Tukey's HSD (honestly significant difference) test, were performed to identify specific group differences and determine which differences were statistically significant. Results SE samples (Group 1) showed minimal penetration, with 100% scoring 1, indicating high resistance to MBP. The ACL group had significant penetration, with 77.78% scoring 3 and 22.22% scoring 2. The RI group completely prevented MBP, with all samples scoring 0. Both RI+2.5% ZnO (Group 4) and RI+2.5% MgO (Group 6) were highly effective, with 88.89% scoring 0 and 11.11% scoring 1. RI+5% ZnO (Group 5) and RI+5% MgO (Group 7) also prevented MBP but had slightly higher minimal penetration, with 77.78% scoring 0 and 22.22% scoring 1. Significant differences were observed between the ACL group and all other groups, underscoring the effectiveness of RI treatments. No significant differences were found between RI+ZnO and RI+MgO at both concentrations, indicating similar effectiveness. Conclusions The study demonstrated that RI modified with 2.5% and 5% ZnO and MgO nanoparticles effectively reduced microleakage in ACLs on bovine teeth compared to untreated lesions. These modifications significantly inhibited MBP, particularly in enamel and dentin, indicating their potential to enhance the durability and effectiveness in clinical applications. This research emphasizes the promising role of nanoparticle-modified RI in minimizing microleakage and optimizing treatment outcomes. Further research is needed to confirm these findings and refine protocols.

Reliability of impedance spectroscopy versus digital radiograph and ICDAS-II in occlusal caries detection: a prospective clinical trial

The traditional methods in early caries detection had many limitations. So, this study aimed to evaluate the clinical performance of alternating current impedance spectroscopy ACIST in comparison with digital radiograph and ICDAS-II in detection of occlusal carious lesions. Occlusal surfaces of molar and premolar teeth from 40 adult participants were examined by two observers using three diagnostic methods: (1) international caries detection and assessment system (ICDAS-II) (2) digital radiograph (DR) and (3) Cariescan Pro device (ACIST). Agreement analysis and the difference in sensitivities and specificities were evaluated. The results showed an excellent agreement in the different groups. The difference from the visual tactile against ACIST scoring for enamel caries detection, was statistically significant (p = 0.012) and the agreement was moderate (k = 0.509). For dentinal caries the difference was not statistically significant (p > 0.05) and the agreement was similarly moderate (k < 0.6). The difference from the digital radiograph against ACIST scoring, for enamel caries, digital radiography had significantly higher sensitivity and specificity than ACIST (p < 0.001) while for dentinal caries detection and overall, ACIST had higher sensitivity and digital radiography had higher specificity and the difference was statistically significant (p < 0.001). Visual-tactile examination is a considered as feasible and valid technique for occlusal caries detection, digital radiography is superior to ACIST in diagnosing enamel caries, but it could underestimate the caries depth, ACIST is a reliable tool for detecting occlusal caries in dentin.

Histological and CBCT evaluation of Zamzam water (gel) versus topical fluoride in remineralization potential of induced enamel caries (In vitro study)

Histological and CBCT evaluation of Zamzam water (gel) versus topical fluoride in remineralization potential of induced enamel caries (In vitro study)

Assessing the impact of the effect of ozone, casein phosphopeptide–amorphous calcium phosphate, silver diamine fluoride, and hydroxyapatite on remineralization of early carious lesions: An investigation using polarized light microscopic study

Abstract Introduction: A popular trend in dental offices, minimal intervention dentistry emphasizes using the least invasive treatments possible to minimize tissue loss and patient discomfort. The earliest indications of dental caries are white spot lesions that can remineralize. Thus, the effects of four different remineralizing agents on early carious lesions were assessed using polarized light microscopy. Materials and Methods: Teeth specimens were immersed in demineralizing agents to create subsurface demineralization. Subsequently, they were randomly assigned to various remineralization regimens, including ozonated water, casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), silver diamine fluoride (SDF), and hydroxyapatite. Each specimen underwent treatment twice daily for 3 min and was then placed in artificial saliva. Mineral content was evaluated at baseline, after demineralization, and during remineralization (on the 7th and 14th day) using a polarized microscopic examination. Results: Group 1 demonstrated the most effective remineralization, consistently displaying the lowest lesion depths at both the 7th and 14th days. Post hoc comparisons indicate significant differences between group 1 and other groups, emphasizing the potential superiority of the remineralization process in group 1 compared to the other treatment groups. Conclusion: Tooth samples treated with ozonated water, followed by CPP-ACP, SDF, and hydroxyapatite demonstrated a more profound level of remineralization. These agents, namely ozonated water, CPP-ACP, SDF, and hydroxyapatite, prove to be effective in reversing the early stages of enamel caries. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and procedural skills, Systems-based practice, Medical knowledge.

Evaluation of the Caries-Arresting Potential of Silver Diamine Fluoride Gel With Potassium Iodide Versus Sodium Fluoride Varnish: An Observational Study.

Introduction Silver diamine fluoride (SDF) with potassium iodide (KI) has emerged as a promising, aesthetic, non-invasive management by limiting the staining caused by SDF. However, no studies are comparing the caries-arresting potential of SDF gel with KI. The study aims to observe and evaluate the caries-arresting potential of SDF gel with KI compared to sodium fluoride (NaF) varnish. Materials and methods The present observational study was conducted with a split-mouth design. A total of 33 participants, in the age group of two to six years, with occlusal caries of the International Caries Detection and Assessment System (ICDAS) I and II involving both right and left upper or lower primary molar teeth, were included. SDF gel with KI and fluoride varnish (FV) was applied to the contralateral teeth on the same arch. Participants were recalled at 3, 6, 9, and 12-month intervals to monitor the progression or arrest of carious lesions. Result At the end of 12 months, 66.7% and 70.5% of the teeth showed arrest of caries with SDF gel with KI and FV, respectively. Intra-group analysis using the Friedman test shows significant differences in both groups across the timeline (p=0.001). Intergroup analysis using the Whitney U test reveals no significant difference in caries-arresting potential between the groups at various timelines (p=0.231). Conclusion There was no significant difference in arresting enamel caries of primary teeth between the use of 5% NaF and 38% SDF with KI. However, there was a significant difference within the group between the 3rd and 12th-month follow-up. Hence, the biannual application is recommended in both FV and SDF with KI.

The effect of silver diammine fluoride on In Vitro Enamel caries lesion remineralization and staining as a function of lesion baseline mineral distribution

Objectivesto investigate whether baseline mineral distribution modulates the ability of silver diammine fluoride (SDF) to remineralize and stain enamel caries lesions. MethodsThis laboratory study followed a 3 [treatment: SDF/fluoride varnish (FV)/deionized water (DIW)] ×3 [lesion protocol: methylcellulose (MeC)/hydroxyethylcellulose (HEC)/Carbopol 907 (C907)] factorial design. Lesions were created in bovine enamel specimens (n = 20). Treatments were applied and lesions remineralized in artificial saliva. Digital transverse microradiography (TMR-D) was used to analyze lesions. Lesion color was monitored spectrophotometrically. The effects of lesion protocol and treatment on changes in lesion depth (ΔLD), mineral loss (ΔΔZ), maximum mineral density at the surface zone (ΔSZmax), and color changes related to remineralization (ΔL*remin) were analyzed using two-way ANOVA. ResultsThe treatment×lesion protocol interaction was significant for ΔΔZ (p < 0.01) and ΔL*remin (p < 0.01), however not for ΔLD (p = 0.23) or ΔSZmax (p = 0.91). There were no differences in ΔΔZ between treatments in HEC and C907 lesions. However, DIW resulted in more remineralization than both SDF (p < 0.01) and FV (p = 0.01) in MeC lesions. Considering changes from lesion baseline after remineralization in MeC lesions, SDF treatment resulted in the highest mineral gain in the surface zone. However, DIW revealed the highest mineral gain after remineralization in the lesion body. SDF stained lesions with the intensity increasing after remineralization in C907 lesions, whereas staining decreased in MeC and HEC lesions. ConclusionHigh fluoride treatments can interfere with continuous remineralization of caries lesions due to partial arrest. Baseline lesion mineral distribution affects SDF's ability to enhance remineralization and the staining caused by SDF. Clinical SignificanceSDF is being used to arrest active caries lesions extending into dentin and to treat dentin hypersensitivity. This study shed light on SDF's effect on an isolated process in dental caries only, remineralization. It achieved this by examining enamel caries lesions with differing mineral distributions and assessing their staining properties.

Increased Fluorohydroxyapatite across Dentin after Fluoride Iontophoresis

Due to the multiple factors contributing to dentin demineralization and hypersensitivity among individuals, the effectiveness of the available treatments in the long term remains unclear. A recent study reported a simple strategy to potentially mimic natural remineralization with increased crystallization on the enamel caries using fluoride iontophoresis. Such an effect is also ideal for accomplishing dentin biomineralization and structural strength. This study aimed to investigate structural and compositional characteristics and permeability changes after fluoride iontophoresis with different polarities, cathodal iontophoresis (CIP), anodal iontophoresis (AIP), and the control without iontophoresis for the treatment of etched dentin under simulated pulpal pressure. The 24 premolars were divided into 3 groups: CIP, AIP, and topical application of 5% sodium fluoride (NaF) for 40 s. Relative to before treatment, iontophoresis with both polarities significantly decreased the permeability with a visible increase in occluding tubules containing crystal formation and growth throughout the dentin structure and depth. The CIP not only restored the etched dentin surface into a sound condition but also reinforced the dentin across the structure and depth by the synergistic effects of remineralization, increasing crystal formation and transformation toward the more crystalline structure of fluorohydroxyapatite. Following topical treatment, X-ray diffraction analysis and Raman spectra revealed a significant reduction in the crystal size and crystallinity associated with the raised B-type carbonate substitution into the hydroxyapatite compared with that in the sound dentin. The result was the first to reveal the ideal strategy to rapidly restore the etched dentin surface into a sound condition, including reinforcing the dentin across the structure and depth by the synergistic effects of decreasing permeability, increasing crystal formation, and transformation toward the more crystalline structure of fluorohydroxyapatite using the 5% NaF applied with the DC cathode iontophoresis. The technique is noninvasive and simple and deserves further development for clinical application.

On elastoplastic behavior of porous enamel–An indentation and numerical study

The micro/nano pores in natural mineralized tissues can, to a certain extent, affect their responses to mechanical loading but are generally ignored in existing indentation analysis. In this study, we first examined the void volume fraction of sound and caries lesion enamels through micro-computed tomography (micro-CT). A Berkovich indentation study was then carried out to characterize the effect of porous microstructure on the mechanical behavior of the human enamels. The indentation tests were also modeled using the nonlinear finite element analysis technique to simulate indentation load-displacement curves, which showed reasonable agreement with the experimental measurements. From the simulation results, the extent of densification in the plastic zone was identified and the corresponding stress and contact pressure evolutions were quantified. Further, a conventional elastic-perfectly plastic material model without considering micropores was also developed to investigate the compaction effect of the porous structure. The simulation results reveal that conventional elastic perfect-plastic constitutive models become less reliable to model the mechanical behavior of carious lesion enamel with increasing loss of mineral content as it underestimates the yield stress and plastic energy dissipation. This study divulges the importance of compaction of porous enamel structure beneath the indented area. Note that understanding the effect of porous microstructures on plastic behavior is vital as the involved inelastic deformation mechanism associated with irreversible processes, such as wear and localized microcracking, has a significant bearing on wear and fatigue behavior of enamel. Statement of significanceBased on micro-CT and nano-indentation characterization, a numerical model was developed aiming to precisely describe the deformation behavior of naturally porous enamel. Inelastic properties and energy dissipation characteristics of porous enamel were investigated in detail. This work demonstrated that the existence of micro-pores in White Spot Lesions (WSLs) contributes to mechanical stability, which can mitigate the reduction in Young's modulus and fracture toughness resulting from loss of mineral components. The knowledge gained from this study can be used to explain the mechanisms related to irreversible processes, such as contact induced cracking and wear, and strengthen understanding of the mechanical behavior of porous mineralized tissues.

Enamel Caries Lesion Depth Obtained by Optical Coherence Tomography and Transverse Microradiography: A Comparative Study

Introduction: Visual imaging of subsurface caries lesions is of vital interest in dentistry, which can be obtained by invasive radiography technique as well as by available non-destructive imaging approaches. Thus, as a first step toward the development of a new innovative approach, Spectral-domain optical coherence tomography (SD-OCT) was applied to detect the lesion depth in comparison to the established reference technique (transverse microradiography [TMR]). Methods: Bovine enamel specimens were demineralized for 5 days, following previous studies. For OCT, the resulting artificial lesions were scanned three-dimensionally (SD-OCT) and semi-automated measured (CarLQuant). For TMR, specimens were sectioned and the lesion depth was manually determined (Inspektor Research System). Results: The range of lesion depth detected with OCT was 24.0–174.0 μm (mouth rinse study), 18.0–178.0 μm (toothpastes study) and with TMR 59.2–198.0 μm (mouth rinse study), 33.2–133.4 μm (toothpastes study). We found a strong correlation between both methods in terms of lesion depth (Spearman rankwith outlierp < 0.001, Rho = 0.75, Spearman rankwithout outlierp = 0.001, Rho = 0.79). The two methods produce similar results (Passing-Bablok regression, 1.16). As deeper is the lesion, the smallest is the difference between both methods as indicated by Bland-Altman-plots. Conclusion: Especially in the case of deep lesions, the values obtained by both methods are in agreement, and OCT can potentially substitute TMR to detect and assess lesion depth with the benefit of being non-destructive.