Enamel White Spot Research Articles

In Vitro Efficacy of Tricalcium Phosphate and Casein Phosphopeptide Amorphous Calcium Phosphate Fluoride for Remineralization of Enamel White Spot Lesions.

Objectives: The main purpose of this study was to compare the remineralizing effects of casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) and tricalcium phosphate (TCP) on artificially induced enamel white spot lesions (WSLs). Materials and Methods: In this in vitro study, 45 sound extracted premolars were immersed in a demineralizing solution (pH=4.5) for 96 hours, and were randomly divided into 3 groups of TCP, MI Paste Plus, and control. They were exposed to the remineralizing agents for 5 minutes once a day for 30 days. After mounting the teeth in resin blocks and polishing, they underwent a microhardness test at 3 different depths from the enamel surface. Data were analyzed by Prism software, two-way ANOVA, and Tukey's test (α=0.05). Results: The volume percentage of mineral content (VPM) was significantly different among the three groups at 30-, 60- and 90µm depths (P<0.0001). At 30µm depth, CPP-ACPF was significantly more effective than TCP (P<0.0001). At 60- and 90µm depths, there was no significant difference between CPP-ACPF and TCP (P>0.05). Conclusion: Both CPP-ACPF and TCP had significant efficacy for remineralization of artificially induced enamel WSLs under in vitro conditions.

Efficacy of different remineralization agents on microhardness and chemical composition of enamel white spot lesion

Background White spot lesions (WSLs) are frequently linked with low microhardness and mineral content changes. several strategies have been employed to deal with these problems. This investigation aimed to analyze the microhardness and mineral content changes after remineralization with bioactive glass (BAG) and casein phospho-peptide-amorphous calcium phosphate with fluoride (CPP-ACPF). Methods Twenty sound maxillary first premolars extracted were used to obtain a total of one hundred enamel samples. forty enamel slabs were split into four experimental groups (n = 10 each): Group I, BAG; Group II, BAG+CPP-ACPF; Group III, CPP-ACPF varnish; and Group IV, artificial saliva (negative control). To create artificial WSLs, all samples were preserved in a prepared demineralizing agent for 72 h before treatment with remineralizing agents. Vickers microhardness test was performed. Additionally, 60 enamel samples were selected for analysis using energy dispersive spectroscopy (EDX) and assigned to six experimental groups; the first four groups were similar to that used in the microhardness test along with Group V: WSLs, and Group VI: baseline. The statistical analyses employed in this study included Tukey’s HSD (p&lt;0.05), one-way ANOVA, and Shapiro-Wilk. Result Regarding surface microhardness, the BAG+CPP-ACPF group showed the most favorable recovery, which was better than the outcomes of the BAG and CPP-ACPF groups. A statistically significant change (p &lt;0.05) was not observed between them. Similarly, for mineral content change, the BAG+CPP-ACPF group demonstrated the greatest result, The BAG group came next, and the CPP-ACPF group came last. Conclusion The BAG+CPP-ACPF group might be regarded as the best course of treatment for enhancing both the surface microhardness and mineral content (Ca, P), while the control group (Artificial saliva) showed the least satisfactory results in comparison. After demineralization, mineral content and microhardness decreased in all samples. Therefore, BAG+CPP-ACPF significantly improved the surface microhardness and mineral content.

Effects of Fractional Carbon Dioxide Laser and CPP-ACP Paste on Remineralization and Discoloration of Enamel White Spot Lesions

Effects of Fractional Carbon Dioxide Laser and CPP-ACP Paste on Remineralization and Discoloration of Enamel White Spot Lesions

Management of white spot enamel lesions with resin infiltration: potentials and future research directions.

The current study1 is a randomized controlled trial with two arm, multicenter and parallel group design. Study subjects were 38 orthodontic patients younger than 17 years who were being treated with metal braces. Patients with at least one white spot lesion (WSL) graded 1 to 2 according to the International Caries Detection and Assessment System (ICDAS) on the labial surface of permanent maxillary and mandibular canines and incisors were included for the trial. Teeth with carious lesions and restorations, anomalies of the enamel, and primary teeth were excluded. Patients were allocated by computer generated random sequence into resin infiltration and fluoride varnish intervention groups. Study subjects were blinded until the allocation, outcome assessors and statisticians remained blinded through the study, however the operators could not be blinded. Resin infiltration treatment involved removal of orthodontic wires and auxiliaries followed by cleaning the teeth with fluoride free prophylactic paste and completing the resin infiltration according to manufacturer's instructions. In the fluoride varnish group, a thin layer of the material was applied after isolating the teeth, and patients were asked not to eat or drink for 1 hour. This was continued twice a month for 6 months. Digital images of the teeth were obtained before, and 1 day (T1), 1 week (T2), 1 month (T3), 3 months (T4) and 6 months (T5) after treatment, using a DSLR camera and a matching polarization filter. The images were processed for calibration and color stability. Regions of interest representing WSL (white spot lesion) and SAE (sound adjacent enamel) were isolated in the images for comparison at different stages the images were captured. Statistical analysis was performed using SPSS version 28. Independent-samples t-test was utilized for comparison between the two groups, and paired-samples t-test for comparison within the groups. A statistical significance level of α = 0.05 was set. At T1, significant color difference was observed between white spot lesion and adjacent sound enamel in the resin infiltration group and it remained stable after 6 months. Whereas in the fluoride varnish group, there were no statistical differences from baseline to 6 months. A statistical difference of 3.27 CIELAB units (p < 0.001) was reported between the infiltration group and the fluoride group at T5. No significant changes were noted in SAE with respect to changes in lightness. Resin infiltration was found to be better at masking the demineralization produced by WSL and also enhanced the esthetic appearance of demineralized areas around the brackets. Resin infiltration did not produce any clinically visible effects in non-affected enamel. These changes remained stable for a period of 6 months.

Surface porosity of enamel white spot lesions and penetration of fluorapatite nanocrystals into their subsurface: proof-of-concept study

ObjectivesIn this study, we used atomic force microscopy (AFM) to quantify the size of surface pore apertures of enamel white spot lesions and then demonstrated the penetration of fluorapatite nanocrystals (nFA) into the subsurface of these lesions. MethodsFor the porosity study, enamel lesions were created on three sound human teeth using a demineralizing gel for 8 days. The interface between sound enamel and the artificial lesion was analyzed by AFM. To visualize the penetration of nFA tagged with a calcium-binding fluorophore (Fluo-4) into the subsurface of white spot lesions, we used two-photon microscopy. Sixteen extracted human teeth with either active, natural, or in vitro-created carious lesions in enamel were randomly divided into three groups. The teeth were treated for 2 min with either a suspension of tagged nFA crystals, Fluo-4 alone, or deionized water, and left for 30 min before being washed with distilled water and examined microscopically. ResultsA greater concentration of surface pores with larger areas was observed on the in vitro demineralized enamel (29 % of pores greater than 1.0 µm2) when compared with the adjacent sound enamel (8 % of pores greater than 1.0 µm2) (p=0.012, Fisher exact test). In vitro and natural lesions treated with tagged nFA showed fluorescence at depths ranging from 50 to 170 µm, demonstrating penetration of the nFA into the lesion subsurface. The lesions treated with Fluo-4 alone with no crystals showed mostly surface fluorescence (restricted to the outer 25 µm), while those treated with deionized water showed minimal (restricted to the outer 20 µm) to no fluorescence. ConclusionWe have demonstrated the use of AFM to quantify the surface pore apertures and two-photon microscopy to visualize nFA crystals in the subsurface of non-cavitated enamel lesions. Clinical SignificanceThe restoration of the subsurface of non-cavitated caries lesions is a clinical challenge. This study demonstrated that a 2 min application of nFA could penetrate through the surface apertures of non-cavitated enamel lesions into their subsurface.

Carboxymethyl chitosan stabilized AuNPs/ACP nanohybrids in enamel white spot lesions.

Acidic bacterial biofilms-associated enamel white spot lesions (WSLs) are one of the hallmarks of early caries, causing demineralization and decomposition of dental hard tissues. Therefore, to effectively prevent and treat WSLs, it is important to inhibit the activity of cariogenic bacteria while promoting the remineralization of demineralized enamel. Amorphous calcium phosphate (ACP) favors hard tissue remineralization due to its biological activity and ability to release large amounts of Ca2+ and PO4 3-. However, ACP-based biomineralization technology is not effective due to its lack of antimicrobial properties. Here, carboxymethyl chitosan (CMCS) was employed as a reducing agent and stabilizer, and dual-functional nanohybrids CMCS/AuNPs/ACP with biofilm resistance and mineralization properties were successfully synthesized. The addition of AuNPs enhances the antimicrobial activity and participates in regulating the formation of hydroxyapatite (HAp). The nanohybrids exhibited significant destructive effects against cariogenic bacteria and their biofilms and showed bactericidal activity under bacteria-induced acidic conditions. More importantly, this nanohybrids showed superior results in promoting the remineralization of demineralized enamel, compared to fluoride and CMCS/ACP in vitro. The CMCS/AuNPs/ACP nanohybrids not only reverse the cariogenic microenvironment at the microbial level, but also promote self-repairing of enamel WSLs regarding the microstructure. The present work offers a theoretical and experimental basis for using the CMCS/AuNPs/ACP nanohybrids as a potential dual-functional agent for the clinical treatment of enamel WSLs.

Enamel White Spot Lesions: A Review of Etiology, Prevention, and Treatment

Enamel White Spot Lesions (EWSLs) are a common dental condition characterized by being opaque or chalky white in appearance. In this review, an overview of the etiology, prevention, and treatment techniques for EWSLs is presented. Enamel demineralization caused by bacteria in dental plaque which releases acids upon the consumption of fermentable carbohydrates causing mineral loss is thought to be the main cause of those lesions, which could be predisposed through orthodontic treatment, poor diet, inadequate oral hygiene and certain medical conditions. So, sustaining an adequate carbohydrate consumption, proper fluoride exposure and good oral hygiene are some of the practices which aid in these lesions’ prevention. Although the success or failure of treatment of EWSLs depends on patient cooperation, depth of the lesion and lesion severity, treatment of those EWSLs should begin with the most conservative approach like remineralization and if failed then more invasive microabrasion, infiltration and maybe even restoration treatment strategies can be pursued. Further research is still needed in the prevention and treatment strategies.

Effectiveness of low-viscosity resin infiltration (Icon) on color change of enamel white spot lesions: 1-year follow-up clinical study

BackgroundTo evaluate the effect of the low-viscosity Icon resin infiltrate application on the color change of white spot enamel lesions (WSLs) over 3-, 6-, and 12-m follow-up periods.MethodsNinety-six teeth diagnosis with WSLs using the ICDAS scoring system in 49 participants were assessed for their color change using the Icon resin infiltration technique. The Icon kit was applied to WSLs as instructed by the manufacturer. Icon-Etch (15% hydrofluoric acid) was applied to the lesions for 2 min, and then, it was rinsed off with copious amount of water for 30 s. Then, Icon-Dry (99% ethanol) was applied to the etched lesions for 30-s followed by the application of the Icon resin infiltrate that was light cured for 40 s. Color change assessment was performed using Vita Easyshade V spectrophotometer at baseline and immediately after Icon resin infiltration, then at 3-, 6-, and 12-m follow-up periods. Analysis of the data was performed using the test of repeated measure ANOVA and the paired sample t test.ResultsThere was a statistically significant difference in ∆E between the different follow-up periods at immediate, 3-m, 6-m, and 12-m. The highest mean value was found in the immediate follow-up period, while the lowest mean value was found in 12-m follow-up period.ConclusionsLow-viscosity Icon resin infiltration has the ability for immediate diffusion into the WSLs giving an immediate improvement in the esthetic outcome of the WSLs. However, its long-term outcomes might not be consistent for the color change of the WSLs.

Efficacy of different remineralization agents on microhardness and chemical composition of enamel white spot lesion.

White spot lesions (WSLs) are frequently linked with low microhardness and mineral content changes. several strategies have been employed to deal with these problems. This investigation aimed to analyze the microhardness and mineral content changes after remineralization with bioactive glass (BAG) and casein phospho-peptide-amorphous calcium phosphate with fluoride (CPP-ACPF). Twenty sound maxillary first premolars extracted were used to obtain a total of one hundred enamel samples. forty enamel slabs were split into four experimental groups (n = 10 each): Group I, BAG; Group II, BAG+CPP-ACPF; Group III, CPP-ACPF varnish; and Group IV, artificial saliva (negative control). To create artificial WSLs, all samples were preserved in a prepared demineralizing agent for 72 h before treatment with remineralizing agents. Vickers microhardness test was performed. Additionally, 60 enamel samples were selected for analysis using energy dispersive spectroscopy (EDX) and assigned to six experimental groups; the first four groups were similar to that used in the microhardness test along with Group V: WSLs, and Group VI: baseline. The statistical analyses employed in this study included Tukey's HSD (p<0.05), one-way ANOVA, and Shapiro-Wilk. Regarding surface microhardness, the BAG+CPP-ACPF group showed the most favorable recovery, which was better than the outcomes of the BAG and CPP-ACPF groups. A statistically significant change (p <0.05) was not observed between them. Similarly, for mineral content change, the BAG+CPP-ACPF group demonstrated the greatest result, The BAG group came next, and the CPP-ACPF group came last. The BAG+CPP-ACPF group might be regarded as the best course of treatment for enhancing both the surface microhardness and mineral content (Ca, P), while the control group (Artificial saliva) showed the least satisfactory results in comparison. After demineralization, mineral content and microhardness decreased in all samples. Therefore, BAG+CPP-ACPF significantly improved the surface microhardness and mineral content.

The effect of combined use of resin infiltration with different bioactive calcium phosphate-based approaches on enamel white spot lesions: An in vitro study

ObjectivesThis in vitro study aimed to evaluate the effect of resin infiltration combined with casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF) or bioactive glass (BAG) on the stability of enamel white spot lesions (WSLs) treatment. Materials and methodsEighty-four enamel blocks were prepared from the buccal surfaces of sound human premolars. All enamel blocks were placed in a demineralisation solution for 3 days to establish the artificial enamel WSLs. Enamel blocks with WSLs were randomly divided into three groups (n = 28 each group): RI/B: one-off resin infiltration followed by twice daily BAG treatment; RI/C: one-off resin infiltration followed by twice daily CPP-ACPF treatment; RI: one-off resin infiltration treatment only (as control) and subjected to pH cycling for 7 days. Surface morphology, elemental analysis, crystal characteristics, surface roughness and microhardness of enamel surfaces were investigated by scanning electron microscopy and energy-dispersive spectrometry observation, X-ray diffraction (XRD), atomic force microscope and Vickers’ hardness testing, respectively. ResultsMean values of the surface roughness (mean±standard deviation (nm)) were 24.52±5.07, 27.39±5.87 and 34.36±4.55 for groups RI/B, RI/C and RI respectively (p = 0.003). The calcium to phosphate ratios were 1.32±0.16, 1.22±0.26 and 0.69±0.24 for groups RI/B, RI/C and RI respectively (p < 0.001). XRD revealed apatite formation in all three groups. The mean enamel surface microhardness (kg/mm2) of the groups were 353.93±28.49, 339.00±27.32 and 330.38±22.55 for groups RI/B, RI/C and RI respectively (p = 0.216). ConclusionsResin infiltration combined with CPP-ACPF or BAG remineralisation appears to improve the surface properties of WSLs. Clinical SignificanceThe combination of resin infiltration and CPP-ACPF/BAG remineralisation may be a potential treatment for the management of the WSLs.

CHN nanocomposites and nanocoating resist enamel white spot lesions by enhancing remineralization and antibacterial activity.

Enamel white spot lesions (WSLs) are usually caused by the dissolution of minerals (mainly calcium and phosphate) on the tooth surface due to the acidic environment in the oral cavity. Without timely intervention, WSLs may lead to white spots or a sense of transparency on the tooth surface, and even the formation of dental caries (tooth decay) in severe cases. The key to preventing and treating WSLs is inhibiting the activity of acid-producing bacteria and promoting the remineralization of demineralized enamel. In this study, the network structure formed by sodium tripolyphosphate (TPP) cross-linked chitosan was used to stabilize calcium phosphate, and the multifunctional nanocomposite was constructed by integrating antibacterial components of traditional Chinese medicine, honokiol nanoparticles (HK-NPs) and sodium fluoride to achieve the purpose of resisting cariogenic bacteria and remineralizing with sustained release of calcium and phosphate ions. Notably, we enhanced the remineralization effect of nanocomposites with the help of functional nanocoatings inspired by the mussel biomimetic coating. The experimental results show that the synergistic remineralization effect of nanocomposite and nanocoating is better than that of a single strategy. This multi-prong treatment strategy provides the theoretical and experimental basis for the clinical prevention and treatment of WSLs.

Use of micro-computed tomography and scanning electron microscopy with energy-dispersive spectroscopy to distinguish natural white spot enamel lesions from sound enamel in human premolars.

The aim of the present study was to develop a novel method for distinguishing white spot lesions (WSLs) from sound enamel in human premolars using micro-computed tomography (micro-CT) and scanning electron microscopy (SEM) with energy-dispersive spectroscopy (EDS), and to examine differences in surface morphology, chemical composition, and mineral density (MD) between these two areas. Fourteen premolars with natural WSLs on the enamel surface of the crowns were examined. After sectioning the teeth, each specimen containing WSLs adjacent to intact enamel was examined for MD, surface morphology, and atomic percentages (At%) of chemical components using micro-CT and SEM/EDS, respectively. Differences between these areas of the same specimen were analyzed statistically using paired t-test. SEM images highlighted increased roughness and irregularity in the lesion area. EDS analysis revealed significant reductions in calcium (Ca), phosphorus (P), fluorine (F), chlorine (Cl), and sodium (Na) levels at the lesion surface in comparison to intact enamel (P < 0.05). The decreases in the MD of the lesions were statistically significant in comparison to sound enamel (P < 0.05). These findings provide standard measurements for evaluating the essential characteristics of WSLs and intact enamel, being vital for assessment of treatment outcomes and development of innovative biomaterials for management of hypo-mineralized enamel lesions.

Evaluation of oral health status for a group of orthodontic patients

Background: Malocclusion and fixed orthodontic appliance convoluted the ordinary oral hygiene measures, which may lead to accumulation and prolonged retention of dental plaque on tooth surfaces particularly around the orthodontic brackets and auxiliaries of the fixed orthodontic appliance. Objective: To evaluate the oral health status among a group of orthodontic patients by evaluating the plaque, gingival, calculus, and Enamel Decalcification indices. Patients and Methods: This study was conducted among 128 persons (64 with fixed orthodontic appliance as a study group and 64 without fixed orthodontic appliance as a control group. An assessment of related clinical parameters as plaque, gingival, as well as enamel decalcification indices were done. Results: The present study revealed that the mean plaque, gingival, as well as enamel decalcification indices for the total sample were (1.182±0.356), (1.230±0.269), and (1.329±0.413) respectively. Additionally, all of these indices were higher among study group (fixed orthodontic patient) than among control group (persons without orthodontic appliance) with statistically significant difference among groups for each. Conclusion: Fixed orthodontic appliance is an effective plaque retentive factor that accumulate dental plaque which is the main causative factor for development of enamel white spot lesion and periodontal disease.

Evaluation of oral health status for a group of orthodontic patients

Background: Malocclusion and fixed orthodontic appliance convoluted the ordinary oral hygiene measures, which may lead to accumulation and prolonged retention of dental plaque on tooth surfaces particularly around the orthodontic brackets and auxiliaries of the fixed orthodontic appliance. Objective: To evaluate the oral health status among a group of orthodontic patients by evaluating the plaque, gingival, calculus, and Enamel Decalcification indices. Patients and Methods: This study was conducted among 128 persons (64 with fixed orthodontic appliance as a study group and 64 without fixed orthodontic appliance as a control group. An assessment of related clinical parameters as plaque, gingival, as well as enamel decalcification indices were done. Results: The present study revealed that the mean plaque, gingival, as well as enamel decalcification indices for the total sample were (1.182±0.356), (1.230±0.269), and (1.329±0.413) respectively. Additionally, all of these indices were higher among study group (fixed orthodontic patient) than among control group (persons without orthodontic appliance) with statistically significant difference among groups for each. Conclusion: Fixed orthodontic appliance is an effective plaque retentive factor that accumulate dental plaque which is the main causative factor for development of enamel white spot lesion and periodontal disease. Keywords: Oral health status, Fixed orthodontic appliance, white spot lesion, periodontal disease.

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

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

Applications of photothermally mediated nanohybrids for white spot lesions in orthodontics

In orthodontic treatment, cariogenic bacteria in the oral cavity are the main cause of enamel white spot lesions (WSLs). Therefore, to effectively prevent and treat WSLs, it is crucial to inhibit the cariogenic bacterial activity while promoting the remineralization of demineralized tooth enamel. However, fluoride preparations commonly used for the prevention and treatment of WSLs can induce dental fluorosis if ingested in excess, and their remineralization effect is limited by the residual hydroxyapatite (HAp) content and salivary Ca2+ and PO43- levels. In this study, we propose a strategy (CMCS/ACP@PDA) for antibacterial and remineralization of WSLs by a nanohybrid of carboxymethyl chitosan (CMCS)-stabilized amorphous calcium phosphate (ACP) loaded polydopamine nanoparticles (PDA NPs) based on biomimetic remineralization techniques and biocompatible near-infrared (NIR) photoactivation therapy. The nanohybrid utilizes the excellent photothermal conversion ability of polydopamine for antimicrobial purposes, while CMCS with its own positive and negative charges (-NH3+ and -COO-) acts as a biomimetic mineralizing agent to stabilize ACP, supplemented with abundant Ca2+ and PO43- for remineralization of demineralized enamel. The results showed that CMCS/ACP@PDA could effectively inhibit the adhesion of cariogenic Streptococcus mutants (S. mutants) with high bactericidal rates. In addition, the remineralization of demineralized enamel by nanohybrid was more effective after 7 days of in vitro mineralization. This study provides a theoretical and experimental basis for the use of CMCS/ACP@PDA nanohybrid materials as potential materials against WSLs.

Synergistic remineralization of enamel white spot lesions using mesoporous bioactive glasses loaded with amorphous calcium phosphate.

Objectives: The purpose of this study was to create a new delivery system that can synergistically remineralize enamel white spot lesions (WSLs). Materials and methods: The delivery system (PAA-ACP@aMBG) was prepared by using aminated mesoporous bioactive glasses (aMBG) as the carrier loaded with polyacrylic-stabilized amorphous calcium phosphate (PAA-ACP). The materials were characterized by transmission electron microscopy (TEM), X-ray powder diffraction (XRD), inductively coupled plasma-optical emission spectrometry (ICP-OES), and so on. Forty-eight artificial WSLs enamel samples were randomized to four groups: artificial saliva (negative control, NC), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), PAA-ACP@aMBG, and MBG. The effects of demineralization and remineralization of the enamel surface were compared by means of surface microhardness (SMH) measurements, surface color change measurements, fluorescence microscopy (FM), X-ray diffraction (XRD) analysis and scanning electron microscopy (SEM). Results: There was no significant difference in the surface microhardness recovery rate (SMHRR) or color recovery rate (CRR) among the CPP-ACP group, PAA-ACP@aMBG group and MBG group (P>0.05), but these values were significantly higher than those in the NC group (p < 0.01). FM demonstrated that the remineralization depth in the PAA-ACP@aMBG group was significantly greater than that of the remaining three groups (p < 0.01). SEM analysis indicated that the enamel demineralization marks in the PAA-ACP@aMBG group, CPP-ACP group, and MBG group were obscured by mineral deposition. Conclusions: PAA-ACP@aMBG showed good mineralization properties, implying its great potential for clinical application.

Resin Infiltration of Non-Cavitated Enamel Lesions in Paediatric Dentistry: A Narrative Review.

The resin infiltration (RI) technique was introduced as one of the minimal intervention dentistry strategies in addressing dental caries among the paediatric population. This technique used the low-viscosity resin monomer to infiltrate the non-cavitated carious lesion and other developmental enamel porosities, thus allowing the conservation of the tooth structure. This narrative review aims to explore the value of RI in Paediatric Dentistry. Through our search of the literature, the development of the material, their clinical applications and shortcomings, as well as the innovation that has been carried out to improve the current RI, were discussed. There are number of high-level evidence supporting the use of RI in arresting non-cavitated proximal caries lesions in primary and permanent teeth, but its efficacy in managing anterior white spot lesions is still unclear. Limited penetration depth, not radiopaque and questionable long-term colour and material stability were among the limitation of the material. Various laboratory-based studies have been conducted to improve the current properties of RI. Nevertheless, RI has emerged as one of the important micro-invasive techniques in addressing non-cavitated and anterior white-spot enamel lesions in children and adolescents with great success.

Effects of an orthodontic primer containing amorphous fluorinated calcium phosphate nanoparticles on enamel white spot lesions

ObjectivesThe study investigated the effects of an orthodontic primer containing amorphous fluorinated calcium phosphate (AFCP) nanoparticles on enamel white spot lesions (WSLs). Materials and methodsThe AFCP nanoparticles were prepared and incorporated into Transbond XT Primer. Thirty-two human enamel slices were highly polished and randomly divided into four groups: no part covered (control), half covered with a primer containing 0 wt%, 25 wt%, and 35 wt% AFCP. Subsequently, samples were challenged by a modified pH-cycling and characterized by color measurement, micro-computed tomography, and scanning electron microscope (SEM). The bonding properties of the primers containing AFCP were assessed using shear bond strength test, and the mouse fibroblasts (L929) were employed to evaluate the cytotoxicity. ResultsWhen the enamel was challenged by pH cycling, 25 wt% and 35 wt% AFCP groups exhibited less color change (ΔE) and less mineral loss than the control and 0 wt% AFCP groups. The SEM images showed that the original microstructural integrity and mineral deposition rate of the enamel surface were better in the 25 wt% and 35 wt% AFCP groups. In particular, the 35 wt% AFCP group exhibited the best performance after 3 weeks of pH cycling. The shear bond strength and cell viability revealed no significant difference among the tested groups (P > 0.05). ConclusionUsing the primer containing 35 wt% AFCP might be a promising strategy for preventing the occurrence and development of WSLs during orthodontic treatment.

Time-dependent effect of intense capsule-coffee and bleaching on the color of resin-infiltrated enamel white spot lesions: an in vitro study.

Background and ObjectivesWhite spot lesions (WSLs) are a common problem that can be conservatively managed by resin infiltration. Consumption of dark beverages such as coffee causes staining of dental hard tissues, which can deteriorate the esthetic qualities of treated WSLs. The aims of this study were to investigate the effect of dark coffee heavy consumption on ICON® resin infiltrated WSLs and the influence of bleaching on them after staining.MethodsTwenty surfaces from sound human extracted third molars were used in the study. Two square-shaped buccal and lingual window areas had artificially created WSLs (received buccal resin infiltration afterward). Using VITA Easyshade, the baseline ΔE was recorded. Espresso coffee was used to immerse all surfaces for 8 days. The color coordinates according to CIE LAB were recorded for all surfaces at 2, 4, 6, and 8 days of immersion, and ΔE was calculated at each timepoint. After 8 days, in-office bleaching was applied to all surfaces according to the manufacturer’s instructions and the color. Coordinates and ΔE were recorded. For statistical analysis, an independent sample t-test was used to compare each group. A general linear mixed model (GLMM) repeated measure ANOVA was applied for statistical analysis of L*and changes due to staining over time.ResultsAnalysis of time as a main effect on the L values of surfaces was statistically highly significant (p < 0.01). The interaction of time with surfaces under investigation and type of surface (test vs. control) as a main effect were non-significant (p = 0.47 and p = 0.35, respectively). Bleaching showed a significant difference in color lightness in both test and control surfaces compared to the mean L value at 8 days of staining (p < 0.01).ConclusionCapsule-coffee consumption gradually influences the esthetic of resin infiltration on treated teeth. However, bleaching materials might restore an esthetic shade.