Natural Enamel Research Articles

ANALYSIS OF SURFACE MICROGEOMETRY AND STRUCTURE OF LAYERED BIOMATERIALS USED FOR PROSTHETIC CONSTRUCTIONS IN DIGITAL TECHNOLOGIES

Veneering layers of prosthetic substructures are responsible for tribological cooperation with opposite teeth in the stomatognathic system (SS). Investigations of microgeometry and structure of veneering layers are aimed at checking to what extent these layers replicate enamel parameters, which, under complex load conditions, are characterized by the phenomenon of resistance to tribological wear. Ceramic veneering layers are dedicated for substructures made in digital technologies from factory fittings by milling and laser sintering of metal powders. Using a confocal microscope, contactless tests of the surface layer stereometry were performed and surface roughness parameters were determined on samples of ceramics veneering of prosthetic substructures. The analysis was performed in comparison to the natural enamel of premolars and molars. The shaping of the surface of materials veneering the substructures is similar to the regularity determined in the statistical analysis of the enamel roughness. Layers facing samples from milling technology are characterized by lower values of roughness parameters than layers created on substructures made of SLM technology.

In Vitro Simulation and In Vivo Assessment of Tooth Wear: A Meta-Analysis of In Vitro and Clinical Research.

Tooth wear may be described as a side-effect of occlusal forces that may be further induced by the common use of contemporary prosthetic materials in practice. The purpose of this systematic review was to appraise existing evidence on enamel wear from both in vitro and clinical research and explore whether evidence from these study designs lies on the same direction. Five databases of published and unpublished research were searched without limitations in August 2019 and study selection criteria included in vitro and clinical research on enamel tooth wear. Study selection, data extraction, and risk of bias assessment were done independently and in duplicate. Random effects meta-analyses of standardized mean differences (SMDs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were conducted while a Monte Carlo permutation test for meta-regression on the exploration of the effect of the study design on the reported outcomes was planned. A total of 27 studies (23 in vitro and 4 clinical) were eligible while 12 contributed to meta-analyses. Overall, some concerns were raised for the quality of the existing evidence and the potential for risk of bias. Enamel wear (mm) of antagonist teeth was more pronounced when opposed to conventional porcelain compared to machinable ceramics (SMD = 2.18; 95%CIs: 1.34, 3.02; p < 0.001). Polished zirconia resulted in decreased volumetric enamel wear (mm3) of opposing teeth compared to pure natural enamel (SMD = –1.06; 95%CIs: –1.73, –0.39; p = 0.002). Monolithic zirconia showed evidence of enhanced potential for antagonist wear (μm) compared to natural teeth (WMD = 107.38; 95%CIs: 30.46, 184.30; p = 0.01). Study design did not reveal an effect on the tooth wear outcome for the latter comparison when both clinical and in vitro studies were considered (three studies; Monte Carlo test, p = 0.66). In conclusion, there is an overriding need for additional evidence from clinical research to substantiate the findings from the already existing laboratory simulation studies.

In vitro longitudinal evaluation of enamel wear by cross-polarization optical coherence tomography

ObjectivesEnamel thickness determination by Cross-Polarization Optical Coherence Tomography (CP-OCT) is a promising approach for quantitative monitoring of tooth wear progression. This study evaluated the ability of CP-OCT to quantify the thickness of natural enamel before, during and after tooth wear simulation. Materials and MethodsNatural, unpolished human dental enamel slabs were submitted to five wear stages (Wear 1: to level the surfaces; Wear 2 to Wear 5: 0.05±0.02mm reduction each) simulated by an automatic grinding/polishing machine. Enamel thickness was evaluated with CP-OCT and a gold-standard method (micro-CT) at baseline and after every wear stage. Data were analyzed using ANOVA with pairwise comparisons for wear stages’ impact on the thickness and wear depth measurements. The inter-method agreement was analyzed using intra-class correlation coefficients, the difference between means, and Bland-Altman plots. ResultsEnamel thickness measurements (mean±standard error, in mm) with natural (1.40±0.05) and worn surfaces (1.08±0.02) by CP-OCT did not differ significantly from those measured by micro-CT (natural=1.39±0.05; worn=1.09±0.02; p-values=0.30 and 0.39, respectively). CP-OCT and micro-CT showed excellent agreement on natural (ICC=0.98) and worn surfaces (ICC=0.98) enamel thickness measurements. Among and between wear stages, there were significant differences in enamel thickness and wear depth measurements for both methods (p-value <0.0001 for all). Both methods yielded similar measurements’ mean (0.14±0.01; p-value=0.87) and were in good agreement (ICC=0.77) for wear depth estimation. SignificanceCP-OCT allows accurate measurement of enamel thickness on natural tooth surfaces. Enamel thickness measurement by CP-OCT allows quantitative monitoring of enamel thickness changes and wear depth following progressive wear.

Repair of tooth enamel by a biomimetic mineralization frontier ensuring epitaxial growth.

The regeneration of tooth enamel, the hardest biological tissue, remains a considerable challenge because its complicated and well-aligned apatite structure has not been duplicated artificially. We herein reveal that a rationally designed material composed of calcium phosphate ion clusters can be used to produce a precursor layer to induce the epitaxial crystal growth of enamel apatite, which mimics the biomineralization crystalline-amorphous frontier of hard tissue development in nature. After repair, the damaged enamel can be recovered completely because its hierarchical structure and mechanical properties are identical to those of natural enamel. The suggested phase transformation-based epitaxial growth follows a promising strategy for enamel regeneration and, more generally, for biomimetic reproduction of materials with complicated structure.

Quantitative affinity parameters of synthetic hydroxyapatite and enamel surfaces in vitro

Particulate synthetic hydroxyapatite (HAP) is rapidly gaining importance as a biomimetic agent in oral care products. The prerequisite for an adequate effect of the treatment is an efficient attachment of the HAP particles to the tooth substance. However, quantitative data about the interaction and affinity parameters involved are scarce. The authors used an in vitro approach with standardized bovine tooth enamel surfaces and aqueous dispersions of chemically pure synthetic HAP particles as a model system. Structural characterization of the HAP powder using high-resolution scanning electron microscopy (SEM) shows that the particles are micrometer-sized stable clusters of crystallites that closely resemble the structure of natural enamel. Using SEM image analysis, the authors investigated the influence of HAP particle concentration and particle size on the efficiency of attachment to bovine tooth enamel based on pure mineral–mineral interaction. The results show that both play an important role and can be tailored for optimizing the efficiency of corresponding oral care formulations. The results also reveal the presence of structures resembling mineral bridges at the interfaces between HAP particles and enamel that provide indications for possible interaction mechanisms.

Comparative evaluation of enamel surface roughness after debonding using four finishing and polishing systems for residual resin removal\u2014an in vitro study

BackgroundOrthodontic bonding and debonding procedures involve risk of damaging the enamel surface and changing its original morphology. The rough surface inhibits proper cleaning, invites plaque deposition, bacterial retention, and stain formation thus dampening the esthetic appearance of the teeth. Restoring the enamel to its original morphology is a challenge. Researches on better adhesive removal methods which can effectively remove the residual resin and restore it best to its original form are continuing till date. No study has compared four contemporary finishing systems for their efficiency on a single platform.AimThe objective of this study is to evaluate and compare enamel surface roughness after debonding using four different finishing and polishing systems.Material and methodsAdhesive resin was removed from the buccal surface of 88 premolars after debonding with 4 groups. It included 22 teeth per group: group 1—One gloss system; group 2—Enhance finishing and polishing system; group 3—fiber reinforced stainbuster bur; and group 4—Soflex discs with wheels. Roughness was measured quantitatively and qualitatively with the help of surface roughness tester and scanning electron Microscope (SEM) respectively.ResultsNo significant difference was found in baseline roughness in four groups. Highest post-polishing roughness was observed in Soflex group (4.62 μm) followed by One gloss system (3.36 μm), Enhance system (3.17 μm), and stainbuster bur (1.99 μm) (p value < 0.01).ConclusionStainbuster bur created the smoothest enamel surface that was close to the natural enamel followed by Enhance system, One gloss system, and Soflex disc and wheels.

Natural enamel caries, dentine reactions, dentinal fluid and biofilm

It is believed that penetration of dentinal fluid into natural enamel caries (NEC) is negligible because of the barrier created by underlying sclerotic dentine, but there are conflicting evidences on whether dentine subjacent to NEC is sclerotic or demineralized. This study aimed at investigating the relationship between NEC, subjacent dentine reactions, modification of dentinal fluid, and composition of cariogenic biofilm formed on the NEC surface. Proximal NEC (PNEC) lesions of human permanent posterior teeth were included in five experiments. Histologically, microradiographic analysis with contrast solution (MRC) in dentine revealed a decreased proportion of sclerotic dentine and an increased proportion of deep dentine demineralization compared to the classical stereomicroscopic histological analysis based on dentin color and translucency. Real-time MRC and 3D optical profilometry, and 3D microtomographic analysis evidenced a facilitated transport of modified dentinal fluid towards PNEC lesions. Cariogenic biofilm formed in vitro on the PNEC surface presented lower amounts of insoluble and soluble matrix polysaccharides when 2% chlorexidine was inserted in the pulp chamber. In conclusion, this study evidenced that dentine subjacent to PNEC is mostly demineralized, providing facilitated pathway for dentinal fluid to penetrate into PNEC and alter the composition of the biofilm formed on the PNEC surface.

Osteogenic response of mesenchymal progenitor cells to natural polysaccharide nanogel and atelocollagen scaffolds: A spectroscopic study

A natural polysaccharide scaffold, referred to as “freeze-dry nanogel-crosslinked-porous” (FD-NanoCliP) gel, was tested in comparison with an atelocollagen scaffold with respect to osteogenesis versus the mouse mesenchymal progenitor cell line KUSA-A1. The amphiphilic polysaccharide network, engineered in its structure to fit chemically crosslinked nanogels as building blocks into a physically crosslinked porous gel, revealed a superior osteointegrative performance as compared to the soluble atelocollagen network and a peculiar c-plane orientation growth of apatite crystallites, which resembled the structure of natural enamel. Besides evaluating osteogenesis in the FD-NanoCliP gel scaffold, an additional purpose of this study was to assess its chemical composition at the nanoscale and, through its knowledge, to interpret the osteogenic response of mesenchymal cells. In addition to conventional (optical and electron) microscopy and biological evaluation kits, the peculiar chemistry of the FD-NanoCliP gel scaffold and the formation of apatite on it were characterized by means of several independent analytical probes at the molecular scale, which included Raman, cathodoluminescence, energy dispersive X-ray, and X-ray fluorescence spectroscopies. This body of information consistently provided evidence for a peculiar chemistry developed in osteogenesis at the polysaccharide scaffold surface. Such chemistry is not available in soluble atelocollagen and it is key in the superior bioactivity found in the polysaccharide network.

Enamel remineralization and repair results of Biomimetic Hydroxyapatite toothpaste on deciduous teeth: an effective option to fluoride toothpaste

BackgroundDental caries is a recognized worldwide public health problem. Despite being one of the most effective strategies against dental caries, the excessive use of fluorine may result in a potential risk of developing dental fluorosis especially in children under age of six. The purpose of this work is to analyze a fluorine-free toothpaste containing Biomimetic Hydroxyapatite to assess enamel re-mineralizing and repairing properties.ResultsThe study was performed in vitro and in vivo, comparing the hydroxyapatite toothpaste with two others toothpaste containing different fluorine concentrations. The coating effect of the micro-structured Hydroxyapatite nanoparticles reintegrates the enamel with a biomimetic film reproducing the structure and the morphology of the biologic Hydroxyapatite of the enamel. As demonstrated, the coating is due to the deposit of a new layer of apatite, which presents fewer particles than the natural enamel, not based on the chemical—physical changes occurring in fluorinated toothpastes. Moreover, it shows resistance to brushing as a consequence of chemical bonds between the synthetic and natural crystals of the enamel.ConclusionsThe use of Biomimetic Hydroxyapatite toothpastes has proven to be a valuable prevention measure against dental caries in primary dentition since it prevents the risk of fluorosis.

Bioinspired enamel-like oriented minerals on general surfaces: towards improved mechanical properties.

As the hardest tissue in human body, enamel has attracted significant research interest in recent years. It has been acknowledged that the highly oriented arrangement of hydroxyapatite (HAp) crystallites of the enamel plays a crucial role owing to its excellent mechanical properties. So far, the preparation of enamel-like HAp crystallites on general substrates using mild conditions remains a challenge. Here, inspired by natural enamel, we developed a biomimetic, anodic alumina oxide (AAO)-assisted, double-layered gel system to fabricate well-oriented HAp crystals on universal surfaces. The one-directional ion flow was elaborately modulated for mineralization based on the synergistic effect of the double-layered gel and the AAO membrane, leading to highly oriented HAp crystallites. In addition, the introduction of polydopamine as a nucleating agent makes this method applicable for a wide range of substrates. The as-prepared minerals show a well-aligned enamel-like structure, exhibiting an elastic modulus of 52 GPa and nanohardness of 0.73 GPa, which are close to those of natural enamel. We envision that the strategy has potential applications for tooth repair and will provide guidelines for the mineralization of other inorganic minerals.

The sensitivity of digital intraoral scanners at measuring early erosive wear

ObjectivesTo investigate the sensitivity of intraoral scanners to quantitatively detect early erosive tooth wear. MethodsNatural buccal enamel samples were mounted in acrylic and scanned at baseline with an intraoral scanner (3 M True Definition Scanner, 3 M, USA). Samples were then exposed to 0.3% citric acid pH 3.2 at intervals of 10 min up to a total of 120 min and scanned after each exposure resulting in analysis of 13 datapoints per sample. Each scan was aligned with the baseline and data points super-imposed using an iterative closest point (ICP) algorithm on the acrylic surfaces (Geomagic Control Software, 3Dsystems, Darmstadt, Germany). Wear was measured using maximum profile loss, average profile loss and volume change. Data were normally distributed and Pearson correlations between erosion time and wear measurements assessed. ResultsAfter each 10-minute exposure until 120 min, maximum profile loss (μm) increased from 33.4 to 72.8 μm, average profile loss from 9.1 to 18.6 μm. Wear correlated with increasing acid exposure for both maximum profile loss wear (r = 0.877 p < 0.001) and average profile loss (r = 0.663 p = 0.019) respectively. Volume measurements were inconsistent at this level of wear. ConclusionsUsing scan data obtained from the intra oral scanners (IOS), increasing step height changes were observed with increasing exposures to acid. This study indicates there is potential of scans taken with an IOS to be used to detect early erosive tooth wear. However, precision was low suggesting limitations for minimal changes. Clinical significanceAlthough sub-visual wear was detected by intra-oral scanners on natural enamel surfaces, the accuracy was not sufficient to reliably diagnose that wear had occurred and interpretation of measurements should be done with caution. However, these results may be promising for detecting wear at more advanced stages.

Dental enamel-mimetic large-sized multi-scale ordered architecture built by a well controlled bottom-up strategy

Tooth enamel possesses excellent mechanical properties owing to its multi-scale highly ordered architecture. To develop tooth enamel-mimetic structural materials (EMSMs) is of great significance for understanding the important role of ordered hydroxyapatite (HAP) nanocrystals in tooth enamel and exploring high-performance materials. However, it is still a great challenge to mimic the unique multi-scale ordered architecture of the natural tooth enamel. Herein, inspired by the multi-scale structure and self-assembly of the tooth enamel, we have developed a novel bottom-up step-by-step assembly strategy to build the EMSMs based on ultralong HAP nanowires, and achieved the multi-scale (from nano- to micro- to macro-scale) highly ordered HAP nanowire structure control. In this work, ultralong HAP nanowires are assembled in sequence into highly ordered HAP nanowire bundles, aligned HAP microfibers, and three-dimensional (3-D) highly ordered HAP nanowire bulk, which perfectly imitate the structure and self-assembly of the tooth enamel. This novel method is suitable to fabricate the EMSMs with arbitrary sizes and well-designed shapes, which are promising for various applications in the biomedical fields such as hard tissue defect repair.

Enamel wear and aging of translucent zirconias: In vitro and clinical studies

Statement of problemZirconia is a widely used restorative material. However, phase transformation on clinical application of zirconia has not yet been studied. PurposeThe purpose of this study was to evaluate the wear, surface roughness, and aging associated with polished translucent zirconia in both in vitro and clinical experiments. Material and methodsIn vitro experiments were performed with Rainbow and Katana zirconia blocks and natural tooth enamel as the control. They were subjected to 100 000 loading cycles with a maxillary premolar antagonist. All specimens were analyzed for wear, and the zirconia specimens were evaluated for surface roughness and monoclinic phase (m-phase) transformation by X-ray diffractometry before and after cyclic loading. The clinical study included participants who required single-crown implant-supported restorations replacing the first or second molar. The participants received Rainbow or Katana zirconia prostheses (n=15, each). For wear analysis, impressions of each prosthesis, antagonist, and adjacent tooth were made at 1 week and 6 months after crown delivery. The occlusal relationship of the crowns in maximum intercuspation was evaluated by using the T-Scan 8 occlusal diagnostic system. The degree of transformation of zirconia to the m-phase was measured by using X-ray diffractometry of the crowns after 6 months of use. ResultsZirconia induced significantly greater enamel wear than the natural tooth control. Katana specimens exhibited significantly greater wear and surface roughness than the Rainbow specimens. The degrees of antagonistic wear and zirconia phase transformation in the clinical experiment were significantly greater than those in the in vitro experiment. The Katana groups showed significantly higher m-phase levels than the Rainbow groups. ConclusionsPhase transformation of zirconia occurs within 6 months of clinical use, and the wear and degrees of phase transformation varied according to the zirconia product used.

Effect of whitening toothpaste on the discoloration level of stained conventional glass ionomer cement

Staining is not unique to natural enamel and may also occur on the restorative material, such as conventional glass ionomer cement (GIC). This study identified the effect of whitening toothpaste on the discoloration level of conventional GIC. In total, 24 GIC specimens were immersed in coffee and then brushed with one of the four commercially available. The specimens were brushed for various durations (1, 2, and 4 weeks), and changes in discoloration were assessed using a digital colorimeter (VITA Easy Shade). Significant changes (p<0.05) in brightness were observed after the first and fourth week of brushing. However, not all toothpaste caused significant color changes. This study provides evidence that some whitening toothpaste can decrease the discoloration level of stained conventional GIC.

In vitro evaluation of the early erosive lesion in polished and natural human enamel

ObjectiveThis study evaluated the capability of profilometry, microhardness, Optical Coherence Tomography (OCT) and Tandem Scanning Confocal Microscopy (TSM) in characterising the early erosive lesion in polished and natural human enamel in vitro. MethodsPolished (n=60) and natural (n=60) human enamel surfaces, were immersed and agitated in 0.3% citric acid erosion at 0s, 10s, 30s, 60s, 120s, and 300s (n=10). Changes in the surface were measured with 3D-step height change (μm), surface roughness (μm), surface microhardness (KHN), and images were assessed qualitatively with OCT and TSM. ResultsMean (SD) 3D-step height change (μm) was measurable for polished enamel at: 60s (0.24±0.1), 120s (1.16±0.71), 300s (2.01±0.47; p<0.05); a step height change was not detectable on acid challenged natural enamel surfaces. Mean (SD) surface roughness (μm) of polished enamel was detected at 10s (0.270±0.013; p<0.05) and all erosion periods; and in natural enamel detected after 120s (0.830±0.125) and 300s (0.800±0.140; p<0.005). Polished enamel Mean (SD) microhardness (KHN) statistically significantly decreased at all time points (p<0.001); this was unmeasurable for natural enamel. Qualitative image analysis of both surface types indicated erosive change at the surface level, with progression after increasing erosion time. SignificanceThe early erosive lesion in polished enamel could be characterised quantitatively surface roughness and microhardness and qualitatively using OCT and TSM; whilst in natural enamel only surface roughness could be utilised. Further investigation of early erosion in natural enamel is required to develop new more clinically relevant models.

Automated Analysis of Spatially Resolved X-ray Scattering and Micro Computed Tomography of Artificial and Natural Enamel Carious Lesions

Radiography has long been the standard approach to characterize carious lesions. Spatially resolved X-ray diffraction, specifically small-angle X-ray scattering (SAXS), has recently been applied to caries research. The aims of this combined SAXS and micro computed tomography (µCT) study were to locally characterize and compare the micro- and nanostructures of one natural carious lesion and of one artificially induced enamel lesion; and demonstrate the feasibility of an automated approach to combined SAXS and µCT data in segmenting affected and unaffected enamel. Enamel, demineralized by natural or artificial caries, exhibits a significantly reduced X-ray attenuation compared to sound enamel and gives rise to a drastically increased small-angle scattering signal associated with the presence of nanometer-size pores. In addition, X-ray scattering allows the assessment of the overall orientation and the degree of anisotropy of the nanostructures present. Subsequent to the characterization with µCT, specimens were analyzed using synchrotron radiation-based SAXS in transmission raster mode. The bivariate histogram plot of the projected data combined the local scattering signal intensity with the related X-ray attenuation from µCT measurements. These histograms permitted the segmentation of anatomical features, including the lesions, with micrometer precision. The natural and artificial lesions showed comparable features, but they also exhibited size and shape differences. The clear identification of the affected regions and the characterization of their nanostructure allow the artificially induced lesions to be verified against selected natural carious lesions, offering the potential to optimize artificial demineralization protocols. Analysis of joint SAXS and µCT histograms objectively segmented sound and affected enamel.

Overview of Calcium Phosphates used in Biomimetic Oral Care.

Background:The use of biomimetic agents is an emerging field in modern oral care. Promising biomimetic substances for such applications are calcium phosphates, because their chemical composition is very similar to that of the mineral phase in human teeth, especially of natural enamel. Examples for their application include the remineralization of early caries lesions and repair of small enamel defects.Objective:This review provides an interdisciplinary view on calcium phosphates and their applications in biomimetic oral care. The aim of this work is to give an overview of in vivo and in situ studies comparing several calcium phosphates in preventive dentistry that can be used as a knowledge base for the development of innovative alternative oral care concepts.Methods:Books, reviews, and original research papers with a focus on in vivo and in situ studies were included. The databases PubMed® and SciFinder® were used for literature search. Calcium phosphates that are frequently utilized in oral care products are covered in this review and were used as search terms alone and together with the following key words: in vivo, in situ, caries, clinical study, and remineralization. From 13,470 studies found, 35 studies complied with the inclusion criteria and were used for this review.Results:Published in vivo and in situ studies demonstrate calcium phosphates’ potential in enamel remineralization. However, more studies are needed to further substantiate existing results and to extend and refine the application of calcium phosphates in modern oral care.Conclusion:Calcium phosphates represent an innovative biomimetic approach for daily oral care because of their high similarity to natural enamel that will broaden the range of future treatments in preventive dentistry.

Exogenous mineralization of hard tissues using photo-absorptive minerals and femto-second lasers; the case of dental enamel

A radical new methodology for the exogenous mineralization of hard tissues is demonstrated in the context of laser-biomaterials interaction. The proposed approach is based on the use of femtosecond pulsed lasers (fs) and Fe3+-doped calcium phosphate minerals (specifically in this work fluorapatite powder containing Fe2O3 nanoparticles (NP)). A layer of the synthetic powder is applied to the surface of eroded bovine enamel and is irradiated with a fs laser (1040 nm wavelength, 1 GHz repetition rate, 150 fs pulse duration and 0.4 W average power). The Fe2O3 NPs absorb the light and may act as thermal antennae, dissipating energy to the vicinal mineral phase. Such a photothermal process triggers the sintering and densification of the surrounding calcium phosphate crystals thereby forming a new, dense layer of typically ∼20 μm in thickness, which is bonded to the underlying surface of the natural enamel. The dispersed iron oxide NPs, ensure the localization of temperature excursion, minimizing collateral thermal damage to the surrounding natural tissue during laser irradiation. Simulated brushing trials (pH cycle and mechanical force) on the synthetic layer show that the sintered material is more acid resistant than the natural mineral of enamel. Furthermore, nano-indentation confirms that the hardness and Young’s modulus of the new layers are significantly more closely matched to enamel than current restorative materials used in clinical dentistry. Although the results presented herein are exemplified in the context of bovine enamel restoration, the methodology may be more widely applicable to human enamel and other hard-tissue regenerative engineering. Statement of significanceIn this work we provide a new methodology for the mineralisation of dental hard tissues using femtosecond lasers and iron doped biomaterials. In particular, we demonstrate selective laser sintering of an iron doped fluorapatite on the surface of eroded enamel under low average power and mid-IR wavelength and the formation of a new layer to substitute the removed material. The new layer is evaluated through simulated brushing trials and nano-indentation. From the results we can conclude that is more acid resistant than natural enamel while, its mechanical properties are superior to that of current restorative materials. To the best of our knowledge this is the first time that someone demonstrated, laser sintering and bonding of calcium phosphate biomaterials on hard tissues. Although we here we discuss the case of dental enamel, similar approach can be adopted for other hard tissues, leading to new strategies for the fixation of bone/tooth defects.

Synthetic Hydroxyapatite as a Biomimetic Oral Care Agent.

Human tooth enamel consists mostly of minerals, primarily hydroxyapatite, Ca10(PO4)6(OH)2, and thus synthetic hydroxyapatite can be used as a biomimetic oral care agent. This review describes the synthesis and characterization of hydroxyapatite from a chemist's perspective and provides an overview of its current use in oral care, with a focus on dentin hypersensitivity, caries, biofilm management, erosion, and enamel lesions. Reviews and original research papers published in English and German were included. The efficiency of synthetic hydroxyapatite in occluding open dentin tubules, resulting in a protection for sensitive teeth, has been well documented in a number of clinical studies. The first corresponding studies on caries, biofilm management and erosion have provided evidence for a positive effect of hydroxyapatite either as a main or synergistic agent in oral care products. However, more in situ and in vivo studies are needed due to the complexity of the oral milieu and to further clarify existing results. Due to its biocompatibility and similarity to biologically formed hydroxyapatite in natural tooth enamel, synthetic hydroxyapatite is a promising biomimetic oral care ingredient that may extend the scope of preventive dentistry.

Precision of 655 nm Confocal Laser Profilometry for 3D surface texture characterisation of natural human enamel undergoing dietary acid mediated erosive wear

ObjectivesTo assess the precision of optical profilometry for characterising the 3D surface roughness of natural and polished human enamel in order to reliably quantify acid mediated surface roughness changes in human enamel. MethodsForty-two enamel samples were prepared from extracted human molars and either polished flat or left unmodified. To investigate precision, the variability of thirty repeated measurements of five areas of one polished and one natural enamel sample was assessed using 655nm Confocal Laser Profilometry. Remaining samples were subjected to forty-five minutes orange juice erosion and microstructural changes were analysed using Sa roughness change (μm) and qualitatively using surface/subsurface confocal microscopy. ResultsEnamel surface profilometry from the selected areas revealed maximal precision of 5nm for polished enamel and 23nm for natural enamel. After erosion, the polished enamel revealed a 48% increase in mean (SD) Sa roughness of 0.10 (0.07)μm (P<0.05), whereas in contrast the natural enamel revealed a 45% decrease in mean (SD) roughness of −0.32 (0.42)μm (P<0.05). These data were supported by qualitative confocal images of the surface/subsurface enamel. SignificanceThis study demonstrates a method for precise surface texture measurement of natural human enamel. Measurement precision was superior for polished flat enamel in contrast to natural enamel however, natural enamel responds very differently to polished enamel when exposed to erosion challenges. Therefore, thus future studies characterising enamel surface changes following erosion on natural enamel may provide more clinically relevant responses in comparison to polished enamel.