Fluoride and mineral content in hyper-remineralized coronal bovine dentine in vitro after an acid challenge

The Application of in Vitro Models to Research on Demineralization and Remineralization of the Teeth: Reaction Paper

Despite the advantages of in situ model studies, in vitro models are most important to provide insight into the mechanism of dental caries, the mechanisms of fluoride action, and profile screening.

In this reaction paper following Dr. White's review, the emphasis is, first, on the role of mobile fluoride (FL) in fluoride efficacy, the formation of "CaF2-like" material as fluoride reaction product, and on fluoride reaction product localization. Second, mineral assessment techniques are discussed. Finally, the main differences between caries lesion formation in vitro and in situ are considered.

Effect of silver diamine fluoride and ammonium hexafluorosilicate applications with and without Er:YAG laser irradiation on the microtensile bond strength in sound and caries-affected dentin

BACKGROUND AND OBJECTIVE

Cariostatic and preventive agents are applied to create caries-resistant dentin surfaces and may affect subsequent resin bonding. The aim of this study was to investigate the effect of different agents with and without Er:YAG laser irradiation on the microtensile bond strength (µTBS) of resin composite to sound dentin (SD) and caries-affected dentin (CAD), and to assess the morphological and chemical changes in the specimens.

MATERIALS AND METHODS

Ninety-six extracted molar teeth were divided into a control group (deionized water) and two experimental groups (ammonium hexafluorosilicate [SiF], silver diamine fluoride [SDF]), that subdivided according to different conditions (SD, CAD, SD+laser irradiation, CAD+laser irradiation). After treatment procedures, the teeth were restored and the µTBS was tested with a universal testing machine. Morover, 144 teeth were prepared and after treatment modalities; morphological changes of the surface were investigated and elemental analyses were performed using scanning electron microscope/energy dispersive spectroscopy (SEM-EDS). The data were analyzed using Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

SDF and SiF applications reduced the µTBS values in both the SD and CAD subgroups (P < 0.05). Laser irradiation increased the µTBS values in the SiF group and the values were adversely affected in the SDF group (P < 0.05). Fluoride content of the specimens increased in all of the treatment groups, compared with the control group. Silver content was detected only in the SDF group, and silicon was detected only in the SiF group.

CONCLUSIONS

The µTBS values of resin composite, surface morphology and chemical characteristics of dentin were affected by the material type, dentin condition and laser irradiation and the use of SiF and SDF solutions under the resin restorations do not seem appropriate.

Formation and characterization of hypermineralized zone beneath dentine lesion body induced by topical fluoride in-vitro

OBJECTIVE

This in-vitro study aimed to evaluate and characterize the hypermineralized zone (Hyper-zone) formed beneath the remineralized dentine lesion body by transverse microradiography (TMR), scanning electron microscopy (SEM) and energy dispersive X-ray analysis (EDS).

DESIGN

Demineralized bovine dentine specimens were treated with fluoride solutions (APF, NaF) and remineralized for 2-4 weeks. Then thin sections were prepared to characterize the Hyper-zone by TMR, EDS. Fractured specimen surfaces were observed by SEM.

RESULTS

TMR analysis revealed a higher mineral density at Hyper-zone than that of sound dentine (48vol%) ranging from 50 up to 61vol% and the thickness ranging from 197 to 344μm for 4-week specimens, while specimens without fluoride treatment did not show Hyper-zone. SEM pictures at Hyper-zone showed no evident crystal-like deposits in dentinal tubules and no notable difference when compared to that in sound dentine. EDS analysis demonstrated higher concentrations of Ca and P at Hyper-zone than those in sound dentine, which corresponded to the TMR profile, while the magnesium (Mg) concentration was low at this zone.

CONCLUSIONS

Demineralized dentine lesions exposed to fluoride and remineralization treatments exhibited Hyper-zone beneath the lesion body, in which the mineral density was higher than that of sound dentine. Possible mechanism for the formation of Hyper-zone was discussed by assuming removal of mineral regulators such as Mg and other organic substances from sound dentine during de-/remineralization processes.

The influence of varying fluoride concentrations on in vitro remineralisation of artificial dentinal lesions with differing lesion morphologies

OBJECTIVE

The influence of low-level fluoride (F) concentrations and lesion characteristics on the remineralisation of sub-surface root caries was investigated in vitro.

DESIGN

Experimentally produced dentinal carious lesions were exposed to artificial saliva in the presence of 0.00ppm, 0.48ppm, 2.49ppm or 4.91ppm F (as NaF) for 5 days. Calcium, phosphate and fluoride ion uptake was quantified by chemical assay. Baseline changes in the mineral content and distribution of the lesions were assessed by transverse microradiography (TMR).

RESULTS

The uptake of calcium and phosphate was significantly increased (p<0.05) by fluoride, even at low concentrations. The action of fluoride was influenced by the mineral content and distribution of the lesions at baseline, however, with the location and degree of mineral deposition being strongly related to the mineral content of the lesions surface layer.

CONCLUSIONS

The process of remineralisation of root dentine is multifactorial. The morphology of lesions at baseline significantly affected the location and quantity of mineral deposition.

Development of an in situ root caries model B. In situ investigations

OBJECTIVES

The aims of this pilot study were to assess the suitability of an in situ model for root caries studies, and to investigate the effect of sub-surface lesion mineral content and ultrastructural organisation on remineralisation.

METHODS

Subjects were selected by criteria generally used for coronal caries models. Plaque pH responses and salivary flow rates were determined by standard methods. The chosen substrate was human dentine with artificially induced caries-like demineralisation and sterilised by gamma-irradiation (4100 Gy). Two levels of baseline demineralisation were induced by exposure to an acid buffer for 2 or 5 days. Mineral content was measured by computer-controlled quantitative microradiography.

RESULTS

Remineralisation in situ was greater in smaller lesions with lower surface mineral content than in larger lesions in which the surface mineral content was high.

CONCLUSIONS

The model is suitable for further development for investigating dentinal caries. More work is needed to validate the model by means of a fluoride dose-response study.

Clinical reversal of root caries using ozone, double-blind, randomised, controlled 18-month trial

OBJECTIVE

To assess the effect of an ozone delivery system, combined with the daily use of a remineralising patient kit, on the clinical severity of non-cavitated leathery primary root carious lesions (PRCL's), in an older population group.

DESIGN

A total of 89 subjects, (age range 60-82, mean +/- SD, 70.8 +/- 6 years), each with two leathery PRCL's, were recruited. The two lesions in each subject were randomly assigned for treatment with ozone or air, in a double-blind design, in a general dental practice. Subjects were recalled at three, six, 12 and 18 months. Lesions were clinically recorded at each visit as soft, leathery or hard, scored with a validated root caries severity index.

RESULTS

There were no observed adverse events. After three months, in the ozone-treated group, 61 PRCL's (69%) had become hard and none had deteriorated, whilst in the control group, four PRCL's (4%) had become worse (p<0.01). At the six-month recall, in the ozone group, seven PRCL's (8%) remained leathery, the remaining 82 (92%) PRCL's had become hard, whilst in the control group, 10 PRCL's had become worse (11%) and one had become hard (p<0.01). At 12 and 18 months, 87 Subjects attended. In the ozone group at 12 months, two PRCL's remained leathery, compared to 85 (98%) that had hardened, whilst in the control group 21 (24%) of the PRCL's had progressed from leathery to soft, i.e. became worse, 65 PRCL's (75%) were still leathery, and one remained hard (p<0.01). At 18 months, 87 (100%) of ozone-treated PRCL's had arrested, whilst in the control group, 32 lesions (37%) of the PRCL's had worsened from leathery to soft (p<0.01), 54 (62%) PRCL's remained leathery and only one of the control PRCL's had reversed (p<0.01).

CONCLUSIONS

Leathery non-cavitated primary root caries can be arrested non-operatively with ozone and remineralising products. This treatment regime is an effective alternative to conventional "drilling and filling".

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.