A flexible and rapid pH cycling procedure for investigations into the remineralisation and demineralisation behaviour of human enamel

Remineralization potential of P11-4 and fluoride on secondary carious primary enamel: A quantitative evaluation using microcomputed tomography

The aim of this study was to assess the ability of self-assembling peptide (P11-4) diffusion, assembly, and remineralization to effect artificial secondary caries-like lesions in human primary teeth in vitro. Enamel-dentin blocks obtained from extracted human primary molars were embedded into epoxy resin blocks. Cavities (approximately 1 × 1 × 2 mm) were prepared on the surface using a high-speed diamond bur under constant water cooling and filled with composite restorative material (Filtek Z250; 3 M ESPE). The samples were immersed in demineralizing solution (20 ml) for 96 h to produce secondary caries lesions and divided into two groups according to the testing materials: fluoride varnish (Duraphat; Colgate, UK) and P11-4 (Curodont Repair; Credentis, Switzerland). Except for the control areas, all samples were remineralized for 3-5 min using the remineralizing agents, and then all the sections were placed in a pH-cycling system for 5 days at 35°C. The pH cycling procedure was followed by micro-CT analysis for the qualitative evaluation of surface changes. The Mann-Whitney U test was used to compare two independent groups. In the comparison of more than two dependent groups, Bonferroni smoothed pairwise analyses were used to determine the source of the Kruskal-Wallis H test difference. The results of the study revealed that the remineralization depths of the peptide group were higher than those of the fluoride group (p < .01). There was a statistically significant difference in remineralization effects between the fluoride and peptide groups. P11-4 can be considered as an effective remineralizing agent for secondary caries lesions.

Study of Demineralized Dental Enamel Treated with Different Fluorinated Compounds by Raman Spectroscopy

BACKGROUND

Current diagnostic methods for enamel caries detection are unable to detect caries lesions (incipient caries lesion) at a very early stage.

OBJECTIVE

This study aims to determine the remineralizing effect of three fluorinated compounds on demineralized subsurface tooth enamel using Raman spectroscopy characterization.

MATERIAL AND METHODS

In this experimental study, sixty impacted 3^rd molars, with intact anatomical crowns recently extracted and without structural defects, were sectioned longitudinally in a mesio-distal direction using a diamond disc, obtaining two working surfaces (buccal and lingual). The 120 working surfaces obtained were immersed for 96 h in a demineralization solution at 37°C in order to demineralize the enamel surface. All samples were randomly divided into three groups (n=30 each) and their surfaces were treated with silver diamine fluoride (SDF), Difluoride silane (DSF), and acidulated phosphate fluoride (APF), and with no treatment undertaken in the control group (CG). The samples were immersed in alternating solutions for demineralization and remineralization at pH 4.4 and pH 7.0, respectively. The results were analyzed with Principal Component Analysis (PCA) in order to determine the variance.

RESULTS

The most important difference (91.7%) is observed in APF group between PCA1 respect to PCA2, followed by DSF (91.5%) and SDF (76.3%) respectively. Therefore, a greater remineralization in the dental enamel can be observed by the three experimental groups.

CONCLUSION

The APF and DSF have the effect of recovering the mineralization of dental enamel, except for the SDF. Functional groups OH^- and PO43- were identified in all subsurface.

Mineralization of Early Stage Carious Lesions In Vitro-A Quantitative Approach

Micro computed tomography has been combined with dedicated data analysis for the in vitro quantification of sub-surface enamel lesion mineralization. Two artificial white spot lesions, generated on a human molar crown in vitro, were examined. One lesion was treated with a self-assembling peptide intended to trigger nucleation of hydroxyapatite crystals. We non-destructively determined the local X-ray attenuation within the specimens before and after treatment. The three-dimensional data was rigidly registered. Three interpolation methods, i.e., nearest neighbor, tri-linear, and tri-cubic interpolation were evaluated. The mineralization of the affected regions was quantified via joint histogram analysis, i.e., a voxel-by-voxel comparison of the tomography data before and after mineralization. After ten days incubation, the mean mineralization coefficient reached 35.5% for the peptide-treated specimen compared to 11.5% for the control. This pilot study does not give any evidence for the efficacy of peptide treatment nor allows estimating the necessary number of specimens to achieve significance, but shows a sound methodological approach on the basis of the joint histogram analysis.

New Approaches to Enhanced Remineralization of Tooth Enamel

Dental caries is a highly prevalent diet-related disease and is a major public health problem. A goal of modern dentistry is to manage non-cavitated caries lesions non-invasively through remineralization in an attempt to prevent disease progression and improve aesthetics, strength, and function. Remineralization is defined as the process whereby calcium and phosphate ions are supplied from a source external to the tooth to promote ion deposition into crystal voids in demineralized enamel, to produce net mineral gain. Recently, a range of novel calcium-phosphate-based remineralization delivery systems has been developed for clinical application. These delivery systems include crystalline, unstabilized amorphous, or stabilized amorphous formulations of calcium phosphate. These systems are reviewed, and the technology with the most scientific evidence to support its clinical use is the remineralizing system utilizing casein phosphopeptides to stabilize and deliver bioavailable calcium, phosphate, and fluoride ions. The recent clinical evidence for this technology is presented and the mechanism of action discussed. Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization show promise for the non-invasive management of dental caries.

Self-assembling peptide scaffolds promote enamel remineralization

Rationally designed beta-sheet-forming peptides that spontaneously form three-dimensional fibrillar scaffolds in response to specific environmental triggers may potentially be used in skeletal tissue engineering, including the treatment/prevention of dental caries, via bioactive surface groups. We hypothesized that infiltration of caries lesions with monomeric low-viscosity peptide solutions would be followed by in situ polymerization triggered by conditions of pH and ionic strength, providing a biomimetic scaffold capable of hydroxyapatite nucleation, promoting repair. Our aim was to determine the effect of an anionic peptide applied to caries-like lesions in human dental enamel under simulated intra-oral conditions of pH cycling. Peptide treatment significantly increased net mineral gain by the lesions, due to both increased remineralization and inhibition of demineralization over a five-day period. The assembled peptide was also capable of inducing hydroxyapatite nucleation de novo. The results suggest that self-assembling peptides may be useful in the modulation of mineral behavior during in situ dental tissue engineering.

In vitro measurement of enamel demineralization in the assessment of fluoride-leaching orthodontic bonding agents

The aim of this study was to measure in vitro demineralization around orthodontic brackets, bonded with five different bonding agents. Two conventional bonding agents, two fluoride-leaching agents, and a glass ionomer were tested. A sixth group utilized a fluoride varnish after bonding. The amount of dissolved enamel mineral was determined from increases in the phosphorus concentration in the demineralizing solution and measurements were made over a 4 week period. The results confirmed that when fluoride is present in the form of a fluoride-leaching bonding agent or a fluoride varnish, resistance to demineralization is enhanced. Analysis of variance showed that Ketac-cem, Concise with Duraphat, and Pulpdent O.B.A. performed statistically significantly better than Concise, Bond-fast, and Rely-a-bond, in resisting enamel demineralization.

The application of in vitro models to research on demineralization and remineralization of the teeth

Progress in in vivo and in situ experimentation has led many researchers to speculate as to the relevance and importance of in vitro testing protocols in caries research. A Medline/Biosis search for the present review revealed well over 300 citations (since 1989) documenting in vitro tests associated with caries research on mineralization and fluoride reactivity. The present survey documents these recent applications of in vitro test methods in both mechanistic and 'profile' caries research. In mechanistic studies, in vitro protocols over the past five years have made possible detailed studies of dynamics occurring in mineral loss and gain from dental tissues and the reaction dynamics associated with fluoride anticaries activity. Similarly, in profile applications, in vitro protocols make possible the inexpensive and rapid--yet sensitive--assessment of F anticaries efficacy within fluoride-active systems, and these tests represent a key component of product activity confirmation. The ability to carry out single variable experiments under highly controlled conditions remains a key advantage in in vitro experimentation, and will likely drive even further utilization, as advances continue in physical-chemical and analytical techniques for substrate analysis in these protocols. Despite their advantages in vitro testing protocols have significant limitations, most particularly related to their inability to simulate the complex biological processes involved in caries.

Effect of intermittent delivery of fluoride to solution on root hard-tissue de- and remineralization measured by 125I absorptiometry

The effect of intermittent fluoride levels on root hard-tissue de- and remineralization was studied once daily for 21 days in a pH-cycling caries model with simulated fluoride clearance curves. Four root hard-tissue blocks, from each of 12 human teeth, were cut out parallel to the cementum surface. During a daily 15-hour period, the blocks were subjected 12 times to pH changes similar to those which occur in plaque after a carbohydrate intake. The fluoride was delivered immediately before a daily nine-hour remineralization period. Four experiments were independently carried out: One block from each tooth was subjected to pH-cycling without and with fluoride delivery, simulating a rinse with 0.025, 0.2, and 1.0% sodium fluoride (NaF), respectively. The mineral change in the blocks was monitored by 125I absorptiometry and expressed as the change in transmission (delta T). The surface between the data points (delta T values) and the x axis (time points) was used as a summary measure, i.e., the area under the curve (AUC). When no fluoride was delivered, the delta T increased over 21 days, indicating loss of mineral. The AUC was, on average, 5.85 +/- 0.68 (mean +/- S.E.) %.day. In the 0.025% NaF-rinse experiment, there was a marked reduction in mineral loss, indicated by an average AUC of 1.66 +/- 0.59%.day. In both the 0.2 and 1.0% NaF-rinse experiments, a decrease in delta T, indicating gain of mineral, was observed from day 2. Negative delta T values occurred after 7 and 3 days, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)