Presence of host and bacterial-derived collagenolytic proteases in carious dentin: a systematic review of ex vivo studies.

Introduction and aim: The presence of host collagenases in the degradation of the protein matrix at later stages of carious dentin lesions development, as well as the potential involvement of bacterial collagenases, have been suggested but lack conclusive evidence. This study aims to conduct a systematic review to comprehensively assess the profile of host and bacterial-derived collagenolytic proteases in both root and coronal dentin carious lesions. Methods: The search was performed in eight databases and the grey literature. Studies evaluating ex vivo dentin, extracted teeth, or biofilms from natural caries lesions were included. The methodological quality of studies was assessed using the Joanna Briggs Institute tool. Synthesis of the results and the certainty of evidence were performed following the Synthesis without Meta-analysis (SWiM) checklist and GRADE approach for narrative synthesis, respectively. Results: From 935 recovered articles, 18 were included. Although the evidence was very uncertain, it was possible to suggest that 1) MMP-2, MMP-9, MMP-13, and CT-B may be increased in carious dentin when compared to sound dentin; 2) there is no difference in MMP-2 presence, while MMP-13 may be increased in root when compared to coronal carious dentin; 3) there is no difference of MMP-2 and MMP-9 expression/activity before and after cavity sealing; 4) MMP-8 may be increased in the dentin before cavity sealing compared to dentin after cavity sealing; 5) there is no difference of MMP-20 in irradiated vs. non-irradiated carious dentin. MMP-20 probably reduces in carious outer dentin when compared to carious inner dentin (moderate certainty). Genes encoding bacterial collagenolytic proteases and protein-degrading bacteria were detected in coronal and root carious lesions. Conclusion: Trends in the direction of the effect were observed for some collagenolytic proteases in carious dentin, which may represent a potential target for the development of new treatments. (Protocol register-PROSPERO: CRD42020213141).

Silver diamine fluoride with sodium fluoride varnish versus silver diamine fluoride in arresting early childhood caries: a 6-months follow up of a randomized field trial.

BACKGROUND: Early childhood caries (ECC) is the most prevalent chronic health problem in young children, and it can be arrested using professionally applied fluoride such as Sodium fluoride (NaF) varnish and Silver Diamine Fluoride (SDF). This trial compared two interventions to arrest ECC lesions: 38% SDF combined with 5% NaF varnish versus 38% SDF and assessed whether the arrest rate was affected by baseline lesion severity measured by ICDAS. METHODS: Children aged ≤ 4 years from 4 nurseries in a rural area in Alexandria, Egypt joined the study in March 2022. They were included if they had at least one active carious lesion with ICDAS codes ≥ 3. They were randomized to receive either 38% SDF with 5% NaF varnish or 38% SDF alone. In both groups, the agents were applied at baseline and after 6 months on the caries lesions. NaF was additionally applied on all teeth in the oral cavity, and it was also applied after three months. The primary outcome was lesion arrest status after six months. Parents' satisfaction with their children's appearance was the secondary outcome. Pearson Chi-Square test was used for bivariate comparison and multi-level multiple logistic regression was used to assess the effect of the intervention on caries arrest controlling for confounders. The interaction between the intervention and baseline lesion severity (categorized into moderate and severe lesions) was assessed and the p value was calculated. RESULTS: The study included 1606 lesions in 220 children, median (IQR) age = 48(9) months. The percentages of arrested lesions after the application of SDF + NaF and SDF only were 77.7% and 73.2% (p = 0.035). In multivariable analysis, SDF + NaF had significantly greater caries arrest effect than SDF alone (AOR = 2.12, p = 0.03) with significant difference (p = 0.03) between moderate (AOR = 4.10, p = 0.005) and advanced (AOR = 1.92, p = 0.08) lesions. Most parents were satisfied with their children's appearance with no significant difference between groups (SDF + NaF = 84.5%, SDF = 78.18%, p = 0.23). CONCLUSION: SDF + NaF had a higher arrest rate than SDF alone and this difference was significant in moderate but not advanced lesions. The findings have implications for the non-invasive management of ECC. TRIAL REGISTRATION: This trial was registered in the clinicaltrials.gov registry (#NCT05642494).

Material of choice for non-invasive treatment of dentin caries: An in vitro study using natural carious lesions.

INTRODUCTION: In community settings with limited dental personnel and equipment, and in an era when the aerosol transmission of infectious agents is on the rise, a non-invasive approach to caries management is critical. To provide information on non-invasive material selection, the aim of this study was to compare the remineralization effect of commonly used fluoride-containing materials, adjunctive to the everyday use of fluoride toothpaste (F-toothpaste), on primary tooth natural dentin caries. METHODS: Fifty-five specimens were randomly divided into five groups: 38% silver diamine fluoride (SDF), 5% fluoride varnish (F-varnish), glass-ionomer cement (GIC), deionized water (DW) with F-toothpaste slurry, and DW as a control group (n = 11). The lesion depth and mineral density were measured before and after bacterial pH-cycling using micro-computed tomography. The percentage of mineral density change (%MDchange) was quantified. The dependent t-test, Wilcoxon-Signed-Rank Test, and one way ANOVA with Bonferroni correction were used to analyse the data. RESULTS: SDF application reduced lesion depth from 844.6 to 759.1 µm (p < 0.045) while increasing mineral density from 551.4 to 763.0 mgHA/cm3 (p < 0.003). Only mineral density rose from 600.2 to 678.4 mgHA/cm3 (p < 0.013) when GIC was used. The other groups showed no difference. The highest %MDchange was also found after SDF treatment (49.7%, p < 0.05), whereas GIC (17.2%, p < 0.05) presented a higher percentage than the F-varnish (2.0%), F-toothpaste (-1.1%) and no-treatment groups (-1.4%). CONCLUSION: In this in vitro study, where the pH of cycling was almost neutral, using SDF as an adjunct to F-toothpaste resulted in the highest remineralization compared with other remineralizing materials.

Caries Experience in Elderly People Consuming a Milk-Based Drink Nutritional Supplement: A Cross-Sectional Study.

Nutritional supplements have been recommended to cope with malnutrition in elderly persons. In Chile, the Supplementary Nutrition Program for the Elderly (PACAM, for its Spanish acronym) consists in a monthly distribution of a low-fat-milk-based drink that contains 8% sucrose. The aim of this study was to determine whether older persons consuming the milk-based drink have a higher caries experience when compared to those not receiving the supplement. A cross-sectional study was conducted in the Maule Region in Chile. The representative sample comprised two groups: (a) PACAM consumers (CS) (n = 60) and (b) nonconsumers (NCS) (n = 60). Participants received intraoral examination and coronal (DMFT/DMFS) and root caries (RCI index) experience were recorded. Additionally, questionnaires regarding acceptability and consumption habits of PACAM and a 24-h diet recall were applied. The influence of predictors was calculated using binary logistic regression for a dichotomized DMFS and Poisson Regression for root caries lesions. A p value <0.05 was considered significant. No differences were detected in food consumption patterns between study groups (p > 0.05). CS participants had increased dairy product consumption. Higher DMFS mean value was observed in the CS (85.35 ± 39.0) compared with NCS (77.28 ± 28.9) (p = 0.043). The multivariate analysis showed nonconsumers of the milk-based product (ß = -0.41, p = 0.02) are less likely to have root surfaces affected by caries. Additionally, CS show higher RCI, compared to nonconsumers (ß = -0.17, p = 0.02). Daily consumption of a PACAM's milk-based drink supplement seems to increase coronal and root caries risk. Based on these results, composition modification of milk-based drinks with added sucrose appears mandatory.

Efficacy of antiseptics and chemomechanical methods for dentin caries lesions: A systematic review with GRADE approach.

Objectives: Selective caries removal aims to remove carious tissue in deep dentin lesions. However, a discussion stands on the value of antiseptics and chemomechanical adjuvant methods to reduce the bacterial load on residual caries lesions. This systematic review has addressed two main clinical questions to compare the antimicrobial efficacy of available methods using (1) antiseptic or (2) chemomechanical agents before restoring dentin carious lesions. Methods: We included randomized and non-randomized controlled trials (RCTs/ NRCTs). We searched eight databases from inception to October 2021. Paired reviewers independently screened studies, extracted data, and assessed the risk of bias. The primary outcome was the reduction in the number of total bacterial in dentin, whereas secondary outcomes were reduction in the number of Lactobacillus and Streptococcus. We used the ratio of ratio of post-treatment to baseline means between two interventions in the logarithmic scale as a proper effect measure. Certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation approach. Results: We included 14 RCTs and 9 NRCTs, with nine interventions. Regardless the method, the number of bacteria at baseline was similar or exceeded that after the intervention, particularly in NRCTs. The evidence was inconclusive for most comparisons. Among antiseptic agents, chlorhexidine (CHX) resulted in an average of 1.14 times [95% confidence interval (CI): 1.08-1.21] more total bacterial than photodynamic therapy in RCTs. Among NRCTS, the natural agents resulted in five times more total bacterial than CHX (95% CI: 2-11). For chemomechanical methods, the control resulted in eight times (95% CI: 4-17) more total bacterial than Carisolv (SHAA). Conclusions: The certainty of the evidence was very low for all comparisons showing uncertainty whether one treatment could be more effective than another for dentin disinfection. So far, exclusively removing soft carious dentin would be enough to reduce the bacterial count.

[Effects of novel bioactive glasses on promoting remineralization of artificial dentin caries].

OBJECTIVE: To investigate the effects of novel bioactive glasses (BG) including PSC with high phosphorus component and FBG with fluorine-doped element on promoting remineralization of artificial dentin caries. METHODS: (1) BGs were used in this study as follows: PSC (10.8%P2O5-54.2%SiO2-35.0%CaO, mol.%) were synthesized using phytic acid as the phosphorus precursor through sol-gel method. FBG (6.1%P2O5-37.0%SiO2-53.9%CaO-3.0%CaF2, mol.%) and 45S5(6.0%P2O5-45.0%SiO2-24.5%CaO-24.5%Na2O, mol.%) were synthesized by traditional melt method. (2) The above BGs were soaked in simulated body fluid (SBF) for 24 hours. Then X-ray diffraction (XRD) was used to analyze the formation of hydroxyapatite (HA) crystals. (3) Prepared 1 mm thick dentin slices were soaked in 17% ethylene diamine tetraacetic acid (EDTA) for 1 week to demineralize the dentin. Then the dentin slices treated by BG were soaked in SBF for 1 week. Field emission scanning electron micro-scopy (FE-SEM) was used to observe the surface morphology of the dentin slices. (4) Four cavities were prepared to 1 mm depth in each 2 mm thick dentin slice, then were treated with lactic acid for 2 weeks to form the artificial dentin caries. Wax, mineral trioxide aggregate (MTA), PSC and FBG were used to fill four cavities as blank control group, MTA group, PSC group and FBG group respectively. Then the spe-cimens were soaked in SBF for 4 weeks. The changes of depth and density of demineralized dentin were analyzed using Micro-CT before filling and after 2 and 4 weeks filling. RESULTS: (1) PSC and FBG promoted mineral formation on the surfaces of the demineralized dentin. And the speed was faster and crystallinity was higher in PSC group than the FBG and 45S5 groups. (2) The increased mineral density of artificial dentin caries in PSC group were (185.98 ± 55.66) mg/cm3 and (213.64 ± 36.01) mg/cm3 2 and 4 weeks after filling respectively, which were significantly higher than the control group [(20.38 ± 7.55) mg/cm3, P=0.006; (36.46 ± 10.79) mg/cm3, P=0.001]. At meanwhile, PSC group was also higher than MTA group [(57.29 ± 10.09) mg/cm3; (111.02 ± 22.06) mg/cm3], and it had statistical difference (P=0.015; P=0.006). The depth of remineralized dentin in PSC group were (40.0 ± 16.9) µm and (54.5 ± 17.8) µm 2 and 4 weeks respectively, which were also statistically different from the control group (P =0.010;P=0.001). There were no statistical differences between the control group and MTA group. The above effects of FBG group were between PSC and MTA. CONCLUSION: PSC has advantages in the speed, quality and depth of mineral deposition in the demineralized layer of artificial dentin caries. It would be expected to be an ideal material to promote the remineralization of dentin caries.

Enhanced effectiveness of silver diamine fluoride application with light curing on natural dentin carious lesions: an in vitro study.

This study aimed to compare the mean mineral density difference (mMDD) and surface morphology of 10- and 60-s silver diamine fluoride (SDF)-applied dentin carious lesions and to study the effect of an additional 20-s light curing (LC) on SDF-treated teeth. Forty primary molar blocks with natural dentin carious lesions were measured for baseline lesion depth and mineral density using Image-Pro Plus software. The samples were randomly distributed into 4 groups; 38% SDF applied for 1) 10-s (10SDF), 2) 60-s (60SDF), 3) 10-s + LC (10SDF + LC), 4) 60-s + LC (60SDF + LC) and an additional control group to assess the outcome of pH-cycling only. Then all the groups underwent a 7-d bacterial pH-cycling. The dentin carious lesions' mMDD was determined by digital subtraction radiographic analysis. The surface morphology and elemental profile were assessed by scanning electron microscopy and energy-dispersive X-ray spectroscopy. The mMDD of the dentin lesions was analyzed using two-way ANOVA, generalized linear models analysis. Light curing was the only factor that affected the mMDD (p = 0.007). The mMDD in the 10SDF + LC and 60SDF + LC groups were significantly higher than those without light curing (p = 0.041 and 0.041, respectively). The 60SDF + LC group demonstrated a significantly higher mMDD than the 10SDF group (p = 0.010), while that in the 10SDF + LC group was similar to the 60SDF group (p = 1.00). Scanning electron microscopy revealed denser mineral content layers, which were likely silver and chloride, in the 10SDF + LC and 60SDF + LC groups than in the 10SDF and 60SDF groups, respectively. In conclusion, shortened application time with light curing enhanced SDF remineralization similarly to the conventional method.

Effects of novel bioactive glasses on promoting remineralization of artificial dentin caries / 北京大学学报(医学版)

OBJECTIVE@#To investigate the effects of novel bioactive glasses (BG) including PSC with high phosphorus component and FBG with fluorine-doped element on promoting remineralization of artificial dentin caries.@*METHODS@#(1) BGs were used in this study as follows: PSC (10.8%P2O5-54.2%SiO2-35.0%CaO, mol.%) were synthesized using phytic acid as the phosphorus precursor through sol-gel method. FBG (6.1%P2O5-37.0%SiO2-53.9%CaO-3.0%CaF2, mol.%) and 45S5(6.0%P2O5-45.0%SiO2-24.5%CaO-24.5%Na2O, mol.%) were synthesized by traditional melt method. (2) The above BGs were soaked in simulated body fluid (SBF) for 24 hours. Then X-ray diffraction (XRD) was used to analyze the formation of hydroxyapatite (HA) crystals. (3) Prepared 1 mm thick dentin slices were soaked in 17% ethylene diamine tetraacetic acid (EDTA) for 1 week to demineralize the dentin. Then the dentin slices treated by BG were soaked in SBF for 1 week. Field emission scanning electron micro-scopy (FE-SEM) was used to observe the surface morphology of the dentin slices. (4) Four cavities were prepared to 1 mm depth in each 2 mm thick dentin slice, then were treated with lactic acid for 2 weeks to form the artificial dentin caries. Wax, mineral trioxide aggregate (MTA), PSC and FBG were used to fill four cavities as blank control group, MTA group, PSC group and FBG group respectively. Then the spe-cimens were soaked in SBF for 4 weeks. The changes of depth and density of demineralized dentin were analyzed using Micro-CT before filling and after 2 and 4 weeks filling.@*RESULTS@#(1) PSC and FBG promoted mineral formation on the surfaces of the demineralized dentin. And the speed was faster and crystallinity was higher in PSC group than the FBG and 45S5 groups. (2) The increased mineral density of artificial dentin caries in PSC group were (185.98 ± 55.66) mg/cm3 and (213.64 ± 36.01) mg/cm3 2 and 4 weeks after filling respectively, which were significantly higher than the control group [(20.38 ± 7.55) mg/cm3, P=0.006; (36.46 ± 10.79) mg/cm3, P=0.001]. At meanwhile, PSC group was also higher than MTA group [(57.29 ± 10.09) mg/cm3; (111.02 ± 22.06) mg/cm3], and it had statistical difference (P=0.015; P=0.006). The depth of remineralized dentin in PSC group were (40.0 ± 16.9) μm and (54.5 ± 17.8) μm 2 and 4 weeks respectively, which were also statistically different from the control group (P =0.010;P=0.001). There were no statistical differences between the control group and MTA group. The above effects of FBG group were between PSC and MTA.@*CONCLUSION@#PSC has advantages in the speed, quality and depth of mineral deposition in the demineralized layer of artificial dentin caries. It would be expected to be an ideal material to promote the remineralization of dentin caries.

A Dentin Biomimetic Remineralization Material with an Ability to Stabilize Collagen.

The integrity of collagen matrix structure is a prerequisite for effectively inducing biomimetic remineralization. Repeated low pH stimulation activates matrix metalloproteinases (MMPs) in dental caries. Activated MMPs cause the breakdown of collagen fibrils. Collagen stabilization is a major obstacle to the clinical application of remineralization templates. Here, galardin-loaded poly(amido amine) (PAMAM)-NGV (PAMAM-NGV@galardin, PNG) is constructed to induce collagen stabilization and dentin biomimetic remineralization simultaneously, in order to combat early caries in dentin. PAMAM acts in the role of nucleation template for dentin remineralization, while galardin acts as the role of MMPs inhibitor. NGV peptides modified on the surface of dendrimer core can form small clusters with synergistic movement in short range, and those short-range clusters can form domain areas with different properties on the surface of PAMAM core and restrict the movement of collagen, favoring collagen crosslinking, which can be explained through the computational simulation analysis results. NGV peptides and galardin show a dual collagen-protective effect, laying the foundation for the dentin remineralization effect induced by PAMAM. PNG induces dentin remineralization in an environment with collagenase, meanwhile showsing anti-dentin caries efficacy in vivo. These findings indicate that PNG has great potential to combat early dentin caries for future clinical application.

Deep dentine caries management of immature permanent posterior teeth with vital pulp: A systematic review and meta-analysis.

OBJECTIVES: Preservation of pulpal vitality in immature permanent teeth with deep carious lesions is essential to enable further root development and apical closure. This systematic review aimed to evaluate the evidence regarding the efficacy, presented clinical and radiographic success, and bacteriological outcomes of techniques and materials used for deep caries management in vital immature permanent teeth. DATA: Randomised controlled trials evaluating Vital Pulp Therapy (VPT) for deep caries in immature permanent posterior teeth without history of irreversible pulpitis, and a follow up period of ≥12 months were included. Study characteristics and outcomes of all included studies were summarized. Cochrane's Risk-of-bias tool 2.0 was used to assess the quality of eligible studies. Meta-analyses using a random effects model was performed. SOURCES: Electronic databases PubMed, Medline, Embase, LILACS, CENTRAL and Cochrane Library were searched, followed by a manual search. STUDY SELECTION: Twelve papers were included into the review. Overall success rates were 98%, 93.5%, 93.6% for direct pulp cap (DPC), indirect pulp cap (IPC) and pulpotomy (PP) respectively. Regardless of VPT technique, there were no significant differences between clinical and radiographic success rates. Completion of root development was achieved in more than 83% of the cases in all VPT techniques. CONCLUSIONS: All treatment modalities for PP were equally efficient with high overall success rates. Biodentine showed high success rates regardless of technique. No significant differences were found in the clinical and radiographic success rates between various follow-up intervals. There are no clear conclusions regarding superiority of either VPT technique on apical closure. CLINICAL SIGNIFICANCE: This manuscript systematically evaluates the evidence and summarises all available data on each vital pulp therapy technique and materials used in treatment of deep caries in immature permanent teeth with vital pulps. The limitations in the current scientific literature and recommendations for future research are also highlighted.

Attenuation of near-ultraviolet, visible and near-infrared light in sound and carious human enamel and dentin.

OBJECTIVES: This in vitro study aimed to investigate the optical attenuation of light at 405, 660 and 780 nm sent through sound and carious human enamel and dentin, including respective individual caries zones, as well as microscopically sound-appearing tissue close to a carious lesion. MATERIALS AND METHODS: Collimated light transmission through sections of 1000-125-µm thickness was measured and used to calculate the attenuation coefficient (AC). The data were statistically analysed with a MANOVA and Tukey's HSD. Precise definition of measurement points enabled separate analysis within the microstructure of lesions: the outer and inner halves of enamel (D1, D2), the translucent zone (TZ) within dentin lesions and its adjacent layers, the enamel side of the translucent zone (ESTZ) and the pulpal side of the translucent zone (PSTZ). RESULTS: The TZ could be distinguished from its adjacent layers and from caries-free dentin at 125 µm. Sound-appearing dentin close to caries lesions significantly differed from caries-free dentin at 125 µm. While sound and carious enamel exhibited a significant difference (p < 0.05), this result was not found for D1 and D2 enamel lesions (p > 0.05). At 405 nm, no difference was found between sound and carious dentin (p > 0.05). CONCLUSIONS: Light optical means enable the distinction between sound and carious tissue and to identify the microstructure of dentin caries partially as well as the presence of tertiary dentin formation. Information on sample thickness is indispensable when interpreting the AC. CLINICAL RELEVANCE: Non-ionising light sources may be suitable to detect lesion progression and tertiary dentin.

Emerging Technologies for Dentin Caries Detection-A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed at assessing the diagnostic accuracy of emerging technologies, such as laser fluorescence (LF), transillumination, light-emitting diode devices, optical coherence tomography (OCT), alternating current impedance spectroscopy, fluorescence cameras (FC), photo-thermal radiometry, and modulated luminescence technology. In vivo and in vitro results of such non-ionizing, non-invasive, and non-destructive methods' effectiveness in non-cavitated dentin caries detection are sometimes ambiguous. Following the PRISMA guidelines, 34 relevant research articles published between 2011-2021 were selected. The risk of bias was assessed with a tool tailored for caries diagnostic studies, and subsequent quantitative uni- and bi-variate meta-analysis was carried out in separate sub-groups according to the investigated surface (occlusal/proximal) and study setting (in vivo/in vitro). In spite of the high heterogeneity across the review groups, in vitro studies on LF and FC proved a good diagnostic ability for the occlusal surface, with area under the curve (AUC) of 0.803 (11 studies) and 0.845 (five studies), respectively. OCT studies reported an outstanding performance with an overall AUC = 0.945 (four studies). Promising technologies, such as OCT or FC VistaProof, still need well-designed and well-powered studies to accrue experimental and clinical data for conclusive medical evidence, especially for the proximal surface. Registration: INPLASY202210097.

Children's dental treatment requirements of first permanent molars with poor prognosis.

OBJECTIVES: This retrospective study aimed to (i) survey the correlation between decayed, missing, filled teeth (DMFT), and presence of first permanent molars (FPMs) with poor prognosis and (ii) evaluate the treatment requirements. MATERIALS AND METHODS: Seven hundred seventy-three children with fully erupted FPMs were included in this study. DMFT for the permanent dentition, FPMs, and Global DMFT were evaluated based on clinical and radiographic evaluation. The ratio of deep dentin caries (DDC) and apical lesion presence among FPMs, including treatment requirements, were analysed. Spearman rank correlation coefficient and t tests were used for statistical analysis. RESULTS: The caries prevalence was found at 61.4%, where the mean DMFT was calculated as 1.89 ± 2.15. There was a positive correlation between DMFT values and age (rs = 0.27). On the other hand, there was a negative correlation between global DMFT values and age (rs = - 0.29). Regarding treatment needs of FPM with poor prognosis, 12.03% of the teeth needed pulpectomy, 8.93% pulpotomy, 8.93% pulp capping, and 5.3% extraction. Having higher DMFT values was correlated significantly (p < 0.01) with the presence of DDC (rs = 0.50) and apical lesion (rs = 0.34). Susceptibility to DDC and apical lesions was significantly higher at mandible than maxilla (p < 0.01). The correlation was significant between DMFT values and apical lesion presence (p < 0.01). CONCLUSION: The ratio of FPMs with poor prognosis was found high in the study group. Treatment requirements of FPMs increased with age, and pulp interventions often took part in the majority. This study successfully concluded that higher DMFT values were correlated with the presence of DDC and apical lesion. CLINICAL RELEVANCE: FPMs with poor prognosis demonstrate a risk factor for apical lesion presence.

Microbiological and SEM assessment of atraumatic restorative treatment in adult dentition.

OBJECTIVES: To investigate the practicability of atraumatic restorative treatment (ART) in adults in terms of marginal adaptation of restorations and microbiological changes in residual carious dentin. MATERIALS AND METHODS: The occlusal dentin caries of 25 permanent molar teeth were removed with hand instruments. The total counts of bacteria (TCB) and the facultative anaerobic bacteria (FAB), mutans streptococci (MS), and Lactobacillus spp. (LB) counts in the affected dentin were evaluated quantitatively. The weights of the samples were measured with an electronic balance (Shimadzu, Type AX200, Japan). The cavities were restored with glass ionomer cement (KetacTM Molar Easymix, ESPE Dental AG, Seefeld, Germany). Twenty replicas of randomly selected ART restorations were prepared and marginal adaptation was evaluated by scanning electron microscopy (SEM). After 6 months, the same protocols were repeated. Data were analyzed with paired sample t-tests, Wilcoxon t-tests, Pearson and Spearman correlations, and chi-square tests (p<0.05). RESULTS: In the sixth month, restoration loss and pulpitis were not observed. The mean weight of samples removed from the cavity floor was less than the baseline (0.014±0.009 and 0.023±0.013 g, respectively) (p<0.01), and the counts of total bacteria, FAB, MS, and LB significantly decreased compared to baseline (p<0.01). The frequency of marginal gaps was increased (p< 0.01). CONCLUSIONS: ART showed that the counts of microorganisms decreased after 6 months although the marginal gap rates of restorations increased. CLINICAL RELEVANCE: ART can be a reliable treatment approach in adults for 6 months due to the decrease in microorganism counts, although gaps exist.

Polymer-Induced Liquid Precursor (PILP) remineralization of artificial and natural dentin carious lesions evaluated by nanoindentation and microcomputed tomography.

OBJECTIVES: The study evaluates the efficacy to remineralize artificial and natural dentin lesions through restorative dental procedures that include the Polymer-Induced Liquid Precursor (PILP) method comprising polyaspartic acid (pAsp). METHODS: Novel ionomeric cement compositions based on bioglass 45S5 and pAsp mixtures, as well as conditioning solutions (conditioner) containing 5 mg/mL pAsp, were developed and tested on demineralized dentin blocks (3-4 mm thick) on shallow and deep lesions with the thickness of 140 µm ± 50 and 700 µm ± 50, respectively. In the first treatment group, 20 µL of conditioner was applied to demineralized shallow (n = 3) and deep (n = 3) lesion specimens for 20 s before restoration with glass ionomer cement (RMGIC). For the PILP cement treatment group, cement was applied onto the wet surface of the demineralized specimen for both shallow (n = 3) and deep (n = 3) artificial lesions after the application of the conditioner and before the final restoration. Sample groups were compared to RMGIC restoration, for both shallow and deep lesions (n = 3 each) and treatments in PILP-solution (n = 3 for deep lesions) without restoration for 4 weeks. All of the restored specimens were immersed in simulated body fluid (SBF) solution for 2 weeks and 4 weeks for shallow and deep lesions respectively to allow for remineralization. The artificial lesion specimens were evaluated for changes in the nanomechanical profile (E-modulus and hardness) using nanoindentation. Shallow lesions were analyzed by SEM under vacuum for changes in morphology caused by PILP treatments. Also, a pilot study on human third molars with moderate lesions in dentin (n = 3) was initiated to test the efficacy of treatments in natural lesions based on mineral densities using microcomputed tomography (µCT) at 0, 1, and 3 months. RESULTS: This study showed that functional remineralization of artificial lesions using PILP-releasing restoratives occurred, indicated by an increase of the elastic modulus in shallow lesions and in the middle zone of deep artificial lesions. The mechanical improvement was significant when compared to RMGIC restoration without pAsp (P < 0.05). Nonetheless, recovery across artificial lesions was most significant when specimens were immersed into PILP-solution with restorative (P < 0.01). Furthermore, natural lesions increased in mineral volume content to a higher degree when the restorative treatment included the PILP-method (P < 0.05). However, none of the natural lesions recovered to full mineral degree regardless of the treatments. CLINICAL SIGNIFICANCE/CONCLUSION: These findings indicate the benefit of PILP applications in the functional repair of dentin caries and illustrate the challenge to integrate the PILP-method into a restorative approach in minimally invasive dental procedures.

Effect of ionizing radiation and cariogenic biofilm challenge on root-dentin caries.

OBJECTIVES: To evaluate the effect of ionizing radiation and cariogenic biofilm challenge using two continuous flow models, normal and reduced salivary flow, on the development of initial root-dentin caries lesions. MATERIALS AND METHODS: Microcosm biofilms were grown under two salivary flow rates (0.06 and 0.03 mL min-1) and exposed to 5% sucrose (3 × daily, 0.25 mL min-1, 6 min) dripped over non-irradiated and irradiated root-dentin blocks for up to 7 days. The vibration modes of root dentin, matrix/mineral (M/M), and carbonate/mineral (C/M) ratios were evaluated by FTIR. The mineral density was assessed by micro-CT. RESULTS: With normal salivary flow, FTIR revealed an increase in the organic matrix (amide III) and a decrease in the mineral phase (ν4, ν2 PO43-, AII + ν2 CO32-, C/M) in caries lesions. Irradiated dentin exhibited a reduction in the mineral phase (ν1, ν3 PO43-, ν2 CO32-, C/M). Differences in mineral densities were not significant. With reduced salivary flow, FTIR also revealed increased organic matrix (amide III) for irradiated caries lesions and decrease in mineral phase (v4, v2 PO43-, v2 CO32-, and C/M) in caries lesions. ν1, ν3 PO43- precipitated on the surface of irradiated dentin and a lower mineral density was observed. CONCLUSIONS: Initial caries lesions differed between non-irradiated and irradiated dentin and between normal and reduced salivary flow rates. Significant mineral loss with exposure of the organic matrix and low mineral density were observed for irradiated dentin with a reduced salivary flow rate. CLINICAL RELEVANCE: Ionizing radiation associated with a reduced salivary flow rate enhanced the progression of root-dentin caries.

Fluoride and Functionalised β-tricalcium Phosphate (fTCP) Fluoride Toothpaste Affect the Primary Dentin Caries Surface: A Comparison by Estimation Statistics

ABSTRACT@#This study aims to compare the effect of fTCP-contained toothpaste in combination with 950 ppm fluoride on primary dentin caries surface to ordinary 1100 ppm fluoride toothpaste by using estimation statistics. Dental caries with deep lesion and dentin exposure from nine primary teeth were cut into two equal parts and randomly divided into two groups in a before-after study. Each group was brushed with one type of toothpaste two times per day for 28 days and rested in artificial saliva. SEM images of cavity bottom surfaces and energy-dispersive X-ray spectrometry (EDX) were used to determine the percentage of calcium (Ca), phosphorus (P), fluoride (F) and oxygen (O) at six continuous measured areas from the surface of the cavity bottom into 45 µm depth before and after brushing. About 95% confidence interval of the mean difference was calculated by performing bootstrap resampling with 5000 resamples followed by comparison analysis. The percentage of Ca, P, F, O was shifted after treatment. There was no difference between the two groups. The SEM images reflected a similar illustration of EDX data. The combination of fTCP and 950 ppm fluoride in toothpaste showed equivalent effectiveness to the 1100 ppm fluoride toothpaste in primary dentin caries.

[Spectroscopic studies of the molecular composition of the dentinal and gingival fluids and their diagnostic potential for preventive screening of dentin caries]. / Spektroskopicheskie issledovaniya molekulyarnogo sostava dentinnoi i desnevoi zhidkostei i ikh diagnosticheskii potentsial dlya preventivnogo skrininga kariesa dentina.

PURPOSE OF THE STUDY: The aim of the work is a spectroscopic investigation and comparison of the molecular composition of dentine and gingival fluids as well as of their diagnostic potential for the preventive screening of dentin caries. MATERIAL AND METHODS: Applying infrared spectroscopy including synchrotron radiation the samples of biological fluids taken from the oral cavity (dentine fluid, fluid from the gingival sulcus and blood) were studied for the patients with the progressive dentine caries. The part of this research was undertaken with the infrared microspectroscopy beamline at the Australian Synchrotron. RESULTS: Dentine and gingival fluids were shown to have no less complicated composition than the blood serum. Having all this in mind, in spite that these two fluids are derivatives of the blood serum, and a majority of the molecular groups observed in all of the three fluids can be detected in their IR-spectra, it follows that there is a number of signature modes that are in fact present in the IR spectra of only dentine and gingival fluids. This fact indicates at the molecular exchange between them under certain conditions. It means the high diagnostic potential in the study of the pathologic processes occurring in the oral fluid of a human. We have observed and fixed an increase of thiocyanates and esters in the samples of both dentine and gingival fluids under the development of dentin caries. CONCLUSION: Utilization of the gingival fluid for screening taking into account that its sampling is not such a complicated challenge as dentine fluid sampling will promote a transition to the personalized medicine, the development of high-technology healthcare and technology of the health preservation as a whole.

How to Intervene in the Caries Process: Dentin Caries in Primary Teeth.

For an ORCA/EFCD consensus, this review systematically assessed available evidence regarding interventions performed and materials used to manage dentin carious lesions in primary teeth. A search for systematic reviews (SRs) and randomized clinical trials (RCTs) with a follow-up of at least 12 months after intervention was performed in PubMed, LILACS, BBO, and the Cochrane Library. The risk of bias tool from the Cochrane Collaboration and the PRISMA Statement were used for assessment of the included studies. From 101 screened articles, 2 SRs and 5 RCTs, which assessed the effectiveness of interventions in terms of pulp vitality and success of restoration, and 10 SRs and 1 RCT assessing the success of restorative materials were included. For treatments involving no carious tissue removal, the Hall technique showed lower treatment failure for approximal carious lesions compared to complete caries removal (CCR) and filling. For the treatment of deep carious lesions, techniques involving selective caries removal (SCR) showed a reduction in the incidence of pulp exposure. However, the benefit of SCR over CCR in terms of pulp symptoms or restoration success/failure was not confirmed. Regarding restorative materials, preformed metal crowns (PMCs) used to restore multisurface lesions showed the highest success rates compared to other restorative materials (amalgam, composite resin, glass ionomer cement, and compomer), and in the long term (12-48 months) these were also less likely to fail. There is limited evidence supporting the use of PMCs to restore carious lesions with single cavities. Among nonrestorative options, silver diammine fluoride was significantly more effective in arresting caries than other treatments for treating active carious lesions of different depths. Considerable heterogeneity and bias risk were observed in the included studies. Although heterogeneity observed among the studies was substantial, the trends were similar. In conclusion, less invasive caries approaches involving selective or no caries removal seem advantageous in comparison to CCR for patients presenting with vital, symptomless, carious dentin lesions in primary teeth. There is evidence in favor of PMCs for restoring multisurface carious lesions in primary molars.

Silver diamine fluoride (SDF) used in childhood caries management has potent antifungal activity against oral Candida species.

BACKGROUND: The microbiome of Severe-Early Childhood Caries (S-ECC), is characterized by an ecosystem comprising bacterial and fungal species, with a predominance of Candida species. Hence, an anti-cariogen effective against both bacteria and fungi would be valuable in the management of S-ECC. Here we evaluate the antifungal effect of silver diamine fluoride (SDF) against 35-clinical yeast isolates (Ten-each of C. albicans, C. krusei, C. tropicalis and five C. glabrata strains) from dentinal caries-lesions from S-ECC. RESULTS: Disc-diffusion and time-kill assays as well as MIC50 and MIC90 evaluations against therapeutic concentrations confirmed the broad-spectrum anti-candidal potency of SDF. Ultrastructural images revealed morphologic aberrations of yeast-cell walls on exposure to SDF. All C. krusei and C. glabrata isolates were significantly more sensitive to SDF, relative to the standard antifungal fluconazole. Further, SDF appears to effectively abrogate filamentation of C. albicans even at very low concentrations. CONCLUSIONS: Our data, for the first time, elucidate the antifungal potency of SDF, in addition to its known antibacterial activity, in the management of S-ECC.