Subsurface Lesions Research Articles

Evaluation of Penetration Depth and Caries Progression using Resin Infiltrant in Natural White Spot Lesions of Primary Molars.

Management of white spot lesions (WSLs) using resin infiltrants, like ICON®, is a novel technique that emphasizes the concept of minimally invasive dentistry. Evaluate penetration depth and its effect on caries progression of ICON® in natural WSLs of primary molars. A total of 30 human primary molars with natural WSLs were selected. A total of 15 samples each were randomly selected to evaluate penetration depth and caries progression. To evaluate penetration depth, lesion surfaces were sectioned into two halves, wherein one half served as control, while the other half received ICON® infiltration treatment. To evaluate the effect on caries progression, samples were sectioned into two halves, wherein one half served as a control to its experimental counterpart, which received ICON® infiltration. The initial depth of the subsurface lesion (baseline data) was measured, and all the sample subsets underwent pH cycling. Confocal laser fluorescence microscope (CFLM) evaluation was performed, and penetration depth was assessed using a laser scanning microscopy (LSM) image reader, while caries progression was evaluated using PhotoScape® software. ICON® resin infiltrant penetrated to significant depths into the WSLs (p < 0.001) and demonstrated significant inhibition of caries progression (p < 0.001). The novel technique using ICON® could be an invaluable tool in the management of WSLs in primary teeth. Babu G, Mallikarjun S, Vijayan V, et al. Evaluation of Penetration Depth and Caries Progression using Resin Infiltrant in Natural White Spot Lesions of Primary Molars. Int J Clin Pediatr Dent 2024;17(4):390-394.

Dense surface reconstruction using a learning-based monocular vSLAM model for laparoscopic surgery.

Augmented reality (AR) has seen increased interest and attention for its application in surgical procedures. AR-guided surgical systems can overlay segmented anatomy from pre-operative imaging onto the user's environment to delineate hard-to-see structures and subsurface lesions intraoperatively. While previous works have utilized pre-operative imaging such as computed tomography or magnetic resonance images, registration methods still lack the ability to accurately register deformable anatomical structures without fiducial markers across modalities and dimensionalities. This is especially true of minimally invasive abdominal surgical techniques, which often employ a monocular laparoscope, due to inherent limitations. Surgical scene reconstruction is a critical component towards accurate registrations needed for AR-guided surgery and other downstream AR applications such as remote assistance or surgical simulation. In this work, we utilize a state-of-the-art (SOTA) deep-learning-based visual simultaneous localization and mapping (vSLAM) algorithm to generate a dense 3D reconstruction with camera pose estimations and depth maps from video obtained with a monocular laparoscope. The proposed method can robustly reconstruct surgical scenes using real-time data and provide camera pose estimations without stereo or additional sensors, which increases its usability and is less intrusive. We also demonstrate a framework to evaluate current vSLAM algorithms on non-Lambertian, low-texture surfaces and explore using its outputs on downstream tasks. We expect these evaluation methods can be utilized for the continual refinement of newer algorithms for AR-guided surgery.

An augmented reality and high-speed optical tracking system for laparoscopic surgery.

While minimally invasive laparoscopic surgery can help reduce blood loss, reduce hospital time, and shorten recovery time compared to open surgery, it has the disadvantages of limited field of view and difficulty in locating subsurface targets. Our proposed solution applies an augmented reality (AR) system to overlay pre-operative images, such as those from magnetic resonance imaging (MRI), onto the target organ in the user's real-world environment. Our system can provide critical information regarding the location of subsurface lesions to guide surgical procedures in real time. An infrared motion tracking camera system was employed to obtain real-time position data of the patient and surgical instruments. To perform hologram registration, fiducial markers were used to track and map virtual coordinates to the real world. In this study, phantom models of each organ were constructed to test the reliability and accuracy of the AR-guided laparoscopic system. Root mean square error (RMSE) was used to evaluate the targeting accuracy of the laparoscopic interventional procedure. Our results demonstrated a registration error of 2.42 ± 0.79 mm and a procedural targeting error of 4.17 ± 1.63 mm using our AR-guided laparoscopic system that will be further refined for potential clinical procedures.

Remineralisation of enamel and dentine with stabilised stannous fluoride dentifrices in a randomised cross-over in situ trial

ObjectivesTo compare the remineralisation efficacy and ion bioavailability of two novel SnF2-containing dentifrices in a blinded, cross-over, randomised in situ clinical study. MethodsSix participants wore removal palatal appliances holding human enamel and dentine blocks with subsurface lesions. Appliances were worn for two treatment periods of 14 consecutive days each, with a one-week washout period in-between. Participants were randomly allocated to rinse with a 1:5 diluted coded slurry of one of two dentifrices containing either 5 % casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) +1100 ppm F as SnF2 [MIPOP], or 1100 ppm F as SnF2 [CT], for 1 min, four times a day. Saliva was collected post-treatment and analysed for tin, calcium, inorganic phosphate and fluoride ions using atomic absorption spectrophotometry and ion chromatography. Enamel and dentine lesions were analysed for percent remineralisation (%R) using transverse microradiography and percent surface microhardness recovery (%SMHR). ResultsMIPOP released significantly higher F (3.00 ± 0.27 mM), Ca (15.23 ± 3.23 mM) and Sn (1.18 ± 0.13 mM) into saliva whereas CT released 2.89 ± 0.32 mM F and only 0.84 ± 0.11 mM Ca and 0.28 ± 0.10 mM Sn. MIPOP produced significantly higher %R than CT: 25.6 ± 1.5 % compared to 15.2 ± 0.7 % in enamel, and 33.6 ± 3.1 % compared to 20.6 ± 1.1 % in dentine. Additionally, MIPOP produced significantly higher %SMHR (18.2 ± 7.9 %) compared to CT (4.1 ± 0.6 %). ConclusionsBoth dentifrices promoted remineralisation, but the MIPOP dentifrice with added CPP-ACP and the ion-stabilising effects of CPP released higher amounts of bioavailable tin and produced significantly higher remineralisation and surface microhardness recovery. Clinical SignificanceModern dentifrices contain SnF2 for a range of oral health benefits. Challenges associated with stability of these formulations can affect ion bioavailability, reducing efficacy. Two dentifrices with SnF2 promoted remineralisation in situ, however the dentifrice with the added saliva biomimetic CPP-ACP was superior and therefore may produce greater health benefits.

Effect of treatment with phosphate, casein phosphopeptide and fluoride on the remineralization: in vitro study.

This study aimed to evaluate in vitro the effect protocols and anticaries agents containing casein amorphous calcium fluoride phosphopeptide-phosphate (CPP-ACPF, MI Paste Plus), sodium trimetaphosphate (TMP) and fluoride (F), in remineralization of caries lesions. Bovine enamel blocks with initial caries lesions were divided into groups (n = 12): 1) Toothpaste without F-TMP-MI Plus (Placebo); 2) Toothpaste 1100 ppm F (1100F), 3) 1100F + MI Paste Plus (1100F-MI Paste Plus), 4) Toothpaste with 1100F + Neutral gel with 4,500 ppm F + 5%TMP (1100F + Gel TMP) and 5) Toothpaste with 1100F + Neutral gel with 9,000 ppm F (1100F + Gel F). For the 4 and 5 groups the gel was applied only once for 1 minute, initially to the study. For the 3 group, after treatment with 1100F, MI Paste Plus was applied 2x/day for 3 minute. After pH cycling, the percentage of surface hardness recovery (%SHR); integrated loss of subsurface hardness (ΔKHN); profile and depth of the subsuperficial lesion (PLM); concentrations of F, calcium (Ca) and phosphorus (P) in enamel was determined. The data were analyzed by ANOVA (1-criterion) and Student-Newman-Keuls test (p < 0.001). Treatment with 1100F alone led to ~ 28% higher remineralization when compared to treatment with 1100F associated with MI Paste Plus (p < 0.001). The 1100F and 1100F + Gel F groups showed similar values for %SHR (p = 0.150). 1100F + Gel TMP treatment also remineralized the enamel surface by ~ 30% and 20% when compared to the 1100F + Gel F and 1100F groups (p < 0.001). The lower lesion depth (ΔKHN) was observed for the 1100F + Gel TMP group (p < 0.001), where it was 54% and 44% lower in comparison to the 1100F and 1100F + Gel F groups (p < 0.001). Polarized light microscopy photomicrographs showed subsurface lesions in all groups, but these lesions were present to a lower extent in the 1100F + Gel TMP group (p < 0.001). Treatment with 1100F + Gel TMP promoted an increase in the concentration of Ca in the enamel by ~ 57% and ~ 26% when compared to the 1100F and 1100F + MI Paste Plus groups (p < 0.001), respectively. There were no significant differences between the 1100F, 1100F + MI Paste Plus and 1100F + Gel F groups (p > 0.001). Similar values of P in the enamel were observed in the 1100F, 1100F + MI Paste Plus and 1100F + Gel F groups (p > 0.001), except for the 1100F + Gel TMP group, which presented a high concentration (p < 0.001). We conclude that the 1100F+TMP gel treatment/protocol led to a significant increased remineralization when compared to the other treatments/protocols and may be a promising strategy for patients with early caries lesions.

The subsurface lesion in erosive tooth wear.

The subsurface lesion in erosive tooth wear.

Effect of the association of microparticles and nano-sized β-calcium glycerophosphate in conventional toothpaste on enamel remineralization: In situ study

ObjectivesThis in situ study aimed to assess the remineralizing effect of a fluoride toothpaste supplemented with β-calcium glycerophosphate in both micro (β-CaGPm) and nano-sized forms (β-CaGPn). MethodsThis blind and cross-over study was performed in 4 phases, each spanning 3 days. Twelve volunteers utilized palatal appliances containing four bovine enamel blocks with artificial caries lesions. Volunteers were randomly assigned to the following treatment groups: Placebo (no F-β-CaGPm-β-CaGPn); 1100 ppm F alone (1100F); 1100F plus 0.5% micrometric β-CaGP (1100F-0.5%β-CaGPm); and 1100F plus 0.25%nano-sized β-CaGP (1100F-0.25%β-CaGPn). Participants were instructed to brush their natural teeth with the palatal appliances in the mouth for 1 min (3 times/day), ensuring that the enamel blocks were exposed to the natural toothpaste slurries. Following each phase, evaluations were conducted to determine the percentage of surface hardness recovery (%SHR), integrated recovery of subsurface hardness (ΔIHR), profile subsurface lesion through polarized light microscopy (PLM), as well as fluoride (F), calcium (Ca), and phosphorus (P) concentrations within the enamel. Data were analyzed by ANOVA and Student-Newman-Keuls test (p < 0.001). ResultsTreatment with 1100F-0.25%β-CaGPn resulted in %SHR ∼69 % and ∼40 % higher when compared to 1100F and 1100F-0.5%β-CaGPm (p < 0.001). The reduction in lesion body (ΔIHR; PLM) was ∼40 % higher with 1100F-0.25%β-CaGPn (p < 0.001) compared to 1100F. The addition of β-CaGPm and β-CaGPn did not influence enamel F concentration (p > 0.001). Treatment with 1100F-0.25%β-CaGPn led to an increase in the concentration of Ca and P in the enamel (p < 0.001). ConclusionThe addition of 0.25%β-CaGPn into 1100F formulation increased the bioavailability of calcium and phosphate, promoting a higher remineralizing effect. Clinical significanceToothpaste containing 1100F-0.25%β-CaGPn showed a potential of higher remineralization to 1100 ppm F and 1100 ppm F micrometric β-CaGP could be a strategy for patients at caries activity.

Comparative Evaluation of the Remineralizing Potential of Silver Diamine Fluoride, Casein Phosphopeptide-amorphous Calcium Phosphate, and Fluoride Varnish on the Enamel Surface of Primary and Permanent Teeth: An In Vitro Study.

With the paradigm shift in the management of dental caries, the focus is now laid on remineralization therapies that can arrest the progression of the disease and remineralize the subsurface lesions. The purpose of this study was to determine and compare the remineralizing potential of silver diamine fluoride (SDF), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and fluoride varnish (FV) on enamel surfaces in primary and permanent teeth. A total of 120 primary anterior teeth and 120 premolars were used to prepare enamel blocks in acrylic resin. The mean baseline surface microhardness (SMH) for each sample was determined using a microvickers hardness testing machine. Thereafter, the samples were randomly and equally distributed into groups and subgroups based on the materials used, that is, SDF, CPP-ACP, FV, and distilled water (control). After subjecting the samples to a pH cycling regime, SMH was determined again and the percentage change in SMH was calculated. The data were tabulated and subjected to statistical analysis using an independent t-test and one-way analysis of variance (ANOVA). In primary teeth, the least mean percentage reduction in SMH was observed after the application of FV followed by SDF, CPP-ACP, and control. In permanent teeth, both SDF and FV showed the least percentage reduction of enamel SMH followed by CPP-ACP and control. Silver diamine fluoride (SDF), FV, and CPP-ACP showed remineralizing potential in both primary and permanent teeth. Kaur S, Bhola M, Bajaj N, et al. Comparative Evaluation of the Remineralizing Potential of Silver Diamine Fluoride, Casein Phosphopeptide-amorphous Calcium Phosphate, and Fluoride Varnish on the Enamel Surface of Primary and Permanent Teeth: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(S-1):S91-S96.

The subsurface lesion in erosive tooth wear

ObjectivesThis study compared the surface change on natural and polished enamel exposed to a joint mechanical and chemical wear regimen. MethodsHuman enamel samples were randomly assigned to natural (n = 30) or polished (n = 30) groups, subjected to erosion (n = 10, 0.3% citric acid, 5 min), abrasion (n = 10, 30 s), or a combination (n = 10). Wear in the form of step height was measured with a non-contact profilometer, and surface changes were inspected with SEM on selected sections. Data was normalised and underwent repeated measures MANOVA, accounting for substrate and erosive challenge as independent variables, with Bonferroni correction for significant post hoc interactions. ResultsAfter four cycles, polished samples had mean step heights of 3.08 (0.40) μm after erosion and 4.08 (0.37) μm after erosion/abrasion. For natural samples, these measurements were 1.52 (0.22) μm and 3.62 (0.39) μm, respectively. Natural surfaces displayed less wear than polished surfaces under erosion-only conditions (p<0.0001), but the difference disappeared with added abrasion. SEM revealed a shallow subsurface layer for polished surfaces and natural ones undergoing only erosion. However, natural surfaces exposed to both erosion and abrasion showed deeper subsurface changes up to 50 µm. ConclusionNatural enamel, when exposed to erosion alone, showed less wear and minimal subsurface alterations. But with added abrasion, natural enamel surfaces saw increased wear and notable subsurface changes compared to polished ones. Clinical SignificanceThe pronounced subsurface lesions observed on eroded/abraded natural enamel surfaces highlight how combined wear challenges may accelerate tooth tissue loss.

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

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

Transverse Microradiography Evidence on the Effect of Phosphoryl Oligosaccharides of Calcium (POs-Ca) in Toothpaste on Decalcified Enamel

In the current study, we sought to evaluate the effects of phosphoryl-oligosaccharides of calcium (POs-Ca) and/or fluoride-containing toothpaste on enamel. Six groups of experimental toothpaste were prepared by adding various concentrations of POs-Ca and/or fluoride. A 5 × 10-mm window on the enamel of the bovine incisor was immersed in resin and divided into three areas for “sound”, “demineralized (DEM)”, and “after pH cycle (aft. pH cycle)”. All specimens were subjected to pH cycling, including soaking in a slurry with toothpaste diluted threefold for 5 min. Transverse microradiography was employed to evaluate the mineral recovery, and the pH values of each demineralization solution were measured. The high fluoride concentration group showed a significantly better mineral recovery rate than the others, with no statistical differences between before and after pH cycling among the POs-Ca with low fluoride, POs-Ca only, low fluoride only, and control groups. In the low-concentration fluoride groups, the group containing POs-Ca tended to have a higher remineralization effect than the non-POs-Ca group. After pH cycling, the demineralization solution showed no pH changes in any group. The addition of POs-Ca and fluoride to toothpaste may recover the mineral density in enamel subsurface lesions at low-fluoride concentrations, but the high-fluoride concentrations did not show a meaningful difference in the two groups with and without POs-Ca.

Comparative Efficacy of Novel Biomimetic Remineralising Technologies.

Biomimetic technologies for the remineralisation of enamel subsurface lesions (ESLs) have been developed and include: fluorocalcium phosphosilicate bioglass (BG/F); casein phosphopeptide-amorphous calcium phosphate (CPP−ACP) and with fluoride (CPP−ACFP); and self-assembling oligopeptide P11-4 (SAP). The aim of this study was to compare the remineralisation of ESLs in vitro using these technologies. Human enamel slabs with ESLs were cut into two half-slabs; one half-slab was untreated (control), and the other half was treated by exposure to one of the four technologies with artificial saliva (AS) or AS alone for 14 days at 37 °C. The technologies were applied to the ESL surface according to the manufacturer’s instructions. At the completion of each treatment, the treated half-slabs and their paired control half-slabs were embedded, sectioned and the mineral content was determined using transverse microradiography. The change in mineral content (remineralisation) between treatments was statistically analysed using one-way ANOVA. The order from highest to lowest remineralisation was CPP−ACFP (52.6 ± 2.6%) > CPP−ACP (43.0 ± 4.9%) > BG/F (13.2 ± 2.5%) > SAP (5.8 ± 1.6%) > AS (2.1 ± 0.5%). Only CPP−ACFP and CPP−ACP produced remineralisation throughout the body of the lesions. All four biomimetic technologies had some effect on the remineralisation of ESLs; however, CPP−ACFP with calcium, phosphate and fluoride ions stabilised by CPP was superior in the level and pattern of remineralisation obtained.

Effect of fluoride gels with nano-sized sodium trimetaphosphate on the in vitro remineralization of caries lesions.

To evaluate the effects of fluoride (F) gels supplemented with micrometric or nano-sized sodium trimetaphosphate (TMPmicro and TMPnano, respectively) on the in vitro remineralization of caries-like lesions. Bovine enamel subsurface lesions (n=168) were selected according to their surface hardness (SH) and randomly divided into seven groups (n=24/group): Placebo (without F/TMP), 4,500 ppm F (4500F), 4500F + 2.5% TMPnano (2.5% Nano), 4500F + 5% TMPnano (5% Nano), 4500F + 5% TMPmicro (5% Micro), 9,000 ppm F (9000F), and 12,300 ppm F (Acid gel). The gels were applied in a thin layer for one minute. Half of the blocks were subjected to pH cycling for six days, whereas the remaining specimens were used for loosely- (calcium fluoride; CaF2) and firmly-bound (fluorapatite; FA) fluoride analysis. The percentage of surface hardness recovery (%SHR), area of subsurface lesion (ΔKHN), CaF2, FA, calcium (Ca), and phosphorus (P) on/in enamel were determined. Data (log10-transformed) were subjected to ANOVA and the Student-Newman-Keuls' test (p<0.05). We observed a dose-response relation between F concentrations in the gels without TMP for %SHR and ΔKHN. The 2.5% Nano and 5% Micro reached similar %SHR when compared with 9000F and Acid gels. For ΔKHN, Placebo and 5% Nano gels had the highest values, and 5% Micro, 2.5% Nano, 9000F, and Acid gels, the lowest. All groups had similar retained CaF2 values, except for Placebo and Acid gel. We verified observed an increase in Ca concentrations in nano-sized TMP groups. Regarding P, TMP groups showed similar formation and retention to 9000F and Acid. Adding 2.5% nano-sized or 5% micrometric TMP to low-fluoride gels lead to enhanced in vitro remineralization of artificial caries lesions.

Iontophoresis as an Effective Drug Delivery System in Dentistry: A Review.

Iontophoresis is a non-invasive method to improve drug delivery by the application of an electric field. The iontophoresis process causes deeper penetration of ions using electric current. The drug delivered through iontophoresis was found to be around 10 to 2,000 times more than conventional forms of delivery. The better results were shown by alternating current (AC) than conventional constant current (DC) iontophoresis. The preparation used in iontophoresis should be soluble in water, of a small voltage, and prone to ionization. More mobility is seen with smaller particles. Iontophoresis could increase the diffusion of drugs into dentin, enamel, and other oral tissues. The chief drugs delivered or studied by iontophoresis in dentistry are non-steroidal anti-inflammatory drugs, local anesthetics, anti-bacterial drugs, and fluorides. To enhance the ability of drug transfer nanomaterials were introduced. Under the impact of iontophoresis, remineralizing nanomaterial can be injected at larger concentrations in the deeper layer of incipient caries. Due to the size of nanocomplexes, it is possible that they will diffuse into the body of the subsurface lesion and enter the porosities to improve remineralization utilizing the iontophoresis approach. The concept of the application of an electric current for drug delivery was introduced several years ago in clinical practice, research, and literature. This review focuses on iontophoresis application in dentistry, its mode of action, and how the technique can be utilized in a beneficial way.

Evaluation of the mineral-promoting effects of in-office bleaching on experimental subsurface enamel lesions

The aim of this study was to investigate the mineral-promoting effects of in-office bleaching agent on enamel subsurface lesions. Enamel subsurface lesions were divided into following groups; D: demineralized samples without any further treatment, DS: samples were further immersed in fresh saliva, DSR: samples were immersed in saliva followed by remineralization buffer, and DSBR: samples were immersed in saliva, subjected to in-office bleaching, and then immersed in remineralization buffer. The control group (CONT) consisted of untreated enamel specimens. Transverse microradiography showed that integrated mineral loss was significantly lower in the DSBR group than in the DSR group. Confocal laser Raman analysis revealed that ν1 phosphate peak height of 959 cm-1 and mineral to matrix ratio of peak heights 959 cm-1 to 1,610 cm-1 in the DSBR group were similar to those in the CONT. In-office bleaching can promote enamel remineralization by altering or removing proteins infiltrated to enamel subsurface lesions.

Comparison of calcium-based technologies to remineralise enamel subsurface lesions using microradiography and microhardness

Assessment of enamel subsurface lesion remineralisation is essential for the evaluation of novel remineralisation technologies. The gold standard to assess subsurface mineral gain of enamel lesions is transverse microradiography (TMR). However, some studies have utilised surface microhardness (SMH) to evaluate efficacy of remineralisation agents. The aim of this study was to assess remineralisation of enamel subsurface lesions using TMR and SMH after in vitro treatment with calcium-containing technologies, and to test correlation between the TMR and SMH measurements. The parameters obtained from the TMR and SMH analyses of enamel subsurface remineralisation were not significantly correlated. Furthermore, the enamel subsurface remineralisation as measured by TMR was significantly correlated with the water-soluble calcium concentration of the remineralisation products. Scanning electron microscopy revealed surface precipitates formed by specific remineralisation treatments obfuscated accurate assessment of remineralisation by SMH. It was concluded that TMR is a more appropriate method for analysis of enamel subsurface remineralisation, and that SMH values of remineralised enamel should be interpreted with caution. Using TMR the level of remineralisation (%R) by the different technologies was CPP-ACP/F (31.3 ± 1.4%); CPP-ACP (24.2 ± 1.4%); CaSO4/K2HPO4/F (21.3 ± 1.4%); f-TCP/F (20.9 ± 1.0%); Nano-HA/F (16.3 ± 0.3%); Nano-HA (15.3 ± 0.6%) and F alone control (15.4 ± 1.3%).

In vitro evaluation of the cis-[Ru(phen)2(pPDIp)]2+⁎⁎ complex for antimicrobial photodynamic therapy against Sporothrix brasiliensis and Candida albicans.

Photodynamic therapy (PDT) activates a photosensitizer by visible light to generate cytotoxic oxygen species that lead to cell death. With proper illumination, PDT is often used in applications on superficial and sub-surface lesions. Sporotrichosis infection occurs by Sporothrix fungi which causes a skin wound, worsened by Candida albicans infections. This study investigated the photosensitizing efficiency of the Ru(phen)2(pPDIp)(PF6)2 complex, RupPDIp, against S. brasiliensis and C. albicans. RupPDIp efficiency against these fungi was tested using 450nm (blue light and 36J/cm2) and 525nm (green light, 25.2J/cm2) at 0.05-20μM concentrations. To ensure PDT effectiveness, control groups were tested in the absence and in the presence of RupPDIp under light irradiation and in the dark. RupPDIp eliminated both fungi at ≤5.0μM. Green light showed the best results, eliminating S. brasiliensis and C. albicans colonies at RupPDIp 0.5μM and 0.05μM, respectively. RupPDIp is a promising photosensitizer in aPDT, eliminating 106CFU/mL of both fungi at 450nm and 525nm, with lower light doses and concentrations when treated with the green light compared to the blue light.

White Spot Lesions: An Iatrogenic Effect of Fixed Orthodontic Therapy

White spot lesions (WSL) around orthodontic attachments are unsightly, and one of the common side effects of fixed orthodontic treatment. Poor oral hygiene during fixed orthodontic treatment leads the plaque accumulation around the brackets which produces demineralization of enamel or subsurface lesions or WSL. Treatment options for WSL vary widely from natural self-recovery to extensive restorative treatment. The severity of the WSL acts as the key determent factor for choosing the best treatment option. Till date various studies were conducted to confirm the reports on remineralisation and to understand the mechanism which is still unknown. Many new concepts are emerging to better understand the factors which promote remineralisation and produce morphologically stable results. Recent investigations have primarily focused on various calcium phosphate-based technologies which are designed to supplement and enhance fluoride’s ability to restore tooth mineral. The purpose of this article is to provide an overview regarding the new diagnostic methods and recent techniques available for early detection and management of WSL.

Effectiveness of Self-Assembling Peptide (P11-4) in Dental Hard Tissue Conditions: A Comprehensive Review.

The limitations on the use of fluoride therapy in dental caries prevention has necessitated the development of newer preventive agents. This review focusses on the recent and significant studies on P11-4 peptide with an emphasis on different applications in dental hard tissue conditions. The self-assembling peptide P11-4 diffuses into the subsurface lesion assembles into aggregates throughout the lesion, supporting the nucleation of de novo hydroxyapatite nanocrystals, resulting in increased mineral density. P11-4 treated teeth shows more remarkable changes in the lesion area between the first and second weeks. The biomimetic remineralisation facilitated in conjunction with fluoride application is an effective and non-invasive treatment for early carious lesions. Despite, some studies have reported that the P11-4 group had the least amount of remineralised enamel microhardness and a significantly lower mean calcium/phosphate weight percentage ratio than the others. In addition, when compared to a low-viscosity resin, self-assembling peptides could neither inhibit nor mask the lesions significantly. Moreover, when it is combined with other agents, better results can be achieved, allowing more effective biomimetic remineralisation. Other applications discussed include treatment of dental erosion, tooth whitening and dentinal caries. However, the evidence on its true clinical potential in varied dental diseases still remains under-explored, which calls for future cohort studies on its in vivo efficacy.

Comparative Evaluation of Remineralization Potential of Acidulated Phosphate Fluoride and Hydroxyapatite Nanoparticles with and without Iontophoresis on the Incipient Carious Lesion in Permanent Teeth

Background: A non- invasive method used to improve the drug delivery with the help of electric arena is termed as Iontophoresis. The iontophoresis process may cause deeper penetration of ions using electric current. Remineralizing nanomaterial may be infused at higher concentrations in the deeper layer of incipient caries under the influence of iontophoresis. Hydroxyapatite crystals are the most stable form of calcium phosphate which is responsible for the mechanical strength of the dental tissues. Improvedre-mineralization occurs more with the apatite particle size of less than 4 µm. Due to the size of the nanocomplexes ofhydroxyapatite, there can be possibilities that they would enter the porosities and diffuse into the body of the subsurface lesion to enhance remineralization using iontophoresis technique.&#x0D; Objectives: 1) To evaluate the remineralization potential of APF gel with or without iontophoresis on the incipient carious lesion in permanent teeth. 2) To evaluate the remineralization potential of hydroxyapatite nanoparticles with or without iontophoresis on the incipient carious lesion of permanent teeth. 3) To compare the remineralization potential of APF gel and hydroxyapatite nanoparticles with or without iontophoresis on the incipient carious lesion in permanent teeth.&#x0D; Methodology: Forty extracted intact teeth will be taken and artificial caries will be induced. These specimens will be randomly divided into five groups as per the treatment - 1) APF gel application 2) APF gel with iontophoresis 3) Hydroxyapatite nanoparticles solution application 4) Hydroxyapatite nanoparticles solution with iontophoresis 5) Distilled water (control group). Remineralization will be analysis by using Vickers hardness test. The alterations in the carious lesion will be assessed by confocal laser scanning microscopy.&#x0D; Expected Results: APF gel and hydroxyapatite nanoparticles with iontophoresis will give superior remineralization effect as compared to the conventional method.&#x0D; Conclusion: The utilization of the iontophoresis with hydroxyapatite nanoparticle will provide improved mineralization of incipient caries and prove to be a better method for treatment.