The influence of chlorhexidine on the remineralization of demineralized dentine

Comparative analysis of remineralizing efficacy of strontium-doped bioactive glass, BioMin, and NovaMin containing dentifrice on artificial white spot lesions after chlorhexidine pretreatment - An in vitro study

Aim

This study aimed to compare the remineralizing efficacy of strontium-doped bioactive glass, BioMin, and NovaMin containing dentifrices on artificial white spot lesions (WSLs) after chlorhexidine (CHX) pretreatment using energy-dispersive X-ray analysis (EDAX).

Materials and Methodology

Twenty-four samples of maxillary first premolars extracted for orthodontic purposes were selected. Artificial WSLs were produced by immersing the samples in a prepared demineralizing solution for 3 days. All the samples were pretreated with CHX and divided into four groups and six samples each. Group A treated with strontium-doped bioactive glass, Group B with BioMin, Group C with NovaMin, and Group D with artificial saliva as the control group for 14 days. pH-cycling model was used to simulate the oral cavity changes. EDAX was used to record the values at baseline, demineralization, and after remineralization.

Statistical Analysis

Data were analyzed using one-way ANOVA (post hoc), followed by unpaired t-test and Scheffe tests with Statistical Package for the Social Sciences version 16.

Results

Strontium-doped bioactive glass exhibited a greater mineral regain compared to BioMin, NovaMin, and control groups.

Conclusion

Strontium-doped bioactive glass has enhanced mineral deposition on carious teeth and may provide an alternative clinical strategy for remineralizing early enamel lesions.

Cathepsins in oral diseases: mechanisms and therapeutic implications

Cathepsins are a type of lysosomal globulin hydrolase and are crucial for many physiological processes, including the resorption of bone matrix, innate immunity, apoptosis, proliferation, metastasis, autophagy, and angiogenesis. Findings regarding their functions in human physiological processes and disorders have drawn extensive attention. In this review, we will focus on the relationship between cathepsins and oral diseases. We highlight the structural and functional properties of cathepsins related to oral diseases, as well as the regulatory mechanisms in tissue and cells and their therapeutic uses. Elucidating the associated mechanism between cathepsins and oral diseases is thought to be a promising strategy for the treatment of oral diseases and may be a starting point for further studies at the molecular level.

Chlorhexidine gluconate enhances the remineralization effect of high viscosity glass ionomer cement on dentin carious lesions in vitro

Background

To compare the mean mineral density (MMD) and examine the remineralization of carious dentin after cavity disinfection with chlorhexidine gluconate (CHX) and restoration with high viscosity glass ionomer cement (H-GIC) in vitro.

Methods

Selective caries removal to leathery dentin was performed in 40 extracted primary molars. The samples were scanned using micro-computed tomography (micro-CT) to determine the MMD baseline and randomly divided into 4 groups (n = 10): Equia™ group, applied dentin conditioner and restored with H-GIC (Equia Forte™), CHX-Equia™ group, disinfected the cavity with 2% CHX before applying dentin conditioner and restored with H-GIC (Equia Forte™), Ketac™ group, restored with H-GIC (Ketac Universal™) and CHX-Ketac™ group, disinfected the cavity with 2% CHX before restored with H-GIC (Ketac Universal™). The samples underwent micro-CT scanning post-restoration and post-pH-cycling to determine their respective MMDs. One sample from each group was randomly selected to analyze by scanning electron microscopy (SEM).

Results

The MMD gain in the 4 groups post-restoration was significantly different between the Equia™ and CHX-Ketac™ groups (oneway ANOVA with Post hoc (Tukey) test, P = 0.045). There was a significant difference in MMD gain post-restoration between the Equia™ and CHX-Equia™ groups (Independent t-test, P = 0.046). However, the Ketac™ and CHX-Ketac™ group’s MMD were similar. The SEM images revealed that the CHX-Ketac™ group had the smallest dentinal tubule orifices and the thickest intertubular dentin among the groups. However, the CHX-Equia™ group had thicker intertubular dentin than the Equia™ group.

Conclusion

Applying 2% CHX on demineralized dentin enhances the remineralization of the dentin beneath the restoration.

Zn-containing Adhesives Facilitate Collagen Protection and Remineralization at the Resin-Dentin Interface: A Narrative Review

This is a narrative review of the literature assessing the potential effectiveness of doping dentin polymeric adhesives with zinc compounds in order to improve bonding efficacy, remineralization and protection against degradation. A literature search was conducted using electronic databases, such as PubMed, MEDLINE, DIMDI and Web of Science. Through our search, we found literature demonstrating that Zn-doped dentin adhesives promote protection and remineralization of the resin-dentin interfaces. The increased bioactivity has also facilitated dentinal tubules' occlusion by crystals' precipitation contributing to improved sealing efficacy of restorations. Loading dentin adhesives with zinc gives rise to an increase of both crystallinity of mineral and crosslinking of collagen. The main role of zinc, in dentin adhesives, is to inhibit collagen proteolysis. We concluded that zinc exerts a protective effect through binding at the collagen-sensitive cleavage sites of matrix-metalloproteinases (MMPs), contributing to dentin matrix stabilization. Zinc may not only act as a MMPs inhibitor, but also influence signaling pathways and stimulate metabolic effects in dentin mineralization and remineralization processes. Zn-doped adhesives increase the longevity of dentin bonding through MMPs inhibition. Zn poses a remineralization strategy in demineralized dentin.

A comprehensive review of the antibacterial activity of dimethylaminohexadecyl methacrylate (DMAHDM) and its influence on mechanical properties of resin-based dental materials

The repetitive restorative cycle should be avoided, aiming at the smallest number of restorations' replacements to ensure greater tooth longevity. Antibacterial materials associated with the control of caries etiological factors can help improve restoration's durability. This review aimed to analyze the results of in vitro studies that added Dimethylaminohexadecyl methacrylate (DMAHDM), an antibacterial monomer, to restorative materials. The PubMed, SCOPUS, Web of Science, and Biblioteca Virtual em Saúde databases were screened for studies published between 2015 and 2020. After full-text reading, 24 articles were included in the final sample. DMAHDM has demonstrated antibacterial efficacy against several bacteria related to dental caries and periodontal diseases, causing a transition in the biofilm balance without inducing resistance. When DMAHDM was included in acrylic resin, the material cytotoxicity increased, and changes in mechanical properties were observed. In contrast, resin composites had their mechanical properties maintained in most studies; however, toxicity was not examined. The association between DMAHDM and 2-methacryloyloxyethyl phosphorylcholine or silver nanoparticles improved the antibacterial effect. Besides, the association with nanoparticles of amorphous calcium phosphate or nanoparticles of calcium fluoride can provide remineralization capacity. There is a lack of information on the cytotoxicity and bacteria resistance induction, and further studies are needed to address this.

Mesoporous calcium silicate nanoparticles for superficial dental tissue reconstruction, in vitro and in vivo

The underlying dentin could be exposed to a humid atmosphere filled with bacteria if the covering enamel layer is broken because of external chemical and physical conditions. Accordingly, some diseases like bacterial invasion and dentin hypersensitivity often occur, which impact the daily life of patients. The study is aimed at evaluating the occluding effects of mesoporous calcium silicate nanoparticles (MCSNs) on the dentinal tubules in vitro and in vivo, as well as the antibacterial property and drug delivery ability when loaded with chlorhexidine (CHX) in vitro. MCSNs were synthesized according to the standard protocol. After a series of complimentary evaluations in vitro and in vivo, it was found that MCSNs and CHX–MCSNs could continually form apatite-like enamel layers on the exposed dentinal tubules and significantly reduced dentin permeability both in vitro and in vivo. Besides, MCSN and CHX–MCSN possessed low cytotoxicity in vitro, and only mild pulp inflammation was observed in two MCSNs containing groups in vivo. In addition, MCSN loaded with CHX released CHX sustainably and revealed a significant antibacterial effect against E. faecalis in vitro. Therefore, the results suggest that MCSN could be used as a promising biomaterial to occlude the dentinal tubules and carry antibiotics for avoiding further pulp infection.

MCSNs could be used as a promising biomaterial for occluding the dentinal tubules in vitro and in vivo. Also, the outstanding drug delivery and antibacterial properties enable it to carry antibiotics easily for inhibiting deeper pulp infection.

In situ effect of a proanthocyanidin mouthrinse on dentin subjected to erosion

Proanthocyanidin has been shown to be efficient in inhibiting matrix metalloproteinases.

Modifying Adhesive Materials to Improve the Longevity of Resinous Restorations

Dental caries is a common disease on a global scale. Resin composites are the most popular materials to restore caries by bonding to tooth tissues via adhesives. However, multiple factors, such as microleakage and recurrent caries, impair the durability of resinous restorations. Various innovative methods have been applied to develop adhesives with particular functions to tackle these problems, such as incorporating matrix metalloproteinase inhibitors, antibacterial or remineralizing agents into bonding systems, as well as improving the mechanical/chemical properties of adhesives, even combining these methods. This review will sum up the latest achievements in this field.

Secondary caries development and the role of a matrix metalloproteinase inhibitor: A clinical in situ study

OBJECTIVES

This in situ study aimed to investigate whether the dentin treatment with MMPs inhibitor (CHX 2%) could influence the development of secondary caries wall lesions in different dentin-composite interfaces.

MATERIAL AND METHODS

For 21 days, 15 volunteers wore a modified-occlusal splint loaded with dentin-composite samples treated or not with CHX and restored according 4 different interface conditions: Bonding (B = samples restored with complete adhesive procedure), no bonding (NB = restored with composite resin without adhesive procedure), 100 μm (no adhesive procedure and with intentional gap) and 100 μm + B (adhesive material on composite side and intentional gap). Eight times per day, the splint with samples was dipped in a 20% sucrose solution for 10 min. Before and after caries development, samples were imaged with T-WIM and lesion depth (LD) and mineral loss (ML) were calculated.

RESULTS

Linear mixed effect analysis showed that dentin treatment with CHX did not significantly affect the caries lesion progression (LD and ML; p ≤ 0.797). Dentin wall lesions were observed in the 100 μm and 100 μm + B groups independently of MMP inhibitor treatment.

CONCLUSION

The treatment of dentin with MMP inhibitor was not able to slow down the secondary caries wall lesion development in this in situ study.

SIGNIFICANCE

The dentin treatment with 2% CHX did not prevent secondary caries wall lesion initiation.

The role of protease inhibitors on the remineralization of demineralized dentin using the PILP method

Mineralized and sound dentin matrices contain inactive preforms of proteolytic enzymes that may be activated during the demineralization cycle. In this study, we tested the hypothesis that protease inhibitors (PI) preserve demineralized collagen fibrils and other constituents of the dentin matrix and thereby affect the potential for remineralization. Artificial carious lesions with lesion depths of 140 μm were created with acetate buffer (pH = 5.0, 66 hours), and remineralized using a polymer-induced-liquid-precursor (PILP) process (pH = 7.4, 14 days) containing poly(aspartic acid) (pAsp) as the process-directing agent. De- and remineralizing procedures were performed in the presence or absence of PI. Ultrastructure and mechanical recovery of demineralized dentin following PILP remineralization were examined and measured in water with atomic force microscopy (AFM) and nanoindentation. Nanomechanical properties of hydrated artificial lesions had a low elastic modulus (E_R <0.4 GPa) extending about 100 μm into the lesion, followed by a sloped region of about 140 μm depth where values reached those of normal dentin (18.0–20.0 GPa). Mapping of mineral content by both micro-FTIR and micro x-ray computed tomography correlated well with modulus profiles obtained by nanoindentation. Tissue demineralized in the presence of PI exhibited higher elastic moduli (average 2.8 GPa) across the lesion and comprised a narrow zone in the outer lesion with strongly increased modulus (up to 8 GPa; p < 0.05), which might be related to the preservation of non-collagenous proteins that appear to induce calcium phosphate mineral formation even under demineralizing physical-chemical conditions. However, mechanical aspects of remineralization through the elastic modulus change, and the micromorphological aspects with SEM and TEM observation were almost identical with PILP treatments being conducted in the presence or absence of PI. Thus, the application of the protease inhibitors (PI) seemed to be less effective in promoting the remineralization of demineralized dentin.

Effect of Proanthocyanidin-enriched extracts on the inhibition of wear and degradation of dentin demineralized organic matrix

OBJECTIVES

The aim of this study was to evaluate the effect of Cranberry and Grape seed-enriched extract gels in inhibiting wear and degradation of demineralized organic matrix (DOM).

DESIGN

225 dentin specimens obtained from bovine incisors were randomly allocated into 5 groups (n=45): 10% Grape seed extract gel (GSE), 10% Cranberry extract gel (CE), 0.012% Chlorhexidine gel (CX), 1.23% NaF gel (F), and no active compound gel (P, placebo). Before the treatments, samples were demineralized by immersion in 0.87M citric acid, pH 2.3 (36h). Then, the studied gels were applied once over dentin for 1min. Next, the samples were immersed in artificial saliva containing collagenase obtained from Clostridium histolyticum for 5days. The response variable for dentin wear was depth of dentin loss measured by profilometry and for collagen degradation was hydroxyproline determination. Data were analyzed by ANOVA followed by Tukey's test and Pearson Correlation Test (p<0.05).

RESULTS

Grape seed extract significantly reduced dentin wear compared to the other groups (p<0.05). Cranberry extract and Chlorhexidine did not differ statistically and were able to reduce wear when compared to NaF and placebo treatments. The hydroxyproline analysis showed that there was no significant difference among groups for all treatments (p<0.05). Correlation analysis showed a significant correlation between the amount of degraded DOM evaluated by profilometry and the determination of hydroxyproline.

CONCLUSION

Cranberry extract was able to reduce the dentin wear and collagen degradation, likely due to the proanthocyanidin content and its action. Therefore, Cranberry could be suggested as an interesting natural-based agent to prevent dentin erosion.

Chlorhexidine Prevents Root Dentine Mineral Loss and Fracture Caused by Calcium Hydroxide over Time

Purpose. To evaluate the mineral ion loss of root dentine after treatment with 2% chlorhexidine solution (CHX) and to compare its yield and flexural strength (fs) after exposure to calcium hydroxide [Ca(OH)₂]. Materials and Methods. Dentine bars (DB) were made from 90 roots of bovine incisors and randomized into three groups: G_Control: distilled/deionized water (DDW), G_NaOCl: 2.5% sodium hypochlorite + 17% EDTA, and G_CHX: CHX + DDW. The release of phosphate (PO₄) and calcium (Ca) ions was measured by spectrophotometry. The DB were exposed to Ca(OH)₂ paste for 0, 30, 90, and 180 days. DB were subjected to the three-point bending test to obtain yield and fs values. The fracture patterns were evaluated (20x). Data were analyzed using Kruskal-Wallis and Dunn's post hoc tests or one- and two-way ANOVA followed by Tukey's post hoc test (α = 0.05). Results. G_CHX showed lower PO₄³⁻ and Ca²⁺ ionic release than G_NaOCl (p < 0.001). For yield and fs, G_CHX > G_NaOCl in all periods (p < 0.001), except for yield strength values on 90 days (p = 0.791). A larger frequency of vertical fractures was observed in G_NaOCl and that of oblique fractures in G_CHX (p < 0.05). Conclusions. CHX prevented PO₄³⁻ and Ca²⁺ loss and showed a tendency to preserve the yield and fs of root dentine over time following exposure to Ca(OH)₂ paste.

Arresting simulated dentine caries with adjunctive application of silver nitrate solution and sodium fluoride varnish: an in vitro study

PURPOSE

The aim of this in vitro study was to assess the ability of silver nitrate solution, followed by sodium fluoride varnish, to arrest caries.

METHODS

Dentine slices were prepared and demineralised. Each slice was cut into three specimens for three groups (SF, SDF and W). Specimens of the SF group received topical application of 25% silver nitrate solution followed by 5% sodium fluoride varnish. The SDF group received topical application of 38% silver diamine fluoride solution (positive control). Specimens of the W group received deionised water (negative control). All specimens were subjected to pH cycling for 8 days. Dentine surface morphology, crystal characteristics, carious lesion depth and collagen matrix degradation were evaluated by scanning electron microscopy, X-ray diffraction, X-ray microtomography and spectrophotometry with a hydroxyproline assay.

RESULTS

Scanning electron microscopy showed that dentine collagen was exposed in group W, but not in groups SF and SDF, while clusters of granular spherical grains were formed in groups SF and SDF. The mean lesion depths (±standard deviation) of groups SF, SDF and W were 128 ± 19, 135 ± 24 and 258 ± 53 μm, respectively (SF, SDF < W; P < 0.001). The X-ray diffraction analysis indicated that silver chloride was formed in groups SF and SDF. The concentration of hydroxyproline released from the dentine matrix was significantly lower in groups SF and SDF than in group W (P < 0.05).

CLINICAL SIGNIFICANCE

The results of this in vitro study indicate that the use of silver nitrate solution and sodium fluoride varnish is effective in inhibiting dentine demineralisation and dentine collagen degradation.

Effect of final irrigation procedures on fracture resistance of root filled teeth: an ex vivo study

AIM

To evaluate the effect of chlorhexidine (CHX) on fracture resistance of roots treated with different concentrations of ethylenediaminetetraacetic acid (EDTA).

METHODOLOGY

One hundred and twenty intact single-rooted premolar teeth were sectioned below the cementum-enamel junction to standardize the length of the teeth to 12 mm. The canals of one hundred specimens were instrumented with ProTaper Universal rotary instruments up to size F4 and were randomly divided into five groups (n = 20) according to the final irrigating solutions: Group 1: distilled water (DW); Group 2: 5% EDTA and 2.5% NaOCl; Group 3: 17% EDTA and 2.5% NaOCl; Group 4: 5% EDTA, 2.5% NaOCl, DW and 2% CHX; Group 5: 17% EDTA and 2.5% NaOCl, DW and 2% CHX. Root canals were filled with gutta-percha and epoxy resin-based root canal sealer using a single-cone technique. Twenty teeth served as negative controls and were not instrumented nor root filled (Group 6). All specimens were embedded in self-curing acrylic resin and loaded vertically at 0.5 mm min^-1 until fracture occurred. The data were evaluated statistically using one-way anova test followed by Holm-Sidak's multiple comparison test (P < 0.05).

RESULTS

Group 1 (only DW) had the lowest vertical fracture strength, followed by Group 3 (17% EDTA and 2.5% NaOCl; P < 0.05). Group 6 (negative control group) had the highest fracture resistance. Final irrigation with CHX following irrigation with 17% EDTA or 5% EDTA and 2.5% NaOCl (groups 4 and 5) significantly increased the fracture resistance of roots (P < 0.05). However, the difference between Group 4 and Group 5 was not significant (P > 0.05).

CONCLUSIONS

Intracanal CHX rinse of EDTA/NaOCl-treated root dentine enhanced the fracture resistance of roots filled with AH Plus.

Novel Cavity Disinfectants Containing Quaternary Ammonium Monomer Dimethylaminododecyl Methacrylate

This study was set to assess the possible benefits of novel cavity disinfectants with 5% dimethylaminododecyl methacrylate (DMADDM); and compare the effectiveness of saliva microbial-aging method with water-aging in measuring the changing of resin-dentin bond strength. Three cavity disinfectants were tested: 0.2% Chlorhexidine (CHX); 5% DMADDM; and 5% DMADDM + 0.2% CHX. Microtensile bond strength (μTBS) test was performed after microbial-aging with saliva microbial or water aging for one month. Hydroxyproline (HYP), the production of collagen degradation, was measured spectrophotometrically. Additionally, the antibacterial effects of each reagent were evaluated. The 5% DMADDM exerted the least percentage of resin-dentin bond strength loss after one month microbial-aging (p < 0.05). There were no statistically significant differences of bond strength decrease after one month water aging among the tested groups (p > 0.05). Microbial-aging method yield more drop of bond strength than water aging in all groups except 5% DMADDM (p < 0.05). Meanwhile, 5% DMADDM had the same matrix metalloproteinases (MMPs) inhibitory effects as the other two agents (p > 0.05), but much stronger antibacterial capability than 0.2% CHX (p < 0.05). This indicated that a cavity disinfectant with 5% DMADDM is promising for improving the stability of resin-dentin bonds in appearance of saliva biofilm; and the saliva microbial-aging method is more promising for studying the durability of resin-dentin bonds than water aging.

Effect of 10% fluoride on the remineralization of dentin in situ

Objective The purpose of this randomized, cross-over, in situ study was to determine the remineralization of demineralized dentin specimens after the application of a 10% fluoride (F-) or a 1% chlorhexidine-1% thymol (CHX-thymol) varnish. Material and Methods Twelve individuals without current caries activity wore removable appliances in the lower jaw for a period of four weeks. Each appliance contained four human demineralized dentin specimens fixed on the buccal aspects. The dentin specimens were obtained from the cervical regions of extracted human third molars. After demineralization, half the surface of each specimen was covered with a nail varnish to serve as the reference surface. The dentin specimens were randomly assigned to one of the three groups: F-, CHX-thymol, and control (no treatment). Before the first treatment period and between the others, there were washout periods of one week. After each treatment phase, the changes in mineral content (vol% µm) and the lesion depths (µm) of the dentin slabs were determined by transverse microradiography (TMR). Data analysis was accomplished by the Kruskal-Wallis test and the Mann-Whitney U test (p<0.05). Results The medians (25th/75th percentile) of integrated mineral loss were 312.70 (203.0-628.7) for chlorhexidine varnish, 309.5 (109.8-665.8) for fluoride varnish, and -346.9 (-128.7 - -596.0) for the control group. The medians (25th/75th percentile) of lesion depth were 13.6 (5.7-34.5) for chlorhexidine varnish, 16.5 (5.6-38.1) for fluoride varnish, and -14.2 (-4.5- -32.9) for the control group. Use of the 10% F- or 1% CHX-1% thymol varnishes resulted in significantly decreased mineral loss and lesion depth in dentin when compared with the control group. There were no statistically significant differences among the test groups. Conclusions Within the limitations of this study, the results suggest that the effect of the treatment of demineralized dentin with 10% F- or 1% CHX-1% thymol is better than without any treatment.

Role of Host-Derived Proteinases in Dentine Caries and Erosion

Demineralization in dentinal caries and erosion exposes dentine organic matrix. This exposed matrix, containing type I collagen and non-collagenous proteins, is then degraded by host collagenolytic enzymes, matrix metalloproteinases (MMPs) and cysteine cathepsins. The knowledge of the identities and function of these enzymes in dentine has accumulated only within the last 15 years, but has already formed a field of research called ‘dentine degradomics'. This research has demonstrated the role of endogenous collagenolytic enzymes in caries and erosion development. In demineralized dentine, the enzymes degrade triple-helical collagen molecules, leading to the gradual loss of collagen matrix. Even before that, they can cleave off the terminal non-helical ends of collagen molecules called telopeptides, leading to the structural changes at the intramolecular gap areas, which may affect or even prevent intrafibrillar remineralization, which is considered essential in restoring the dentine's mechanical properties. They may also cause the loss of non-collagenous proteins that could serve as nucleation sites for remineralization. Here we review the findings demonstrating that inhibition of salivary or dentine endogenous MMPs and cysteine cathepsins may provide preventive means against the progression of caries or erosion. Furthermore, we also suggest the future directions for the new experimental preventive research to gain more knowledge of the enzymes and their function during and after dentine demineralization, and the pathways to find the clinically acceptable means to prevent the functional activity of these enzymes.

Preventive effect of different toothpastes on enamel erosion: AFM and SEM studies

The aim of the present in vitro study was the evaluation of new formulation toothpastes on preventing enamel erosion produced by a soft drink (Coca Cola), using atomic force microscopy (AFM) and scanning electron microscopy (SEM). Fifty enamel specimens were assigned to 10 groups of 5 specimens each. 1: intact enamel, 2: enamel + soft drink, 3: intact enamel + BioRepair Plus-Sensitive Teeth, 4: enamel + soft drink + BioRepair Plus-Sensitive Teeth, 5: intact enamel + BioRepair Plus-Total Protection, 6: enamel + soft drink + BioRepair Plus-Total Protection, group 7: intact enamel + Sensodyne Repair & Protect, 8: dentin + soft drink + Sensodyne Repair & Protect, 9: intact dentin + Colgate Sensitive Pro Relief, 10: dentin + soft drink + Colgate Sensitive Pro Relief. The surface of each specimen was imaged by AFM and SEM. The root mean-square roughness (Rrms ) was obtained from the AFM images and the differences in the averaged values among the groups were analyzed by ANOVA test. Comparing groups 4, 6, 8, 10 (soft drink + toothpastes) Colgate Sensitive Pro Relief promoted enamel remineralization, while BioRepair Plus-Sensitive Teeth, Biorepair Plus-Total Protection and Sensodyne Repair & Protect provided lower effectiveness in protecting enamel against erosion.

SIGNIFICANCE

the use of new formulation toothpastes can prevent enamel demineralization.

The role of different toothpastes on preventing dentin erosion: an SEM and AFM study®

The aim of the present in vitro study was the evaluation of new formulation toothpastes on preventing dentin erosion produced by a soft drink (Coca Cola®), using atomic force microscopy (AFM) and scanning electron microscopy (SEM). Fifty dentin specimens were divided in treatment and control halves and were than assigned to 5 groups of 10 specimens each: group 1a: intact dentin, group 1b: dentin + soft drink, group 2a: intact dentin + Biorepair Plus-Sensitive Teeth®, group 2b: dentin + soft drink + Biorepair Plus-Sensitive Teeth®, group 3a: intact dentin + Biorepair Plus-Total Protection®, group 3b: dentin + soft drink + Biorepair Plus-Total Protection®, group 4a: intact dentin + Sensodyne Repair & Protect®, group 4b: dentin + soft drink + Sensodyne Repair & Protect®, group 5a: intact dentin + Colgate Sensitive Pro Relief®, group 5b: dentin + soft drink + Colgate Sensitive Pro Relief®. The surface of each specimen was imaged by AFM and SEM. Comparing specimens of group a and b (no demineralization and demineralization), a statistically significant difference (p < 0.01) in Rrms values was registered. Comparing b groups, all the analyzed toothpastes tended to remineralize the dentine surface in different extent. Biorepair Plus-Total Protection® and Sensodyne Repair & Protect® provided higher protective effect against dentin demineralization.

Surface microanalysis and chemical imaging of early dentin remineralization

This study reports physical and chemical changes that occur at early dentin remineralization stages. Extracted human third molars were sectioned to obtain dentin discs. After polishing the dentin surfaces, three groups were established: (1) untreated dentin (UD), (2) 37% phosphoric acid application for 15 s (partially demineralized dentin-PDD), and (3) 10% phosphoric acid for 12 h at 25° C (totally demineralized dentin-TDD). Five different remineralizing solutions were used: chlorhexidine (CHX), artificial saliva (AS), phosphate solution (PS), ZnCl2, and ZnO. Wettability (contact angle), ζ potential and Raman spectroscopy analysis were determined on dentin surfaces. Demineralization of dentin resulted in a higher contact angle. Wettability decreased after immersion in all solutions. ζ potential analysis showed dissimilar performance ranging from -6.21 mV (TDD + AS) up to 3.02 mV (PDD + PS). Raman analysis showed an increase in mineral components after immersing the dentin specimens, in terms of crystallinity, mineral content, and concentration. This confirmed the optimal incorporation and deposition of mineral on dentin collagen. Organic content reflected scarce changes, except in TDD that appeared partially denatured. Pyridinium, as an expression of cross-linking, appeared in all spectra except in specimens immersed in PS.

Saliva and dental erosion

Dental erosion is a multifactorial condition. The consideration of chemical, biological and behavioral factors is fundamental for its prevention and therapy. Among the biological factors, saliva is one of the most important parameters in the protection against erosive wear.

OBJECTIVE

This review discusses the role of salivary factors on the development of dental erosion.

MATERIAL AND METHODS

A search was undertaken on MeDLINe website for papers from 1969 to 2010. The keywords used in the research were "saliva", "acquired pellicle", "salivary flow", "salivary buffering capacity" and "dental erosion". Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were solved by discussion and consensus or by a third party.

RESULTS

Several characteristics and properties of saliva play an important role in dental erosion. Salivary clearance gradually eliminates the acids through swallowing and saliva presents buffering capacity causing neutralization and buffering of dietary acids. Salivary flow allows dilution of the acids. In addition, saliva is supersaturated with respect to tooth mineral, providing calcium, phosphate and fluoride necessary for remineralization after an erosive challenge. Furthermore, many proteins present in saliva and acquired pellicle play an important role in dental erosion.

CONCLUSIONS

Saliva is the most important biological factor affecting the progression of dental erosion. Knowledge of its components and properties involved in this protective role can drive the development of preventive measures targeting to enhance its known beneficial effects.

The role of matrix metalloproteinases in dental erosion

This review discusses the role of matrix metalloproteinases (MMPs) in the development of dentin erosion and the protective effects of MMP inhibitors, based on recent evidence from in vitro and in situ studies. MMPs are present in both dentin and saliva and play an important role in dentin erosion progression. Enzymatic removal of the organic matrix by MMPs increases the demineralization process, since the demineralized organic matrix has been shown to hamper ionic diffusion after an acidic challenge. Recent evidence from in vitro and in situ studies has shown a protective role of MMP inhibitors against dentin erosion and erosion plus abrasion. The inhibitors tested were green tea and its active epigallocatechin-gallate (EGCG), ferrous sulfate, and chlorhexidine. They have been tested in dentifrices, solutions, and gels. The latter led to a more pronounced protective effect against dentin erosion and erosion plus abrasion. The protection was long-lasting and could be observed after up to 10 days of severe erosive and erosive-plus-abrasive challenges in situ. Thus, the use of MMP inhibitors has emerged as an important preventive tool against dentin erosion. Clinical studies should be conducted to confirm the results obtained and to give support to the establishment of clinical protocols of use.

One year effect of chlorhexidine on bonding of fibre-reinforced composite root canal post to dentine

OBJECTIVES

Chlorhexidine preserves the long-term bonding between composite restorations and coronal dentine. Our aim was to evaluate the long-term effect of chlorhexidine on attachment of fibre-reinforced composite (FRC) root canal posts to root canals. We hypothesized that chlorhexidine would not negatively affect the bond strength in aged specimens.

METHODS

Root canals of 40 human extracted third molars were prepared for post cementation with each post systems' own burs. Four commercially available FRC posts (Glassix, D.T. Light-Post, Unicore, everStickPOST) were cemented with three different cements (Duo-link, PermaFlo DC, RelyX Unicem). After etching, except with self-adhesive RelyX Unicem, the post spaces were irrigated either with 2% chlorhexidine (Consepsis) or physiological saline for 60s. The roots (n=5 per group) were cut into 2mm thick dentine discs. The discs were stored in artificial saliva for one year. The bond strength was measured with the push-out method, and the failure mode was evaluated with a stereomicroscope.

RESULTS

Unicore with PermaFlo DC and everStickPOST with RelyX Unicem demonstrated significantly higher bond strength values both with and without chlorhexidine. After one year of storage chlorhexidine application improved the bond strength with D.T. Light-Post/Duo-link. With other posts and cements chlorhexidine application did not affect the bond strength.

CONCLUSION

2% chlorhexidine did not negatively affect the long-term bond strength of any material tested.

CLINICAL SIGNIFICANCE

Irrigation of root canals with chlorhexidine, as indicated to prevent root canal infection during post placement, does not interfere with post bond strength when FRC posts are used.

AFM study of the effects of collagenase and its inhibitors on dentine collagen fibrils

OBJECTIVE

This study evaluated the effects of exogenous collagenase and two collagenase inhibitors on the variation in microstructure of human collagen fibrils.

METHODS

Dentine specimens which were sectioned from 6 freshly extracted human caries-free third molars were wet polished. Each specimen was divided into 4 parts which were treated as experimental groups (group 1, group 2, group 3) and the control group, respectively. All the specimens were etched and further treated with NaClOaq. Subsequently, the topography of each specimen was observed using atomic force microscopy (AFM) in tapping mode in air. Group 1 was then treated with a solution of collagenase II. Group 2 was treated with a solution of collagenase II and chlorhexidine (saturated solution). Group 3 was treated with a solution of collagenase II and captopril (0.3%). The control group was treated with a buffer solution. After 3h and 6h of treatment, the topography of the collagen fibrils was measured with AFM in air, respectively.

RESULTS

AFM images of the dentine collagen fibrils were obtained after treatment with NaOClaq. Following further treatment with collagenase II, the topography of the collagen fibrils changed. Most reticular collagen fibrils disappeared after 6h. After treatment with collagenase II in the presence of chlorhexidine or captopril for 3h and 6h, the morphology of the collagen fibres was not changed obviously.

CONCLUSIONS

Exogenous collagenase II effectively degraded human dentine collagen fibrils, and its collagenolytic activity was inhibited by the exogenous collagenase inhibitors, chlorhexidine and captopril.