Chemical & Nano-mechanical Study of Artificial Human Enamel Subsurface Lesions.

White lesions represent an early phase of caries formation. 20 human sound premolars were subjected to pH cycling procedure to induce subsurface lesions (SLs) in vitro. In addition, 2 teeth with naturally developed white spot lesions (WSLs) were used as references. All specimens characterized by confocal Raman microscopy being used for the first time in examining white & subsurface lesions and providing a high resolution chemical and morphological map based on phosphate peak intensity alterations at 960 cm-1. Nanoindentation technique was used to measure Hardness (H) and Young's modulus (E) of enamel. Phosphate map of examined samples exhibited presence of intact surface layer (ISL) followed by severe depletion in (PO43-) peak in the area corresponding to the body of the lesion. In all examined groups, the mechanical properties of enamel were decreased in lesion area and found to be inversely related to penetration depth of indenter owing to enamel hierarchical structure. By combining the above two techniques, we linked mechanical properties of enamel to its chemical composition and ensured that the two methods are highly sensitive to detect small changes in enamel composition. Further work is required to bring these two excellent tools to clinical application to perceive carious lesions at an early stage of development.

Performance of a recent light fluorescence device for detection of occlusal carious lesions in children and adolescents.

AIM: To assess the validity and reliability of a recent light fluorescence device, Soprolife® (Sopro-Acteon group) in detecting occlusal caries in children and adolescents and to compare its diagnostic performance with DIAGNOPen® (Kavo). METHODS: A multi-centre study was carried out to validate Soprolife® in 103 children, aged from 5-15 years, on 310 primary and 433 permanent posterior teeth. The sensitivity (SE), specificity (SP) and the area under the Receiver Operating Characteristic (ROC) curve (AUC) were evaluated using visual International Caries Detection and Assessment System (ICDAS) and radiographic examinations as the gold standards. The performance of the Soprolife® was compared with that of the DIAGNOPen® on the same teeth. The reproducibility was assessed using weighted Kappa coefficient. RESULTS: When all carious lesions using ICDAS 1-6 were considered, SE, SP and AUC for the Soprolife® were 88.50, 70.73 and 0.84 respectively. The validity was significantly higher for primary teeth (AUC = 0.90) than for permanent teeth (0.80); the validity of the Soprolife® (0.84) was significantly higher than that of DIAGNOPen® (0.80). The inter- and intra-examiner kappa coefficients were 0.87 and 0.85 respectively. CONCLUSION: The Soprolife® was a valid instrument providing reproducible results, particularly for primary teeth.

Laboratory Studies of Nonlinear Optical Signals for Caries Detection.

Multiphoton confocal microscopy and nonlinear spectroscopy are used to investigate the caries process in dentin. Although dentin is a major calcified tissue of the teeth, its organic phase comprises type I collagen fibers. Caries drive dentin demineralization and collagen denaturation. Multiphoton microscopy is a powerful imaging technique: the biological materials are transparent to infrared frequencies and can be excited to penetration depths inaccessible to 1-photon confocal microscopy. The laser excitation greatly reduces photodamage to the sole focal region, and the signal-to-noise ratio is improved significantly. The method has been used to follow pathologic processes involving collagen fibrosis or collagen destruction based on their 2-photon excited fluorescence (2PEF) emission and second harmonic generation (SHG). Combining multiphoton imaging with nonlinear spectroscopy, we demonstrate that both 2PEF and SHG intensity of human dentin are strongly modified during the tooth caries process, and we show that the ratio between SHG and 2PEF signals is a reliable parameter to follow dental caries. The ratio of the SHG/2PEF signals measured by nonlinear optical spectroscopy provides valuable information on the caries process, specifically on the degradation of the organic matrix of dentin. The goal is to bring these nonlinear optical signals to clinical application for caries diagnosis.

A preliminary study of a new endodontic irrigation system: Clean Jet Endo.

The purpose of the present study was to assess the irrigant penetration and cleaning ability of a new irrigation system, the Clean Jet Endo (Produits Dentaires SA, Switzerland) in comparison to conventional irrigation followed or not by sonic activation. Irrigant penetration was evaluated on resin blocks simulators by measuring the methylene blue absorbance thanks to a UV/visible spectrophotometer and cleaning ability was assessed in an ex vivo experiment according to the debris score in an artificial canal extension before and after the final irrigation protocol. A statistical analysis was carried out in order to highlight the significant differences between the irrigation techniques. Clean Jet Endo permitted to better eliminate the methylene blue into the simulated canals. A significant difference between the 2 techniques was observed in the middle third (p = 0.005) as well as in the apical third (p < 0.2). An additional microscope observation (16X) confirmed that Clean Jet Endo@ usage led to a better penetration of irrigant within the lateral canals of the simulators. Likewise, this irrigating system permitted to better eliminate the debris in the lateral groove than the other techniques. In conclusion, our findings implied the potential of this new irrigation system to enhance root canal debridement and disinfection.

Dental caries and enamelin haplotype.

In the literature, the enamelin gene ENAM has been repeatedly designated as a possible candidate for caries susceptibility. Here, we checked whether ENAM variants could increase caries susceptibility. To this aim, we sequenced coding exons and exon-intron boundaries of ENAM in 250 children with a severe caries phenotype and in 149 caries-free patients from 9 French hospital groups. In total, 23 single-nucleotide polymorphisms (SNPs) were found, but none appeared to be responsible for a direct change of ENAM function. Six SNPs had a high minor allele frequency (MAF) and 6 others were identified for the first time. Statistical and evolutionary analyses showed that none of these SNPs was associated with caries susceptibility or caries protection when studied separately and challenged with environmental factors. However, haplotype interaction analysis showed that the presence, in a same variant, of 2 exonic SNPs (rs7671281 and rs3796704; MAF 0.12 and 0.10, respectively), both changing an amino acid in the protein region encoded by exon 10 (p.I648T and p.R763Q, respectively), increased caries susceptibility 2.66-fold independent of the environmental risk factors. These findings support ENAM as a gene candidate for caries susceptibility in the studied population.

Use of new minimum intervention dentistry technologies in caries management.

Preservation of natural tooth structure requires early detection of the carious lesion and is associated with comprehensive patient dental care. Processes aiming to detect carious lesions in the initial stage with optimum efficiency employ a variety of technologies such as magnifying loupes, transillumination, light and laser fluorescence (QLF® and DIAGNOdent® ) and autofluorescence (Soprolife® and VistaCam®), electric current/impedance (CarieScan(®) ), tomographic imaging and image processing. Most fluorescent caries detection tools can discriminate between healthy and carious dental tissue, demonstrating different levels of sensitivity and specificity. Based on the fluorescence principle, an LED camera (Soprolife® ) was developed (Sopro-Acteon, La Ciotat, France) which combined magnification, fluorescence, picture acquisition and an innovative therapeutic concept called light-induced fluorescence evaluator for diagnosis and treatment (LIFEDT). This article is rounded off by a Soprolife® illustration about minimally or even non-invasive dental techniques, distinguishing those that preserve or reinforce the enamel and enamel-dentine structures without any preparation (MIT1- minimally invasive therapy 1) from those that require minimum preparation of the dental tissues (MIT2 - minimally invasive therapy 2) using several clinical cases as examples. MIT1 encompasses all the dental techniques aimed at disinfection, remineralizing, reversing and sealing the caries process and MIT2 involves a series of specific tools, including microburs, air abrasion devices, sonic and ultrasonic inserts and photo-activated disinfection to achieve minimal preparation of the tooth. With respect to minimally invasive treatment and prevention, the use of lasers is discussed. Furthermore, while most practices operate under a surgical model, Caries Management by Risk Assessment (CaMBRA) encourages a medical model of disease prevention and management to control the manifestation of the disease, or keep the oral environment in a state of balance between pathological and preventive factors. Early detection and diagnosis and prediction of lesion activity are of great interest and may change traditional operative procedures substantially. Fluorescence tools with high levels of magnification and observational capacity should guide clinicians towards a more preventive and minimally invasive treatment strategy.

Factors affecting the viscosity of sodium hypochlorite and their effect on irrigant flow.

AIM: To assess the influence of concentration, temperature and surfactant addition to a sodium hypochlorite solution on its dynamic viscosity and to calculate the corresponding Reynolds number to determine the corresponding flow regimen. METHODOLOGY: The dynamic viscosity of the irrigant was assessed using a rotational viscometer. Sodium hypochlorite with concentrations ranging from 0.6% to 9.6% was tested at 37 and 22 °C. A wide range of concentrations of three different surfactants was mixed in 2.4% sodium hypochlorite for viscosity measurements. The Reynolds number was calculated under each condition. Data were analysed using two-way anova. RESULTS: There was a significant influence of sodium hypochlorite concentration (P < 0.001) and temperature (P < 0.001) on dynamic viscosity: the latter significantly increased with sodium hypochlorite concentration and decreased with temperature. A significant influence of surfactant concentration on dynamic viscosity (P < 0.001) occurred, especially for high surfactant concentrations: 6.25% for benzalkonium chloride, 15% for Tween 80 and 6.25% for Triton X-100. Reynolds number values calculated for a given flow rate (0.14 mL s(-1)), and root canal diameter (sizes 45 and 70) clearly qualified the irrigant flow regimen as laminar. CONCLUSIONS: Dynamic viscosity increased with sodium hypochlorite and surfactant concentration but decreased with temperature. Under clinical conditions, all viscosities measured led to laminar flow. The transition between laminar and turbulent flow may be reached by modifying different parameters at the same time: increasing flow rate and temperature whilst decreasing irrigant viscosity by adding surfactants with a high value of critical micellar concentration.

Common SNPs of AmelogeninX (AMELX) and dental caries susceptibility.

Genetic approaches have shown that several genes could modify caries susceptibility; AmelogeninX (AMELX) has been repeatedly designated. Here, we hypothesized that AMELX mutations resulting in discrete changes of enamel microstructure may be found in children with a severe caries phenotype. In parallel, possible AMELX mutations that could explain resistance to caries may be found in caries-free patients. In this study, coding exons of AMELX and exon-intron boundaries were sequenced in 399 individuals with extensive caries (250) or caries-free (149) individuals from nine French hospital groups. No mutation responsible for a direct change of amelogenin function was identified. Seven single-nucleotide polymorphisms (SNPs) were found, 3 presenting a high allele frequency, and 1 being detected for the first time. Three SNPs were located in coding regions, 2 of them being non-synonymous. Both evolutionary and statistical analyses showed that none of these SNPs was associated with caries susceptibility, suggesting that AMELX is not a gene candidate in our studied population.

Quantitative evaluation by glucose diffusion of microleakage in aged calcium silicate-based open-sandwich restorations.

This study compared the in vitro marginal integrity of open-sandwich restorations based on aged calcium silicate cement versus resin-modified glass ionomer cement. Class II cavities were prepared on 30 extracted human third molars. These teeth were randomly assigned to two groups (n = 10) to compare a new hydraulic calcium silicate cement designed for restorative dentistry (Biodentine, Septodont, Saint Maur des Fossés, France) with a resin-modified glass ionomer cement (Ionolux, Voco, Cuxhaven, Germany) in open-sandwich restorations covered with a light-cured composite. Positive (n = 5) and negative (n = 5) controls were included. The teeth simultaneously underwent thermocycling and mechanocycling using a fatigue cycling machine (1,440 cycles, 5-55°C; 86,400 cycles, 50 N/cm(2)). The specimens were then stored in phosphate-buffered saline to simulate aging. After 1 year, the teeth were submitted to glucose diffusion, and the resulting data were analyzed with a nonparametric Mann-Whitney test. The Biodentine group and the Ionolux group presented glucose concentrations of 0.074 ± 0.035 g/L and 0.080 ± 0.032 g/L, respectively. No statistically significant differences were detected between the two groups. Therefore, the calcium silicate-based material performs as well as the resin-modified glass ionomer cement in open-sandwich restorations.

Effect of dual cure composite as dentin substitute on the marginal integrity of Class II open-sandwich restorations.

This study compared the marginal adaptation of Class II open-sandwich restorations with an RMGIC versus a dual-cure composite as dentin substitute. Class II cavities were prepared on 50 extracted human third molars. The teeth were randomly assigned to two groups of 25 teeth to compare one dual cure composite (Multicore Flow) with one resin-modified glass-ionomer cement (Fuji II LC) in open-sandwich restorations covered with a light cure composite. The teeth were thermomechanically cycled (2000 cycles, 5 degrees C to 55 degrees C; 100,000 cycles, 50 N/cm2). The specimens were then sealed with a 1 mm window around the cervical margin interface. Samples were immersed in a 50% w/v ammoniacal silver nitrate solution for two hours and exposed to a photodeveloping solution for six hours. The specimens were sectioned longitudinally and silver penetration was directly measured using a light microscope. The results were expressed as a score ranging from 0 to 3. The data were analyzed with a non-parametric Kruskall and Wallis test. The degree of leakage significantly increased with Multicore Flow (median = 2) compared to Fuji II LC (median = 1). The resin-modified glassionomer cements remain the best intermediate materials when open-sandwich restorations are indicated. A comparison of the degradation of these materials over time remains a topic to be investigated by future studies.

Effect of dual cure composite as dentin substitute on marginal integrity of class II open-sandwich restorations.

The current study compared the marginal adaptation of Class II open-sandwich restorations with a RMGIC versus a dual-cure composite as dentin substitute. Class II cavities were prepared on 50 extracted human third molars. The teeth were randomly assigned to two groups of 25 teeth to compare one dual cure composite (MultiCore Flow) with one resin-modified glass-ionomer cement (Fuji II LC) in open-sandwich restorations recovered with a light cure composite. The teeth were thermomechanocycled (2000 cycles, 5 degrees C to 55 degrees C; 100,000 cycles, 50 N/cm2). The specimens were then sealed with a 1 mm window around the cervical margin interface. Samples were immersed in a 50% w/v ammoniacal silver nitrate solution for two hours and exposed to a photo-developing solution for six hours. The specimens were sectioned longitudinally and silver penetration was directly measured using a light microscope. The results were expressed as a score from 0 to 3. The data were analyzed with a non-parametric Kruskal and Wallis test. The degree of leakage significantly increased with MultiCore Flow (median 2) compared to Fuji II LC (median 1). Resin-modified glassionomer cements remain the best intermediate material when open-sandwich restorations are indicated. A comparison of the degradation of these materials over time remains a topic to be investigated by future studies.

In vivo diagnostic assessment of dentinal caries by junior and senior students using red acid dye.

The aim of this study was firstly to determine and compare the ability of inexperienced junior dental students (Fourth-year) and senior students (Fifth-year) versus a dental school instructor to identify demineralized dentine with the aid of a caries-disclosing solution and secondly to evaluate an eventual improvement of the caries diagnosis accuracy of junior (Fourth-year) and senior (Fifth-year) dental students. Three successive stages were used to check the ability of the dental students to diagnose and excavate the de-mineralized dentine. This study pointed out that 96% of junior dental students versus a teacher failed to remove all of the demineralized dentine without the use of a caries detector at the first stage and 79% at the second stage in the same condition. 100% of senior students versus a teacher, also failed to diagnose dental caries without a caries detector, but only at the first stage. However, at the second stage, unlike the junior students, all of the senior students were able to remove all of the demineralized dentine. Without the use of a caries detector dye, the risks of the dental students leaving demineralized dentine are high. This technique may be particularly helpful for the fourth-year students who are performing their first restorative treatment.

In vitro assessment of polymerization procedures in Class II restorations: sealing, FTIR, and microhardness evaluations.

PURPOSE: This study was undertaken to evaluate several polymerization and filling procedures (incremental, bulk, light-tip, soft-cured, plasma devices) in Class II restorations through (1) a sealing evaluation of restorations filled with Tetric Ceram (TC) and Bisfil 2B (B2B, self-cured composite used as a control), (2) a FTIR analysis measuring the variations of the degree of conversion in terms of area unit ratio of the relevant resin composites and (3) a microhardness test to corroborate the FTIR analysis. MATERIALS AND METHODS: The length of the tracer penetration was measured from the gingival margin up to the cavity wall with an episcope on sectioned teeth. A ceramic mould, simulating a Class II, was filled according to the different groups and the samples were analyzed with a Bruker IFS 55 spectrometer on ultrathin sections (3 mu). The results were analyzed in terms of area unit ratio and total exposed energy. Under the same conditions, a microhardness test was run with a Frank Weihem machine. RESULTS: The results of the sealing evaluation for light-tip, incremental and self-cured techniques did not differ. The plasma procedure failed in this evaluation as the bottom increment was not polymerized. The smallest area unit ratio (the best degree of conversion) was observed in 2 groups: one, the combination of the light-tip and soft process, and two, the self-cured resin composite (B2B). The distance at which the plasma procedure failed to cure the resin composite was between 3.5 and 4.5 mm. The microhardness test confirmed the FTIR analysis except for the group G2 (TC + light-tip). As also shown by FTIR analysis, no difference between the two relevant levels was observed with the hardness test. CONCLUSION: The dentin marginal sealing efficiency of Tetric Ceram restorations was increased with the light-tip technique, but was not better than the self-cured resin composite (B2B). For Tetric Ceram, the combination of the light-tip and soft process leads to a higher degree of conversion than the other groups. There is no linear relationship between the degree of conversion, the microhardness and the total exposed energy. The combination of the soft polymerization and the light-tip device might be an alternative restorative technique to the current incremental technique.

Comparison of two implantation sites for testing intraosseous biocompatibility.

The purpose of this study was to compare two implantation sites--the mandible and the femur of the rabbit--for testing in vivo intraosseous biocompatility. Twenty-two new Zealand rabbits were anesthetized, and the mandibular and femur bones were exposed. A hybrid glass ionomer cement or zinc oxide eugenol cement was loaded into silicone carriers and inserted into the two bones after drilling the two cortical plates. Eleven rabbits were killed 4 wk after implantation, and 11 rabbits were killed after 12 wk. The mandibles and femurs were prepared using standard histological procedures; tissue reactions were graded from none to severe. At 4 wk, no statistically significant difference was found between the two implantation sites. After 12 weeks, bone healing was statistically better in the mandible than in the femur. The mandible seems to be a better implantation site in the case of intraosseous implantation tests. The intraosseous biocompatibility of Vitremer was similar at 4 wk and superior at 12 wk to that of Super-EBA.

Comparison of the intraosseous biocompatibility of Vitremer and super EBA by implantation into the mandible of rabbits.

OBJECTIVES: This study compared the intraosseous biocompatibility of Vitremer, a new hydrophilic glass-ionomer cement, to that of Super EBA. STUDY DESIGN: Twenty-two New Zealand rabbits were anesthetized, the mandibular bone exposed, and two holes were drilled through the cortical plate. The materials were loaded into silicone carriers and inserted into the mandibles. Eleven rabbits were killed 4 weeks after implantation, 11 animals after 12 weeks. The mandibles were prepared with standard histologic procedures; the tissue reactions were graded from none to very severe. RESULTS: At 4 weeks Vitremer implants showed very slight to slight reactions, and the Super EBA implants showed slight reactions and one moderate reaction with no significant difference between the two materials. At 12 weeks, bone healing had occurred, despite the persistence of some fibrous tissue interposition. The reactions were classified as none to very slight for Vitremer and very slight to slight for EBA. Statistical analysis showed better results for Vitremer at 12 weeks. CONCLUSION: The intraosseous biocompatibility of Vitremer was similar at 4 weeks and superior at 12 weeks to that of Super EBA. Its other properties should be evaluated before considering its use in clinical practice.