Evaluation of Struthio camelus eggshell as an in vitro alternative to extracted human teeth in preliminary screening studies on dental erosion

OBJECTIVES

This in vitro work investigates the potential of ostrich eggshell as a substitute for extracted human teeth in preliminary screening studies on dental erosion. Additionally, it aims to demonstrate the potential of ostrich eggshell compared to human enamel in evaluating the efficacy of a preventive agent in protecting against dental erosion, using an artificial mouth model.

METHODS

The experiment utilized 96 erosion testing specimens from each substrate, human enamel, and ostrich eggshell. The specimens were subjected to six different experimental regimens of increasing erosive challenge, simulating the consumption of an acidic drink. The acidic drink was delivered at a consistent volume and duration range. Both artificially stimulated and unstimulated saliva flowed throughout the experimental regimens. Surface hardness was measured using a Through-Indenter Viewing hardness tester with a Vickers diamond, while surface profiling was done using a surface contacting profilometer with a diamond stylus. An automated chemistry analyzer system was used to detect calcium and phosphate ions.

RESULTS

The study found that ostrich eggshell specimens demonstrated predictable surface loss, hardness drop, and ion loss due to the acidic challenge. Meanwhile, enamel appeared to fall short in terms of surface hardness predictability. The transient hardness loss phase, which manifests as an overlooked decrease in surface hardness despite significant ion and structural loss, may explain this phenomenon.

CONCLUSIONS

The experiment showed that assessing surface loss is essential in addition to hardness testing, particularly as certain experimental conditions may produce a false perception of tissue recovery despite the actual surface loss. By analyzing the response of ostrich eggshell specimens to erosive challenges, researchers were able to identify an "overlooked" reduction in hardness in enamel specimens. The differences in the structure, chemical composition, and biological response to erosion in the presence of artificial saliva between enamel and ostrich eggshell could explain their distinct behaviors.

Gels containing statherin-derived peptide protect against enamel and dentin erosive tooth wear in vitro

The effect of gels containing a statherin-derived peptide (Stn) on the protection against enamel and dentin erosive tooth wear (ETW) in vitro was evaluated. Bovine enamel and dentin specimens were divided into 2 groups (n = 15 and 18/group for enamel and dentin, respectively) that were treated with Chitosan or Carboxymethylcellulose (CMC) gels containing Stn15pSpS at 1.88 × 10-5 M or 3.76 × 10-5 M. Chitosan or CMC gels without active ingredients served as negative controls, while chitosan gel containing 1.23% F (as NaF) and acidulated phosphate fluoride gel (1.23% F) served as positive controls. The gels were applied on the specimens for 4 min. Stimulated saliva was collected from 3 donors and used to form a 2-h acquired pellicle on the specimens. Then, the specimens were submitted to an erosive pH cycling protocol 4 times/day for 7 days (0.01 M HCl pH 2.0/45 s, artificial saliva/2 h, and artificial saliva overnight). The gels were applied again during pH cycling, 2 times/day for 4 min after the first and last erosive challenges. Enamel and dentin loss (μm) were assessed by contact profilometry. Scanning electron microscopy (SEM) was analyzed using a cold field emission. Data were analyzed by two-way ANOVA (for chitosan and CMC gels, separately) and Tukey's multiple comparison test. SEM images showed changes to enamel topography after application oft the gels containing Stn or F. Regarding CMC-based gels, for enamel, none of the treatments significantly reduced ETW in comparison with placebo; for dentin, however, gels containing Stn, regardless the concentration, significantly reduced the ETW. Moreover, Chitosan-based gels, regardless the Stn concentration, were able to protect enamel and dentin against ETW. Gels containing Stn might be a new approach to protect against ETW.

Effect of high-fluoride dentifrice on root dentine de-remineralization exposed to erosion challenge in vitro

Background

High-fluoride dentifrice can be used to manage dental erosion; however, little is known about it effect on root dentine previously demineralized. This study evaluated the effect of high-fluoride treatment on dentin de/remineralization exposed to an erosion challenge in vitro.

Material and Methods

Sound and demineralized dentine blocks were submitted to a 5-days-erosive challenge in soft drink (4/day during 90 s) and treated with fluoride solutions (0, 1,100, or 5,000 µg F/mL). After this, the percentage of surface hardness loss (%SHL) or recovery (%SHR) was calculated. Data were analyzed by one-way ANOVA and Tukey post hoc test with p fixed at 5%.

Results

High-fluoride treatment was able to reduce dentine remineralization and increase mineral recovery of previously demineralized dentine compared to other treatments tested (p<0.05).

Conclusions

High-fluoride treatment was able to increase the remineralization and reduce the demineralization of root dentine submitted to an erosive challenge in vitro, being an option for the erosion prevention/treatment.

Key words:Fluorides, root caries, tooth erosion, toothpastes.

Effect of three different remineralizing agents on artificial erosive lesions of primary teeth

BACKGROUND

This study aimed to investigate the efficacy of three remineralizing agents on dental erosion in primary teeth.

METHODS

Forty primary molars were randomly divided into four groups (n = 10 each): self-assembling peptide (P_11-4 ), casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP), sodium fluoride (NaF) and artificial saliva (AS; control). The erosion-like formation was created by immersing the samples in citric acid (4 × 2 min, pH 2.3) and AS (4 × 2 h, pH 7). The eroded samples were then treated with remineralizing agents and subjected to further erosion consisting of 15 cycles (3x/8-h interval) of immersion in citric acid and AS for 6 s each. Alterations in the mineral content and morphology of the samples were quantified using a microhardness tester and atomic force microscope.

RESULTS

All agents had a significant remineralization effect on eroded primary tooth enamel. After further erosive challenge, enamel loss in the CPP-ACFP group was found to be significantly lower than in all other groups, and no significant difference was found between the P_11-4 and NaF groups.

CONCLUSIONS

This study showed that all tested materials had remineralization ability, and CPP-ACFP had a superior effect in inhibiting enamel loss due to dental erosion in primary teeth. © 2022 Australian Dental Association.

Assessment of a novel bleaching agent formula containing 35% hydrogen peroxide and titanium tetrafluoride: an in vitro study

This study developed experimental gels containing titanium tetrafluoride (TiF4) combined with commercial 35% hydrogen peroxide (HP), and evaluated bleaching efficacy and pH of the gels, and mineral content and morphology of enamel submitted to these treatments. In phase-1, different stock gels mixed with TiF4 were combined with HP. In phase-2, the selected gels were tested on enamel/dentin specimens (n=8): HP; HP and Natrosol+TiF4 (HPnT); HP and Natrosol+Chemygel+TiF4 (HPncT); HP and Aristoflex+TiF4 (HPaT). Bleaching was performed in four sessions (3x15min-application/session). Color (CIEL*a*b*) and whiteness index (WID) were measured after each session, whereas whiteness index differences (ΔWID), color alteration (CIELab-ΔE, CIEDE2000-ΔE00), enamel morphology and pH, at end of bleaching therapy. The change in Knoop microhardness (ΔKHN) was compared before and after bleaching. Data were analyzed by two-way repeated measures ANOVA and Bonferroni (CIEL*, a*, b*), one-way ANOVA and Tukey (ΔWID, ΔE, ΔE00), and LSD (ΔKHN) tests (α=5%). SEM and pH measurements were submitted to descriptive analysis. No differences were observed in lightness (L*) or WID among the groups (p > 0.05), but HP exhibited lower b* values (p<0.05), higher ΔWID than HPnT, and the highest ΔE among the groups (p < 0.05). No differences in ΔE00 were observed between HP and HPncT (p > 0.05), and HPncT showed higher ΔKHN than HP (p < 0.05). HP presented pH values closer to neutral (6.9), whereas experimental agents showed acidic pH values (2.3-3.9). No morphological changes were observed in HP or HPncT groups. HPncT was able to bleach the enamel and maintain enamel microhardness and surface integrity, even at low pH.

Effect of TiF4 varnish after pre-treatment with proanthocyanidin or chlorhexidine on the progression of erosive dentin loss in the presence or absence of the demineralized organic matrix

This study evaluated the protective effect of TiF₄ varnish, after pre-treatment with proantocyanidin or chlorhexidine, on the progression of erosive dentin loss (EDL), under the presence or absence of the demineralized organic matrix (DOM). Bovine root dentin samples were eroded for 30 min (0.1% citric acid, pH 2.5) and the loss was measured by profilometry. Half of them were subjected to the DOM removal using collagenase for 4 days, while the other half remained immersed in water. The removal of DOM was checked by profilometry. Samples were divided into 24 groups (n = 15) according to the factors: 1- With or without DOM; 2- Pre-treatment with 0.012% chlorhexidine gel, 10% proanthocyanidin gel or untreated for 1 min; 3-Final Treatment with TiF₄ varnish, NaF varnish, placebo varnish or untreated for 6 h. The samples were submitted to a pH cycling for 5 days: 0.1% citric acid (4 × 90s/day) and artificial saliva between the challenges. The final profile was obtained for the calculation of EDL (μm, three-way ANOVA/Tukey test). When DOM was preserved, the EDL was lower compared to the condition without DOM (7.08 ± 4.03 μm and 9.80 ± 3.79 μm, p < 0.001, respectively), regardless of the treatments. The pre-treatment had no influence on the progression of EDL (p = 0.637), while the final treatment (TiF₄ varnish only, 6.77 ± 4.08 μm) was effective in reducing the progression of EDL (NaF varnish: 9.52 ± 4.02 μm; Placebo varnish: 8.64 ± 4.06 μm and no treatment: 8.80 ± 3.95 μm). It can be concluded that DOM has important protective effect on the progression of EDL. TiF₄ was the unique treatment capable of reducing EDL progression, regardless of the pre-treatment of DOM.

TiF4 varnish protects the retention of brackets to enamel after in vitro mild erosive challenge

The effect of fluoride agents on the retention of orthodontic brackets to enamel under erosive challenge is little investigated. The aim of this study was to evaluate the effect of titanium tetrafluoride (TiF4) and sodium fluoride (NaF) agents on the shear bond strength of brackets to enamel and on the enamel microhardness around brackets under erosive challenge. Brackets were bonded to bovine incisors. Five groups were formed according to fluoride application (n=10): TiF4 varnish, TiF4 solution, NaF varnish, NaF solution and control (without application). The specimens were submitted to erosive challenge (90 s cola drink/2h artificial saliva, 4x per day for 7 days). Solutions were applied before each erosive cycle and varnishes were applied once. Vickers Microhardness (VHN) was obtained before and after all cycles of erosion and the percentage of microhardness loss was calculated. Shear bond strength, adhesive remnant index and polarized light microscopy were conducted after erosion. The data were analyzed by ANOVA, Tukey, Kruskal-Wallis and Mann-Whitney U tests (α=0.05). The %VHN had no statistically significant differences among the experimental groups. However, considering the comparisons of all groups with the control group, TiF4 varnish showed the highest protection from enamel demineralization (effect size of 2.94, while the effect size for the other groups was >2.4). The TiF4 varnish group had significantly higher shear bond strength compared to other groups. There was no difference among groups for adhesive remnant index. Polarized light microscopy showed higher demineralization depth for the control group. Application of NaF and TiF4 agents during mild erosive challenge minimized the enamel mineral loss around brackets, however only the experimental TiF4 varnish was able to prevent the reduction of shear bond strength of brackets to enamel.

Mechanism of Action of TiF4 on Dental Enamel Surface: SEM/EDX, KOH-Soluble F, and X-Ray Diffraction Analysis

This in vitro study aimed to evaluate the action of TiF4 on sound and carious bovine and human enamel. Sound (S) and pre-demineralised (DE) bovine and human (primary and permanent) enamel samples were treated with TiF4 (pH 1.0) or NaF varnishes (pH 5.0), containing 0.95, 1.95, or 2.45% F for 12 h. The enamel surfaces were analysed using SEM-EDX (scanning electron microscopy/energy-dispersive X-ray spectroscopy) (n = 10, 5 S and 5 DE) and KOH-soluble fluoride was quantified (n = 20, 10 S and 10 DE). Hydroxyapatite powder produced by precipitation method was treated with the corresponding fluoride solutions for 1 min (n = 2). The formed compounds were detected using X-ray diffraction (XRD). All TiF4 varnishes produced a coating layer rich in Ti and F on all types of enamel surface, with micro-cracks in its extension. TiF4 (1.95 and 2.45% F) provided higher fluoride deposition than NaF, especially for bovine enamel (p < 0.0001). It also induced a higher fluoride deposition on DE samples compared to S samples (p < 0.0001), except for primary enamel. The Ti content was higher for bovine and human primary enamel than human permanent enamel, with some differences between S and DE. The XRD analysis showed that TiF4 induced the formation of new compounds such as CaF2, TiO2, and Ti(HPO4)2·H2O. In conclusion, TiF4 (>0.95% F) interacts better, when compared to NaF, with bovine and human primary enamel than with human permanent enamel. TiF4 provoked higher F deposition compared to NaF. Carious enamel showed higher F uptake than sound enamel by TiF4 application, while Ti uptake was dependent on the enamel condition and origin.

The cytotoxic effect of TiF4 and NaF on fibroblasts is influenced by the experimental model, fluoride concentration and exposure time

Objective

Titanium tetrafluoride (TiF₄) has shown promising effect in preventing tooth lesions. Therefore, we compared the cytotoxicity of TiF₄ with sodium fluoride (NaF) (already applied in Dentistry) considering different fluoride concentrations, pH values and experimental models.

Materials and methods

Step 1) NIH/3T3 fibroblasts were exposed to mediums containing NaF or TiF₄ (from 0.15 to 2.45% F), both at native and adjusted pH, for 6 h. Step 2) NIH/3T3 were exposed to NaF or TiF₄ varnishes with 0.95, 1.95 or 2.45% F (native pH), for 6, 12 or 24 h. We applied MTT (1^st and 2^nd steps) and Hoescht/PI stain (2^nd step) assays. Step 3) NIH/3T3 were exposed to NaF or TiF₄ varnish (2.45% F), at native pH, for 6 or 12 h. The cell stiffness was measured by atomic force microscopy (AFM).

Results

Step 1) All cells exposed to NaF or TiF₄ mediums died, regardless of the F concentration and pH. Step 2) Both varnishes, at 1.90 and 2.45% F, reduced cell viability by similar extents (33–86% at 6 h, 35–93% at 12 h, and 87–98% at 24 h) compared with control, regardless of the type of fluoride. Varnishes with 0.95% F did not differ from control. Step 3) TiF₄ and NaF reduced cell stiffness to a similar extent, but only TiF₄ differed from control at 6 h.

Conclusions

Based on the results of the 3 experimental steps, we conclude that TiF₄ and NaF have similar cytotoxicity. The cytotoxicity was dependent on F concentration and exposure time. This result gives support for testing the effect of TiF₄ varnish in vivo.

The Impact of the Demineralized Organic Matrix on the Effect of TiF4 Varnish on the Progression of Dentin Erosive Loss

This in vitro study compared the effect of TiF4 varnish with that of NaF varnish, applied on pre-eroded bovine dentin samples, with respect to the progression of erosive loss, in the presence or absence of the demineralized organic matrix (DOM). One hundred and sixty bovine dentin samples were pre-eroded (0.1% citric acid, pH 2.5, 30 min). Half of the samples were subjected to the DOM removal (collagenase solution, 5 days). Samples with and without the DOM were treated according to the groups (n = 20 with DOM and 20 without DOM/group): TiF4 varnish (2.45% F), NaF varnish (2.45% F), placebo varnish (without fluoride) and control (no treatment). Thereafter, the treated samples were submitted to erosive challenges 4 × 90 s/day (0.1% citric acid, pH 2.5) during 7 days. Between the challenges, the samples were immersed in artificial saliva. The dentin erosive loss was measured using contact profilometry (µm, n = 15). Five dentin samples per group were prepared for energy-dispersive X-ray spectroscopy analysis. Data were compared using 2-way ANOVA/Bonferroni test (p < 0.05). Both fluoride varnishes were effective in reducing the erosive loss progression regardless of the dentin condition when compared to placebo varnish and control groups. Despite the fact that the TiF4 varnish was more effective than the NaF varnish for both dentin conditions (p < 0.001), its effect was significantly reduced in the absence of DOM (p < 0.05). It can be concluded that the TiF4 varnish is the best treatment in reducing the progression of dentin erosive loss (100%) in vitro, but its protective effect is more pronounced in the presence of DOM.

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.

Prevention of Enamel Adjacent to Bracket Demineralization Following Carbon Dioxide Laser Radiation and Titanium Tetra Fluoride Solution Treatment: An In Vitro Study

Introduction: The aim of this study was to assess the caries-preventive potential of carbon dioxide (CO₂) laser application in conjunction with the use of titanium tetra fluoride solution on the enamel adjacent to bracket. Methods: Seventy-five freshly extracted bovine incisors were used. In order to attach the brackets, the area of examination was covered with adhesive tape to limit acid etching of the entire enamel surface. Metal orthodontic brackets for upper central were bonded to all the teeth following the manufacturer's instruction. Then all the teeth were painted with 2 layers of acid-resistant nail varnish on all surfaces except the boxes area cervical to the brackets. The teeth were then randomly divided into five groups (n = 15): control group (C); laser group (L); titanium group (T); laser-titanium group (LT) and titanium-laser group (TL). The laser-titanium group was first irradiated with CO₂ laser (same as the L group) then TiF4 solution was applied on the enamel (same as the T group). Samples in the TL group were first treated with TiF4 solution (same as the T group) and then irradiated with CO₂ laser on the surface (same as the L group). Then, the teeth were immersed in pH-cycling solutions. After that, the amount of calcium released into the two solutions (de- and re-mineralization) was measured with an atomic absorption spectroscopy. The data were analyzed by one-way Analysis of var-iance (ANOVA) and Tukey test. Results: Calcium loss in LT, TL and T groups were significantly lower than those in the L and C groups (P < 0.05). Conclusion: The application of Titanium tetra fluoride 4% solution on enamel can inhibit as much as 87% of subsequent caries like lesion progression.

Enamel lesions: Meta-analysis on effect of prophylactic/therapeutic agents in erosive tissue loss

This study aims to perform a meta-analysis on the effect of prophylactic/therapeutic agents in enamel tissue loss due to erosion. A paper search was done on Medline, PubMed, Embase, and Cochrane Library, and 732 papers were identified. The inclusion criteria were very restrictive in order to be able to compare different protocols and methodologies used on those studies. Sixteen papers were eligible, grouped according to the measurement method of enamel tissue loss, and a meta-analysis was done for each type of fluoride- and casein-based agent applied. Standardized mean differences were pooled across studies. There was a significant difference between all the treatment groups and their respective control groups. The highest standardized mean difference on enamel tissue loss (mean; 95% confidence interval) was obtained by stannous fluoride (4.789 μm; 1.968-7.610; P < 0.001), followed by amine fluoride (2.485 μm; 0.746-4.225; P < 0.010), and titanium tetrafluoride (1.787 μm; 1.106-2.469; P < 0.001); the lowest difference was obtained by casein phosphopeptide-amorphous calcium phosphate (0.869 μm; 0.007-1.731; P < 0.050) and sodium fluoride (0.820 μm; 0.417-1.223; P < 0.001). Stannous fluoride as a fluoride-based prophylactic/therapeutic agent allowed the lowest enamel tissue loss in erosive conditions. Standardization among future study protocols will allow better comparison regarding the prophylactic/therapeutic agent with the best clinical efficacy.

Effect of a Single Application of TiF4 Varnish versus Daily Use of a Low-Concentrated TiF4/NaF Solution on Tooth Erosion Prevention in vitro

This study investigated the isolated and combined effect of a single application of TiF4 or NaF varnish versus daily use of a solution containing a low concentration of TiF4/NaF against tooth erosion in vitro. A total of 90 bovine enamel and 108 root dentin samples were treated as follows: control (no treatment), solution containing TiF4/NaF (500 ppm F-, pH 4.4), NaF varnish (24,500 ppm F-, pH 5.0), TiF4 varnish (24,500 ppm F-, pH 1.0), TiF4 varnish + solution, and NaF varnish + solution. The erosive challenges were performed 4 × 90s/day (0.1% citric acid, pH 2.5) and, between them, the samples were immersed in artificial saliva. The tooth loss was measured using contact profilometry (after 7 days for dentin and after 7, 10, and 14 days for enamel). All treatments were effective in reducing tooth loss, except NaF varnish for enamel on day 7 (p < 0.0001). TiF4/NaF solution and TiF4 varnish did not differ with respect to enamel loss for 10 days; thereafter, TiF4 varnish lost its protective effect compared to TiF4/NaF solution. The combination of vehicles was more effective in reducing enamel loss than both varnishes on their own but not compared to the solution. For dentin, TiF4 varnish was more effective than NaF varnish, while TiF4/NaF solution and NaF varnish were similar. The combination of vehicles improved the protective effect only when compared to NaF varnish on its own (p < 0.0001). Both types of TiF4 applications, isolated or combined, were effective against tooth erosion, but some differences in their performance were seen between enamel and dentin.

Protective effect of experimental mouthrinses containing NaF and TiF4 on dentin erosive loss in vitro

Objective

This in vitro study assessed the anti-erosive effect of experimental mouthrinses containing TiF₄ and NaF on dentin erosive loss.

Material and Methods

Bovine dentin specimens were randomly allocated into the groups (n=15): 1) SnCl₂/NaF/AmF (Erosion Protection^®/GABA, pH 4.5, positive control); 2) experimental solution with 0.0815% TiF₄ (pH 2.5); 3) 0.105% NaF (pH 4.5); 4) 0.042% NaF+0.049% TiF₄ (pH 4.4); 5) 0.063% NaF+0.036% TiF₄ (pH 4.5); 6) no treatment (negative control). Each specimen was cyclically demineralized (Sprite Zero, pH 2.6, 4x90 s/day) and exposed to artificial saliva between the erosive challenges for 7 days. The treatment with the fluoride solutions was done 2x60 s/day, immediately after the first and the last erosive challenges of the day. Dentin erosive loss was measured by profilometry (μm). The data were analyzed using Kruskal Wallis/Dunn tests (p<0.05).

Results

Mouthrinses containing TiF₄ or Sn/F were able to show some protective effect against dentin erosive loss compared to negative control. The best anti-erosive effect was found for experimental solution containing 0.0815% TiF₄ (100% reduction in dentin loss), followed by 0.042% NaF+0.049% TiF⁴ (58.3%), SnCl₂/NaF/AmF (52%) and 0.063% NaF+0.036% TiF₄ (40%). NaF solution (13.3%) did not significantly differ from control.

Conclusion

The daily application of experimental mouthrinse containing TiF₄ and NaF has the ability to reduce dentin erosion, as well as Erosion Protection^® and TiF₄ alone.

Artificial Saliva Formulations versus Human Saliva Pretreatment in Dental Erosion Experiments

The aim of this study was to evaluate the erosion-preventive effect of different artificial saliva formulations and human saliva in vitro compared to human saliva in situ. In the in vitro experiment, bovine enamel and dentin specimens were stored in artificial saliva (4 different formulations, each n = 20), deionized water (n = 20) or human saliva (n = 6 enamel and dentin specimens/volunteer) for 120 min. In the in situ experiment, each of the 6 enamel and dentin specimens was worn intraorally by 10 volunteers for 120 min. The specimens were then eroded (HCl, pH 2.6, 60 s). Half of the specimens were subjected to microhardness analysis (enamel) and the determination of calcium release into the acid (enamel and dentin), while the other half were again placed in the respective medium or worn intraorally, respectively, for 120 min before a second erosion was performed. Knoop microhardness of enamel and the calcium release of enamel and dentin into the acid were again determined. Statistical analysis was conducted by two-way repeated-measures ANOVA or two-way ANOVA (α = 0.05). Enamel microhardness was not significantly different between all test groups after the first and the second erosive challenge, respectively. Enamel calcium loss was significantly lower in situ compared to the in vitro experiment, where there was no significant difference between all test groups. Dentin calcium loss was significantly lower than deionized water only after the first and than all except one artificial saliva after the second erosion. Under the conditions of this experiment, the use of artificial saliva formulations and human saliva in vitro does not reflect the intraoral situation in dental erosion experiments adequately.

In Vitro Evaluation of Dentin Hydraulic Conductance After 980 nm Diode Laser Irradiation

BACKGROUND

Dentin hypersensitivity treatments are based on the physical obliteration of the dentinal tubules to reduce hydraulic conductance. The aim of the present study is to evaluate the hydraulic conductance of bovine root dentin after irradiation with a 980-nm diode laser, with or without associated fluoride varnish.

METHODS

Sixty bovine root dentin specimens were divided into six groups (n = 10 in each group): G1, G3, and G5 (0.5 W, 0.7 W, and 1 W diode laser, respectively); G2, G4, and G6 (fluoride varnish application + 0.5 W, 0.7 W, and 1 W diode laser, respectively). The dentin hydraulic conductance was evaluated at four time periods with a fluxmeter: 1) with smear layer, 2) after 37% phosphoric acid etching, 3) after the treatments, and 4) after 6% citric acid challenge. After the dentinal fluid flow measurements, specimens were also evaluated for mineral composition using energy dispersive X-ray spectroscopy (EDS).

RESULTS

Analysis demonstrated a better result with increased irradiation power (P < 0.001), especially if the diode laser irradiation was associated with the application of fluoride varnish (P < 0.001), ensuring a greater reduction in permeability. Considering the groups treated only with laser irradiation, the 1 W group was superior when compared with the 0.5 W and 0.7 W irradiated groups immediately after treatment (P < 0.001). After citric acid testing, all groups showed similar results, except when comparing the 1 W groups with the 0.5 W groups (P = 0.04). EDS results of the irradiated groups showed an increase in the proportion of calcium and phosphorus ions, which demonstrates a superficial composition modification after laser treatments.

CONCLUSION

Laser irradiation of exposed dentin promoted significant reduction in the dentin hydraulic conductance, mainly with higher energy densities and association with fluoride varnish.

Informing a realistic laboratory erosion-testing regime--observations

OBJECTIVES

To measure aspects of fizzy drink consumption in a social environment to inform the development of a laboratory testing regime.

METHODS

This was an observational study in which participants were invited to attend one of four pizza and soft drink parties. All such foods and drinks were served in an air conditioned room at a temperature of 24°C. All drinks were at a temperature of 4°C and each participant was asked to spit out, into graduated cups, their first and second sips. Both the temperature and volume of these were measured. Upon completion of the party the volume of drinks consumed was determined. Video footage of the experiment was recorded for subsequent analysis to determine sip count and the elapsed time period between first and last sip. These values were compared to the analogous measured value of expectorated volume in order to assess the usefulness of video observation in the context of this work.

RESULTS

The mean expectorated beverage temperature was 14.9±2.0°C. The mean time spent drinking was 44.2±17.4 minutes with a mean consumption rate of 13.3±6.0 ml/min. Only the sip volume and sip count per can values were significantly different between sexes (P<0.05) with females displaying lower values for volume and a higher sip count. There was close agreement between the sip volume values observed and calculated using video observation derived parameters.

CONCLUSIONS

Several human drinking behaviour values were reported in this study and these will be of value in the development of more realistic laboratory erosion-testing regimes. It is concluded, within the limitations of this work, that (1) there are differences in the drinking behaviour of males and females with respect to sip volume and count, (2) the intraoral rise in temperature of a 4°C beverage is lower than that used in previous laboratory simulations and (3) the values derived from video observation agree with those measured directly validating this technique for use in further studies.

CLINICAL SIGNIFICANCE

The work provides valuable quantitative data on which to base simulated laboratory erosion work. Perhaps the most significant finding is that sipped beverages attain a temperature of only 14.9°C.

TiF4 and NaF varnishes as anti-erosive agents on enamel and dentin erosion progression in vitro

OBJECTIVE

This study assessed the effect of fluoride varnishes on the progression of tooth erosion in vitro.

MATERIAL AND METHODS

Forty-eight enamel and 60 root dentin samples were previously demineralized (0.1% citric acid, pH 2.5, 30 min), leading to a baseline and erosive wear of 12.9 and 11.4 µm, respectively. The samples were randomly treated (6 h) with a 4% TiF4 varnish (2.45%F-, pH 1.0), a 5.42% NaF varnish (2.45%F-, pH 5.0), a placebo varnish and no varnish (control). The samples were then subjected to erosive pH cycles (4x90 s/day in 0.1% citric acid, intercalated with artificial saliva) for 5 days. The increment of the erosive tooth wear was calculated. In the case of dentin, this final measurement was done with and without the demineralized organic matrix (DOM). Enamel and dentin data were analyzed using ANOVA/Tukey's and Kruskal-Wallis/Dunn tests, respectively (p<0.05).

RESULTS

The TiF4 (mean±s.d: 1.5±1.1 µm) and NaF (2.1±1.7 µm) varnishes significantly reduced enamel wear progression compared to the placebo varnish (3.9±1.1 µm) and control (4.5±0.9 µm). The same differences were found for dentin in the presence and absence of the DOM, respectively: TiF4 (average: 0.97/1.87 µm), NaF (1.03/2.13 µm), placebo varnish (3.53/4.47 µm) and control (3.53/4.36 µm).

CONCLUSION

The TiF4 and NaF varnishes were equally effective in reducing the progression of tooth erosion in vitro.

Fluoride varnishes containing calcium glycerophosphate: fluoride uptake and the effect on in vitro enamel erosion

OBJECTIVES

Calcium glycerophosphate (CaGP) was added to fluoride varnishes to analyze their preventive effect on initial enamel erosion and fluoride uptake: potassium hydroxide (KOH)-soluble and KOH-insoluble fluoride bound to enamel.

MATERIALS AND METHODS

This study was carried out in two parts. Part 1: 108 enamel samples were randomly distributed into six varnish groups: base varnish (no active ingredients); Duraphat® (2.26%NaF); Duofluorid® (5.63%NaF/CaF2); experimental varnish 1 (1%CaGP/5.63 NaF/CaF2); experimental varnish 2 (5%CaGP/5.63%NaF/CaF2); and no varnish. Cyclic demineralization (90 s; citric acid, pH = 3.6) and remineralization (4 h) was made once a day, for 3 days. Change in surface microhardness (SMH) was measured. Part 2: 60 enamel samples were cut in half and received no varnish (control) or a layer of varnish: Duraphat®, Duofluorid®, experimental varnishes 1 and 2. Then, KOH-soluble and KOH-insoluble fluoride were analyzed using an electrode.

RESULTS

After cyclic demineralization, SMH decreased in all samples, but Duraphat® caused less hardness loss. No difference was observed between varnishes containing CaGP and the other varnishes. Similar amounts of KOH-soluble and insoluble fluoride was found in experimental varnish 1 and Duofluorid®, while lower values were found for experimental varnish 2 and Duraphat®.

CONCLUSION

The addition of CaGP to fluoride varnishes did not increase fluoride bound to enamel and did not enhance their protection against initial enamel erosion.

CLINICAL RELEVANCE

We observe that the fluoride varnishes containing CaGP do not promote greater amounts of fluoride bound to enamel and that fluoride bound to enamel may not be closely related to erosion prevention.

Comparative In Vitro Effect of TiF4 to NaF and Potassium Oxalate on Reduction of Dentin Hydraulic Conductance

Dentin hypersensitivity (DH) is related to an increase in dentin permeability. This study tested the effect of titanium tetrafluoride (TiF4) compared with sodium fluoride (NaF) and potassium oxalate gel on reducing hydraulic conductance (Lp) from the perspective of diminishing dentin permeability. The Lp of the dentin disks (1.0 ± 0.2 mm) was evaluated using Flodec. The maximum Lp values of each disk were taken after phosphoric acid etching (15 seconds) and randomly allocated to seven groups (n=8) according to the treatments. The minimum (smear layer) and the maximum (after acid etching) Lp values were recorded. Treatments were performed for 4 minutes as follows: 1) NaF varnish 2) and solution (2.45% F, pH 5.0), 3) TiF4 varnish and 4) solution (2.45% F, pH 1.0), 5) 3% potassium oxalate gel, 6) free fluoride varnish (placebo, pH 5.0), 7) and no treatment (control). The Lp after each treatment was assessed. Samples were exposed to an erosive challenge (6% citric acid, pH 2.1, 1 minute), and the final Lp was recorded. The data were statistically analyzed using repeated measures two-way analysis of variance (p&lt;0.05). All treatments were effective in reducing dentin Lp compared with the control immediately after the application. However, only potassium oxalate and NaF varnish significantly differed from placebo varnish (p&lt;0.0001). The same results were found after the erosive challenge. Therefore, the TiF4 was less effective than the NaF varnish and potassium oxalate gel in reducing dentin permeability. Using this experimental model, both NaF varnish and potassium oxalate gel reduced the Lp similarly to the presence of smear layer.

In vitro effect of calcium nanophosphate and high-concentrated fluoride agents on enamel erosion: an AFM study

BACKGROUND

Calcium nanophosphate paste can provide ions to remineralize enamel. There are, however, no data available about the remineralizing effect of this paste on the prevention of enamel erosion, when compared with highly concentrated fluoride agents.

AIM

To analyze the effect of calcium nanophosphate paste, fluoride gel, and varnish to protect against enamel erosion using surface Knoop hardness (KNH) and atomic force microscopy (AFM).

DESIGN

Forty enamel blocks (4 × 4 mm) of third molars were used for 4 groups (n = 10): 1.23% fluoride gel (Fluorgel-DFL(®) ); calcium nanophosphate paste (Desensibilize NanoP-FGM(®) ); fluoride varnish (Duraphat-Colgate(®) ) and control (without agent). The specimens were immersed in cola drink for 5 min and 2 h in artificial saliva, 4× per day for 5 days. The agents were applied before the first erosive cycle. KNH values were obtained before and after the erosive challenge. The surface morphology was evaluated by AFM. anova, Tukey's, and T-Student tests were applied.

RESULTS

After erosion, no significant difference was found for KNH among gel, nanophosphate, and varnish groups; however, they showed higher KNH than control group. Gel and nanophosphate paste showed a protective layer formation on enamel surface by AFM.

CONCLUSIONS

The calcium nanophosphate paste showed similar protection against enamel erosion compared with high-concentrated fluoride agents, even containing lower fluoride concentration.

Sodium fluoride inhibits MMP-2 and MMP-9

The importance of fluoride (F) in preventing dental caries by favorably interfering in the demineralization-remineralization processes is well-established, but its ability to inhibit matrix metalloproteinases (MMPs), which could also help to prevent dentin caries, has not been investigated. This study assessed the ability of F to inhibit salivary and purified human gelatinases MMPs-2 and -9. Saliva was collected from 10 healthy individuals. Pooled saliva was centrifuged, and supernatants were incubated for 1 hr at 37°C and subjected to zymography. Sodium fluoride (50-275 ppm F) was added to the incubation buffer. The reversibility of the inhibition of MMPs-2 and -9 by NaF was tested by the addition of NaF (250-5,000 ppm F) to the incubation buffer, after which an additional incubation was performed in the absence of F. F decreased the activities of pro- and active forms of salivary and purified human MMPs in a dose-response manner. Purified gelatinases were completely inhibited by 200 ppm F (IC50 = 100 and 75 ppm F for MMPs-2 and -9, respectively), and salivary MMP-9 by 275 ppm F (IC50 = 200 ppm F). Inhibition was partially reversible at 250-1,500 ppm F, but was irreversible at 5,000 ppm F. This is the first study to describe the ability of NaF to inhibit MMPs completely.

Durability of the anti-erosive effect of surfaces sealants under erosive abrasive conditions

OBJECTIVE

To test the durability of sealants applied for prevention of erosive dentine mineral loss under erosive/abrasive conditions.

METHODS

Forty-eight bovine dentine samples doped with (32)P were randomly allocated to four groups (1-4). All samples performed a de- and remineralizations pre-cycling (6 × 1 min erosion in HCl: pH 3.0, mean time and overnight immersion in artificial saliva) for 1 day. Sealing was done as follows; (1) unsealed, (2) Seal & Protect, (3) K-0184 (experimental sealer) and (4) OptiBond FL. After sealing, samples were immersed in HCl for 3 h (baseline measurement). Then, the following erosive/abrasive and remineralisations cycling was performed for 8 days: 3 h/day erosion with HCl, 600 brushing strokes/day and storage in artificial saliva for the rest of the day. Sealer permeability was evaluated by assignation of (32)P in the acid used for the erosive attacks.

RESULTS

At baseline, the significantly highest dentine loss was observed for the unsealed control group, while the mineral loss was not statistically significantly different between the sealed groups 2 and 3. At all days of the erosive/abrasive and remineralizations cycling and cumulatively the significantly highest mineral loss was observed for group 1, while the significantly lowest mineral loss was observed for the samples sealed with Seal & Protect (group 2) and K-0184 (group 3). In all groups, no significant increase in the (32)P release was observed.

CONCLUSION

Surface sealants are able to reduce the erosive dentine mineral loss and maintain this erosion-preventing efficacy over the whole duration (simulating 8 month in-vivo) of the erosive/abrasive cycling.

Influence of prophylaxis paste treatment on the abrasive wear of surface sealants

OBJECTIVE

To investigate the abrasive wear of surface sealants (Seal&Protect and K-0184 (experimental sealant)) and the influence of pre-treatment with mineral deposit forming prophylaxis pastes (NUPRO Sensodyne and NUPRO) on this wear.

METHODS

One hundred and eight bovine dentine samples were randomly allocated to nine groups (1-9). Pre-treatment (10 s): groups 1-3: untreated, groups 4-6: NUPRO, groups 7-9: NUPRO Sensodyne. Sealing: groups 1, 4 and 7: unsealed, groups 2, 5 and 8: Seal&Protect, groups 3, 6 and 9: K-0184 (experimental sealer). Samples were then brushed with 12 000 brushing strokes (BS) with toothpaste slurry in an automatic brushing machine (120 BS/min; F = 2.5 N). Surface profiles were recorded at baseline, after pre-treatment and sealing and after each 2000 BS.

RESULTS

Total profile change (wear or gain due to pre-treatment, treatment and 12 000 BS): groups 1, 4 and 7 (no surface sealant) showed a not significantly different wear of 18.48 ± 2.63 µm, 24.98 ± 3.02 µm and 21.50 ± 5.47 µm, respectively. Remaining groups (sealed) showed a gain in height with no significant difference among each other. Wear in sealed groups (2, 3, 5, 6, 8 and 9) were not significantly different at all numbers of brushing strokes. Starting with 4000 BS, the wear in unsealed groups (1, 4 and 7) was statistically significantly higher compared to all other groups.

CONCLUSION

Stability and wear resistance of surface sealants are not affected by pre-treatment of dentine with NUPRO Sensodyne. The surface sealants tested provide a stable protective surface layer on dentine, which lasts for at least 12 000 brushing strokes.

Effect of NaF, SnF(2), and TiF(4) Toothpastes on Bovine Enamel and Dentin Erosion-Abrasion In Vitro

The aim of this study was to compare the effect of toothpastes containing TiF₄, NaF, and SnF₂ on tooth erosion-abrasion. Bovine enamel and dentin specimens were distributed into 10 groups (n = 12): experimental placebo toothpaste (no F); NaF (1450 ppm F); TiF₄ (1450 ppm F); SnF₂ (1450 ppm F); SnF₂ (1100 ppm F) + NaF (350 ppm F); TiF₄ (1100 ppm F) + NaF (350 ppm F); commercial toothpaste Pro-Health (SnF₂—1100 ppm F + NaF—350 ppm F, Oral B); commercial toothpaste Crest (NaF—1.500 ppm F, Procter & Gamble); abrasion without toothpaste and only erosion. The erosion was performed 4 × 90 s/day (Sprite Zero). The toothpastes' slurries were applied and the specimens abraded using an electric toothbrush 2 × 15 s/day. Between the erosive and abrasive challenges, the specimens remained in artificial saliva. After 7 days, the tooth wear was evaluated using contact profilometry (μm). The experimental toothpastes with NaF, TiF₄, SnF₂, and Pro-Health showed a significant reduction in enamel wear (between 42% and 54%). Pro-Health also significantly reduced the dentin wear. The toothpastes with SnF₂/NaF and TiF₄/NaF showed the best results in the reduction of enamel wear (62–70%) as well as TiF₄, SnF₂, SnF₂/NaF, and TiF₄/NaF for dentin wear (64–79%) (P < 0.05). Therefore, the experimental toothpastes containing both conventional and metal fluoride seem to be promising in reducing tooth wear.

Xylitol concentrations in artificial saliva after application of different xylitol dental varnishes

Objective

The present study analyzed xylitol concentrations in artificial saliva over time after application of varnishes containing 10% and 20% xylitol.

Material and Methods

Fifteen bovine enamel specimens (8x4 mm) were randomly allocated to 3 groups (n=5/group), according to the type of varnish used: 10% xylitol, 20% xylitol and no xylitol (control). After varnish application (4 mg), specimens were immersed in vials containing 500 µL of artificial saliva. Saliva samples were collected in different times (1, 8, 12, 16, 24, 48 and 72 h) and xylitol concentrations were analyzed. Data were assessed by two-way repeated-measures ANOVA (p<0.05).

Results

Colorimetric analysis was not able to detect xylitol in saliva samples of the control group. Salivary xylitol concentrations were significantly higher up to 8 h after application of the 20% xylitol varnish. Thereafter, the 10% xylitol varnish released larger amounts of that polyol in artificial saliva.

Conclusions

Despite the results in short-term, sustained xylitol releases could be obtained when the 10% xylitol varnish was used. These varnishes seem to be viable alternatives to increase salivary xylitol levels, and therefore, should be clinically tested to confirm their effectiveness.

In situ effect of dentifrices associated to CO2 laser in the permeability of eroded root dentin

OBJECTIVE

The aim of this study was to evaluate, through a crossover 2×2 in situ trial, the effect of a desensitizing dentifrice associated with CO2 laser irradiation to control the permeability of eroded root dentin.

BACKGROUND DATA

Facing the increased prevalence of erosive lesion and the need for preventive means to control painful symptoms related to them.

METHODS

Eighty slabs of bovine root dentin were subjected to initial erosive challenge (citric acid 0.3%, 2 h), followed by a remineralizing period in artificial saliva (24 h). Specimens were then divided according to dentin treatment: desensitizing dentifrice, desensitizing dentifrice+CO2 laser, fluoride anticavity dentifrice. and fluoride anticavity dentifrice+CO2 laser. After a 2-day lead-in period, 10 volunteers wore an intraoral palatal appliance containing four root dentin slabs, in two phases of 5 days each. During the intraoral phase, one side of the appliance was immersed in 0.3% citric acid, and the opposite side was immersed in deionized water, four times a day. One hour after the immersions, all specimens were brushed with dentifrice slurry provided by the researcher. After a 7-day washout period, volunteers were crossed over on the different dentifrice group. Each phase having been completed, the specimens were evaluated for permeability through an optical microscope.

RESULTS

Data were analyzed using ANOVA and no significant difference (p=0.272) was found between the surface treatments performed on bovine root dentin.

CONCLUSIONS

It can be concluded that fluoride anticavity or desensitizing dentifrice, regardless of the association with the CO2 laser irradiation, was able to control the permeability of eroded root dentin.

Effect of NaF and TiF(4) varnish and solution on bovine dentin erosion plus abrasion in vitro

OBJECTIVES

This in vitro study aimed to analyze the effect of TiF(4) compared to NaF varnishes and solutions, to protect against dentin erosion associated with abrasion.

MATERIALS AND METHODS

Bovine dentin specimens were pre-treated with NaF-Duraphat (2.26% F), NaF/CaF(2)-Duofluorid (5.63% F), experimental-NaF (2.45% F), experimental-TiF(4) (2.45% F) and placebo varnishes; NaF (2.26% F) and TiF(4) (2.45% F) solutions. Controls remained untreated. The erosive pH cycling was performed using a soft drink (pH 2.6) 4 × 90 s/day and the toothbrushing-abrasion 2 × 10 s/day, in vitro for 5 days. Between the challenges, the specimens were exposed to artificial saliva. Dentin tissue loss was measured profilometrically (μm).

RESULTS

ANOVA/Tukey's test showed that all fluoridated varnishes (Duraphat, 7.5 ± 1.1; Duofluorid, 6.8 ± 1.1; NaF, 7.2 ± 1.9; TiF(4), 6.5 ± 1.0) were able to significantly reduce dentin tissue loss (40.7% reduction compared to control) when compared to placebo varnish (11.2 ± 1.3), control (11.8 ± 1.7) and fluoridated (NaF, 9.9 ± 1.8; TiF(4), 10.3 ± 2.1) solutions (p < 0.0001), which in turn did not significantly differ from each other.

CONCLUSION

All fluoridated varnishes, but not the solutions, had a similar performance and a good potential to reduce dentin tissue loss under mild erosive and abrasive conditions in vitro. Risk patients for erosion and abrasion, especially those with exposed dentin, should benefit from this clinical preventive measure. Further research has to confirm this promising result in the clinical situation.