Enamel Lesions Research Articles

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.

In vitro remineralization assessment of enamel subsurface lesions using different percentages of surface reaction-type pre-reacted glass-ionomer containing gum-based material

ObjectiveTo identify the remineralization activity of enamel subsurface lesions using different percentages of surface pre-reacted glass-ionomer (S-PRG) filler containing gum-base material. MethodsGum extracts from gum-base materials containing 0wt%, 5wt%, and 10wt% S-PRG filler were prepared as GE0, GE5, and GE10, respectively. A total of 50 bovine enamel specimens were used, and the polished enamel surface of a 3 × 3 mm2 window area was exposed. The specimens were then subjected to a demineralization solution for seven days to create a subsurface enamel lesion. Remineralization was then conducted for seven days using a protocol whereby the specimens were immersed three times a day in prepared gum extracts (0wt%, 5wt%, and 10wt%) and artificial saliva of pH 7 (Control) for 20 min at 37 °C. Thereafter, remineralization assessment was performed by using Swept Source Optical Coherence Tomography (SS-OCT) and micro-computed tomography (μCT). Surface morphology and elemental analysis were conducted by scanning electron microscopy (SEM) and energy-dispersive X-ray spectrometry (EDS). ResultsThe depths of the demineralized lesions in the GE5 and GE10 groups were significantly lower than those of the Control and the GE0 groups. SEM observations of the enamel surface morphology of the GE5 and GE10 groups indicated remineralization with S-PRG filler-related elements present. ConclusionThe GE5 and GE10 S-PRG filler containing gum-base materials showed significantly improved surface remineralization and reduced demineralization of the enamel lesions. EDS analysis suggested that the released ions from the S-PRG filler might be responsible for surface remineralization. Clinical significanceThe S-PRG filler containing gum-base material may have a significant remineralization effect and improve the surface morphology of enamel subsurface lesions.

Evaluating the comparative efficacy of Bioactive glass containing Toothpaste, Amine fluoride-containing toothpaste and CPP-ACPF on remineralization of Artificial Incipient Enamel Lesion

Objectives: The purpose of this in-vitro study was to evaluate the comparative efficacy of Bioactive glass containing toothpaste (BioMin) and Amine fluoride-containing toothpaste (Amflor), and CPP-ACPF (GC Tooth mousse plus) on remineralization of artificial incipient enamel lesion and evaluated using Vickers micro-hardness test. Materials and Methods: A total of fifty freshly extracted premolar teeth were collected and decoronated at 1mm below the CEJ. An adhesive tape of size 4x4 mm is placed on the labial surface of each specimen. Following this, the specimens were mounted in acrylic resin moulds such that only the adhesive tape was exposed, and on the removal of the tape, a window of 4x4 mm is created. Then the specimens were randomly divided into five groups, among which specimens of four groups were subjected to demineralization for four days at 370c using an incubator. Group A (sound enamel), Group B (BioMin), Group C (CPP-ACPF), Group D (Amflor), Group E (demineralized lesion). The specimens of groups B,C,D were subjected to pH cycling for 10 days. Following whichmicro-hardness,all the specimens were evaluated using Vickers Micro-hardnessTest. Statistical analysis: The analysis was done using One Way ANOVA and inter-group comparison was done using a post hoc test. Results: Results showed statistically significant differences (p<0.001) between groups B,C,D, and group E. Among the interventional groups even though there was no significant difference, group B( BioMin) showed higher micro-hardness values when compared to group C (CPP-ACPF) and group D(Amf). Conclusion: Under the limitation of this study, it can be concluded that Bioactive glass-based toothpaste (BioMin) is a novel technology that can be used for the remineralization of early enamel caries.

Detection of artificial enamel caries-like lesions with a blue hydroxyapatite-binding porosity probe

ObjectivesThis in vitro study investigated the ability of a blue protein-based hydroxyapatite porosity probe to selectively detect artificial enamel caries-like lesions of varying severities. MethodsArtificial caries-like lesions were formed in enamel specimens using a hydroxyethylcellulose-containing lactic acid gel for 4/12/24/72 or 168 h. One untreated group was used as a control. The probe was applied for 2 min and unbound probe rinsed off with deionized water. Surface color changes were determined spectrophotometrically (L*a*b* color space) and with digital photography. Lesions were characterized using quantitative light-induced fluorescence (QLF), Vickers surface microhardness, and transverse microradiography (TMR). Data were analyzed using one-way ANOVA. ResultsDigital photography did not reveal any discoloration in unaffected enamel. However, all lesions stained blue with color intensity positively correlated with demineralization times. The color data reflected similar trends: lesions became significantly darker (L* decreased) and bluer (b* decreased), while overall color differences (ΔE) increased significantly after probe application (4-h lesion, mean±standard deviation: ΔL*=-2.6 ± 4.1/Δb*=0.1 ± 0.8/ΔE=5.5 ± 1.3 vs. 168-h lesion: ΔL*=-17.3 ± 1.1/Δb*=-6.0 ± 0.6/ΔE=18.7 ± 1.1). TMR analysis revealed distinct differences in integrated mineral loss (ΔZ) and lesion depth (L) between demineralization times (4-h lesion: ΔZ=391±190 vol%min × µm/L = 18.1 ± 10.9 µm vs. 168-h lesion: ΔZ=3606±499 vol%min × µm/L = 111.9 ± 13.9 µm). QLF and microhardness were also able to differentiate between demineralization times. L and ΔZ strongly correlated (Pearson correlation coefficient [r]) with Δb* (L vs. Δb*: r=-0.90/ΔZ vs. Δb*: r=-0.90), ΔE (r = 0.85/r = 0.81), and ΔL* (r=-0.79/r=-0.73). ConclusionConsidering the limitations of this study, the blue protein-based hydroxyapatite-binding porosity probe appears to be sufficiently sensitive to distinguish between unaffected enamel and artificial caries-like lesions. Clinical significanceEarly detection of enamel caries lesions remains one of the most critical aspects in the diagnosis and management of dental caries. This study highlighted the potential of a novel porosity probe in detecting artificial caries-like demineralization by objective means.

Evaluation of a new 3D-printed tooth model allowing preoperative ICDAS assessment and caries removal.

Teaching caries lesion management with operative care requires tooth models with highly realistic anatomical detail and caries lesions that can be assessed using ICDAS. This study aimed to develop and evaluate a new 3D-printed teeth model for ICDAS assessment and caries removal for pre-clinical hands-on education. Printable tooth with different layers for enamel, dentin and carious lesions was designed and tested by 31 dental students. They were asked to visually and radiologically assess the ICDAS severity of the simulated carious lesions, establish the therapeutic strategy according to CariesCare 4D, and perform a qualitative assessment of the models based on five-point Likert scale items. Concerning carious lesions, the texture was realistic, and the shade was adequate for 94% and 97% of the participants. Ninety per cent of the participants found the model adequate to perform an ICDAS visual assessment. Seventy-four per cent of the students found the hardness adequate. Concerning the difference in shade and the noticeable hardness difference between enamel and dentin, participants have mixed agreement with a proportion of 61% and 55%, respectively. All the participants agreed these 3D-printed models provide a good caries simulation, are suitable for hands-on operative dentistry courses, and that learning outcomes better than the standard model. The present work shows that rapid prototyping paves the way for customized educational models capable of supporting operative but also preoperative skills. 3D printing opens up new opportunities by reducing the gap between pre-clinical training and clinical reality in caries management, which can positively impact the quality of patient care.

Evaluation of the effects of different mouthrinses on dental remineralization.

Dental caries occurs with the release of organic acids from the fermentable carbohydrates metabolized by cariogenic microorganisms. Microbial, genetic, immunological, behavioral, and environmental factors play a role in the development and severity of dental caries. The aim of the present study was to investigate the possible effects of different mouthwash solutions on dental remineralization. This in vitro study compared the remineralization capacity of different mouthwash solutions applied topically to the enamel surface. A total of 50 tooth specimens were prepared from the buccal and lingual halves, with 10 teeth in each group: G1 (control); G2 (Listerine®); G3 (Sensodyne®); G4 (Oral B® Pro-Expert); and G5 (DentaSave® Zinc). Remineralization capacity was evaluated in all groups. The one-way analysis of variance (ANOVA) and the paired samples t test were used for statistical analysis, with a p-value <0.05 considered significant. There were significant differences in the calcium (Ca)/phosphorus (P) atomic percentage (at%) ratio between the demineralized and remineralized dentin (p = 0.001), and between the demineralized and remineralized enamel (p = 0.006). Similarly, there were significant differences in the at% of P (p = 0.017) and zinc (Zn) (p = 0.010) between the demineralized and remineralized dentin. There was a significant difference in the at% of P (p = 0.030) between the demineralized and remineralized enamel. The Zn at% in enamel was significantly higher after remineralization in G5 as compared to the control group (p < 0.05). The images of the demineralized enamel showed the usual keyhole prism appearance, with intact prism sheaths and negligible inter-prism porosity. The scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) findings seem to confirm the effectiveness of DentaSave Zinc for the remineralization of enamel lesions.

Remineralization Potential of a Novel Biomimetic Material (Self-assembling Peptide P11-4) on Early Enamel Caries: An In Vitro Study.

To assess the remineralizing potential of self-assembling peptide P11-4 and compare it to the remineralizing potential of fluoride varnish using DIAGNOdentTM, as well as the amount of mineral gain after application of fluoride varnish and self-assembling peptide P11-4. This study included 20 premolars extracted during orthodontic therapy with all surfaces intact and free of hypoplastic regions, white spot lesions (WSL) and dental caries. The teeth sample for Curodont RepairTM (self-assembling P11-4) and Bifluorid 10® (fluoride varnish) was equally divided. On each tooth surface, a 2 × 2 mm window was created. The samples were immersed in a demineralizing solution for 96 hours before being subjected to DIAGNOdentTM pen reading, ICDAS-II scoring, and scanning electron microscopy-energy-dispersive X-ray (SEM-EDX) analysis on one half of the sample. The remineralizing agents were applied to the second half of the sample according to the manufacturer's instructions and placed in artificial saliva for 21 days, with the artificial salvia being replaced every 24 hours. After 21 days, the second half of the sample was subjected to DIAGNOdentTM pen reading, ICDAS-II score, and SEM-EDX analysis. Following remineralization, the DIAGNOdentTM pen and ICDAS-II score values differed statistically between the two groups, with the Bifluorid 10® group reporting higher mean values (p > 0.05) using t-test analysis. Energy-dispersive X-ray analysis using the t-test revealed a statistically significant result for remineralization (p < 0.05), with CurodontTM Repair group (55.150.84) reporting better mean values than Bifluorid 10® for phosphorus and calcium, but Bifluorid 10® reporting a higher result in remineralization (p < 0.05) than CurodontTM Repair for fluoride. CurodontTM Repair showed better remineralizing potential compared with Bifluorid 10® varnish. In terms of the mineral gain, CurodontTM Repair showed better results for calcium and phosphorus post-remineralization. Whereas Bifluorid 10® showed a higher gain in terms of fluoride. Self-assembling peptide P11-4 can be used as an alternative to fluoride varnish for remineralizing WSL. Self-assembling polypeptide P11-4 is a novel remineralizing agent for initial enamel lesions, which is the least-invasive method of enamel remineralization.

Selenomonas sputigena acts as a pathobiont mediating spatial structure and biofilm virulence in early childhood caries

Streptococcus mutans has been implicated as the primary pathogen in childhood caries (tooth decay). While the role of polymicrobial communities is appreciated, it remains unclear whether other microorganisms are active contributors or interact with pathogens. Here, we integrate multi-omics of supragingival biofilm (dental plaque) from 416 preschool-age children (208 males and 208 females) in a discovery-validation pipeline to identify disease-relevant inter-species interactions. Sixteen taxa associate with childhood caries in metagenomics-metatranscriptomics analyses. Using multiscale/computational imaging and virulence assays, we examine biofilm formation dynamics, spatial arrangement, and metabolic activity of Selenomonas sputigena, Prevotella salivae and Leptotrichia wadei, either individually or with S. mutans. We show that S. sputigena, a flagellated anaerobe with previously unknown role in supragingival biofilm, becomes trapped in streptococcal exoglucans, loses motility but actively proliferates to build a honeycomb-like multicellular-superstructure encapsulating S. mutans, enhancing acidogenesis. Rodent model experiments reveal an unrecognized ability of S. sputigena to colonize supragingival tooth surfaces. While incapable of causing caries on its own, when co-infected with S. mutans, S. sputigena causes extensive tooth enamel lesions and exacerbates disease severity in vivo. In summary, we discover a pathobiont cooperating with a known pathogen to build a unique spatial structure and heighten biofilm virulence in a prevalent human disease.

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.

Use of polyvinyl siloxane impressions to monitor sub-5-μm erosive tooth wear on unpolished enamel

Statement of problemWhether polyvinyl siloxane impressions are capable of reproducing 5-μm changes on natural freeform enamel and potentially enabling clinical measurements of early surface changes consistent with wear of teeth or materials is unclear. PurposeThe purpose of this in vitro study was to investigate and compare polyvinyl siloxane replicas with direct measurements of sub-5-μm lesions on unpolished human enamel lesions by using profilometry, superimposition, and a surface subtraction software program. Material and methodsTwenty ethically approved unpolished human enamel specimens were randomized to a previously reported cyclic erosion (n=10) and erosion and abrasion (n=10) model to create discrete sub-5-μm lesions on the surface. Low viscosity polyvinyl siloxane impressions were made of each specimen before and after each cycle and scanned by using noncontacting laser profilometry and viewed with a digital microscopy and compared with direct scanning of the enamel surface. The digital maps were then interrogated with surface- registration and subtraction workflows to extrapolate enamel loss from the unpolished surfaces by using step-height and digital surface microscopy to measure roughness. ResultsDirect measurement revealed chemical loss of enamel at 3.4 ±0.43 μm, and the polyvinyl siloxane replicas were 3.20 ±0.42 μm, respectively. For chemical and mechanical loss direct measurement was 6.12 ±1.05 μm and 5.79 ±1.06 μm for the polyvinyl siloxane replica (P=.211). The overall accuracy between direct and polyvinyl siloxane replica measurements was 0.13 +0.57 and −0.31 μm for erosion and 0.12 +0.99 and −0.75 μm for erosion and abrasion. Surface roughness and visualization with digital microscopy provided confirmatory data. ConclusionsPolyvinyl siloxane replica impressions from unpolished human enamel were accurate and precise at the sub-5-μm level.

RESIN INFILTRATION FOR MINIMALLY INVASIVE TREATMENT OF INITIAL CARIES AND NON-CARIOUS SPOT LESIONS: LITERATURE REVIEW

A concept of minimal intervention dentistry focuses on dental caries prevention, managing risk factors, detection of initial caries lesions and minimally invasive treatment. The article presents the possibilities, indications and advantages of Icon resin infiltration in the treatment of initial dental caries and non-carious spot lesions. Based on data from previous studies it is effective, painless and aesthetic method. After resin infiltration of enamel lesions the integrity of the tooth is preserved, the restoration of luster, transparency and color of the enamel is observed, the microhardness and surface roughness of the demineralized area increased to the values of intact dental tissues. Icon infiltration can be used for the treatment of initial non-cavitated dental caries on proximal and smooth surfaces of teeth as well as for the aesthetic treatment of non-carious spot lesions.

REMINERALISING AGENTS IN DENTISTRY-A REVIEW

The main component of the human dentition is hydroxyapatite, which is a highly mineralized tissue. The weight of all oral diseases worldwide is exacerbated by dental caries. Caries is not a one-way process that only involves demineralization; rather, it is a cyclical process with stages of both demineralization and remineralization. The intricate interplay between saliva, diet, and bacteria causes demineralisation leading to cavitation. With the aid of the right tools and even non-fluoride remineralization methods,initial non-cavitated lesions can be repaired. Using a range of topical remineralizing treatments, the formation of fluorapatite in enamel and white spot lesions is inhibited and remineralized. The minerals, including ions and hydroxyapatite crystal lattices, are replenished naturally through a process known as rremineralization. Putting a strong emphasis on the remineralization concept is the best strategy for managing caries. New mineralization agents have been developed to preserve the enamel's structure and prevent the growth of carious cavities. The goal of modern dentistry is to halt the progression of disease and enhance appearance, tensile strength, and function by remineralizing non-cavitated caries lesions

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 Effect of Two Types of Varnishes on Induced Enamel Caries

Purpose: to assess the remineralization capacity of MI varnish and Bifluorid 10 varnish on induced white spot lesions in deciduous enamel, using Scanning Electron Microscope- Energy Dispersive X-ray. Materials and methods: Sixty human caries-free deciduous teeth were collected. The teeth were stored in 0.1% thymol solution. A 4*4*2 window was created on the buccal surface of each tooth using acid-resistant nail varnish. Samples were then divided into 3 groups according to the remineralizing agent used, each group containing 20 teeth. Group I was remineralized with MI varnish, group II was remineralized using Bifluorid 10 varnish, while group III was a control group that didn’t receive any remineralization. Then, baseline assessment of Calcium/Phosphorous (% weight) was done using SEM-EDX. Teeth were then immersed in a demineralizing solution at 37°C for 72 hours, until white spot lesions in enamel were visible. SEM-EDX assessment was carried out for the demineralized samples. Remineralization using MI varnish and Bifluorid 10 varnish was done in groups I and II respectively. SEM-EDX assessment was carried out to evaluate the remineralization capacity of each varnish. Results: SEM-EDX examination showed that MI varnish had the highest remineralization capacity. The examination showed statistically significant difference between group I and II. They are both superior to the control group. Conclusion: Both MI varnish and Bifluorid 10 varnish had acceptable remineralization capacity. MI varnsih is preferred.

Remineralization Effect of Two Types of Varnishes on Induced Enamel Caries

Purpose: to assess the remineralization capacity of MI varnish and Bifluorid 10 varnish on induced white spot lesions in deciduous enamel, using Scanning Electron Microscope- Energy Dispersive X-ray. Materials and methods: Sixty human caries-free deciduous teeth were collected. The teeth were stored in 0.1% thymol solution. A 4*4*2 window was created on the buccal surface of each tooth using acid-resistant nail varnish. Samples were then divided into 3 groups according to the remineralizing agent used, each group containing 20 teeth. Group I was remineralized with MI varnish, group II was remineralized using Bifluorid 10 varnish, while group III was a control group that didn’t receive any remineralization. Then, baseline assessment of Calcium/Phosphorous (% weight) was done using SEM-EDX. Teeth were then immersed in a demineralizing solution at 37°C for 72 hours, until white spot lesions in enamel were visible. SEM-EDX assessment was carried out for the demineralized samples. Remineralization using MI varnish and Bifluorid 10 varnish was done in groups I and II respectively. SEM-EDX assessment was carried out to evaluate the remineralization capacity of each varnish. Results: SEM-EDX examination showed that MI varnish had the highest remineralization capacity. The examination showed statistically significant difference between group I and II. They are both superior to the control group. Conclusion: Both MI varnish and Bifluorid 10 varnish had acceptable remineralization capacity. MI varnsih is preferred.

Effect of self-assembling peptide and other remineralizing agents on preventing initial enamel lesions around orthodontic brackets: An in vitro comparative study

To investigate and compare the effect of self-assembling peptide SAP (P11-4), casein phosphopeptide-amorphous calcium phosphate fluoride paste (CPP-ACPF), and fluoride varnish (FV) on preventing enamel demineralization around orthodontic brackets. Orthodontic brackets were bonded to the buccal surfaces of 80 freshly extracted human maxillary premolars. Teeth were randomly assigned to four groups (n=20) according to the remineralizing agent used as follows: SAP (P11-4) group (Curodont™ Protect/Credentis), CPP-ACPF group (MI Paste Plus®/Recaldent™), fluoride varnish group (Profluoride varnish®/VOCO), and control group. All products were applied according to the manufacturer's instructions. Specimens were cycled in daily refreshed demineralizing and remineralizing solutions for 8h and 16h, respectively, for 28days. The calcium/phosphorus ratio (Ca/P) and surface microhardness (SMH) were evaluated at baseline and at two and four weeks. Two-way ANOVA (analysis of variance), one-way ANOVA and repeated measures ANOVA were used for statistical analysis. Two-way ANOVA demonstrated significant differences between remineralizing agents and time points. After 4weeks, the SAP (P11-4) group had had significantly higher Ca/P ratio and SMH (1.68±0.11 and 346.47±55.38) compared to other groups, followed by CPP-ACPF (1.52±0.19 and 283.53±64.75), FV (1.37±0.14 and 262.80±82.98), and the control group (1.31±0.10 and 213.00±41.95). Significantly higher Ca/P ratio and SMH were observed at 2weeks in the control group (1.44±0.10 and 269.63±57.37) and FV group (1.52±0.09 and 321.17±55.24) compared to 4weeks. No significant differences were found regarding Ca/P ratio and SMH at 2 weeks in the CPP-ACPF (1.55±0.15 and 295.14±53.88) and SAP P11-4 groups (1.64±0.10 and 320.18±58.04) compared to 4weeks. SAP (P11-4) had the greatest remineralizing efficacy compared to FV and CPP-ACPF. Moreover, extended period of time improved the preventive efficacy of SAP (P11-4) compared to the other regimens.

Resin Infiltration: Ultraconservative Treatment Options for Carious and Non-carious Enamel Lesions

Resin Infiltration: Ultraconservative Treatment Options for Carious and Non-carious Enamel Lesions

Effectiveness and Color Stability of Resin Infiltration on Demineralized and Hypomineralized (MIH) Enamel in Children: Six-month Results of a Prospective Trial.

To evaluate the masking effect and color stability of resin infiltration treatment in demineralized (white spot lesion) and hypomineralized (molar incisor hypomineralization) enamel lesions of young permanent anterior teeth. Eighty-four (84) anterior teeth with molar incisor hypomineralization or white spot lesions were treated with resin infiltration. The CIE L*a*b* values of sound enamel and enamel lesions were assessed with spectrophotometer and digital image analysis at baseline, immediate postop, 1 week and 6 months. The difference in ΔL, Δa, Δb, and ΔE measurements between sound enamel and the enamel lesions was compared using the repeated analysis of variance (ANOVA) test at p < 0.05. The enamel lesions were clearly discernible from the sound adjacent enamel at baseline. After resin infiltration, there was a significant drop in ΔE values of sound enamel and enamel lesions compared to baseline, and this difference did not change for 6 months, indicating a durable masking effect. At baseline and after 6 months, there was no significant difference in the ΔE values of the test groups. The demineralized and hypomineralized enamel defects were effectively masked by resin infiltration, which remained clinically stable for 6 months.

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.

Comparison of Cariostatic and Remineralizing Potential of Two Commercial Silver Diamine Fluoride Preparations using Confocal Laser Microscopy and EDX-SEM Spectroscopy: An In Vitro study.

To investigate the cariostatic and remineralizing effect of two commercial silver diamine fluoride (SDF) preparations on enamel and dentinal caries using a bacterial plaque model. A total of 32 extracted primary molars were divided into two groups (n = 16), group I (FAgamin), and group II (SDF). Plaque bacterial model was used to induce caries on enamel and dentin. Preoperative evaluation of samples was done using confocal laser microscopy (CLSM) and energy-dispersive X-ray spectroscopy-scanning electron microscope (EDX-SEM). All samples were treated with test materials and evaluated for postoperative remineralization quantification. Energy-dispersive X-ray spectroscopy (EDX) revealed that mean preoperative levels (in weight %) of silver (Ag) and fluoride (F2) in carious enamel lesions were 0.0 and 0.0, which increased postoperatively to 11.40 and 31.05 for FAgamin and 13.61 and 31.87 for SDF, respectively. For dentinal caries, EDX revealed mean preoperative levels (in weight %) of Ag and F2 were 0.0 and 0.0, which increased to 11.47 and 48.71 for FAgamin and 10.16 and 47.82 for SDF, respectively postoperatively. Both the groups showed evident demineralization with exposed collagen under SEM. The mean value of enamel lesion depth for the group I and II were 38.64 and 39.30 µm, that reduced to 28.02 and 28.70 µm while for dentinal caries, the mean depth from 38.05 and 38.29 µm that reduced significantly to 28.96 and 30.10 µm, respectively (p < 0.001). Caries depth declined significantly after the application of both FAgamin and SDF (p < 0.001). FAgamin and SDF show similar cariostatic and remineralization potential for dental caries. The bacterial plaque model used in this study is an efficient method to induce artificial carious lesions in teeth. A comparative evaluation of these two cariostatic and remineralizing agents will aid in identifying the efficacy of both commercial products in treating initial caries lesions in an effective noninvasive and child-friendly manner. Kale YJ, Misal S, Dadpe MV, et al. Comparison of Cariostatic and Remineralizing Potential of Two Commercial Silver Diamine Fluoride Preparations using Confocal Laser Microscopy and EDX-SEM Spectroscopy: An In Vitro study. Int J Clin Pediatr Dent 2022;15(6):643-651.