Nanotechnology and its role in caries therapy.

The purpose of this review is to highlight recent nanotechnological developments for remineralization of incipient caries lesions as well as biomimetic strategies for enamel synthesis based on the application of nanotechnology. Analysis of in vitro data indicates that apatite nanoparticles might be effective in reversing lesion progression in the outer but not in the deeper part of early caries lesions. To control caries-induced demineralization, investigators have developed calcium and phosphate or fluoride ion-releasing nanofillers, enabling resin composites to release ions, if the pH decreases under in vitro conditions. Extensive in vitro investigations of apatite crystallization have been performed to mimic the hierarchical topology of natural enamel. Strategies for formation of highly organized biomineralized structures include oriented aggregation of nanocrystallites or the assembly of apatite nanoparticles mediated by organic scaffolds. Despite all these promising in vitro experiments, the effectiveness of such strategies for the control of demineralization processes as well as for caries therapy still needs validation by clinical studies.

Latest developments in non-fluoridated remineralizing technologies.

The goal of modern dentistry is to manage non-cavitated carious lesions non-invasively through remineralization in an attempt to prevent disease progression, and to improve strength, esthetics, and function of teeth. The emphasis currently is being given to new technologies for enamel remineralization which suggest the changes in the understanding of dental caries. The aim of this paper is to review the contemporary non-fluoridated systems available for remineralization therapy and ideas for their implementation into clinical practice. A search of articles from "Pubmed" and "Medline" with the keywords Remineralization-demineralization, Casein derivatives, Non-fluoridated remineralizing agents was conducted. A total of 526 abstracts were collected, out of which 172 articles that discussed current technologies of non-fluoridated remineralizing agents were read and 33 most relevant articles were included in this paper. Casein phosphopeptide based technology has been established as a strong non-fluoridated remineralizing agent fulfilling all the criteria of an ideal remineralizing material.

What is different in operative dentistry?

There have been both large and small changes in operative dentistry in the last 30 years. Extension for prevention is no longer the mantra. The design features of amalgam preparations have moved into the smallest preparations possible to gain full access to the carious dentin. The default Class 2 amalgam or resin composite is a slot preparation with no preparation of the occlusal fissures. Class 1 fissure caries once implied the entire fissure system was to be cut out. Now only the known carious portions of the fissure are cut away, the tooth is restored, and the remaining fissures in that tooth are sealed. Resin composite preparations have no depth requirements and saucer shaped boxes are more favorable for lowering shrinkage strains on the bonded walls. Re-mineralization of proximal lesions that can be seen on a radiograph is now a proven successful service for many lesions that are at or just into the dentin by radiographic interpretation. The largest paradigm shift has been in the decision that in vital teeth with normal pulps soft dentin can be left over a vital asymptomatic pulp with every expectation that the direct restoration will be successful long term.