Surface-modified deproteinized human demineralized tooth matrix for bone regeneration: physicochemical characterization and osteoblast cell biocompatibility.

Tooth presents an intriguing option as a bone graft due to its compositional similarity to bone. However, the deproteinized human demineralized tooth matrix (dpDTM), developed to overcome the limited availability of autologous tooth grafts, has suboptimal pore size and surface roughness. This study aimed to fabricate a surface-modified dpDTM using acid etching and collagen coating, followed by in vitro evaluation of physicochemical and biological properties. The dpDTM was modified into two protocols: Acid-modified dpDTM (A-dpDTM) and collagen-modified dpDTM (C-dpDTM). Results demonstrated that A-dpDTM and C-dpDTM had increased pore sizes and rougher surfaces compared to dpDTM. Collagen immobilization was evidenced by nitrogen presence exclusively in C-dpDTM. All groups had a Ca/P molar ratio of 1.67 and hydroxyapatite as the sole constituent, with 65-67% crystallinity. Degradation rates significantly increased to 30% and 20% for C-dpDTM and A-dpDTM, respectively, compared to 10% for dpDTM after 120 days. Cumulative collagen release of C-dpDTM on Day 30 was 45.16 µg/ml. Osteoblasts attachment and proliferation were enhanced on all scaffolds, especially C-dpDTM, which displayed the highest proliferation and differentiation rates. In conclusion, surface modified of dpDTM, including A-dpDTM and C-dpDTM, significantly enhances bioactivity by altering surface properties and promoting osteoblast activity, thereby demonstrating promise for bone regeneration applications.

The temporospatial relationship between mouse dental pulp stem cells and tooth innervation.

Background/purpose: Dental pulp stem cells (DPSCs) exhibit versatile differentiation capabilities, including neural differentiation, prompting the hypothesis that they may be implicated in the neurodevelopment of teeth. This study aimed to explore the temporospatial dynamics between DPSCs and tooth innervation, employing immunofluorescence staining and fluorescent dye injections to investigate the distribution of DPSCs, neural stem cells (NSCs), nerve growth cones, and sensory nerves in developing mouse tooth germs at various stages. Materials and methods: Immunofluorescence staining targeting CD146, Nestin, and GAP-43, along with the injection of AM1-43 fluorescent dye, were utilized to observe the distribution of DPSCs, NSCs, nerve growth cones, and sensory nerves in mouse tooth germs at different developmental stages. Results: Positive CD146 immunostaining was observed in microvascular endothelial cells and pericytes within and around the tooth germ. The percentage of CD146-positive cells remained consistent between 4-day-old and 8-day-old second molar tooth germs. Conversely, Nestin expression in odontoblasts and their processes decreased in 8-day-old tooth germs compared to 4-day-old ones. Positive immunostaining for GAP-43 and AM1-43 fluorescence revealed the entry of nerve growth cones and sensory nerves into the pulp in 8-day-old tooth germs, while these elements were confined to the dental follicle in 4-day-old germs. No co-localization of CD146-positive DPSCs with nerve growth cones and sensory nerves was observed. Conclusion: DPSCs and NSCs were present in dental pulp tissue before nerves penetrated the pulp. The decline in NSCs after nerve entry suggests a potential role for DPSCs and NSCs in attracting neural growth and/or differentiation within the pulp.

Comparative Histomorphometric Analysis of Bone Regeneration According to Bone Graft Type.

PURPOSE: To use histomorphometric analysis to evaluate bone reconstruction in rabbit calvaria with autogenous bone, anorganic bovine bone, undecalcified human tooth bone (UdTB), and decalcified human tooth bone (dTB) grafts. MATERIALS AND METHODS: Extracted human teeth were crushed, and tooth bone with and without decalcification was prepared. Bony defects were made in 10 rabbit calvaria and allocated to one of the following four groups: group 1, in which UdTB was grafted; group 2, in which dTB was grafted; group 3, in which anorganic bovine bone was grafted; group 4, in which autogenous bone was grafted. The rabbits were sacrificed at 2 or 8 weeks postoperatively, and histomorphometric comparison was performed. RESULTS: Histologically, new bone formation was observed at the defect margin and around all graft materials. The dTB group revealed significantly greater new bone areas at 2 and 8 weeks compared to the UdTB group and the anorganic bovine bone group (P < .05). The dTB group revealed no significant difference in the new bone area at 2 weeks but revealed significantly less new bone area at 8 weeks compared to the autogenous bone group (P < .05). The dTB group also revealed significantly less graft material area compared to the anorganic bovine bone group at 8 weeks (P < .05). The autogenous bone group revealed significantly less graft material area and significantly greater bone marrow area compared to other groups at 8 weeks (P < .05). CONCLUSIONS: Grafting with dTB resulted in better bone regeneration than UdTB and anorganic bovine bone grafting at 8 weeks and addresses the potential disadvantages of autogenous bone grafting.

Contribution to Knowledge on Bioapatites: Does Mg Level Reflect the Organic Matter and Water Contents of Enamel?

The matter constituting the enamels of four types of organisms was studied. The variability of the ions was presented in molar units. It was proven that the changes in water contents of the enamel are significantly positively related to changes in Mg; inversely, there is also a strong connection with changes in Ca and P, the main components of bioapatite. The variability in the organic matter has the same strong and positive characteristics and is also coupled with changes in Mg contents. Amelogenins in organic matter, which synthesize enamel rods, likely have a role in adjusting the amount of Mg, thus establishing the amount of organic matter and water in the whole enamel; this adjustment occurs through an unknown mechanism. Ca, P, Mg, and Cl ions, as well as organic matter and water, participate in the main circulation cycle of bioapatites. The selection of variations in the composition of bioapatite occurs only along particular trajectories, where the energy of transformation linearly depends on the following factors: changes in the crystallographic d parameter; the increase in the volume, V, of the crystallographic cell; the momentum transfer, which is indirectly expressed by ΔsinΘ value. To our knowledge, these findings are novel in the literature. The obtained results indicate the different chemical and crystallographic affinities of the enamels of selected animals to the human ones. This is essential when animal bioapatites are transformed into dentistic or medical substitutes for the hard tissues. Moreover, the role of Mg is shown to control the amount of water in the apatite and in detecting organic matter in the enamels.

An approach to investigate the crystallographic unit cell of human tooth enamel.

Human tooth enamel (HTE) is the hardest tissue in the human body and its structural organization shows a hierarchical composite material. At the nanometric level, HTE is composed of approximately 97% hydroxyapatite [HAP, Ca10(PO4)6(OH)2] as inorganic phase, and of 3% as organic phase and water. However, it is still controversial whether the hexagonal HAP phase crystallizes in P63/m or another space group. The observance in HTE of Ca2+, Mg2+ and Na+ ions using X-ray characteristic energy-dispersive spectroscopy in the scanning electron microscope has been explained by substitutions in the HAP unit cell. Thus, Ca2+ can be replaced by Na+ and Mg2+ ions; the PO43- group can be replaced by CO32- ions; and the OH- ions can also be replaced by CO32-. A unit-cell model of the hexagonal structure of HTE is not fully defined yet. In this work, density functional theory calculations are performed to study the hexagonal HAP unit cell when substitution by OH-, CO32-, Mg2+ and Na+ ions are carried out. An approach is presented to study the crystallographic unit cell of HTE by examining the changes resulting from the inclusion of these different ions in the unit cell of HAP. Enthalpies of formation and crystallographic characteristics of the electron diffraction patterns are analysed in each case. The results show an enhancement in structural stability of HAP with OH defects, atomic substitution of Mg2+, carbonate and interstitial Na+. Simulated electron diffraction patterns of the generated structures show similar characteristics to those of human tooth enamel. Hence, the results explain the indiscernible structural changes shown in experimental X-ray diffractograms and electron diffraction patterns.

Synchrotron X-ray Studies of the Structural and Functional Hierarchies in Mineralised Human Dental Enamel: A State-of-the-Art Review.

Hard dental tissues possess a complex hierarchical structure that is particularly evident in enamel, the most mineralised substance in the human body. Its complex and interlinked organisation at the Ångstrom (crystal lattice), nano-, micro-, and macro-scales is the result of evolutionary optimisation for mechanical and functional performance: hardness and stiffness, fracture toughness, thermal, and chemical resistance. Understanding the physical-chemical-structural relationships at each scale requires the application of appropriately sensitive and resolving probes. Synchrotron X-ray techniques offer the possibility to progress significantly beyond the capabilities of conventional laboratory instruments, i.e., X-ray diffractometers, and electron and atomic force microscopes. The last few decades have witnessed the accumulation of results obtained from X-ray scattering (diffraction), spectroscopy (including polarisation analysis), and imaging (including ptychography and tomography). The current article presents a multi-disciplinary review of nearly 40 years of discoveries and advancements, primarily pertaining to the study of enamel and its demineralisation (caries), but also linked to the investigations of other mineralised tissues such as dentine, bone, etc. The modelling approaches informed by these observations are also overviewed. The strategic aim of the present review was to identify and evaluate prospective avenues for analysing dental tissues and developing treatments and prophylaxis for improved dental health.

Determination of the compressive modulus of elasticity of periodontal ligament derived from human first premolars.

Purpose: There are two commonly cited modulus of elasticity of the human periodontal ligament (EPDL), i.e., 6.89 ✕ 10-5 GPa (E1) and 6.89 ✕ 10-2 GPa (E2), which are exactly 1000-fold different from each other. This study aims to clarify the ambiguity of the two EPDL used for simulations and determine a more accurate EPDL value of human first premolars using experimental and simulation approaches. Methods: Numerical simulations using finite element analysis were performed to analyze PDL deformation under an average Asian occlusal force. To confirm the results, simple and multi-component, true-scale 3D models of a human first premolar were used in the simulations. Finally, a compression test using a universal testing machine on PDL specimens was conducted to identify the compressive EPDL of human first premolars. Results: The simulation results from both models revealed that E1 was inaccurate, because it resulted in excessive PDL deformation under the average occlusal force, which should not occur during mastication. Although the E2 did not lead to excessive PDL deformation, it was obtained by an error in unit conversion with no scientific backing. In contrast, the compression test results indicated that the compressive EPDL was 9.64 ✕ 10-4 GPa (E3). In the simulation, E3 did not cause excessive PDL deformation. Conclusion: The simulation results demonstrated that both commonly cited EPDL values (E1 and E2) were incorrect. Based on the experimental and simulation results, the average compressive EPDL of 9.64 ✕ 10-4 GPa is proposed as a more accurate value for human first premolars. Clinical significance: The proposed more accurate EPDL would contribute to more precise and reliable FEA simulation results and provide a better understanding of the stress distribution and deformation of dental materials, which will be beneficial to precision dentistry, orthodontics and restoration designs.

Fatigue and wear of human tooth enamel: A review.

Human tooth enamel must withstand the cyclic contact forces, wear, and corrosion processes involved with typical oral functions. Furthermore, unlike other human tissues, dental enamel does not have a significant capacity for healing or self-repair and thus the longevity of natural teeth in the oral environment depends to a large degree on the fatigue and wear properties of enamel. The purpose of this review is to provide an overview of our understanding of the fatigue and wear mechanisms of human enamel and how they relate to in vivo observations of tooth damage in the complex oral environment. A key finding of this review is that fatigue and wear processes are closely related. For example, the presence of abrasive wear particles significantly lowers the forces needed to initiate contact fatigue cracking while subsurface fatigue crack propagation drives key delamination wear mechanisms during attrition or attrition-corrosion of enamel. Furthermore, this review seeks to bring a materials science and mechanical engineering perspective to fatigue and wear phenomena. In this regard, we see developing a mechanistic description of fatigue and wear, and understanding the interconnectivity of the processes, as essential for successfully modelling enamel fatigue and wear damage and developing strategies and treatments to improve the longevity of our natural teeth. Furthermore, we anticipate that this review will stimulate ideas for extending the lifetime of the natural tooth structure and will help highlight where our understanding is too limited and where additional research into fatigue and wear of human tooth enamel is warranted.

Raman Analyses of Laser Irradiation-Induced Microstructural Variations in Synthetic Hydroxyapatite and Human Teeth.

The microstructural and molecular-scale variations induced by laser irradiation treatment on human teeth enamel in comparison with synthetic hydroxyapatite (HAp) were examined through Raman microprobe spectroscopy as a function of irradiation power. The results demonstrated that laser irradiation could modify stoichiometry, microstructure, and the population of crystallographic defects, as well as the hardness of the materials. These modifications showed strong dependences on both laser power and initial nonstoichiometric structure (defective content of HPO4), because of the occurrence of distinct reactions and structural reconstruction. The reported observations can redirect future trends in tooth whitening by laser treatment and the production of HAp coatings because of the important role of stoichiometric defects.

Knowledge and Attitude of Undergraduate Students and Interns about Human Tooth Bank: A Cross-sectional Study.

Introduction: Human tooth banks (HTBs) are philanthropic institutions that assist to alleviate academic pressure by supplying human teeth essential for preclinical laboratory activities and experimental research. The primary focus of this research was to assess the knowledge and attitude of undergraduate students and interns who have taken up dentistry as their field of study in Jazan University, Saudi Arabia, about HTB. Materials and methods: An online structured self-explanatory questionnaire containing 16 questions was sent via email to the undergraduate students and interns. The Google e-forms questionnaire contained a consent attached for participating in this cross-sectional observational study. Results: A good response rate of 93.3% was recorded, but the results were surprising as 66.43% of the participants did not have the slightest idea regarding the concept of a tooth bank, while only a meager 17.4% of them supported the idea of getting the teeth preauthorized from HTBs before using it on patients. A majority (80.36%) of students unanimously promoted the idea of having facilities like HTBs, but only 15.36% of students had stored teeth at a teeth bank previously. Conclusion: There is an overwhelming lack of awareness among students regarding HTBs and the legal procedures involved in procuring teeth from them. It is necessary to do all that's required to create awareness about the perks of linking HTB with various dental institutions and the legal process involved to use human teeth. How to cite this article: Vishwanathaiah S, Eshaq RH, Maganur PC, et al. Knowledge and Attitude of Undergraduate Students and Interns about Human Tooth Bank: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(1):60-64.

Heterogeneous hardening of enamel surface by occlusal loading: Effect of nanofiber orientation.

Human tooth enamel is composed of enamel rods and surrounding inter-rod enamel. As the fundamental block of enamel, hydroxyapatite (HAP) nanofibers are mostly longitudinally aligned in the rods but inclined in the inter-rod enamel. The surface hardening of enamel by occlusal loading is reportedly a result of hydroxyapatite nanofiber fragmentation and rearrangement and plays an important role in the anti-wear performance of enamel, but little is known about the effect of HAP nanofiber orientation on enamel surface hardening. In this study, the occlusal loading-induced surface hardening behaviors of enamel at different zones (rod and inter-rod) and different orientations (occlusal and axial) were investigated in vitro using impact treatment and a nanoindentation technique, aiming to reveal the effect of nanofiber orientation on enamel surface hardening. It was found that surface hardening by occlusal loading occurs in the rod and inter-rod areas, but the former shows a greater hardening degree than the latter, leading to an increase in the mechanical heterogeneity of enamel surface. Under the same loading condition, the HAP nanofibers in the inter-rod enamel are more likely to tilt into transverse nanofibers than those in the rods. Compared with longitudinal nanofibers, transverse nanofibers fragment into more transverse crystal particles, but the transverse particles impair the compactness of the hardening layer and decrease its hardening degree. In sum, inherent non-uniform nanofiber orientation endows the enamel with the ability to undergo heterogeneous surface hardening upon occlusal loading, which is critical for providing and maintaining its surface mechanical heterogeneity. These findings extend the understanding of the relationship between microstructure and mechanical properties of dental enamel and provide valuable insights into the bionic design of engineering materials.

Opalescence and color stability of composite resins: an in vitro longitudinal study.

OBJECTIVES: This study aims to evaluate the opalescence (OP) and color stability of composite resins over a period of 180 days and to compare composite resins' OP with enamel's OP. MATERIALS AND METHODS: Twenty human enamel specimens (5.0 × 0.3 mm) and 9 specimens (10.0 × 1.0 mm) of 10 colors of 4 different composite resins (3 M ESPE, FGM, Ivoclar-Vivadent, Miscerium) and one brand of adhesive (3 M ESPE) were made. The results were obtained by measuring the reflectance and transmittance spectra in the visible region. After baseline measurement, composites and adhesive were analyzed after 2, 7, 30, 60, 120, and 180 days. The Lab color coordinates were used in the calculations of the OP parameter and color differences in the CIELab and CIEDE2000 methods. The data were analyzed statistically. RESULTS: The materials tested showed variation and an increase in OP over time. The OP found for enamel was 18.06 ± 2.99, and some resins showed higher results. There was a strong correlation between the coordinate b*T and the OP over time. Enamel Plus was the only one material that presented no color changes during all periods in both color analyses. Filtek Z350 XT, AT, and BT did not show differences in any time when analyzed by CIELAB. CONCLUSIONS: The OP of most composite resins changed during the period of 180 days and was different from the OP of tooth enamel. In general, composites demonstrated small color changes over the period tested, being this characteristic material dependent. CLINICAL RELEVANCE: Natural teeth present different optical properties. Composite resins restorations should present properties similar to natural teeth and it is important that characteristics like color and opalescence remain stable over time.

Effect of reciprocating instrumentation on chlorhexidine substantivity on human dentin: chemical analysis followed by confocal laser microscopy

The present research analyzed the reciprocating instrumentation associated to chlorhexidine (CHX) substantivity as its correlation with E. faecalis viability in ex vivo root canals. Eighty extracted single-rooted human teeth were used, being 40 to high-performance liquid chromatography (HPLC) and 40 to confocal laser scanning microscopy (CLSM). In both, teeth were decoronated and the cervical third was prepared. In the CLSM analysis, the root canals were inoculated with E. faecalis for 14 days. Samples were divided into 4 groups (n=10) according to instrumentation technique: no instrumentation and irrigation with distilled water (control); manual instrumentation (K-File); rotary instrumentation (ProTaper Next); and reciprocating instrumentation (Reciproc R25). Two percent chlorhexidine was applied as irrigating substance in experimental groups. Longitudinal grooves resulted in 2 halves root and 20 proof bodies in each group. Samples were divided by chance in two groups (n=10) and the outcomes were evaluated after two days and one week. The retained chlorhexidine and live cells after instrumentation techniques in each evaluation time was measured by HPLC and CLSM, respectively. Specific analysis was applied for experimental tests (p≤0.05). Both rotary as well as reciprocating techniques significantly reduced the amount of chlorhexidine on dentin in all observation periods (p<0.05). After evaluation times, all experimental groups presented lower live cells compared to control, but without statistically difference. Intragroup comparisons in times of evaluation showed no differences in instrumentation techniques, in chlorhexidine retention and number of live cells (p>0.05). Reciprocating instrumentation does not interfere on chlorhexidine substantivity.

Determination of natural radionuclides and some metal concentrations in human tooth samples in the Rize province, Turkey.

The main purpose of this study was to identify the concentrations of naturally occurring radionuclides (226Ra, 232Th and 40K) and some metals (Fe, Ni, Cu, Zn, Pb and Cd) in tooth samples collected from humans living in the Rize province of Turkey. It was found that the activity concentrations ranged from 8.1 to 114.51 Bq kg-1 for 226Ra, from 10.44 to 97.3 Bq kg-1 for 232Th and from 14.53 to 489.27 Bq kg-1 for 40K. The mean activity concentration values of 226Ra and 232Th in tooth samples were higher than the average world values for bones. Furthermore, when the metal concentrations were examined, there was no regular increase or decrease according to age or sex. The results of the metal analysis on the tooth samples were compared with the results of similar studies and were generally found to be consistent.

A Comparative Study of Two Fractional-Order Equivalent Electrical Circuits for Modeling the Electrical Impedance of Dental Tissues.

Background: Electrical impedance spectroscopy (EIS) is a fast, non-invasive, and safe approach for electrical impedance measurement of biomedical tissues. Applied to dental research, EIS has been used to detect tooth cracks and caries with higher accuracy than visual or radiographic methods. Recent studies have reported age-related differences in human dental tissue impedance and utilized fractional-order equivalent circuit model parameters to represent these measurements. Objective: We aimed to highlight that fractional-order equivalent circuit models with different topologies (but same number of components) can equally well model the electrical impedance of dental tissues. Additionally, this work presents an equivalent circuit network that can be realized using Electronic Industries Alliance (EIA) standard compliant RC component values to emulate the electrical impedance characteristics of dental tissues. Results: To validate the results, the goodness of fits of electrical impedance models were evaluated visually and statistically in terms of relative error, mean absolute error (MAE), root mean squared error (RMSE), coefficient of determination (R2), Nash-Sutcliffe's efficiency (NSE), Willmott's index of agreement (WIA), or Legates's coefficient of efficiency (LCE). The fit accuracy of proposed recurrent electrical impedance models for data representative of different age groups teeth dentin supports that both models can represent the same impedance data near perfectly. Significance: With the continued exploration of fractional-order equivalent circuit models to represent biological tissue data, it is important to investigate which models and model parameters are most closely associated with clinically relevant markers and physiological structures of the tissues/materials being measured and not just "fit" with experimental data. This exploration highlights that two different fractional-order models can fit experimental dental tissue data equally well, which should be considered during studies aimed at investigating different topologies to represent biological tissue impedance and their interpretation.

Human Teeth-Derived Bioceramics for Improved Bone Regeneration.

Hydroxyapatite (HAp, Ca10(PO4)6(OH)2) is one of the most promising candidates of the calcium phosphate family, suitable for bone tissue regeneration due to its structural similarities with human hard tissues. However, the requirements of high purity and the non-availability of adequate synthetic techniques limit the application of synthetic HAp in bone tissue engineering. Herein, we developed and evaluated the bone regeneration potential of human teeth-derived bioceramics in mice's defective skulls. The developed bioceramics were analyzed by X-ray diffraction (XRD), Fourier-transform infrared (FTIR) spectroscopy, and scanning electron microscopy (FE-SEM). The developed bioceramics exhibited the characteristic peaks of HAp in FTIR and XRD patterns. The inductively coupled plasma mass spectrometry (ICP-MS) technique was applied to determine the Ca/P molar ratio in the developed bioceramics, and it was 1.67. Cytotoxicity of the simulated body fluid (SBF)-soaked bioceramics was evaluated by WST-1 assay in the presence of human alveolar bone marrow stem cells (hABMSCs). No adverse effects were observed in the presence of the developed bioceramics, indicating their biocompatibility. The cells adequately adhered to the bioceramics-treated media. Enhanced bone regeneration occurred in the presence of the developed bioceramics in the defected skulls of mice, and this potential was profoundly affected by the size of the developed bioceramics. The bioceramics-treated mice groups exhibited greater vascularization compared to control. Therefore, the developed bioceramics have the potential to be used as biomaterials for bone regeneration application.

In Vitro Properties of Manganese-Substituted Tricalcium Phosphate Coatings for Titanium Biomedical Implants Deposited by Arc Plasma.

Bioactive manganese (Mn)-doped ceramic coatings for intraosseous titanium (Ti) implants are developed. Arc plasma deposition procedure is used for coatings preparation. X-ray Diffraction, Scanning Electron Microscopy-Energy Dispersive X-ray Spectroscopy, and Electron Paramagnetic Resonance (EPR) methods are applied for coatings characterization. The coatings are homogeneous, composed of the main phase α-tricalcium phosphate (α-TCP) (about 67%) and the minor phase hydroxyapatite (about 33%), and the Mn content is 2.3 wt%. EPR spectroscopy demonstrates that the Mn ions are incorporated in the TCP structure and are present in the coating in Mn2+ and Mn3+ oxidation states, being aggregated in clusters. The wetting contact angle of the deposited coatings is suitable for cells' adhesion and proliferation. In vitro soaking in physiological solution for 90 days leads to a drastic change in phase composition; the transformation into calcium carbonate and octacalcium phosphate takes place, and no more Mn is present. The absence of antibacterial activity against Escherichia coli, Enterococcus faecalis, and Pseudomonas aeruginosa bacteria strains is observed. A study of the metabolic activity of mouse fibroblasts of the NCTC L929 cell line on the coatings using the MTT (dye compound 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) test demonstrates that there is no toxic effect on the cell culture. Moreover, the coating material supports the adhesion and proliferation of the cells. A good adhesion, spreading, and proliferative activity of the human tooth postnatal dental pulp stem cells (DPSC) is demonstrated. The developed coatings are promising for implant application in orthopedics and dentistry.

Wear mechanism of human tooth enamel: The role of interfacial protein bonding between HA crystals.

Human tooth enamel, the most mineralized tissue in body, contains less than 2 wt% protein. Consequently, the importance of the protein to enamel mechanical response has always been overlooked. In this study, the role of minor protein in providing enamel microstructure and mechanical performance, especially tribological properties, were studied using deproteinization treatment and nano-indentation/scratch technique. Via the change from the original to the deproteinated conditions, a nanostructure degeneration from the assembly of hydroxyapatite (HA) crystals into nano-fibers to crystal aggregation has been found between the high-wear-resistance and low-wear-resistance on the enamel surface. Correspondingly, an energy dissipation to cause a unit volume of wear on enamel surface decreases by 50%, and wear volume increases by 80%. With the presence of protein, the occurrence of enamel wear requires to break the interfacial protein bonding between the HA crystals in nano-fibers and the break dissipates considerable energy, which benefits the enamel to resist wear. Thus, the protein in enamel, although of a very low content, is essential to resisting wear by mediating the assembly of rigid HA crystals via interfacial protein bonding. Replicating functions of the protein component will be critical to the successful development of bio-inspired materials that are designed for wear-resistance.

Surface Hardening Behavior of Enamel by Masticatory Loading: Occurrence Mechanism and Antiwear Effect.

Previous studies have suggested that surface hardening occurs in human tooth enamel under certain loading conditions. However, the occurrence mechanism and significance remain unclear. In this study, the surface hardening behavior of enamel under masticatory loading was studied in vitro using impact treatment and the nanoindentation/scratch technique to identify the mechanism and antiwear effect. The fundamental block of enamel is made of hydroxyapatite (HAP) nanofibers, which consist of fine nanoparticles held together by protein. These fibers respond to masticatory loading in two ways: bending deflection at low loads and fragmentation at high loads. When the contact pressure exceeds the bonding strength between the nanoparticles, the HAP fibers split into fine nanoparticles and then form a surface layer consisting of tightly packed nanoparticles. This results in surface hardening dominated by an increased hardness and elastic modulus. The maximum degree and depth of surface hardening were determined as approximately 60% and 100 nm, respectively. With the occurrence of surface hardening, the wear resistance of the enamel is enhanced, which is manifested by a reduced friction coefficient and wear volume. In summary, the surface hardening of enamel induced by masticatory loading is a result of HAP nanoparticle rearrangement as a response of the enamel hierarchical structure to high chewing loads. It is adaptive overload protection derived from the enamel hierarchical structure and plays a critical role in resisting excessive wear induced by high chewing loads.

Effect of CO2 Laser and 1.23% Acidulated Phosphate Fluoride on Acid Resistance and Fluoride Uptake of Human Tooth Enamel: An In Vitro Assessment.

AIM: To evaluate the effectiveness of CO2 laser treatment before applying 1.23% acidulated phosphate fluoride (APF), through topically applied 1.23% APF solution, and after applying 1.23% APF on acid resistance and fluoride uptake of the enamel. MATERIALS AND METHODS: Sixty non-carious human premolars were extracted due to the orthodontic reason and stored in distilled water solution under refrigeration. Using a water-cooled diamond disc, enamel slabs of 4 mm × 4 mm × 1.5 mm were cut from the buccal surface of each tooth. Sixty samples were randomly divided into one control group and five test groups of 10 premolars each. Solution was prepared for wet chemical analysis followed by fluoride analysis that was carried out using a fluoride ion selective electrode (Thermo Scientific Orion 4-Star Plus ISE Meter). The weight of enamel (WE) was determined from the amount of calcium (Ca) etched away considering the fact that the Ca content of the human enamel is 37.4 wt%. The subgroups were statistically analyzed using ANOVA for fluoride determination and evaluation of acid resistance. RESULTS: There was a significant increase in acid resistance of enamel slabs when treated individually or in combination of a low-power CO2 laser and 1.23% APF solution. Application of 1.23% APF solution after low-power CO2 laser treatment showed maximum increase in acid resistance. CONCLUSION: Application of a low-power pulsed CO2 laser through topically applied 1.23% APF solution resulted in a detrimental effect of the human tooth enamel with resultant decrease in acid resistance. High fluoride uptake does not necessarily indicate increased acid resistance. CLINICAL SIGNIFICANCE: The present study provides evidence that a low-power CO2 laser can be used effectively in combination with topically applied 1.23% APF solution in order to make the enamel more resistant to acid attack, thereby helping in controlling dental caries.