Initial Caries Research Articles

Multicenter RCT on intensive caries prevention for children undergoing dental general anaesthesia: Intensive caries prevention for children undergoing dental general anesthesia

ObjectivesEarly childhood caries is a persistent problem often leading to dental treatment under general anesthesia (GA). Thus, this study investigated the effect of two additional individual caries prevention appointments before and after GA. Materials and MethodsIn this multi-center, 2-arm randomized, controlled clinical trial, 408 children (age 2–5 years, mean 4.2 ± 1.04) intended for GA were recruited and randomly assigned to the intervention and control groups with or without two additional intensive oral hygiene appointments before and after the GA. At baseline and at 6-/12-months follow-ups, approximal plaque index (API), gingival sulcus bleeding index (SBI), caries experience (dmft/s) and initial caries were recorded. ResultsParticipants in test group and control group (ITT; n = 161 vs. n = 147) as well as drop-outs in test and control groups (n = 40 vs. n = 58) showed no statistical significant difference in baseline characteristics. Test and control groups showed equivalent baseline oral health parameters (API: 78 and 77%, SBI: 22.6 and 23.5%, dmft: 8.5 and 8.2, respectively), which continuously improved during the study. The test group exhibited statistically significant greater improvement (API: 42%, SBI: 7%) than the control (API: 54%, OR: 0.48; P = 0.003; SBI: 12%, OR=0.44; P = 0.005). Due to the robust rehabilitation with predominantly stainless steel crowns and extractions, caries incidence was minimal and, therefore, without statistical significance (mean increase dt, test: 0.5, control: 0.6; P = 0.68), which was also true for new initial carious lesions (mean increase test: 0.8 vs. control: 0.9; P = 0.55). ConclusionsAdditional preventive sessions for children undergoing treatment under GA improved their oral hygiene parameters signifiqantly. Clinical significanceIntensive caries prevention appointments for children receiving dental treatment under GA improved their oral hygiene and might reduce their caries risk.

Clinical effectiveness of high definition fluorescence camera in detection of initial occlusal caries.

BackgroundAlthough visual inspection is the preferred route in everyday clinical practise for detecting early caries lesions, novel technologies like light fluorescence-based devices (Vista Proof iX HD smart) have been developed to enhance early caries detection. Material and MethodsOcclusal surface of 45 molar and 49 premolar teeth from 34 adult participants who fulfilled the eligibility criteria were examined by two observers using three diagnostic methods. Examination was performed visually using the International Caries Detection and Assessment System (ICDAS-II) followed by Vista Proof. Fissurotomy was applied for histological validation. Intra- and inter-observer agreement were measured for ICDAS-II and light-induced fluorescence camera using Kappa test. The overall diagnostic accuracy parameters, area under the receiver operating characteristic curve (AUC-ROC) and 95% confidence interval (95% CI) of the (AUC) for caries detection by Vista Poof were evaluated. ResultsFor ICDAS-II and Vista Proof methods, there was almost perfect intra- and inter-observer agreement. Based on ICDAS-II as a reference standard 1, Vista Proof showed a low level of agreement in enamel carious lesion detection with low sensitivity value of 48%, high specificity of 100%, and AUC was 0.112, while a high level of agreement in dentin carious lesion detection with high sensitivity value of 100%, low specificity of 48% and AUC was 0.888. Based on fissurotomy as reference standard 2, Vista Proof showed a high level of agreement in dentin carious lesion detection with high sensitivity value of 95% and 0% specificity and AUC was 0.814. ConclusionsQuantitative light-induced fluorescence camera with reference to ICDAS-II is considered as an accurate diagnostic modality for detection of early occlusal caries. Histological findings validate the diagnostic accuracy of the camera in dentin. Key words:Histological validation, Initial caries, ICDAS, Light induced fluorescence, Vista Cam.

Tactile perception of roughness to assess activity in artificial initial caries lesions with a novel force-controlled probe.

Roughness-tactile perception is part of activity assessment in initial-caries-lesions. Hypothesizing that a probe's design influences this examiner's assessment, four probes were designed. The aims of this study were to select the probe with highest inter-/intra-examiners' roughness-assessment agreement and to determine its diagnostic accuracy on artificial initial-caries lesions. A pilot study was conducted with trained dentists to select one controlled-pressure probe design (n = 4) by assessing roughness on known-roughness metal plaques with 5-point Likert scale. Diagnostic accuracy of roughness assessment was conducted with the selected controlled-pressure probe and the WHO-probe on sound and artificial initial-caries-lesion (n = 20) human enamel blocks. Intra-class correlation coefficients (ICCs) and quadratic weighted-Kappa scores were used to assess examiners' reproducibility and Multilevel Poisson models to determine diagnostic accuracy between both probes controlling for confounding variables. The probe design with the highest inter/intra-examiner's agreement (ICC = 0.96) was selected for subsequent analyses. Unadjusted sensitivity, specificity and accuracy values were for the controlled-pressure and the WHO probes: 71.1%,90.6%,81.2%, and 67.4%,84.6%,75.8%, respectively (p > 0.05). Examiner remained the most important factor influencing diagnostic accuracy. While this study did not show significantly higher diagnostic accuracy of the designed controlled-pressure vs. the WHO-probe when used by trained dentists, all over roughness-assessment accuracy and reproducibility were high.

Comparative assessment of the results of noninvasive and microinvasive treatment of initial caries in permanent teeth in children

The aim of the study is comparative evaluation of the results of treatment of enamel caries (initial caries) of permanent teeth in children using non-invasive and microinvasive methods. The study involved 45 children aged 10-16 years, who revealed enamel caries in 451 permanent teeth. Noninvasive treatment was carried out using toothpaste with a fluoride content of 2800 ppm (group 1, 138 teeth) or 5% fluoride varnish (group 2, 155 teeth). Microinvasive treatment was performed using caries infiltration (group 3, 99 teeth) or amelogenin peptide (group 4, 59 teeth). The observation was carried out for 18 months. The method of laser fluorescence was used to assess the demineralization of enamel. After treatment, repeated examinations did not reveal carious cavities in groups 1, 2 and 3, and one carious cavity was revealed in group 4 after 18 months. The average values of laser fluorescence after treatment in groups 1, 2 and 4 decreased slightly, in group 3 they corresponded to the values of healthy enamel throughout the observation period. The use of noninvasive and microinvasive methods of treatment of permanent tooth enamel caries in children was effective. However, according to laser fluorescence, only the use of caries infiltration significantly reduced enamel demineralization.

Effect of Amelogenin Solution in the Microhardness of Remineralized Enamel and Shear Bond Strength of Orthodontic Brackets.

Objectives To evaluate the microhardness of tooth enamel remineralized with enamel matrix protein solution as well as the shear bond strength of orthodontic brackets bonded to this surface. Materials and Methods In total, 24 human premolars were selected and divided into 3 experimental groups (n = 8): SE—sound enamel, DE—demineralized enamel, and TE—demineralized enamel treated with amelogenin solution. Samples from DE and TE groups were subjected to pH cycling to induce initial artificial caries lesion. TE group was treated with amelogenin solution. Samples were placed in artificial saliva for 7 days. Knoop microhardness was measured before any intervention (T0), after pH cycling (T1) and after amelogenin solution treatment application (T2). Twenty-four hours after ceramic orthodontic brackets were bonded, samples were subjected to shear test in a universal testing machine. Microhardness and shear measurement distributions were subjected to Kolmogorov–Smirnov normality test, which was followed by parametric tests (α = 0.05): 2-way analysis of variance (factors: enamel condition × treatment) and Tukey posttest for all three groups (SE, DE, and TE) in T0 and T2 for microhardness; analysis of variance and Tukey's test, for shear bond strength test. Results Means recorded for Knoop microhardness in T2, for the SE (366.7 KHN) and TE (342.8 KHN) groups, were significantly higher than those recorded for the DE group (263.5 KHN). The shear bond strength of the SE (15.44 MPa) and TE (14.84 MPa) groups statistically differed from that of the DE group (11.95 MPa). Conclusion In vitro demineralized enamel treatment with amelogenin solution was capable of taking samples' hardness back to levels similar to those observed for sound enamel. The shear bond strength on the enamel subjected to this treatment was similar to that observed for healthy enamel and higher than that observed for demineralized enamel.

Anti-caries evaluation of a nano-hydroxyapatite dental lotion for use after toothbrushing: An in situ study

ObjectivesThe aim of this randomized, double-blind, two-arm crossover in situ study was to investigate whether nano-hydroxyapatite (nanoHAP) dental lotion (Apagard Deep Care) applied immediately after tooth-brushing with nanoHAP toothpaste (Apagard M-plus) enhances the remineralization promotion and the demineralization inhibition efficacies of nanoHAP toothpastes. Methods64 sound enamel blocks and 64 blocks bearing artificially-produced initial caries were produced from human permanent molar teeth. During each treatment period, lasting 14 days per arm, two blocks, one sound and one lesion-bearing, were exposed to either 5% nanoHAP-containing or placebo dental lotion after tooth-brushing with 5% nanoHAP toothpaste, via an intra-oral appliance worn by 30 adults in each of the study groups. Baseline and post-test mineral loss were quantified using transverse microradiography (TMR). One-sided t-test of one group mean was used for intragroup comparison, while two-sided t-test of two independent means was used to compare the two dental lotions. ResultsPairwise comparison (baseline vs. post-test) indicated significant (p<.001) remineralization by nanoHAP toothpaste in both groups. However, when compared against each other, there was a significantly (p<.001) greater percentage of remineralization with nanoHAP lotion [58.4(±1.8)%] than with placebo lotion [37.7(±2.2)%]. TMR examination showed absolute demineralization inhibition in sound enamel blocks exposed to either lotions. ConclusionsToothpaste containing 5% nanoHAP effectively remineralized initial caries and inhibited demineralization of healthy enamel; however, the application of a dental lotion containing 5% nanoHAP after brushing resulted in superior remineralization compared to a placebo lotion. Clinical SignificanceDental lotion containing 5% nanohydroxyapatite used immediately after toothbrushing with 5% nanohydroxyapatite toothpaste can serve as an adjunct to enhance the clinical benefits of the toothpaste.

Bioactive self-etching sealant on newly erupted molars: A split-mouth clinical trial

ObjectivesThis randomized clinical trial compares retention, survival rate, and evolution of caries of newly erupted permanent molars sealed with bioactive self-etching sealants with pre-reacted glass ionomer (S-PRG). MethodsA split-mouth clinical trial was conducted with 56 permanent second molars in stages 2 and 3 of crown eruption; ICDAS (International Caries Detection and Assessment System) was between 0 and 2. The molars were randomized and blinded in relation to the side (right or left) that would receive the sealants; the conventional resin sealant (FS), Fluroshield (Dentsply), or bioactive self-etch sealant (BS), BeautiSealant with S-PRG (Shofu). The sealants were compared in terms of retention, quality of sealant remnant (anatomical shape, marginal adaptation, surface texture, and marginal discoloration), and development of caries by ICDAS after 1, 6, and 12 months. The Wilcoxon, x² of independence, Kaplan–Meier, and Mantel–Cox survival statistical tests were applied (α = 5%). ResultsThe total retention was higher for FS (57.1%) at all periods, and there was no difference in the quality of sealants at all periods. The ICDAS decreased after 6 (p = 0.025) and 12 months (p = 0.027) for both materials. Despite the lower retention of BS, the clinical quality of sealants over 12 months were similar. ConclusionTeeth sealed with BS presented higher sound teeth predominance (ICDAS 0) compared to FS sealant, even with a higher loss of material. Clinical relevanceEruption of permanent molars is a relevant period, and the prevention/management of initial caries is essential in these critical stages. Sealants can be an important prevention strategy. After 12 months of follow-up, there was a major failure of the bioactive sealant but without the development of caries lesions.

Diagnostic validity of early proximal caries detection using near-infrared imaging technology on 3D range data of posterior teeth

ObjectivesThis in vitro study analysed potential of early proximal caries detection using 3D range data of teeth consisting of near-infrared reflection images at 850 nm (NIRR).Materials and methodsTwo hundred fifty healthy and carious permanent human teeth were arranged pairwise, examined with bitewing radiography (BWR) and NIRR and validated with micro-computed tomography. NIRR findings were evaluated from buccal, lingual and occlusal (trilateral) views according to yes/no decisions about presence of caries. Reliability assessments included kappa statistics and revealed high agreement for both methods. Statistical analysis included cross tabulation and calculation of sensitivity, specificity and AUC.ResultsUnderestimation of caries was 24.8% for NIRR and 26.4% for BWR. Overestimation was 10.4% for occlusal NIRR and 0% for BWR. Trilateral NIRR had overall accuracy of 64.8%, overestimation of 15.6% and underestimation of 19.6%. NIRR and BWR showed high specificity and low sensitivity for proximal caries detection.ConclusionsNIRR achieved diagnostic results comparable to BWR. Trilateral NIRR assessments overestimated presence of proximal caries, revealing stronger sensitivity for initial caries detection than BWR.Clinical relevanceNIRR provided valid complement to BWR as diagnostic instrument. Investigation from multiple angles did not substantially improve proximal caries detection with NIRR.

Intraoral scanner featuring transillumination for proximal caries detection. An in vitro validation study on permanent posterior teeth

ObjectivesTo assess the validity of an intraoral scanner system featuring near-infrared (NIR) transillumination to aid the detection of proximal caries lesions, and to compare the diagnostic performance of this system with that of conventional caries detection methods and with that of an intraoral camera featuring NIR transillumination (DIAGNOcam). MethodsNinety-five permanent posterior teeth were examined using a prototype tip functioning with TRIOS 4 intraoral scanner system (3Shape TRIOS A/S, Denmark) and emitting NIR light, DIAGNOcam, and visual and radiographic examination employing ICDAS criteria. One or two approximal surfaces per tooth, sound or with caries lesions at different stages, were examined (N1=158). Histological assessment was used as the reference standard. ResultsAll methods showed excellent intra-examiner reliability (κintra ≥0.80). Two independent examiners assessed the NIR images obtained with both devices. The first examiner, who obtained and assessed the images, showed improved diagnostic performance than the second examiner, who only had access to the images. The inter-examiner agreement between the two examiners assessing the NIR images was substantial (κinter 0.57-0.72). The intraoral scanner and DIAGNOcam showed similar diagnostic performance. Regarding initial caries lesions, the NIR image assessment resulted in equal or improved sensitivity (SE 0.50-0.89) compared to radiographic assessment (SE 0.49-0.51) and higher than visual examination (SE 0.28-0.39). Radiographic and NIR image assessment resulted in similar SE in detecting moderate-extensive dentin caries lesions (SE 0.59-0.70), while visual examination showed an inferior value (SE 0.30). ConclusionsThe intraoral scanner system featuring NIR transillumination and DIAGNOcam showed an overall good diagnostic performance. The conventional caries detection methods showed inferior sensitivity at initial caries lesion stages. Clinical significanceConsidering the promising diagnostic performance of the intraoral scanner featuring transillumination and the advantages offered by combining the NIR images with the 3D models of the teeth, this system has the potential to contribute towards more reliable caries detection and monitoring in clinical practice without the use of ionizing radiation.

The effectiveness of ozone therapy as a non-drug method for treatment of initial caries of permanent teeth in children

Background. It is proved that the use of ozone will contribute to the growth of caries dental resistance, but the question about the adequacy of this method for the complete restoration of the already partly demineralized enamel structure remains controversial. Therefore, the purpose of our study was to determine the effectiveness of the isolated use of ozone for the treatment of initial caries of permanent teeth in children of different age groups (6, 12 and 15 years old). Materials and me­thods. We have performed treatment of initial caries with Ozone DTA/Ozonymed in 60 patients aged 6 to 15 years. CRT test was used to assess the structural resistance of enamel to the action of the acid factor. The enamel resistance to caries was determined using a modified enamel resistance of teeth test. The statistical processing of the study results was carried out in the Microsoft Excel 2017 software using arithmetic mean, arithmetic mean deviations, Pearson, Spearman and point-biserial correlation coefficients. Results. Results of the initial topographical distribution of caries lesions analysis showed a statistically higher (p ≤ 0.05) frequency of chewing teeth fissure defeat (36.67 %) compared with pathology of another localization. The sites of initial caries in 58.33 % of the examined persons were found on the upper jaw, in 46.67 % — on the lower. There was a decrease in the number of patients with a maximum and high risk of caries progression within a month of treatment — by 3.33 and 5.0 %, respectively. And three months later, the reduction in the number of patients with high risk of caries progression was documented (by 49.98 %). The finding indicate a positive ozone effect in terms of enamel resistance index increasing. However, none of the patients ma­naged to achieve a complete reduction of carious spot, although a significant percentage of examined children noted a decrease in its size to those that statistically differed from the initial ones (p &lt; 0.05). Conclusions. Feasibility of non-drug methods of initial caries treatment implementation was justified, however, the effectiveness of isolated ozone use is not enough.

Comparison of the effect of fluoride gel and two toothpastes with different materials on remineralization of initial carious lesions in primary teeth.

Introduction:Various types of toothpastes are claimed to be able to improve initial enamel caries. This study compared the effect of fluoride gel and two toothpastes on remineralization of initial caries lesions in primary teeth.Materials and Methods:A total of sixty-four sound extracted primary canine were immersed in demineralizing solution at 37°C for 96 h to produce artificial caries in vitro. Enamel pieces (3 × 3 × 5 mm) were prepared from each tooth and mounted in self cure acrylic blocks. The specimens were randomly assigned to four groups (n = 16) based on treatment agent (fluoride gel, Chitodent toothpaste, ReminPro toothpaste, no treatment as control) and underwent a pH cycling model for 10 days. Vickers microhardness (VH) was measured before and after treatment. Data was analyzed using analysis of variance and paired t-test by SPSS 18 (P < 0.05).Results:No significant difference was found in VH between groups at baseline (fluoride group: 265.9 ± 44.8, Chitodent group: 282.6 ± 34.6, ReminPro group: 266.5 ± 26.6, control: 272.7 ± 32.5; P = 0.516). Microhardness significantly increased after exposure to ReminPro toothpaste (VH change: 24.1%, P < 0.001) and fluoride gel (VH change: 10.9%, P = 0.046), but no significant changes were observed in Chitodent (VH change: 2.8%, P = 0.635) and control (VH change: - 2.2%, P = 0.181) groups.Conclusion:ReminPro toothpaste might be effective in remineralizing initial carious lesions of primary teeth.

Effectiveness of fissure sealants on initial caries lesions (ICDAS 1-3) of permanent molars: A 4-year follow-up.

The aim of the present prospective study was to evaluate the retention and effectiveness of two types of sealants (clear vs. opaque) on early pit and fissure occlusal non-cavitated ICDAS II #1-3, caries lesions of permanent posterior teeth of children. Study Design: 6986 pit and fissure occlusal surfaces were randomly sealed with clear or opaque sealants out of which, 5828 sealants were placed on sound and 1158 on questionable surfaces, while 3508 were clear and 3478 opaque sealants. The mean age of the sample at initial sealant placement was 9.5 (±2.9) years and the follow-up time was 12-48 months. The median (IQR, range) follow-up time was 17.9 (8.7-28.6) months. Study inclusion and exclusion criteria applied to the combined database in order to select the study sample. Teethmate™ F-1 natural and opaque sealants (Kuraray, Hattersheim am Main, Germany) were applied following the standard procedure of preparation with moisture control kept by cotton rolls handled Dri-Angles" and a 30 seconds acid-etch with 37% ortho-phosphoric acid gel was used followed by 10 sec air-water spraying washing and polymerization for 20x2 sec. Sealants were applied on sound tooth surfaces (ICDAS #0) with no visible defects or on surfaces with early caries lesions (ICDAS #1-3), randomly and interchangeably on the upper or lower Jaw. Total retention was considered when all pits and fissures were completely sealed, while partial or complete loss was scored as one code, although was registered separately. Separate analyses were performed for each type of failure (loss of sealant or restoration). Cumulative probabilities of failure over time after sealant placement, overall or by specific characteristics, were calculated using the Kaplan-Meier method. Association between these characteristics and the hazard of failure were investigated using appropriate Cox proportional hazard models. Sealed surfaces with ICDAS II # 1-3, showed 100% higher probability of having a restoration and 60% higher probability of sealant loss, with both differences being statistically significant (aHR=2.03, p=0.046), adjusted for age, sex, type of sealant and location of surface. Opaque sealants presented statistically significant (p 0.009) higher re-application rate, while fissures had 70% statistically significant (p<0.001) higher probability for resealing with time compared to pits, with gender not affecting sealant retention while the earlier a sealant was placed on children's teeth, the more probable it was to need resealing or restoration (p <0.012). The therapeutic use of sealants on occlusal surfaces of posterior permanent molars with early carious lesions (ICDAS II 1-3) is inferior compared to sound surfaces, showing higher sealant failures and restorations.

Deep learning for early dental caries detection in bitewing radiographs

The early detection of initial dental caries enables preventive treatment, and bitewing radiography is a good diagnostic tool for posterior initial caries. In medical imaging, the utilization of deep learning with convolutional neural networks (CNNs) to process various types of images has been actively researched, with promising performance. In this study, we developed a CNN model using a U-shaped deep CNN (U-Net) for caries detection on bitewing radiographs and investigated whether this model can improve clinicians’ performance. The research complied with relevant ethical regulations. In total, 304 bitewing radiographs were used to train the CNN model and 50 radiographs for performance evaluation. The diagnostic performance of the CNN model on the total test dataset was as follows: precision, 63.29%; recall, 65.02%; and F1-score, 64.14%, showing quite accurate performance. When three dentists detected caries using the results of the CNN model as reference data, the overall diagnostic performance of all three clinicians significantly improved, as shown by an increased sensitivity ratio (D1, 85.34%; D1′, 92.15%; D2, 85.86%; D2′, 93.72%; D3, 69.11%; D3′, 79.06%; p < 0.05). These increases were especially significant (p < 0.05) in the initial and moderate caries subgroups. The deep learning model may help clinicians to diagnose dental caries more accurately.

Effect of Amalgam Restorations and Operation Parameters on Diagnostic Accuracy of Caries Detection Using Cone Beam Computed Tomography: An In Vitro Study.

This study was aimed to evaluate the diagnostic accuracy of cone beam computed tomography (CBCT) in detecting noncavitated approximal caries at different exposure parameters and to assess the impact of artifacts generated by amalgam restorations in an in vitro study. Seventy-eight approximal surfaces of extracted teeth were prepared with intentionally created noncavitated approximal caries of different depths; then, thirteen teeth with class 2 amalgam restorations were replaced with one tooth with normal surfaces in each block. CBCT volumes for all teeth were acquired using a Planmeca Promax 3D Mid imaging unit before and after placement of amalgam teeth, with different exposure parameters at low and high definition, both applying and omitting the Metal Artifact Reduction algorithm. The lesions were classified into four groups with regard to lesion extension. All teeth underwent histological analysis as gold standard. The histological examination showed that the distribution of lesions was as follows: 39.8% sound, enamel lesions of less and more than half the enamel thickness each 17.8%, and 24.6% dentin lesions. The detection sensitivity was found to be 0.972%, and specificity was found to be 0.937% for the detection of noncavitated approximal initial enamel and dentin caries. The highest diagnostic accuracy was found when using operating parameters of 90 kVp, 8 mA, and high resolution (75 μm) with nonamalgam teeth; all modes showed statistically significant higher AUCs than mode 2 (80 kVp, 7 mA, and 75 μm). However, for teeth with amalgam restorations, the highest accuracy was obtained at low resolution (200 μm) with the other parameters kept the same. It could be concluded that increasing the peak voltage and current improves diagnostic accuracy for the detection of noncavitated approximal caries. Moreover, diagnostic accuracy was found to be higher upon using high spatial resolution when diagnosing caries without adjacent amalgam restorations. There is a statistically significant difference with and without amalgam with respect to all modes.

Study Of Awareness Of Pupils About Methods For Preventing Dental Caries

Caries is the leading cause of tooth loss in the adult population. The terminology of the early stage of caries is rather contradictory and is designated as “initial caries”, “enamel caries”, “focal demineralization of enamel”, “caries in the stain stage”, “chalky spots” [2,7,9]. Caries is currently being interpreted as a chronic infectious disease. It has been proven that the initial forms of carious lesions can be cured by non-surgical methods [10,18,20]. Therefore, the optimization of the activities of a pediatric dentist in a school stationary dental office is an urgent task, it brings the provision of the primary level of specialized dental care as close as possible to the territory of compact residence of children, improves the availability, timeliness of treatment and prevention of dental caries. Thus, timely diagnosis and treatment of early forms of caries is an urgent problem in dentistry, especially in pediatric dentistry.

In Vitro Remineralizing Effect of Some Herbals on Initial Enamel Carious Lesions.

Purpose: As the goal of modern dentistry is the non-invasive management of non-cavitated caries lesions and the growing interest in the field of phytotherapeutics by the medicinal use of their plant extracts, this study was conducted to evaluate the remineralizing potential of some herbals (tea tree, grape seed, and ginger) in comparison with fluoridated toothpaste on initial enamel carious lesions. Materials and Methods: Forty human enamel samples were classified into four groups. Ten samples for each group were used in this in vitro recycling study with the following treatments which applied three times a day: 1) tea tree oil, 2) grape seed oil, 3) ginger oil, and 4) sodium fluoride toothpaste. Treatment regimens of demineralization and remineralization cycle were applied for 21 days. The baseline and post-treatment data were assessed by digital radiographs of the mineral density of WSLs based on subtraction concept. Data were statistically analyzed by ANOVA test with Bonferroni significant difference test. Results: There was no statistically significant difference between different study groups (fluoride, tea tree, grape seed, and ginger) along consequent follow up periods. While, after repeated measure analysis, there was a statistically significant difference regarding all the study groups respectively (0.12 (0.00), 0.22 (0.01), 0.25 (0.02), 0.12 (0.00). The post hoc test for each study group showed also a significant decrease in mineral density along different follow-up periods (P≤0.05). Conclusion: There was no statistically significant difference between different study groups on remineralization of initial caries lesion.

Conservative treatment of interproximal incipient caries lesions by resin infiltration

Minimally invasive dentistry is based on conservative techniques for the treatment of initial caries lesions, the so-called white spot lesions. One of the conservative maneuvers includes the use of enamel resin infiltrant: a low viscosity material that penetrates the enamel pores to stop lesion progression. Aim: Therefore, this case report aimed to describe the clinical case of a 28-year-old female patient under routine consultation, in which a radiographic examination showed the presence of two incipient caries lesions in the left upper premolars. Methods: The application of a resin infiltrating agent (Icon®, DMG – Hamburg, Germany) was chosen as treatment to stop caries lesions progression. Conclusion: The use of this conservative technique can be considered a promising approach for the prevention of dental tissue wear, and the resin infiltrant is considered an effective material.

REMINERALIZATION POTENTIAL OF GINGER AND ROSEMARY HERBALS VERSUS SODIUM FLUORIDE IN TREATMENT OF WHITE SPOT LESIONS: A RANDOMIZED CLINICAL TRIAL

ABSTRACT: Aim: The current study was conducted to evaluate the effectiveness of ginger and rosemary herbals versus sodium fluoride in remineralization of incipient enamel caries. Methodology: white spot lesions in anterior teeth of post orthodontic debanding patients received randomly two types of remineralizing agents, either ginger and rosemary gel or sodium fluoride varnish (bifluorid 10). White spot lesions were evaluated at base line one month and after 3, 6 months follow up periods by two blinded assessors to assess white spot lesion progression by Kavo DIAGNOdent. Results: Mann-Whitney test showed that there at baseline, sodium fluoride varnish group yielded similar readings as ginger and rosemary gel group (P=0.060). While at 1 month, ginger and rosemary gel group showed significantly higher readings compared to sodium fluoride varnish group (P<0.001). However, there were no statistically significant differences in readings of both groups at 3 months (P=0.302) and 6 months (P=0.070). Conclusion: Fluoride varnish and ginger and rosemary gel can decrease post-orthodontic white spot lesions. The herbals ginger and rosemary may be preferable for prevention purposes on initial remineralization of enamel lesions as more natural products are preferred today. Keywords: white spot lesions, ginger and rosemary in initial caries, sodium fluoride varnish, DIAGNOdent.

Evaluation of Remineralizing Capacity of P11-4, CPP-ACP, Silver Diamine Fluoride, and NovaMin: An In Vitro Study

To determine and compare remineralizing efficacy of NovaMin, CPP-ACP, silver diamine fluoride (SDF), and P11-4. Sixty permanent premolars were divided into four groups with 15 samples in each group; group I: self-assembling peptide (P11-4), group II: SDF, group III: Casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP), and group IV: NovaMin. Mineral content was assessed using a scanning electron microscope at 7, 14, and 21 days after remineralization with each agent. The mean remineralization in group I at 7 days was 1.73 ± 0.02, at 14 days was 1.79 ± 0.01, and at 21 days was 1.90±0.03. Mean remineralization in group II was 1.61 ± 0.01, 1.64 ± 0.02, and 1.73 ± 0.03 at 7, 14, and 21 days, respectively. Mean remineralization in group III was 1.62 ± 0.01, 1.65 ± 0.02, and 1.74 ± 0.05 at 7, 14, and 21 days, respectively. Mean remineralization in group IV was 1.59 ± 0.02, 1.62 ± 0.07, and 1.70 ± 0.09 at 7, 14, and 21 days, respectively. The maximum value was obtained on day 21. There was a significant difference in mean remineralization values between group I vs group II, group I vs group III, and group I vs group IV (p < 0.05). Self-assembling peptides showed maximum remineralization in tested specimens followed by CPP-ACP, SDF, and NovaMin-containing toothpaste. CPP-ACP, SDF, and NovaMin-containing toothpaste can be indicated for remineralization of initial caries in clinical use.

Light-based diagnostic methods for the in vivo assessment of initial caries lesions: Laser fluorescence, QLF and OCT.

To evaluate different light-based caries diagnostic methods for assessment of non-cavitated initial carious lesions on smooth surfaces. 39 participants were included. For each participant, three regions of interest (ROI) with ICDAS codes 0, 1 or 2 were defined. All ROIs (n = 117) were investigated/imaged with laser fluorescence (LF, DIAGNOdent 2095; KaVo dental GmbH), quantitative light-induced fluorescence (QLF; Biluminator 2+, Inspektor Research Systems B.V.) and spectral-domain optical coherence tomography (SD-OCT; Telesto II, Thorlabs GmbH). The values of LF, ΔF of QLF, and the lesion extent assessed by OCT were categorized. Frequency distribution of LF-/QLF- and OCT-scores was determined for each ICDAS code included. Inter- and intra-examiner reproducibility of QLF and OCT measurements were assessed by unweighted kappa coefficient (ĸ) and Wilcoxon test (α = 0.05). Compared with LF and QLF, OCT showed various manifestations of carious lesions for visually sound ROIs and a larger variation of caries extent in depth within the same ICDAS code groups. Intra-examiner reproducibility ranged between 0.49 and 1.00 for the QLF analysis and between 0.95 and 0.99 for the OCT analysis. Inter-examiner reproducibility ranged between 0.17 and 0.32 for the QLF analysis and between 0.65 and 0.79 for the OCT analysis. LF and QLF were insensitive to less pronounced smooth-surface lesions while OCT allowed differentiation based on the penetration depth of the carious lesions. This makes OCT a suitable method to complement conventional visual inspection in order to detect and assess (very) early lesions.