Effectiveness of non-operative approaches in active enamel carious lesions: a retrospective longitudinal study

Abstract The aim of the study was to investigate the effectiveness of non-invasive and micro-invasive treatments in active enamel carious lesions in high-caries-risk children. Clinical records of children treated in a dental school setting were retrospectively screened for active enamel carious lesions treated non-invasively (topical fluoride applications, oral hygiene instruction, or dietary guidance) or micro-invasively (sealant). The control of active carious lesions was set as the main outcome established by the combination of inactivation and non-progression of the lesions based on Nyvad and ICDAS criteria, respectively. Individual and clinical factors associated with the outcome were analyzed by Poisson regression. The sample consisted of 105 high-caries-risk children with a mean age of 8.3 (± 2.4) years. From a total of 365 active enamel carious lesions, most lesions (84.1%) were active non-cavitated carious lesions (ICDAS scores 1 and 2) and only 15.9% presented localized enamel breakdown (ICDAS score 3). Of these, 72.6% were inactivated and 92.1% did not progress (mean time of 6.5 ± 4.1 months). The prevalence of controlled carious lesions was higher among children older than 6 years (PR:1.43; 95%CI:1.00-2.03; p = 0.04) and in those with better biofilm control (PR:0.99; 95%CI: 0.98-0.99; p = 0.03). Non-operative approaches are effective for controlling active enamel carious lesions. The majority of active enamel carious lesions became inactive and did not progress after treatment. Caries control was associated with older children and better biofilm control.

Effect of phenylmethylsulfonyl fluoride, a protease inhibitor, on enamel surface remineralization

Phenylmethylsulfonyl fluoride (PMSF) is a protease inhibitor widely used in research, but fluoride is released during its action and this knowledge has been neglected in dental research. Aim: to evaluate if fluoride released by salivary protease action on PMSF affects enamel remineralization and fluoride uptake. Methods: Groups of 10 enamel slabs, with caries-like lesions and known surface hardness (SH), were subjected to one of the following treatment groups: Stimulated human saliva (SHS), negative control; SHS containing 1.0 µg F/mL (NaF), positive control; and SHS containing 10, 50 or 100 µM PMSF. The slabs were subjected to a pH-cycling regimen consisting of 22 h/day in each treatment solution and 2 h/day in a demineralizing solution. After 12 days, SH was again measured to calculate the percentage of surface hardness recovery (%SHR), followed by enamel fluoride uptake determination. The time-related fluoride release from 100.0 µM PMSF by SHS action was also determined. Data were analyzed by ANOVA followed by Newman-Keuls test. Results: The release of fluoride from PMSF by SHS was rapid, reaching a maximum value after 10 min. Fluoride released from PMSF was more effective in enhancing %SHR and increasing fluoride uptake in enamel compared with SHS alone (p < 0.05); furthermore, it was equivalent to the positive control (p > 0.05). Conclusion: In conclusion, fluoride released by saliva from PMSF is available to react with enamel and needs to be taken into account in research using this protease inhibitor

Incorporation of bioactive glass-ceramic into coconut oil for remineralization of incipient carious lesions

Abstract This study evaluated the efficacy of incorporating different concentrations of bioactive glass-ceramic (Biosilicate) into coconut oil on the remineralizing potential and surface roughness of white spot lesions. Fragments (6 x 6 x 2mm) of bovine teeth were sectioned and initial microhardness (KHN) and surface roughness (Ra) readings were obtained. The samples were submitted to cariogenic challenge to form white spot lesions and were separated into six groups (n=13): 1) Artificial Saliva (AS); 2) Coconut Oil (CO); 3) CO+2% Biosilicate (CO+2%Bio); 4) CO+5% Biosilicate (CO+5%Bio); 5) 2% Biosilicate Suspension (2% Bio) and 6) 5% Biosilicate Suspension (5% Bio). The treatments for 1 cycle/day were: immersion into the treatments for 5 minutes, rinsing in distilled water, and storage in artificial saliva at 37ºC. After 14 days, KHN and Ra readings were taken. The surface roughness alteration ((Ra) was analyzed (Kruskal-Wallis, Dunn's post-test, p<0.05). CO+2%Bio had higher (p = 0.0013) (Ra followed by CO+5%Bio (p = 0.0244) than AS. The relative KHN and remineralization potential were analyzed (ANOVA, Tukey, p<0.05), and 5% Bio treatment presented a higher relative microhardness than all other groups (p>0.05). The remineralizing potential of all the treatments was similar (p > .05). When Biosilicate was added, the pH of the suspensions increased and the alkaline pH remained during the analysis. Biosilicate suspension is more efficient than the incorporation of particles into coconut oil at white spot lesion treatment. In addition to the benefits that coconut oil and Biosilicate present separately, their association can enhance the remineralizing potential of Biosilicate.

Resumo Este estudo avaliou a eficácia da incorporação de diferentes concentrações de vitrocerâmica bioativa (biosilicato) ao óleo de coco no potencial remineralizante e na rugosidade superficial de lesões de manchas brancas. Fragmentos (6 x 6 x 2mm) de dentes bovinos foram seccionados e as leituras iniciais de microdureza (KHN) e rugosidade superficial (Ra) foram obtidas. As amostras foram submetidas ao desafio cariogênico para formação de lesões de manchas brancas e foram separadas em seis grupos (n=13): 1) Saliva Artificial (AS); 2) Óleo de Coco (CO); 3) CO+2% Biosilicato (CO+2%Bio); 4) CO+5% Biosilicato (CO+5%Bio); 5) Suspensão de Biosilicato 2% (2% Bio) e 6) Suspensão de Biosilicato 5% (5% Bio). Os tratamentos de 1 ciclo/dia foram: imersão nos tratamentos por 5 minutos, enxágue em água destilada e armazenamento em saliva artificial a 37ºC. Após 14 dias, foram feitas as leituras de KHN e Ra. A alteração da rugosidade superficial ((Ra) foi analisada (Kruskal-Wallis, pós-teste de Dunn, p<0,05). CO+2%Bio apresentou maior (p = 0,0013) (Ra seguido de CO+5%Bio (p = 0,0244) do que AS. O KHN relativo e o potencial de remineralização foram analisados (ANOVA, Tukey, p<0,05), e o tratamento 5% Bio apresentou uma microdureza relativa maior do que todos os outros grupos (p>0,05). A suspensão de biosilicato é mais eficiente que a incorporação de partículas ao óleo de coco no tratamento de lesões de mancha branca. Além dos benefícios que o óleo de coco e o Biosilicato apresentam separadamente, sua associação pode amplificar o potencial remineralizante do Biosilicato.

Application of proanthocyanidin in the treatment and repair of deep caries / 口腔疾病防治

@#Proanthocyanidin (PA), as a kind of natural plant polyphenol, have a variety of biological functions, such as promoting remineralization, inducing collagen cross-linking, inhibiting protease activity and inhibiting bacteria. Therefore, PA could be broadly used in the clinical application of treatment and repair of deep caries in the future; for example, PA could promote dentin remineralization, improve resin-dentin bonding durability and improve the dentin acid erosion effect. This application potential of PA arises from several features, firstly, PA can not only promote dentin remineralization on its own or with other remineralizers but also exhibits antibacterial effects, which can inhibit acid production while reducing the formation of cariogenic pathogens and their biofilms. Based on the above features, PA can reduce the incidence of caries disease; thus, PA improves deep caries and long-term effects after treatment. In addition, PA added to adhesives or etch agents can improve the etching and bonding effect of dentin by inducing collagen cross-linking and inhibiting protease activity, thus achieving the ultimate goal of improving the bonding performance of deep caries. This paper summarizes recent progress of research on PA for the treatment and repair of deep caries, including the promotion of dentin remineralization and antibacterial activity as well as the improvement in dentin bonding and acid etching effect, to provide a more comprehensive reference for treating and restoring deep caries in clinical practice.

Efficacy of 30% and 38% Silver Diamine Fluoride in Arresting Caries Lesions After Different Application Times: An in Vitro Study

Abstract Objective: To evaluate the efficacy of silver diamine fluoride (SDF) in arresting dentin caries lesions when applied under different concentrations and times. Material and Methods: Forty-two bovine blocks were selected and fixed in 24-well plates. Each well received a mixed bacterial inoculum added to the culture medium with 5% sucrose. The plates were incubated in microaerophilia (7 days) for caries formation, confirmed by micro-CT (M1). SDF was applied over the carious lesions for different times and concentrations (n=6): SDF 30% - immediate removal, 1 minute and 3 minutes; SDF 38%, - immediate removal, 1 minute and 3 minutes. The group without treatment was the control. Then, the samples were again scanned by micro-CT (M2) and submitted to a second cariogenic challenge for 21 days. Then, a final scan was performed (M3). Results: Mean pH at the culture medium and lesion depth were compared using Kruskal-Wallis and Wilcoxon tests. 38% SDF showed the lowest metabolic activity of the biofilm. All 38% groups and 30% 1 and 3 minutes did not show an increase in mean lesion depth comparing M3 with M1. However, only 30% 3 minutes and 38% 1 and 3 minutes showed a significant reduction of lesion depth. Conclusion: The minimum application time of 30% SDF to arrest dentin caries lesion was 1 minute, while 38% SDF arrested with application and immediate removal.

Análise in vitro da capacidade de soluções contendo fluoreto e/ou trimetafosfato na remineralização da dentina e na inibição da atividade de metaloproteinases da matriz dentinária / In vitro analysis of the capacity of solutions containing fluoride and/or trimetaphosphate in the remineralization of dentin and in the inhibition of the activity of dentin matrix metalloproteinases

Objetivo: O objetivo deste estudo foi investigar o potencial anti-proteolítico contra MMP-2 e MMP-9 e a capacidade de induzir a remineralização da dentina, através de soluções contendo diferentes concentrações de TMP (na sua forma cíclica), diferentes concentrações de F e associação TMP/F. Métodos: Blocos de dentina radicular (6mmx4mmx2mm, n = 130) foram selecionados e divididos aleatoriamente em 13 grupos/soluções experimentais (n = 10): 1) Placebo (sem F/TMP); 2) 0,3% TMP hidrolisado; 3) 1% TMP hidrolisado; 4) 3% TMP hidrolisado; 5) 0,3% TMP; 6) 1% TMP; 7) 3% TMP; 8) 250 ppm F; 9 500 ppm F; 10) 1100 ppm F; 11) 250 ppm F associado a 0,3% TMP; 12) 500 ppm F associado a 1% TMP e 13) 1100 ppm F associado a 3% TMP. A avaliação do potencial anti-proteolítico das soluções experimentais contra as metaloproteinases da matriz dentinária (- 2 e -9) foi realizado por meio da análise zimográfica. Para as análises mecânicas, três áreas foram determinadas para cada espécime: 1- controle (sem tratamento); 2- desmineralizado (cárie artificial); 3- tratado (desmineralizado e submetido a ciclagem de pH por 7 dias, e tratado por 1 min com as soluções experimentais). Os espécimes de dentina foram analisados quanto à porcentagem de recuperação de dureza superficial (%SHR), em dureza transversal (%CSHR) e por microtomografia computadorizada (IMC). Para os dados de dureza e Micro-CT, os resultados foram analisados por ANOVA de medidas repetidas seguida do teste de Student-Newman-Keuls (p <0,05). Resultados: A análise zimográfica mostrou que 1100 ppm F + 3% de TMP promoveu inibição completa da atividade gelatinolítica (MMP-2; MMP-9). Os grupos com TMP não hidrolisados apresentaram efeito remineralizador (% SHR e % CSHR) superior aos grupos hidrolisados. O grupo 1100F + TMP promoveu a maior %SHR e %CSHR entre todos os grupos (p <0,001), sendo respectivamente 15,4 e 10,5%, superior ao grupo 1100F. Os grupos contendo 1100F e 1100F + 3%TMP apresentaram maior concentração mineral. Conclusão: Com base nos resultados, 3% TMP atua como um agente antiproteolítico contra metaloproteinases da matriz dentinária. Além disso, quando suplementado com 1100F, 3% TMP potencializa a remineralização, aumentando significativamente as propriedades mecânicas da dentina tratada. Os tratamentos com TMP não hidrolisado e associado ao F maior que as soluções fluoretadas sem o TMP. Significância clínica: Dessa forma, uma potencial estratégia preventiva e terapêutica pode ser considerada na clínica odontológica, principalmente na terapia da cárie radicular, como também para método preventivo de lesões iniciais de cárie dentinária ou no pré-tratamento da dentina, utilizando-os como agentes cross-linker em procedimentos restauradores(AU)

Objective: The aim of this study was to investigate the anti-proteolytic potential against MMP-2 and MMP-9 and the ability to induce dentin remineralization, through solutions containing different concentrations of TMP (in its cyclic form), different concentrations of F and TMP / F association. Methods: Root dentin blocks (6mmx4mmx2mm, n = 130) were selected and randomly divided into 13 groups / experimental solutions (n = 10): 1) Placebo (without F / TMP); 2) 0.3% hydrolyzed TMP; 3) 1% hydrolyzed TMP; 4) 3% hydrolyzed TMP; 5) 0.3% TMP; 6) 1% TMP; 7) 3% TMP; 8) 250 ppm F; 9,500 ppm F; 10) 1100 ppm F; 11) 250 ppm F associated with 0.3% TMP; 12) 500 ppm F associated with 1% TMP and 13) 1100 ppm F associated with 3% TMP. The evaluation of the antiproteolytic potential of experimental solutions against dentin matrix metalloproteinases (- 2 and -9) was carried out by means of zymographic analysis. For mechanical analysis, three areas were determined for each specimen: 1- control (without treatment); 2- demineralized (artificial caries); 3- treated (demineralized and subjected to pH cycling for 7 days, and treated for 1 min with the experimental solutions). The dentin specimens were analyzed for the percentage of recovery of superficial hardness (% SHR), in crosssectional hardness (% CSHR) and by computed microtomography (∆IMC). For the hardness and Micro-CT data, the results were analyzed by repeated measures ANOVA followed by the Student-Newman-Keuls test (p <0.05). Results: The zymographic analysis showed that 1100 ppm F + 3% TMP promoted complete inhibition of gelatinolytic activity (MMP-2; MMP-9). The groups with non-hydrolyzed TMP showed a remineralizing effect (% SHR and % CSHR) superior to the hydrolyzed groups. The 1100F + TMP group promoted the highest % SHR and % CSHR among all groups (p <0.001), being 15.4 and 10.5%, respectively, higher than the 1100F group. The groups containing 1100F and 1100F + 3% TMP showed higher mineral concentration. Conclusion: Based on the results, 3% TMP acts as an antiproteolytic agent against dentinal matrix metalloproteinases. In addition, when supplemented with 1100F, 3% TMP enhances remineralization, significantly increasing the mechanical properties of the treated dentin. Treatments with non-hydrolyzed TMP and associated with F greater than fluoridated solutions without TMP. Clinical significance: Thus, a potential preventive and therapeutic strategy can be considered in the dental clinic, mainly in the treatment of root caries, as well as for the preventive method of initial lesions of dental caries or in the pretreatment of dentin, using them as agents cross-linker in restorative procedures(AU)

Silicon-enriched hydroxyapatite formed induced by REFIX-based toothpaste on the enamel surface / Formação de hidroxiapatita enriquecida com silício induzida por dentifrício à base de REFIX na superfície do esmalte

Objetivo: Este estudo in vitro objetivou caracterizar o teor de minerais e a morfologia das partículas de um dentifrício fluoretado contendo tecnologia REFIX e o teor de minerais e a morfologia da superfície do esmalte tratada com este produto. Material e Métodos: Blocos de esmalte bovino (n=5) foram obtidos (4×4×6 mm), desmineralizados (lesão de cárie artificial) e tratados (ciclagem de pH e escovação com dentifrício). Durante a ciclagem de pH de 7 dias (desmineralização e remineralização levaram 6 h e 18 h, respectivamente), o esmalte foi escovado por 5 min com uma escova dental elétrica antes de ser imerso em uma solução de remineralização. Avaliou-se a micromorfologia e os níveis elementares (% em peso) dos íons presentes no dentifrício e na camada formada sobre o esmalte após o tratamento. A morfologia da superfície foi avaliada por meio de microscopia eletrônica de varredura (MEV). As análises elementares foram realizadas usando um espectrômetro de energia dispersiva de raios-X (EDS). Resultados: A análise por MEV do dentifrício demonstrou uma distribuição de tamanho uniforme de partículas de forma regular que foram organizados esparsamente em "nanoclusters". A análise elementar da formulação do dentifrício demonstrou a presença de Si (silício), Na (sódio), P (fósforo) e F (flúor), entre outros. Observou-se também uma camada mineral na superfície de esmalte com espessura uniforme consistente em torno de 14 µm. Conclusão: De acordo com os resultados, conclui-se que a tecnologia REFIX modifica a superfície e subsuperfície da estrutura do esmalte, formando uma camada mineral rica em silício. (AU)

Objective: This in vitro study aimed at characterizing the mineral content and filler particle morphology of a fluoridated toothpaste containing REFIX technology and the mineral content and the morphology of the enamel surface treated with this product. Material and Methods: Bovine enamel blocks (n=5) were obtained (4×4×6 mm), demineralized (artificial caries lesion), and treated (pH cycling and brushing with the toothpaste). During the pH cycling, which lasted for 7 days (demineralization and remineralization took 6 h and 18 h, respectively), the enamel was brushed for 5 min using an electric toothbrush before being immersed in a remineralization solution. We evaluated the micromorphology and elemental levels (wt%) of ions present in the toothpaste and on the layer formed over the enamel following the treatment. The surface morphology was assessed using scanning electron microscopy (SEM). The elemental analyses were performed using an energy-dispersive X-ray spectrometer (EDS). Results: Scanning electron micrographs of the toothpaste demonstrated a uniform size distribution of regular-shaped fillers sparsely organized in nanoclusters. Elemental analysis of the toothpaste's formulation demonstrated the presence of Si (silicon), Na (sodium), P (phosphorus), and F (fluorine), among others. We also detected a mineral layer that had formed on the treated enamel surface; the layer had a consistent uniform thickness of ~14 µm. Conclusion: Based on the results, it can be stated that REFIX technology modifies the surface and subsurface of the enamel structure, forming a Si-rich mineral layer. (AU)

Análise in vitro da capacidade de soluções contendo fluoreto e/ou hexametafosfato na remineralização da dentina / In vitro analysis of the capacity of solutions containing fluoride and/or hexametaphosphate on the remineralization of dentin

O objetivo do presente estudo foi avaliar a capacidade de soluções contendo HMP e F, sozinhos ou em associação, em induzir a remineralização dentinária em um protocolo in vitro. Blocos de dentina radicular bovina (4 × 6 cm, n = 100) foram preparados e submetidos à indução de lesões de cárie artificiais em dois terços da superfície; cada bloco foi utilizado como seu próprio controle. Em seguida, os blocos foram divididos em 10 grupos experimentais (n=10/grupo), de acordo com as soluções a serem testadas: (1) Placebo (sem F ou HMP); (2) 0,5% HMP; (3) 0,75% HMP; (4) 1% HMP; (5) 250 ppm F; (6) 500 ppm F; (7) 1100 ppm F; (8) 250 ppm F + 0,5% HMP; (9) 500 ppm F + 0,75% HMP e (10) 1100 ppm F + 1% HMP. Os blocos foram tratados por um minuto, duas vezes ao dia com as respectivas soluções, e submetidos a uma ciclagem de pH durante 7 dias. Em seguida, foram determinadas a porcentagem de recuperação da dureza de superfície (%RDS) e a área integrada da lesão de subsuperfície (ΔKHN). Os dados foram submetidos a ANOVA e teste de Fisher LSD (p<0.05). Uma relação dose-reposta foi observada entre as concentrações de F nas soluções sem HMP e as variáveis %RDS e ΔKHN; quanto às soluções contendo apenas HMP, uma relação dose-resposta foi observada somente para ΔKHN. Em relação à %RDS, os grupos placebo e 0,5% HMP, e os grupos 0,75% e 1% HMP não apresentaram diferenças significativas entre si. Quando associado ao F, o HMP aumentou a capacidade de remineralização da superfície e subsuperfície dentinária, visto que os grupos contendo F + HMP apresentaram resultados significativamente melhores em relação aos grupos contendo F sozinho. Em acréscimo, a solução contendo 250 ppm F + 0,5% HMP promoveu um efeito remineralizador semelhante à solução contendo 500 ppm F. Já em relação à ∆KHN, diferenças estatísticas foram observadas entre todos os grupos na área tratada, sem diferenças significativas quanto às áreas controle e desmineralizada. Os resultados permitem concluir que a adição de HMP às soluções fluoretadas potencializou o efeito destas sobre a remineralização das lesões artificiais de cárie em dentina, tanto na superfície quanto em profundidade(AU)

The present study aimed to investigate the ability of solutions containing HMP and F, alone or in association, in promoting dentin remineralization in an in vitro protocol. Bovine root dentin blocks (4 × 6 cm, n = 100) were prepared, and caries-like lesions were induced in two thirds of the surface; each block served as its own control. Then, blocks were divided into 10 experimental groups (n = 10 / group), according to the solutions to be tested: (1) Placebo (without F or HMP); (2) 0.5% HMP; (3) 0.75% HMP; (4) 1% HMP; (5) 250 ppm F; (6) 500 ppm F; (7) 1100 ppm F; (8) 250 ppm F + 0.5% HMP; (9) 500 ppm F + 0.75% HMP and (10) 1100 ppm F + 1% HMP. Specimens were treated for one minute, twice a day with the respective solutions, and subjected to a pH-cycling regime for 7 days. Next, the percentage of the superficial hardness recovery (%SHR) and integrated loss of subsurface hardness (ΔKHN) were determined. Data were submitted to ANOVA and Fisher LSD's test (p<0.05). A dose-response relationship was observed between F concentrations in solutions without HMP and the variables %SHR and ΔKHN; as for the solutions containing HMP alone, a dose-response relationship was only observed for ΔKHN. Regarding %SHR, no significant differences were observed Placebo and 0.5% HMP groups, nor between 0.75% and 1% HMP groups. When associated with F, HMP was shown to increase the remineralizing capacity of the solutions both at the surface and the subsurface of dentin specimens, since the groups containing F + HMP showed significantly superior results compared to groups containing F alone. In addition, the solution containing 250 ppm F + 0.5% HMP promoted a remineralizing effect similar to that containing 500 ppm F. Regarding ∆KHN, significant differences were observed among all groups in the treated area, while no significant differences were observed among the groups in the control and demineralized areas. The results allowed the conclusion that the addition of HMP to fluoridated solutions significantly enhanced their remineralizing potential on dentin artificial caries lesions, both at the surface and in depth(AU)

Research progress in CPP-ACP combined with fluoride on enamel remineralization / 国际生物医学工程杂志

With the improvement of people's living standard and the strengthening of people's recognition of dental caries prevention and treatment, enamel remineralization has attracted extensive attention. Fluoride, bioactive glass and casein phosphopeptide-amorphic calcium phosphate (CPP-ACP) are the most widely studied remineralisation agents at present, which have a certain effect of promoting enamel remineralization. The results of different studies shown that the effect of CPP-ACP combined with fluoride was quite different, which may be affected by many factors. In this paper, the recent progress of the combined application of CPP-ACP and fluoride on enamel remineralization was reviewed, and various influencing factors were analyzed in order to provide references for future experimental design and clinical applications.

Effectiveness of Two Bioactive Restorative Materials in Dental Hard Tissues Remineralization as Indicated by Laser Fluorescence

Twenty extracted human sound premolars were selected and grouped into four groups and two class V cavity preparations, facial and lingual, were prepared at the cervical one-third of the crown of each tooth and extending into the root cementum to make a total of 40 cavities (n=10). The teeth were soaked in a demineralizing solution of pH 4.5 for 72 hours and a tooth surface conditioner was applied to remove remnants of the smear layer. Three laser fluorescence readings were recorded by DIAGNOdent pen for each cavity at enamel margin, dentin floor, and cementum margin. The groups were restored with four different restorative materials Cavit, temporary filling material (control), Ketac-Fil; a conventional glass-ionomer, and two bioactive restorative materials; Glass Carbomer and Biodentine. The restored teeth were stored in mineral water (37°C) for three weeks and brushed twice daily with Tooth Mousse toothpaste. The teeth were longitudinally cut into halves in the middle of the restorations and three DIAGNOdent pen readings were recorded at the same previous sites. Data were collected and statistically analyzed by one-way ANOVA and Tukey’s post-hoc-test at (p˂0.05). The results showed a significant increase in DIAGNOdent pen readings after soaking in the demineralizing solution in all tooth hard tissues, while a significant decrease was noted after the application of the restorations and storage in the three groups, other than control, indicating that both examined bioactive restorative materials were suitable for enhancing remineralization and subsequently arresting the three-tooth hard tissues carious lesions as the conventional glass-ionomer.

Effect of CPP-ACP on remineralization of artificial caries-like lesion: an in situ study

Abstract The purpose of this double-blind, randomized, crossover in situ study is to compare remineralization of preformed enamel lesions by casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP) and fluoride dentifrice products. During each of four 10-day experimental legs, 10 participants wore intraoral removable palatal acrylic appliances with four human enamel slabs with preformed lesions. A 0.03-mL treatment paste was dripped extraorally onto the enamel blocks once a day for 3 min. The four randomly allocated treatments were as follows: CO- Control: silica dentifrice without fluoride; MP: MI Paste; MPP: MI Paste Plus and FD: Fluoride dentifrice - 1100 ppm F as NaF). Knoop surface hardness (SH) test was performed in three stages (T0 - sound enamel, T1 - after preformed lesion, and T2 - after treatment) and the cross-sectional hardness (CSH) test was performed after treatment using a 50-gram Knoop load for 15 s. Knoop hardness number (KHN) was similar between treatments. %SHr was significantly higher in the MP, FD, and MPP when compared to CO group (Kruskal-Wallis and Mann-Whitney tests, p < 0.05). Harder enamel was found in MP (75 μm) and FD groups at 75 to 175 μm. Treatment with DF, MP, and MPP promoted an increase of 20.27%, 19.24%, and 14.71%, respectively, in Integral Hardness Change (ΔIHC) when compared to CO (p<0.05). Remineralizing agents (MP, MPP, and DF) were able to inhibit demineralization of human enamel subjected to high cariogenic challenge in situ. DF had the greatest preventive potential against the progression of carious lesions.

The use of a new calcium mesoporous silica nanoparticle versus calcium and/or fluoride products in reducing the progression of dental erosion

Abstract Objective There is increasingly common the consumption more times a day of foods and acidic drinks in the diet of the population. The present study aimed to evaluate and compare the effects of a calcium mesoporous silica nanoparticle single application of other calcium and/or fluoride products in reducing the progression of dental erosion. Methodology Half of the eroded area was covered of 60 blocks of enamel, after which the block was submitted to the following treatments: (Ca2+-MSN), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP); CPP-ACP/F-(900 ppm F−); titanium tetrafluoride (TiF4 1%) (positive control); sodium fluoride (NaF 1.36%) (positive control); and Milli-Q® water (negative control) before being submitted to a second erosive challenge. A surface analysis was performed via a three-dimensional (3D) noncontact optical profilometry to assess the volumetric roughness (Sa) and tooth structure loss (TSL) and and through scanning electron microscopy (MEV). An analysis of variance (ANOVA) and Tukey's test were performed. Results Regarding Sa, all experimental groups exhibited less roughness than the control (p<0.05). The TSL analysis revealed that the Ca2+-MSN and NaF groups were similar (p>0.05) and more effective in minimizing tooth loss compared with the other groups (p<0.05). Conclusions The Ca2+-MSN and NaF treatments were superior compared with the others and the negative control.

Experimental gel containing bioactive glass-ceramic to minimize the pulp damage caused by dental bleaching in rats

Abstract Objectives This study evaluated if the use of a bioactive glass-ceramic-based gel, named Biosilicate (BS), before, after or mixed with bleaching gel, could influence the inflammation of the dental pulp tissue of rats' molars undergoing dental bleaching with hydrogen peroxide (H2O2). Methodology The upper molars of Wistar rats (Rattus norvegicus, albinus) were divided into Ble: bleached (35% H2O2, 30-min); Ble-BS: bleached and followed by BS-based gel application (20 min); BS-Ble: BS-based gel application and then bleaching; BS/7d-Ble: BS-based gel applications for 7 days and then bleaching; Ble+BS: blend of H2O2 with BS-based gel (1:1, 30-min); and control: placebo gel. After 2 and 30 days (n=10), the rats were euthanized for histological evaluation. The Kruskal-Wallis and Dunn statistical tests were performed (P<0.05). Results At 2 days, the Ble and Ble-BS groups had significant alterations in the pulp tissue, with an area of necrosis. The groups with the application of BS-based gel before H2O2 had moderate inflammation and partial disorganization in the occlusal third of the coronary pulp and were significantly different from the Ble in the middle and cervical thirds (P<0.05). The most favorable results were observed in the Ble+BS, which was similar to the control in all thirds of the coronary pulp (P>0.05). At 30 days, the pulp tissue was organized and the bleached groups presented tertiary dentin deposition. The Ble group had the highest deposition of tertiary dentin, followed by the Ble-BS, and both were different from control (P<0.05). Conclusion A single BS-based gel application beforehand or BS-based gel blended with a bleaching gel minimize the pulp damage induced by dental bleaching.

The Use of Resinous Infiltrants for the Management of Incipient Carious Lesions: a Literature Review / Uso de Infiltrantes Resinosos para Tratamento de Lesões Cariosas Incipientes: uma Revisão da Literatura

The objective of this work was to analyze scientific evidence from a literature review pertaining to the effectiveness of resinous infiltrants for minimally invasive treatment of incipient carious lesions. Studies published between 2002 and 2019 were queried from the following databases: Capes, PubMed, Medline, BBO, Lilacs and SciELO. The search keywords included "Dental Caries", "Tooth Remineralization", "Dental Leakage". Most of the studies found resin-infiltrating treatment to be a viable option for the minimally invasive treatment of incipient carious lesions; this treatment was able to fulfill the primary expected effects: inhibition of carious progression and the lesions esthetic improvement. However, some issues need to be clarified to improve the safety of this treatment because it can be recommended in clinical practice. Inconclusion, the use of resinous infiltrants has been reported as promising for the treatment of incipient carious lesions. However, there is a need for long-term studies to confirm the effectiveness of this treatment to determine its applicability for clinical use. (AU)

O objetivo desse trabalho foi analisar evidências científicas, por meio de uma revisão de literatura, sobre a eficácia do uso de infiltrantes resinosos para o tratamento minimamente invasivo de lesões cariosas incipientes. A seleção do material literário utilizado foi realizada por pesquisa sobre o tema nas bases de dados: portal de periódicos Capes, PubMed, Medline, BBO, Lilacs e SciELO, abrangendo prioritariamente, o período de 2002 a 2019. Para busca nas bases de dados foram utilizadas palavras-chave como "Cárie Dentária", "Remineralização Dentária", "Infiltração Dentária", assim como suas correspondentes na língua inglesa. A maioria dos estudos encontrados aponta o tratamento infiltrante resinoso como uma opção viável para o tratamento minimamente invasivo de lesões cariosas incipien tes sendo capaz de cumprir os principais efeitos esperados: inibição da progressão cariosa e melhoria estética das lesões. Entretanto, alguns impasses necessitam ser esclarecidos para que o tratamento seja recomendado com mais segurança na prática clínica. Conclui-se que o uso de infiltrantes resinosos tem sido relatado como promissor para o tratamento de lesões cariosas incipientes, contudo há necessidade de novas pesquisas e estudos a longo prazo para confirmar sua eficácia em todos aspectos desejáveis para seu uso clínico. (AU)

Reparación de defecto localizado en restauración de amalgama como tratamiento de mínima intervención en cariología / Repair of a localized defect in a restoration with amalgam filling as minimal intervention treatment in cariology

Introducción: La reparación de restauraciones ha sido estudiada desde muy recientemente, pero a pesar de haber demostrado efectividad y mejoras en la terapéutica de la caries dental, aún tiene seguidores y detractores, lo que justifica la necesidad de estudios que sigan avalando tales prácticas. Objetivo: Describir, a través de la presentación de un caso, la reparación de un defecto localizado en una restauración de amalgama como tratamiento de mínima intervención en cariología. Presentación del caso: Paciente femenina de 16 años con antecedentes de salud acude a consulta refiriendo una pequeña fractura de restauración en diente 4.6 desde hace varias semanas. La regularización del defecto en la restauración, la mínima preparación cavitaria, la eliminación del fragmento de la base intermedia, la protección del complejo dentino-pulpar y el llenado de la cavidad resultante, fueron los primeros pasos de una técnica que se cumplimentó luego del pulido final de la interface tejido dentario-restauración y se evolucionó cinco años después. Se evidenció el estado y presencia de la reparación de la restauración realizada, sin fracturas añadidas, microfiltraciones, sintomatologías, desplazamientos ni pérdidas de la continuidad. Conclusiones: La reparación del defecto localizado de amalgama se realizó con el fin de preservar los tejidos dentarios no afectados como lo dicta la mínima intervención en cariología. Cinco años más tarde, la evolución evidencia una práctica que se tradujo en resultados satisfactorios e incremento de la calidad de vida de la paciente(AU)

Introduction: Restoration repair has been studied recently; but, even when it has demonstrated effectiveness and improvements in the therapy of dental caries, it still has followers and detractors that justify the need for studies that continue supporting such practices. Objective: To describe, through a case presentation, the repair of a defect located in a restoration with amalgam filling as minimal intervention treatment in cariology. Case presentation: Sixteen-year-old female patient with health history that went to the clinic reporting a small fracture of a restoration performed in tooth 4.6 several weeks ago. The regularization of the defect in the restoration, minimum cavity preparation, elimination of the fragment of the intermediate base, protection of the dentin-pulp complex, and filling of the resulting cavity were the first steps of a technique that was completed after the final polishing of the dental tissue/restoration interface that was evolved five years later. The status and presence of the restoration repair performed without added fractures, microfiltration, symptomatology, displacement or loss of continuity was evidenced. Conclusions: The repair of the localized defect in a restoration with amalgam filling was performed with the aim of preserving the unaffected dental tissues as dictated by minimal intervention in cariology. Five years later, the patient´s evolution shows a practice that resulted in satisfactory results and an increase in the patient's quality of life(AU)

Conceptos actualizados en cariología / Updated concepts in cariology

La ICCC (International Caries Consensus Cooperation) ­constituida por expertos de doce países de América del Norte y del Sur, Europa y Australasia­ se ha reunido en grupos de trabajo para producir documentos referidos a las definiciones y las terminologías de la caries dental, así como los abordajes actuales de su tratamiento. Recientemente, sus publicaciones fueron incluidas en un libro titulado Excavación de las caries. Evolución en el tratamiento de las lesiones de caries cavitadas. El presente trabajo tiene por objeto plantear y revisar los conceptos surgidos de esas publicaciones (AU)

Experts in cariology research from twelve countries covering North and South America, Europe and Australasia met at the International Caries Consensus Collaboration (ICCC), and published a series of papers related to modern caries definitions, terminology and current approaches for treating carious lesions. A book entitled Caries excavation. Evolution of treating cavitated caries lesions was recently published by this authors. The objetive of this paper is to communicate and review the concepts exposed in the mentioned documents (AU)

Comparative Evaluation of Remineralizing Potential of a Paste Containing Bioactive Glass and a Topical Cream Containing Casein Phosphopeptide-Amorphous Calcium Phosphate: An in Vitro Study

Objective: To evaluate and compare the remineralization potential of a dentifrice containing bioactive glass and a topical cream containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) in remineralizing artificial carious lesion on enamel. Material and Methods: Forty-five freshly extracted human permanent premolar teeth were selected. Samples were divided into three groups: GI - regular tooth paste without specific remineralizing agent; GII - tooth paste containing calcium sodium-phosphosilicate (novamin) and GIII - topical cream containing casein phosphopeptide-amorphous calcium phosphate. All the sound enamel samples were viewed under scanning electron microscope (SEM) to assess the topographical pictures of enamel surface and energy dispersing x-ray analysis (EDAX) was done to estimate quantitatively the amounts of mineral (calcium and phosphorous). The mineral content of calcium and phosphorus after demineralization in each group was noted. The samples were then subjected to SEM and EDAX. Results: GI does not show any increase in the calcium and phosphorus after applying toothpaste without any remineralizing agent but GII and GIII showed a net increase in calcium and phosphorous values after applying concern-remineralizing agents. Inter group comparison showed GIII yield higher net calcium and phosphorous values than GII. Conclusion: Two remineralizing agents showed remineralization potential on enamel surfaces. Casein phosphopeptide-amorphous calcium phosphate showed better remineralizing potential than calcium sodium phosphosilicate. Hence CPP-ACP can be considered as the material of choice in remineralizing early enamel carious lesions.

The Ability of Biodentine™ of Guided Tissue Remineralization (GTR): Analysis Using SEM, EDX and TEM

Objective: To analyze the Biodentine™ capability in guided tissue remineralization. Material and Methods: Four premolar with two cavities per tooth of 3 mm depth were demineralized with EDTA 17% in shaking incubator at 37°C temperature. After 7 days, the sample were washed with aquabidest then were soaked in 20 ml NaCl 1 M (pH 7.0) at 25°C temperature for 8 hours. The samples were divided into two groups: G1: The control group (cavity directly restored with composite resin); G2: Biodentine™ group (cavity with Biodentine™ as a base then restored with composite resin). All samples were stored in shaking incubator under PBS solution at 37°C temperature. SEM, EDX and TEM analysis were performed on the 7th and 14th day. Results: The 14th day Biodentine group had the best SEM remineralization feature with irregular dentine tubular features covered by density of mass. In the EDX analysis, the concentration of calcium ion of the Biodentine group was higher than the control group on the 7th day analysis (Biodentin™ 10.2167 and control 1.9667) and on the 14th day analysis (Biodentine™ 29.833 and Control 22.080). The Biodentine™ group and control group of the 7th and 14th day experienced significant increases in calcium ion concentration while the concentration of phosphate ion in the Biodentine™ and control group had a much lower value of calcium either on the 7th or 14th day. The TEM analysis of Biodentine™ group showed more intrafibrillar remineralization than the control group. The feature of intrafibrillar dentin remineralization is analyzed by looking at the density of black dots in collagen. Conclusion: Biodentine™ is able to trigger the process of remineralization by guided tissue remineralization.

The in vitro remineralizing effect of CPP-ACP and CPP-ACPF after 6 and 12 weeks on initial caries lesion

Abstract Objective: The aim of this in vitro study was to determine the effects of remineralization promoting agents containing casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP), or CPP-ACP in combination with fluoride (CPP-ACPF) on artificial white spot lesions (WSLs) after 6 and 12 weeks. Methodology: White spot lesions were created on 123 sectioned premolars (246 specimens) with a demineralization solution during a 96 hours pH-cycling regime. Two experimental groups were created: a CPP-ACP group (Tooth Mousse™), and a CPP-ACPF group (Mi Paste Plus™). Additionally, two control groups were created, one using only a conventional toothpaste (1450 ppm fluoride) and another one without any working agents. All teeth were also daily brushed with the conventional toothpaste except the second control group. Tooth Mousse™ and Mi Paste Plus™ were applied for 180 seconds every day. The volume of demineralization was measured with transverse microradiography. Six lesion characteristics regarding the lesion depth and mineral content of WSLs were also determined. Results: The application of CPP-ACP and CPP-ACPF had a significant regenerative effect on the WSLs. Compared to Control group 1 and 2 the volume of demineralization after 6 weeks decreased significantly for CPP-ACP (respectively p<0.001 and p<0.001) and CPP-ACPF (respectively p=0.001 and p=0.003). The same trend was observed after 12 weeks. For the CPP-ACPF group, WSL dimensions decreased significantly between 6 and 12 weeks follow-up (p=0.012). The lesion depth reduced significantly after application of CPP-ACP and CPP-ACPF but increased significantly in the Control groups. Mineral content increased for CPP-ACP and CPP-ACPF after an application period of 12 weeks, but this was only significant for CPP-ACP. Conclusions: Long-term use of CPP-ACP and CPP-ACPF in combination with a conventional tooth paste shows beneficial effects in the recovery of in vitro subsurface caries lesions.

Remineralizing effect of commercial fluoride varnishes on artificial enamel lesions

Abstract: The aim of this study was to evaluate soluble and insoluble fluoride concentrations in commercial varnishes, and their remineralization effect on artificial caries enamel lesions using surface and cross-sectional microhardness evaluations. Forty bovine enamel blocks were separated into four groups (n=10): control (no treatment), Enamelast (Ultradent Products), Duraphat (Colgate-Palmolive) and Clinpro White Varnish (3M ESPE). Surface enamel microhardness evaluations were obtained, artificial enamel caries lesions were developed by dynamic pH-cycling, and the varnishes were then applied every 6 days, after which the enamel blocks were submitted to dynamic remineralization by pH cycles. After removal of the varnishes, the enamel surfaces were reassessed for microhardness. The blocks were sectioned longitudinally, and cross-sectional microhardness measurements were performed at different surface depths (up to 300 μm depth). Polarized light microscopy images (PLMI) were made to analyze subsurface caries lesions. The fluoride concentration in whole (soluble and insoluble fluoride) and centrifuged (soluble fluoride) varnishes was determined using an extraction method with acetone. The data were analyzed to evaluate the surface microhardness, making adjustments for generalized linear models. There was a significant decrease in enamel surface microhardness after performing all the treatments (p<0.0001). Enamelast and Duraphat showed significantly higher enamel microhardness values than the control and the Clinpro groups (p = 0.0002). Microhardness loss percentage was significantly lower for Enamelast (p = 0.071; One-way ANOVA). PLMI showed that subsurface caries lesions were not remineralized with the varnish treatments. No significant differences in the in-depth microhardness levels (p = 0.7536; ANOVA) were observed among the treatments. Enamelast presented higher soluble and insoluble fluoride concentrations than the other varnishes (p < 0.0001; Kruskal-Wallis and Dunn tests). Enamelast and Duraphat varnishes promoted enamel surface remineralization, but no varnish remineralized the subsurface lesion body. Although insoluble and soluble fluoride concentration values did not correspond to those declared by the manufacturer, Enamelast presented higher fluoride concentration than the others.