Effects of toothpastes on white spot lesions around orthodontic brackets using quantitative light-induced fluorescence (QLF) : An in vitro study.

AIM: The aim of this study was to investigate the effects of toothpastes with different contents on the remineralization of white spot lesions around orthodontic brackets by quantitative light-induced fluorescence (QLF). MATERIALS AND METHODS: A total of 45 freshly extracted human mandibular first molars were selected. Artificial caries lesions were created on enamel surfaces using an acidified gel system for 7 days. Initial relative fluorescence loss was calculated as the pretreatment (baseline) fluorescence value by QLF device. Molar tubes were bonded using light-cured resin composite cement. The specimens were randomly divided into three experimental groups (n = 15). Different toothpastes were applied to demineralized enamel: (1) fluoride-containing toothpaste (Colgate Total®), (2) Novamin-containing toothpaste (Sensodyne® Repair and Protect), (3) probiotic-containing toothpaste (GD Probiotic Toothpaste®). After 2 weeks of treatment, fluorescence loss and lesion area were measured with QLF. To determine fluorescence changes, intergroup comparisons were performed with a multivariate analysis of variance, followed by Tukey's test at a probability value of p < 0.05. RESULTS: Significant differences were observed between initial and posttreatment QLF measurements of the demineralized enamel specimens treated with the various agents (p < 0.05). In all experimental groups, significant fluorescence radiance increase and decrease of the lesion area (p = 0.000) was found. CONCLUSION: Novamin-containing toothpaste provided more increase of fluorescence compared to fluoride- and probiotic-containing toothpastes.

Measuring the remineralization potential of different agents with quantitative light-induced fluorescence digital Biluminator.

BACKGROUND: The aim of this study was to investigate the effectiveness of different remineralization agents by quantitative light-induced fluorescence digital BiluminatorTM (QLF-D). METHODS: Artificial caries lesions were created, and the teeth were divided according to the tested materials: (i) distilled water, (ii) acidulated phosphate fluoride (APF), (iii) Curodont Repair (CR), (iv) ammonium hexafluorosilicate (SiF) and (v) ammonium hexafluorosilicate plus cetylpyridinium chloride (SiF + CPC). After treatment procedures, each of the samples was placed in artificial saliva. After demineralization and 1 and 4 weeks of remineralization procedures, fluorescence loss and lesion areas were measured with QLF-D. Data were statistically analyzed (α = 0.05). RESULTS:: The fluorescence values of the demineralized enamel specimens treated with the various agents differed significantly compared with pretreatment values for both 1 and 4 weeks (p<0.05). At 4 weeks, the highest fluorescence gain was calculated in the CR, APF and SiF groups compared with the control (p<0.05). CONCLUSIONS:: APF, SiF and CR groups yielded greater remineralization ability than SiF + CPC and control groups.

Spectrophotometric color analysis of maxillary permanent central incisors in a pediatric population: a preliminary study.

BACKGROUND: Although several studies have reported the color distribution of maxillary central incisors and the effects of age and gender, a reliable database of the color of newly erupted teeth with open apices and the effect of the root development stage on tooth color shades do not currently exist. AIM: The purpose of this in vivo study was to perform a spectrophotometric color analysis of maxillary permanent central incisors based on apical developmental stage, age, and gender groups. DESIGN: A total of 734 maxillary permanent central incisors from 367 children aged 7-18 years who have fully erupted, intact, unrestored, vital right and left maxillary central incisors were evaluated. The patients were divided into nine groups, according to the root development stage and age. Digital images were quantified by non-contact spectrophotometry to determine the tooth color. Each tooth's color shade and L*, a*, and b* values were recorded. The L*, a*, and b* values were analyzed statistically with a multivariate analysis of variance test, and the color shades were analyzed with chi-square tests at the α = 0.05 level. RESULTS: The most common general tooth shade, for both genders, was A2. A statistically significant difference was found between the 7- to 12-year-old and 13- to 18-year-old age groups in the general tooth shade and its L* value in the overall, cervical, middle, and incisal sites (P < 0.05). CONCLUSION: There is a strong relationship between the apical developmental stages of the teeth and the L* values.

Evaluation of the remineralization capacity of CPP-ACP containing fluoride varnish by different quantitative methods.

OBJECTIVE: The aim of this study was to evaluate the efficacy of CPP-ACP containing fluoride varnish for remineralizing white spot lesions (WSLs) with four different quantitative methods. MATERIAL AND METHODS: Four windows (3x3 mm) were created on the enamel surfaces of bovine incisor teeth. A control window was covered with nail varnish, and WSLs were created on the other windows (after demineralization, first week and fourth week) in acidified gel system. The test material (MI Varnish) was applied on the demineralized areas, and the treated enamel samples were stored in artificial saliva. At the fourth week, the enamel surfaces were tested by surface microhardness (SMH), quantitative light-induced fluorescence-digital (QLF-D), energy-dispersive spectroscopy (EDS) and laser fluorescence (LF pen). The data were statistically analyzed (α=0.05). RESULTS: While the LF pen measurements showed significant differences at baseline, after demineralization, and after the one-week remineralization period (p<0.05), the difference between the 1- and 4-week was not significant (p>0.05). With regards to the SMH and QLF-D analyses, statistically significant differences were found among all the phases (p<0.05). After the 1- and 4-week treatment periods, the calcium (Ca) and phosphate (P) concentrations and Ca/P ratio were higher compared to those of the demineralization surfaces (p<0.05). CONCLUSION: CPP-ACP containing fluoride varnish provides remineralization of WSLs after a single application and seems suitable for clinical use.

Evaluation of the remineralization capacity of CPP-ACP containing fluoride varnish by different quantitative methods

ABSTRACT Objective The aim of this study was to evaluate the efficacy of CPP-ACP containing fluoride varnish for remineralizing white spot lesions (WSLs) with four different quantitative methods. Material and Methods Four windows (3x3 mm) were created on the enamel surfaces of bovine incisor teeth. A control window was covered with nail varnish, and WSLs were created on the other windows (after demineralization, first week and fourth week) in acidified gel system. The test material (MI Varnish) was applied on the demineralized areas, and the treated enamel samples were stored in artificial saliva. At the fourth week, the enamel surfaces were tested by surface microhardness (SMH), quantitative light-induced fluorescence-digital (QLF-D), energy-dispersive spectroscopy (EDS) and laser fluorescence (LF pen). The data were statistically analyzed (α=0.05). Results While the LF pen measurements showed significant differences at baseline, after demineralization, and after the one-week remineralization period (p<0.05), the difference between the 1- and 4-week was not significant (p>0.05). With regards to the SMH and QLF-D analyses, statistically significant differences were found among all the phases (p<0.05). After the 1- and 4-week treatment periods, the calcium (Ca) and phosphate (P) concentrations and Ca/P ratio were higher compared to those of the demineralization surfaces (p<0.05). Conclusion CPP-ACP containing fluoride varnish provides remineralization of WSLs after a single application and seems suitable for clinical use.

Effect of silver diamine fluoride and ammonium hexafluorosilicate applications with and without Er:YAG laser irradiation on the microtensile bond strength in sound and caries-affected dentin.

BACKGROUND AND OBJECTIVE: Cariostatic and preventive agents are applied to create caries-resistant dentin surfaces and may affect subsequent resin bonding. The aim of this study was to investigate the effect of different agents with and without Er:YAG laser irradiation on the microtensile bond strength (µTBS) of resin composite to sound dentin (SD) and caries-affected dentin (CAD), and to assess the morphological and chemical changes in the specimens. MATERIALS AND METHODS: Ninety-six extracted molar teeth were divided into a control group (deionized water) and two experimental groups (ammonium hexafluorosilicate [SiF], silver diamine fluoride [SDF]), that subdivided according to different conditions (SD, CAD, SD+laser irradiation, CAD+laser irradiation). After treatment procedures, the teeth were restored and the µTBS was tested with a universal testing machine. Morover, 144 teeth were prepared and after treatment modalities; morphological changes of the surface were investigated and elemental analyses were performed using scanning electron microscope/energy dispersive spectroscopy (SEM-EDS). The data were analyzed using Kruskal-Wallis and Mann-Whitney U tests. RESULTS: SDF and SiF applications reduced the µTBS values in both the SD and CAD subgroups (P < 0.05). Laser irradiation increased the µTBS values in the SiF group and the values were adversely affected in the SDF group (P < 0.05). Fluoride content of the specimens increased in all of the treatment groups, compared with the control group. Silver content was detected only in the SDF group, and silicon was detected only in the SiF group. CONCLUSIONS: The µTBS values of resin composite, surface morphology and chemical characteristics of dentin were affected by the material type, dentin condition and laser irradiation and the use of SiF and SDF solutions under the resin restorations do not seem appropriate.

Effects of Remineralization Agents on Artificial Carious Lesions.

PURPOSE: The purpose of this study was to evaluate the remineralization potentials of different agents on demineralized enamel surfaces. METHODS: Four hundred and sixty extracted human molars with artificial carious lesions were divided into six groups: (1) control; (2) acidulated phosphate fluoride (APF); (3) Curodont Repair (CR); (4) silver diamine fluoride (SDF); (5) ammonium hexafluorosilicate (SiF); and (6) SiF plus cetylpiridinium chloride (SiF+CPC). They were subdivided according to immersion periods (seven out of 30 days). After demineralization and remineralization procedures, microhardness test (VHN), energy-dispersive X-ray spectroscopy analysis, and confocal laser scanning microscopy evaluation were performed. The data were statistically analyzed. RESULTS: By the 30-day remineralization, the mean differences in VHN values were ranked as follows, in order: (1) CR; (2) APF; (3) SiF; (4) SiF+CPC; (5) SDF; and (6) control (P<0.05). The calcium (Ca) content and calcium/phosphate ratio for all groups were significantly higher after 30 days (P<0.05). The greatest lesion depth changes were observed in the CR, APF, SiF, and SDF groups (P<0.05), while the greatest fluorescence changes were observed in the APF, SiF, and CR groups (P<0.05). CONCLUSIONS: The remineralization was most successful in the CR, APF, and SiF groups, with higher values than for those of the other treatments.

Effects of different antibacterial agents on enamel in a biofilm caries model.

Using a mature biofilm model, the aim of this study was to evaluate the effectiveness of different antibacterial agents in comparison with silver diamine fluoride (SDF). Forty-eight saliva-coated enamel slabs were inoculated with Streptococcus mutans monospecies biofilm. The biofilms were then exposed to 10% sucrose in tryptone yeast-extract culture medium, 8 times per day for 7 days. After the biofilm growth period, the enamel slabs were treated with one of the following substances: 1) distilled water; 2) SDF; 3) acidulated phosphate fluoride (APF); 4) ammonium hexafluorosilicate (AHF); 5) ammonium hexafluorosilicate + cetylpyridinium chloride (AHF+CPC); or 6) 0.2% chlorhexidine (CHX). After these treatment procedures, the samples were incubated at 37ºC for 2 days, and the numbers of viable microorganisms in the biofilms were counted. The number of viable bacteria was significantly reduced by all of the antibacterial agents (P < 0.05). However, SDF showed the highest antibacterial activity (P < 0.05), and the effectiveness of the other agents was lower (P < 0.05). SDF has a highly effective antibacterial action against cariogenic Streptococcus mutans biofilm; none of the other fluoride agents used in this study, or 0.2 CHX agent, showed an antibacterial effect comparable to that of SDF.

Evaluation of Different Fissure Sealant Materials and Flowable Composites Used as Pit-and-fissure Sealants: A 24-Month Clinical Trial.

PURPOSE: The effectiveness of resin-based pit-and-fissure sealants mainly depends on their retention and integrity over time. The purpose of this study was to evaluate retention rates of two different pit-and-fissure sealants compared with a flowable composite and a self-adhesive flowable composite over a 24 month period. METHODS: A split-mouth study design was used for all four permanent first molars of each patient. They were subjected to different kinds of sealants--either flowable composites or with fissure sealants. The flowable composites used were: flowable composite with an adhesive system (Tetric EvoFlow); and a self-adhesive flowable composite (Vertise Flow). The fissure sealants used were: a highly filled pit-and-fissure sealant (Fissurit FX); and a highly filled nano-hybrid pit-and-fissure sealant (Grandio Seal). Evaluation of the sealants was carried out at three-, six-, 12-, 18-, and 24-month follow-up visits. RESULTS: The complete retention rates were 95.7 percent for Tetric EvoFlow, 80.6 percent for Fissurit FX, 73.1 percent for Grandio Seal, and 62.9 percent for Vertise Flow. The retention rate of Tetric EvoFlow was significantly higher among all materials tested (P<0.05). CONCLUSION: The flowable composite used with an adhesive system was found to be superior to other sealing materials.

Effects of pulp capping materials on fracture resistance of Class II composite restorations.

OBJECTIVE: The aim of this study was to investigate the effect of cavity design and the type of pulp capping materials on the fracture resistance of Class II composite restorations. MATERIALS AND METHODS: Sixty freshly extracted, sound molar teeth were selected for the study. A dovetail cavity on the mesio-occlusal and a slot cavity on disto-occlusal surfaces of each tooth were prepared, and the teeth were divided 4 groups which one of them as a control group. The pulp capping materials (TheraCal LC, Calcimol LC, Dycal) applied on pulpo-axial wall of each cavity, and the restoration was completed with composite resin. The teeth were subjected to a compressive load in a universal mechanical testing machine. The surfaces of the tooth and restoration were examined under a stereomicroscope. The data were analyzed using factorial analysis of variance and Tukey's test. RESULTS: For pulp capping materials, the highest fracture load (931.15 ± 203.81 N) and the lowest fracture load (832.28 ± 245.75 N) were calculated for Control and Dycal group, respectively. However, there were no statistically significant differences among all groups (P > 0.05). The fracture load of the dovetail groups was significantly higher than those of the slot cavity groups (P < 0.05). CONCLUSION: Dovetail cavity design shows better fracture resistance in Class II composite restorations, independent of used or not used pulp capping materials.

Periostitis ossificans managed with endodontic treatment.

Periostitis ossificans (PO) is a specific type of chronic osteomyelitis. Radiographically, it is characterized by the presence of lamellae of newly formed periosteal bone outside the cortex, giving the characteristic appearance of "onion skin." The most common cause of PO is periapical infection of the mandibular permanent first molar, which occurs primarily in children and young adults. Treatment in these cases is directed toward eliminating the source of the infection, either by extraction of the offending tooth or endodontic therapy. The purpose of this paper is to present a case of PO involving a permanent mandibular first molar managed with endodontic treatment.

Delayed replantation of avulsed teeth: two case reports.

This case report presents two cases of delayed replantation of avulsed maxillary central incisors after an extended dry extra-alveolar period. Eight-year-old boy and 10-year-old boy presented with avulsed maxillary central incisors due to trauma occurring 27 and 7 hours earlier, respectively. Treatment guidelines for avulsed mature/immature permanent teeth with prolonged extra-oral time were carried out for the teeth and the extra-oral endodontic treatment was completed. After having been repositioned, the teeth were stabilized for 4 weeks and prophylactic antibiotic was prescribed. Clinical and radiographic controls were done after 18 months for Case I and 12 months for Case II. During the follow-up periods the teeth reported in these cases have remained in a stable, functional position but revealed clinical initial replacement resorption and ankylosis.

Genetic background of supernumerary teeth.

Supernumerary teeth (ST) are odontostomatologic anomaly characterized by as the existence excessive number of teeth in relation to the normal dental formula. This condition is commonly seen with several congenital genetic disorders such as Gardner's syndrome, cleidocranial dysostosis and cleft lip and palate. Less common syndromes that are associated with ST are; Fabry Disease, Ellis-van Creveld syndrome, Nance-Horan syndrome, Rubinstein-Taybi Syndrome and Trico-Rhino-Phalangeal syndrome. ST can be an important component of a distinctive disorder and an important clue for early diagnosis. Certainly early detecting the abnormalities gives us to make correct management of the patient and also it is important for making well-informed decisions about long-term medical care and treatment. In this review, the genetic syndromes that are related with ST were discussed.

Evaluation of Apically Extruded Debris and Irrigant Produced by Different Nickel-Titanium Instrument Systems in Primary Teeth.

AIM: The purpose of this study was to determine the amount of extruded debris and irrigant associated with different single-file systems and one multiple-file system. MATERIALS AND METHODS: Forty-five newly extracted single rooted primary canine teeth were used in this study. The root canals were instrumented using the reciprocating single-file system, the single-file rotary system and the multiple-file rotary system. A 10(-6) precision micro-balance was used to calculate the amount of extruded debris and irrigant. The incubation period was set as 15 days at 37°C to obtain dry debris. The preparation time for instrumentation was also recorded. The data were statistically analyzed by Manova and Bonferroni adjustment. RESULTS: Considering the apically extruded debris, while there was statistically significant difference between Reciproc and OneShape groups (p < 0.05), no statistically significant difference was found among the other groups (p > 0.05). In terms of irrigation solution, although significant difference was obtained between the Reciproc and other two groups (p < 0.05), no statistically significant difference was obtained between the two rotary instruments (p > 0.05). Instrumentation was significantly faster using Reciproc than with all other instrument (p < 0.05). CONCLUSION: All systems caused apical debris and irrigant extrusion. Full-sequences rotary instrumentation systems may be preferable for preparation primary teeth. CLINICAL SIGNIFICANCE: This is the first study carrying out to compare both apical debris and irrigation solution extrusion with reciprocal and rotary single-file systems with other preparation systems in primary teeth.

Assessment of apically extruded debris and irrigant produced by different nickel-titanium instrument systems.

The aim of this study was to evaluate the preparation time and the amounts of apically extruded debris and irrigant using different nickel-titanium instrumentation systems. Forty-five extracted single-rooted mandibular premolar teeth were selected and divided into three groups. The root canals were instrumented according to the manufacturers' instructions, using a reciprocating single-file system, a single-file rotary system and a multiple-file rotary system. Bidistilled water was used as the irrigant solution. The apically extruded debris and irrigant were collected into preweighed Eppendorf tubes. The amounts of extruded debris and irrigant were assessed with a precision micro-balance. The Eppendorf tubes were incubated at 37°C for 15 days. After the incubation period, they were weighed again to assess the debris extrusion. The time required to prepare the canals was also recorded. The results were statistically analyzed using MANOVA and Bonferroni's adjustment. Considering the apically extruded debris and irrigant, there were no statistically significant differences among the groups (p > 0.05). The Reciproc group produced the highest debris (0.000632 ± 0.000162 gr) and irrigant (0.844587 ± 0.437814 ml) extrusion values. While the least extruded debris was observed with OneShape (0,000431 ± 0,000171 gr), the least extruded irrigant was observed with ProTaper system (0.564147 ± 0.370596 ml). Instrumentation was faster using the Reciproc than the other two instruments (70.27 ± 13.38 s) (p < 0.05). All of the instrumentation systems used in this study produced apical debris and irrigant extrusion. The reciprocating single-file system tended to produce more debris and irrigant extrusion, compared with the rotary systems. Considering the preparation time, the single-file systems appeared to be advantageous due to their working time.

Evaluation of temperature changes in the pulp chamber during polymerization of light-cured pulp-capping materials by using a VALO LED light curing unit at different curing distances.

The aim of this study was to evaluate temperature changes in the pulp chamber during polymerization of four different pulp-capping materials using a LED-light-curing-unit in the contact and noncontact positions. A pulpal circulation mechanism was simulated to measure increases in temperature in four pulp-capping materials that were applied to the occlusal dentin surface. Two different distances were used between the tip of the unit and the material surface during polymerization; 0 and 2 mm. The data were statistically analyzed using factorial-ANOVA, one-way-ANOVA, and Tukey's HSD test. There were statistically differences between contact and noncontact groups (p<0.05). Contact groups produced significantly lower temperature rise compared with noncontact groups. The highest and lowest mean temperature increases were calculated for the Biner LC and the TheraCal LC, respectively. Considering the effects of temperature rising, the distance of the light curing units from restorations should not be overlooked as well as the types of the materials.

A comparative study of different radiographic methods for detecting occlusal caries lesions.

OBJECTIVES: The aim of this in vitro study was to compare the diagnostic accuracy of different radiographic imaging modalities in detecting occlusal caries lesions. MATERIALS AND METHODS: Under standardized conditions, 125 extracted human permanent molar teeth with sound or occlusal caries lesions were radiographed using a conventional film system (F-speed), a direct digital imaging system (complementary metal oxide semiconductor sensor), an indirect digital imaging system (photostimulable phosphor plate) and a cone beam computed tomography system (CBCT). Two observers scored the resultant images for the presence or absence of caries. Then, the teeth were histologically prepared and a definite diagnosis was determined by stereomicroscopic assessment. The area under the receiver operating characteristic curve (Az), sensitivity, specificity and accuracy of each imaging modality were calculated, as well as the intra- and interexaminer reproducibility. RESULTS: For both thresholds, interexaminer agreement were higher for CBCT. For intraexaminer agreement, observers had different scores for both thresholds, but the scores were generally higher for CBCT. Similar Az values were achieved with all imaging methods at a diagnostic D1 threshold. The Az values of the CBCT system were found to be statistically higher than those of the other imaging modalities at a diagnostic D3 threshold (p > 0.05); no significant differences were found among the other imaging modalities. All radiographic methods showed similar sensitivities, specificities and accuracy in detecting D1 threshold. The CBCT system showed higher sensitivity and accuracy in detecting dentine lesions. CONCLUSIONS: Within the limitations of this study, CBCT exhibited better performance in detecting deep occlusal caries lesions than the other radiographic systems.

Assessment of apically extruded debris and irrigant produced by different nickel-titanium instrument systems

The aim of this study was to evaluate the preparation time and the amounts of apically extruded debris and irrigant using different nickel-titanium instrumentation systems. Forty-five extracted single-rooted mandibular premolar teeth were selected and divided into three groups. The root canals were instrumented according to the manufacturers’ instructions, using a reciprocating single-file system, a single-file rotary system and a multiple-file rotary system. Bidistilled water was used as the irrigant solution. The apically extruded debris and irrigant were collected into preweighed Eppendorf tubes. The amounts of extruded debris and irrigant were assessed with a precision micro-balance. The Eppendorf tubes were incubated at 37°C for 15 days. After the incubation period, they were weighed again to assess the debris extrusion. The time required to prepare the canals was also recorded. The results were statistically analyzed using MANOVA and Bonferroni’s adjustment. Considering the apically extruded debris and irrigant, there were no statistically significant differences among the groups (p > 0.05). The Reciproc group produced the highest debris (0.000632 ± 0.000162 gr) and irrigant (0.844587 ± 0.437814 ml) extrusion values. While the least extruded debris was observed with OneShape (0,000431 ± 0,000171 gr), the least extruded irrigant was observed with ProTaper system (0.564147 ± 0.370596 ml). Instrumentation was faster using the Reciproc than the other two instruments (70.27 ± 13.38 s) (p < 0.05). All of the instrumentation systems used in this study produced apical debris and irrigant extrusion. The reciprocating single-file system tended to produce more debris and irrigant extrusion, compared with the rotary systems. Considering the preparation time, the single-file systems appeared to be advantageous due to their working time.