Enamel White Spot Lesions Research Articles

THERAPEUTIC EFFECT OF TWO FLUORIDE VARNISHES INTENSIVE MODE ON WHITE SPOT LESIONS (RANDOMIZED CLINICAL TRIAL)

Background: Fluoride varnish has been used as therapeutic agent for white spot lesions. Bio-active calcium and phosphate was included in the varnish in order to provide better subsurface remineralization. One of the most promising modifications is the addition of casein phosphopeptide amorphous calcium phosphate to fluoride varnish (MI varnish). Objectives: Evaluate the therapeutic effect of intensive application of casein phosphopeptide amorphous calcium phosphate fluoride (CCP-ACPF) varnish and fluoride varnish on the activity of enamel white spot lesions (WSLs) in primary teeth over a 6 weeks follow-up period. Materials and Methods: Forty-four participants with at least 4 active WSLs each were divided randomly into two groups. Test group (22 participants) received three times intensive professional application of MI varnish with two weeks apart. Control group (22 participants) received three times intensive professional application of Duraphat with two weeks apart. Lesions’ activity in both groups was assessed using DIAGNOdent and visio-tactile lesion activity index at baseline and at 6 weeks. Results: Both groups had a significant decrease in mean DIAGNOdent scores and number of active WSLS when compared to their baseline mean score. However when comparing the results of both groups, the control group (Duraphat varnish) had a significant decrease in DIAGNOdent mean score and number of active WSLs when compared to the test group (MI varnish). Conclusions: Intensive application of fluoride varnish decreases caries lesion activity which may lead to the arrest of the early caries lesions. Duraphat varnish is superior to MI varnish in remineralization of early caries lesions.

Knowledge of dental enamel defects amongst undergraduate dental students-a cross-sectional survey.

Enamel defects are disturbances in the quantity or quality of enamel, due to disruption or damage to the enamel organ during amelogenesis. The correct diagnosis of enamel defects is critical as diverse management options could be required for different conditions. Difficulties in diagnosis can happen, because these defects may have similar clinical presentations. This study evaluated the diagnostic skills in enamel defects of dental students of a prominent Australasian school. A questionnaire consisting of clinical photographs of the affected teeth/dentition in multiple views and four standardised questions for each case of enamel defect were given to Year 4 and Year 5 students. Localised/Chronological Hypoplasia had the lowest percentage of correct diagnosis (20.5%), whilst Enamel White Spot Lesions (EWSLs) had the highest (85%). Localised/Chronological Hypoplasia had the lowest aetiology score (20.5%), and the highest was obtained for EWSLs (85%). In regard to which question to ask to gain insight into the conditions, Enamel Hypomineralisation/MIH had the lowest score for both Year 4 and Year 5 respondents (35.4% and 21.3%). Most respondents agreed more teaching in this topic was needed, with further clinical sessions to observe the enamel defects, workshops/seminars, lectures and student-driven presentations suggested. Final-year dental students showed variable knowledge in diagnosis, aetiology and clinical management of enamel defects. Further didactic and clinical teaching should be incorporated in the undergraduate curriculum on this topic .

Evaluation of surface roughness and microhardness of enamel white spot lesions treated by resin infiltration technique (icons): An in-vitro study

Objectives This research was designed to evaluate the effect of resin infiltration material (Icon) and remineralizing agents (n-HA, CPP-ACP) on micro hardness and surface roughness of enamel white spot lesion. Materials & Methods 120 sound non carious human anterior teeth were used in this study. The teeth were divided according to the test of evaluation into two main groups. Group H: for assessment of micro hardness and group R: for assessment of surface roughness (60 teeth each).Then each group was divided into four equal subgroups (15 teeth each) according to the treatments applied as follows: subgroup(C): control, subgroup (P): CPPACP, subgroup (I): Icon and subgroup (N): n-HA. Each subgroup was further subdivided into three equal divisions (5 teeth each) according to the storage times in artificial saliva; one week (S1), four weeks (S2) and eight weeks (S3). The crowns of all teeth were separated from the roots and embedded horizontally in middle of the mould leaving the labial surface projecting using self-curing acrylic resin. Al specimens were immersed in demenaralizing solution for artificial enamel white spot lesion formation. Then treated with each respective material as follow: In subgroup (I) Icons was applied on labial surface of specimens and then immersed in artificial saliva. In subgroup (P) the labial surfaces of specimens were brushed manually by a soft toothbrush and with gentle pressure; brushing procedures were carried out three times daily with CPP–ACP- containing paste for 3 minutes then immersed in artificial saliva. In subgroup (N) specimens were immersed in 10% n-HA solution for 3min then immersed in artificial saliva and these applications were repeated daily. While subgroup (C) did not receive any surface treatment, but it immersed in artificial saliva as a positive control subgroup, artificial saliva was changed daily. For assessment of microhardness and surface roughness the enamel white spot lesion specimens in the four different subgroups were examined three times (after one week, four weeks and eight weeks from the first time of treatment application) by Vickers micro hardness testing machine and none contact profilometer. Results The results of microhardness revealed that the subgroup (N) was provided the highest micro hardness mean value, followed by subgroup (I) group, then subgroup (P) group while subgroup (C) showed the lowest micro hardness mean value.The results of surface roughness revealed that the subgroup (P) group was provided the highest surface roughness mean value, followed by subgroup (C), then subgroup (N) while subgroup (I) showed the lowest surface roughness. Conclusions Resin infiltration material (Icon) had a positive effect on microhardness and surface roughness of enamel white spot lesion.

Influence of topical fluoride on shear bond strength of orthodontic brackets and enamel white spot lesions formation

Abstract Introduction Fluoride is considered a key element in the remineralization process of tooth enamel. Objective To evaluate the influence of a topical solution of sodium fluoride (NaF) on the shear bond strength of orthodontic brackets and white spot lesions formation. Material and method Sixty bovine teeth were divided into three groups (n=20). Group 1 (Control): shear bond strength; Group 2: shear bond strength after pH cycling; Group 3: shear bond strength after pH cycling and treatment with 0.04% NaF solution. Groups 2 and 3 underwent pH cycling with demineralizing (6hs) and remineralizing (17hs) solutions at pH of 4.3 and 7.0 respectively for 15 days. The specimens were submitted to the shear bond strength and the Adhesive Remnant Index was verified (ARI). The specimens of each group (n=3) were qualitatively analyzed by means of Scanning Electron Microscopy (SEM). Kruskal-Wallis test assessed the shear bond strength and Fisher's exact test evaluated ARI, with significance level of 5%. Result There was no significant difference among the three groups in shear bond strength (p=0.2679). Significant difference was found in ARI (p=0.0199). The frequency of ARI 1 was 55% in group 1, 90% in group 2, and 80% in group 3. SEM showed difference between the enamel and bonding. Group 2 showed structural change of the enamel surface, adjacent to the bond area; and group 3 showed enamel with characteristics similar to those of group 1. Conclusion It was concluded that there was no NaF influence on the bracket shear bond strength and even in low concentrations it prevented the development of areas of demineralization of white spot lesions.

In Vitro Study To Evaluate The Effect Of 45S5 Bioglass Paste And Er,Cr:YSGG 2780 nm Laser On Re-Mineralization Of Enamel White Spot Lesions (Energy Dispersive X-ray Analysis and Stereomicroscopic assessments).

BACKGROUND: White spot lesions (WSLs) are one of the common problems which occur on enamel surface around bonded brackets following orthodontic treatment. AIM: Evaluate the effect of Er,Cr:YSGG (λ = 2780 nm) laser and 45S5 bioactive glass (BAG) paste either alone or in combination on re-mineralization of enamel white spot lesions. MATERIAL AND METHODS: 50 enamel samples with induced WSLs. There are 5 groups (n=10). Group 1, control; Group 2, 45S5 BAG paste treatment only; Group 3, Er,Cr:YSGG laser irradiated (0.5 W, 20 Hz, 10 s) alone, Group 4, 45S5 BAG paste treatment applied before irradiation with same laser parameters in group 3 and Group 5, 45S5 BAG paste treatment applied after laser irradiation. Enamel surface was assessed morphologically by stereomicroscope and Mineral content analysis by Energy Dispersive X-ray Analysis (EDXA). The results were statistically analyzed. RESULTS: EDXA revealed the highest Ca, Ca/P ratio and least C mass % in group 4. The highest P mass% in group 5. Stereomicroscopic results of outer enamel surface revealed that WSLs were reduced in group 2 while disappeared in group 3, 4 & 5. Group 4 showed more translucent enamel surfaces, whereas group 5 showed homogenous radio-opaque enamel surface. Stereomicroscopic results of enamel subsurface revealed the least M.B dye penetration depth in group 3 followed by 5, 4, 3, 2 and 1 respectively. CONCLUSIONS: 45S5 BAG paste treatment before Er,Cr:YSGG laser showed the best re-mineralized enamel surface with complete absence of WSLs.

Effect of high-fluoride dentifrice and bracket bonding composite material on enamel demineralization adjacent to orthodontic brackets in vitro

BackgroundThere is a lack of information about the association of high-fluoride dentrifrice and fluoride-containing bonding material to prevent enamel white spot lesions development adjacent to brackets. The aim of this in vitro study was to evaluate the effect of high-fluoride dentifrice and fluoride-containing bonding material on enamel demineralization adjacent to orthodontic brackets. Material and MethodsForty-eight enamel specimens with 7x7x2 mm were obtained from bovine incisors. Orthodontic brackets were bonded with fluoride-containing resin composite (OrthoCem®) or fluoride-free low viscosity resin. The specimens were submitted to an 8-day pH cycling that consisted in the daily immersion of specimens in the demineralizing solution for 4 h and in artificial saliva for 20 h in an incubator at 37° C. The treatments consisted in 5 min-immersion between the cycles of fluoride (F) suspensions containing 275 µg F/mL, 1,250 µg F/mL or distilled water (negative control). The 275 and 1,250 µg F/mL concentrations were used to simulate salivary dilution of 1,100 and 5,000 µg F/g dentifrices during toothbrushing. After the experiment, cross-sectional hardness was performed to analyze the lesion area of the specimens. Tukey post hoc test after two-way ANOVA with p at 5% was used as statistical analysis. ResultsThe specimens treated with high-fluoride dentifrice showed significantly less demineralization in comparison with the other treatments (p>0.05). There was a significant difference in the cross-sectional hardness values for the specimens bonded with OrthoCem when compared to the low viscosity resin (p>0,05). ConclusionsThe use of high-fluoride dentifrice associated with fluoride-containing bonding material promoted a greater reduction of enamel demineralization adjacent to orthodontic brackets. Key words:Demineralization, dentifrice, fluoride, bonding materials, orthodontic brackets.

Effect of Two Resin Infiltration on Color Masking of Artificial Enamel White Spot Lesion Using Different Pretreatment Methods. (An in Vitro Study)

Purpose: This study aimed at investigating the masking effect and depth of penetration of two resin infiltrants (ICON ® and unfilled adhesive resin) on artificial white spot lesions after different pretreatment methods (15% hydrochloric acid, 37% phosphoric acid and air abrasion through micro etcher) Materials and methods: Artificial white spot lesions were produced in enamel slabs from 60 freshly extracted permanent human anterior teeth (extracted from diabetic patients). The samples were divided into two main groups: resin infiltrant; ICON ® (B1) and adhesive resin bond; ONE-STEP® Universal Dental Adhesive (B2). Each group was subdivided into three subgroups according to the pretreatment used; (HCl 15%) was applied in (A1), (H3PO4 37%) was applied in (A2) and aluminum oxide particles (50/90 µm), through micro etcher was applied in (A3). The assessment of colour was performed by a spectrophotometer in three distinct stages: baseline, after the production of artificial caries and after infiltration treatment expressed in L*, a* and b* values. To analyze measurement results, the chromatism value, ΔE was used to quantify the overall differences of the colors. Results: All the test groups showed no statistically signifiant differences between each other where the highest value was recorded with the adhesive bond after micro-etching 2.250 ± 0.192 and the lowest value was recorded with the adhesive bond after HCl pre-treatment 1.710 ± 0.244 (Statistical significance is achieved when the P-value ≤ 0.05). Conclusion: Both tested infiltrants reacted similarly and the three tested pretreatment methods were equally effective.

Effect of CO2 laser (10.6μm) and Remin Pro on microhardness of enamel white spot lesions.

This study investigated the combined effect of CO2 laser irradiation and Remin Pro paste on microhardness of enamel white spot lesions (WSLs). Seventy-eight intact premolars were randomly assigned into six groups and then stored in a demineralizing solution to create WSLs. Afterwards, the teeth in group 6 (negative control) remained untreated, while groups 1 and 4 were exposed to CO2 laser irradiation (20Hz, 1W, 30s) and Remin Pro paste, respectively. In groups 2 and 3, the teeth were exposed to laser either before (group 2) or after (group 3) Remin Pro application. The teeth in groups 1 to 5 were then immersed in artificial saliva for 90days while subjected to fluoride mouthwash and weekly brushing. Finally, the teeth were sectioned, and Vickers microhardness was measured at the enamel surface and at 50, 100, and 150μm from the surface. One sample of each group was also examined with scanning electron microscope (SEM). Data were analyzed by two-way analysis of variance (ANOVA) and Tukey's test. The significance was set at 0.05. Laser irradiation followed by Remin Pro application (group 2) caused a significant increase in total WSLs' microhardness compared with laser alone (group 1) and control groups (P < 0.05). Microhardness at depths of 100 and 150μm was also significantly greater in group 2 compared with those of group 3 and control groups (P < 0.05). Combined application of CO2 laser with Remin Pro paste, when laser is irradiated before the paste, is suggested for re-hardening of WSLs in deep layers of enamel.

Resin infiltration of enamel white spot lesions: An ultramorphological analysis.

There is not a clear understanding of the ultramorphology of enamel white spot lesions (WSLs). The purpose of this study is to characterize resin infiltration of enamel WSLs using electron microscopy. Enamel sections with sound enamel and WSLs were sectioned from extracted teeth and assigned to three groups: (a) left untreated; (b) etched with 15% hydrochloric acid (Icon-Etch); (c) restored with the resin infiltration sequence (Icon-Etch, Icon-Dry, and Icon-Infiltrant). Restored specimens were demineralized to obtain replicas. Observations were carried out under a field-emission scanning electron microscope. Icon-Etch resulted in an array of pits and funneled holes on the WSL. Replicas of WSLs depicted 0.5-6.0-μm-thick shaggy resin tags up to a depth of 465 μm. Enamel crystallites were enveloped with resin at the bottom of the WSL forming a hybrid layer. The resin infiltrant filled the spaces between the crystallites and resulted in an enamel hybrid layer. In addition to masking enamel WSLs, resin infiltration is able envelop residual enamel crystallites forming an enamel hybrid layer. This hybridization makes resin-embedded enamel more resistant to acid attack than sound enamel.

In vitro remineralization of enamel white spot lesions with a carrier-based amorphous calcium phosphate delivery system.

To achieve in vitro remineralization of enamel white spot lesions (WSLs) via a mesoporous delivery system of amorphous calcium phosphate (ACP) precursors. Amine-functionalized expanded pore mesoporous silica (aMSN) was loaded with polyacrylic acid-stabilized amorphous calcium phosphate (PAA-ACP) to develop a carrier-based delivery system (PAA-ACP@aMSN). Thirty-six artificial WSLs samples were created and randomly assigned to three treatments: artificial saliva solution (negative control, n = 12), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) slurry (n = 12), and PAA-ACP@aMSN slurry (n = 12). Surface microhardness, Raman intensity, and color were measured before/after artificial demineralization and after remineralization treatments to evaluate the remineralization level of each sample. SEM images were taken on the surface and cross-section of samples to observe microstructure changes. The surface microhardness recovery ratio (%SMHRR), Raman intensity change ratio (%ICR), and color recovery ratio (%CRR) were not significantly different between CPP-ACP and PAA-ACP@aMSN groups (P > 0.05), but both of them had significantly higher %SMHRR, %ICR, and %CRR values than negative control (P < 0.01). SEM images showed that apparent enamel prism imprints and inter-prism gaps in negative control were masked by mineral deposition in the PAA-ACP@aMSN and CPP-ACP groups. PAA-ACP@aMSN has an ability to remineralize enamel WSLs. The carrier-based amorphous calcium phosphate delivery system has great potential to serve as a remineralizing agent for the treatment of WSLs.

Evaluation of the thickness and depth of penetration of icon into the artificial enamel white spot lesion

This research was designed to compare the thickness and the depth of penetration of two resin-based materials (Icon and one-step self-etch adhesive (Single Bond Universal)) in artificial white spot lesion (WSL) created on caries-free molar teeth, without and with surface treatment prior application of the resin-based materials at different storage time (one day, one week and one month). The 126 samples were randomly divided into three equal main groups (n=42) according to the resinous material (M); Group 1 (M1) was considerate to be control group. Group 2 (M2) was restored with Icon. Group 3 (M3) was restored with Single Bond Universal. Each group was divided into two equal subgroups (n=21) according to the surface treatment (W); Where the first subgroup (W1) was subjected to surface treatment while the second subgroup (W2) was without surface treatment. The samples were further divided into three divisions (n=7) according to the storage time (S). Division 1 (S1) was stored for one day. Division 2 (S2) was stored for one week. Division 3 (S3) was stored for one month. Each resin-based material was applied after creation of white spot lesion, according to the manufacture instruction. Buccal and lingual surface of each sample was used to measure the thickness of the resin-based materials using Optical profilometer while confocal laser scanning microscopy (CLSM) was used to measure the depth of penetration. The result of this study reveals that: the surface treatment prior application of Icon group improve the degree of penetration depth to get the highest value compared with the other groups while the thickness of the untreated surface prior application of Icon groups gives the thickest value compared with the thickness of the other groups. Conclusion; Icon is the best choice for treatment of (WSLs).

A nano-CaF2-containing orthodontic cement with antibacterial and remineralization capabilities to combat enamel white spot lesions

ObjectivesThe objectives of this study were to develop a resin-modified glass ionomer containing nanoparticles of calcium fluoride (nCaF2) and dimethylaminohexadecyl methacrylate (DMAHDM) for the first time and investigate the antibacterial and remineralization properties. MethodsnCaF2 was synthesized using a spray-drying method and characterized using a transmission electron microscope. Twenty weight percentage (wt%) nCaF2 and 3 wt% DMAHDM were incorporated into a RMGI (GC Ortho LC). Enamel shear bond strength (SBS) and cytotoxicity were determined. Fluoride (F) and calcium (Ca) ion releases were assessed. Biofilm live/dead staining, metabolic activity, polysaccharide and lactic production, and colony-forming units (CFU) were evaluated. The remineralization ability was determined by measuring the effects of cements on enamel surface hardness and lesion depth. ResultsIncorporating 20 wt% nCaF2 and 3 wt% DMAHDM did not compromise the SBS (p > 0.1). The decrease of pH from 7.0 to 4.0 significantly increased the F and Ca ion releases. The new cement greatly reduced the metabolic activity, polysaccharide and lactic acid productions, and lowered the biofilm CFU by 3 log, compared to commercial control (p < 0.05). The new cement increased the enamel hardness by 56% and decreased the lesion depth by 43%, compared to control (p < 0.05). The cell viability at 7 days against the new cement extracts was 82.2% of that of the negative control in culture medium without any extracts. ConclusionsThe novel orthodontic cement containing nCaF2 and DMAHDM achieved much stronger antibacterial and remineralization capabilities and greater enamel hardness than the commercial control did, without compromising the orthodontic bracket-enamel SBS and biocompatibility. Clinical SignificanceThe novel bioactive and nanostructured orthodontic cement is promising to inhibit enamel demineralization, white spot lesions and caries in orthodontic treatments.

Remineralization Potential of Pearl Powder Compared to CPP-ACP on Enamel White Spot Lesions

Remineralization Potential of Pearl Powder Compared to CPP-ACP on Enamel White Spot Lesions

Hyperspectral imaging system associated with novel subtracting image processing algorithm for dental caries early detection

Early detection of caries is vital for demineralization reverse offering a less pain, as well as accurate and precise caries removal. In this study, the difference in optical properties of normal tissue and human caries lesion has been used for early diagnosis, using laser induced fluorescence spectroscopy. The human tooth sample was illuminated with visible band sources (488, 514 and 633 nm) with power 5 mW. The reflected and emitted light of tested sample was collected using hyperspectral camera in an attempt to generate multispectral images (cubic image). The variation of reflected and emitted power as function in wavelength was employed to generate characteristic spectrum of each tooth tissue. Human teeth caries tissue lesion releases its excess power by emitting fluorescence light producing chemical footprint signature; this signature is dependent on the elemental composition of tooth elements and caries state. This non-invasive, non-contact and non-ionizing imaging system with associated novel pattern recognition algorithm was employed to diagnose and classify dental (enamel and dentin), caries, and white spot lesion. It was reported that the perceived fluorescence emission is function of the illuminating wavelength. While enamel and dentin caries were distinguished and characterized at 633 nm illuminating wavelength; white spot lesion cannot be detected. The enamel caries, dentin caries, and white spot lesion were contoured and recognized at 488 nm and 514 nm wavelengths. Therefore full recognition was achieved through generated cubic image after sample irradiation at 488 nm and 514 nm. This non-invasive, non-contact, and non-ionizing imaging technique with customized image processing algorithm offered high sensitivity, high resolution, and early caries detection with optimum performance at 514 nm.

Caries Prevention Potential of Pearl Powder Versus CPP-ACP on Enamel White Spot Lesions

Caries Prevention Potential of Pearl Powder Versus CPP-ACP on Enamel White Spot Lesions

Comparison between the effectiveness of two sealants in prevention of enamel white spot lesions: in vitro study

Comparison between the effectiveness of two sealants in prevention of enamel white spot lesions: in vitro study

Corrigendum to: Effectiveness of self-applied topical fluorides against enamel white spot lesions from multi-bracketed fixed orthodontic treatment: a systematic review.

Corrigendum to: Effectiveness of self-applied topical fluorides against enamel white spot lesions from multi-bracketed fixed orthodontic treatment: a systematic review.

Effectiveness of self-applied topical fluorides against enamel white spot lesions from multi-bracketed fixed orthodontic treatment: a systematic review.

The regular use of fluoride dentifrices is quite practical, widespread and linked to global decline of dental caries. However, the role of self-applied topical fluorides in prevention and reversal of Enamel White Spot Lesions (EWSLs) during multi-bracketed fixed orthodontic treatment is not yet explored. To systematically appraise the current literature on the effectiveness of self-applied topical fluorides in the prevention and reversal of EWSLs occurring during multi-bracketed fixed orthodontic treatment. Four electronic databases (Cochrane Library, Embase via Ovid, Medline via Ovid, and Scopus) and gray literature were searched using the broad MeSH terms and keywords. Only randomized/quasi-randomized controlled clinical trials evaluating the effectiveness of self-applied fluorides in the prevention of EWSLs during multi-bracketed fixed orthodontic treatment or reversal of post-orthodontic EWSLs were included. Two reviewers independently screened for studies, extracted data and assessed the risk of bias using the Cochrane risk of bias tool 2.0. Due to substantial variations in the interventions, control groups, and the measurement of outcome among studies, quantitative synthesis could not be performed as planned. Only three studies could be included in the present review; two of them assessing prevention of EWSLs and one addressing reversal of post-orthodontic EWSLs. One of the studies was judged to be of low risk of overall bias, whereas 2 studies were adjudged to be of high risk of overall bias because of deviations from intended interventions. The certainty of evidence about the role of self-applied fluorides in prevention and reversal of EWSLs was found to be of low quality; hence, our confidence in the effect estimate is limited, and future well-conducted trials might alter the effect estimates. The inclusion of only English literature and inability to perform quantitative synthesis due to a limited number of studies. Although the review did not confirm the effectiveness of self-applied fluorides in the reversal of EWSLs, it did partially substantiate the positive role of self-applied fluorides in the prevention of EWSLs occurring during multi-bracketed fixed orthodontic treatment. The review recommends the need for well-designed randomized controlled trials evaluating the effectiveness of self-applied fluorides on the prevention and reversal of EWSLs during multi-bracketed fixed orthodontic treatment. PROSPERO database (Registration number: CRD42018108590) and is freely available at: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018108590. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Chitosan-bioglass complexes promote subsurface remineralisation of incipient human carious enamel lesions

ObjectivesTo test the in vitro subsurface remineralisation efficacy of chitosan-bioglass complex on artificial white spot lesions.Methods: 64 artificial enamel white spot lesions were created by acidic gel and equally separated for static and 7d pH-cycling models. In each model, samples were assigned to 4 groups: (1) bioglass application on chitosan pre-treated lesions (CB); (2) chitosan-bioglass slurry (CBS); (3) "standard" remineralisation solution (RS - positive control); (4) deionised water (NC - negative control). Before each treatment using remineralising agents, 3-minute pellicle was formed on lesions' surfaces. Mineral content changes, surface and subsurface microhardness and ultrastructure were evaluated by Raman intensity mapping, Knoop microhardness and scanning electron microscopy, respectively. Data were statistically analysed using one-way ANOVA with Tukey's test (p < 0.05 is considered as significant). ResultsChitosan-bioglass complexing was found to exhibit greater mineral regain and recovery of surface and subsurface microhardness compared to "standard" remineralisation solution and control groups, after static and dynamic pH-cycling remineralisation for 7 days (p < 0.05). Specifically, dense precipitations with Ca/P ratios similar to that in pure hydroxyapatite (HA) were observed on surfaces and subsurfaces which filled the porosities in the dynamic pH-cycling group, leaving no prismatic enamel structure exposed. ConclusionsChitosan-bioglass complex is positive in promoting subsurface mineral deposition in spite of the presence of a short-term salivary pellicle. Clinical significance chitosan-bioglass complexing may provide an alternative clinical strategy in remineralising early enamel carious lesions as well as desensitizing exposed porous vital dental tissues clinically.

Color Modifying Effect of Resin Infiltrant (icon) Versus Adhesive Resin on Aesthetic Correction of Enamel White Spot Lesion: RCT

Objectives: Resin infiltration is an innovative approach for enhancing the esthetic appearanceof white spot lesions (WSLs). The aim of this study was to compare the effect of both resin infiltrant(ICON) and adhesive resin with respect to esthetic improvement.Methods: A randomized controlled split- mouth clinical trial was conducted on 10 youngadults with at least two non-cavitated white spot lesions in esthetic zones. They were randomlyassigned to two treatment groups: resin infiltrant (Icon, pre-product: DMG) or AdperTM singlebond 2 adhesive system (3M ESPG dental product, USA) application after 15% hydrochloric acid(HCL) etching and dehydration with ethanol. Vita Easyshade V (Vita Zahnfabrik, Bad Sackingen,Germany) spectrophotometer was used to measure the CIELAB coordinates and values were usedto calculate difference in color (ΔE). Data were tabulated and statistically analyzed using computersoftware SPSS.Results: There was a statistically significant decrease in both (ΔL) and (Δa) with increase in(Δb) with ICON application (p<0.05). Regarding adhesive resin, there was a significant decrease inboth (ΔL) and (Δa) coordinates with non-significant change in (Δb). Also, there was a statisticallysignificant difference between ICON and adhesive resin regarding (ΔE).Conclusions: Color change of white spot lesion treated with ICON and adhesive resin wasclinically obvious after treatment with hydrochloric acid. However, ICON reported significantresults in esthetic improvement in all color parameters.