Remineralization of root surfaces demineralized in solutions of differing fluoride levels

Reversal of Root Caries with Casein Phosphopeptide-Amorphous Calcium Phosphate and Fluoride Varnish in Xerostomia

Different formulas of topical fluoride have been used to manage root carious lesions. This clinical trial aimed to investigate the efficacy of a dental varnish containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride compared with fluoride alone in reversing/arresting root caries in xerostomic patients over 1 year. A total of 80 patients (age range 45-92 years) with primary root caries (n = 184 root carious lesions) and unstimulated salivary flow rate of <0.2 mL/min were randomly allocated to receive either dental varnish containing CPP-ACP and 5% fluoride (group 1: MI varnish; GC, Japan) (n = 41, 83 lesions), or dental varnish with 5% fluoride alone (group 2: NUPRO White; Dentsply, USA) (n = 39, 101 lesions). Clinical assessments with Severity Index (SI) for root caries, DIAGNOdent measurements, and varnish application were carried out at baseline, 3, 6, and 12 months. Standard oral hygiene instructions with 1,450 ppm fluoride toothpastes were provided for both groups. After 3 months, 63.9% (n = 46) of root caries in group 1 became hard (SI: 0) compared with 39.3% (n = 35) in group 2 (p < 0.01). After 6 and 12 months, the differences in SI were insignificant (group 1, n = 60, 83.3%) (group 2, n = 66, 74.2%) (p = 0.36), and (group 1, n = 60, 89.6%) (group 2, n = 67, 81.7%, n = 1 soft, 1.2%) (p = 0.29), respectively. In both groups, noncavitated leathery lesions were more likely to become hard when compared to the cavitated root caries. A significant decrease in plaque index, surface roughness, lesion dimension, and DIAGNOdent readings with a significant increase in lesion distance from the gingival margin was reported in both groups (p < 0.05). This study has provided evidence that fluoride dental varnish either with or without calcium and phosphate has the potential to arrest/reverse root caries, especially noncavitated lesions for patients with xerostomia.

Tests to detect and inform the diagnosis of root caries

BACKGROUND

Root caries is a well-recognised disease, with increasing prevalence as populations age and retain more of their natural teeth into later life. Like coronal caries, root caries can be associated with pain, discomfort, tooth loss, and contribute significantly to poorer oral health-related quality of life in the elderly. Supplementing the visual-tactile examination could prove beneficial in improving the accuracy of early detection and diagnosis. The detection of root caries lesions at an early stage in the disease continuum can inform diagnosis and lead to targeted preventive therapies and lesion arrest.

OBJECTIVES

To assess the diagnostic test accuracy of index tests for the detection and diagnosis of root caries in adults, used alone or in combination with other tests.

SEARCH METHODS

Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 31 December 2018); Embase Ovid (1980 to 31 December 2018); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 31 December 2018); and the World Health Organization International Clinical Trials Registry Platform (to 31 December 2018). We studied reference lists as well as published systematic review articles.

SELECTION CRITERIA

We included diagnostic accuracy study designs that compared one or more index tests (laser fluorescence, radiographs, visual examination, electronic caries monitor (ECM), transillumination), either independently or in combination, with a reference standard. This included prospective studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. In vitro and in vivo studies were eligible for inclusion but studies that artificially created carious lesions were excluded.

DATA COLLECTION AND ANALYSIS

Two review authors extracted data independently and in duplicate using a standardised data extraction and quality assessment form based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) specific to the review context. Estimates of diagnostic test accuracy were expressed as sensitivity and specificity with 95% confidence intervals (CI) for each dataset. We planned to use hierarchical models for data synthesis and explore potential sources of heterogeneity through meta-regression.

MAIN RESULTS

Four cross-sectional diagnostic test accuracy studies providing eight datasets with data from 4997 root surfaces were analysed. Two in vitro studies evaluated secondary root caries lesions on extracted teeth and two in vivo studies evaluated primary root caries lesions within the oral cavity. Four studies evaluated laser fluorescence and reported estimates of sensitivity ranging from 0.50 to 0.81 and specificity ranging from 0.40 to 0.80. Two studies evaluated radiographs and reported estimates of sensitivity ranging from 0.40 to 0.63 and specificity ranging from 0.31 to 0.80. One study evaluated visual examination and reported sensitivity of 0.75 (95% CI 0.48 to 0.93) and specificity of 0.38 (95% CI 0.14 to 0.68). One study evaluated the accuracy of radiograph and visual examination in combination and reported sensitivity of 0.81 (95% CI 0.54 to 0.96) and specificity of 0.54 (95% CI 0.25 to 0.81). Given the small number of studies and important differences in the clinical and methodological characteristics of the studies we were unable to pool the results. Consequently, we were unable to formally evaluate the comparative accuracy of the different tests considered in this review. Using QUADAS-2 we judged all four studies to be at overall high risk of bias, but only two to have applicability concerns (patient selection domain). Reasons included bias in the selection process, use of post hoc (data driven) positivity thresholds, use of an imperfect reference standard, and use of extracted teeth. We downgraded the certainty of the evidence due to study limitations and serious imprecision of the results (downgraded two levels), and judged the certainty of the evidence to be very low.

AUTHORS' CONCLUSIONS

Visual-tactile examination is the mainstay of root caries detection and diagnosis; however, due to the paucity of the evidence base and the very low certainty of the evidence we were unable to determine the additional benefit of adjunctive diagnostic tests for the detection and diagnosis of root caries.

The role of fluoride and chlorhexidine in preserving hardness and mineralization of enamel and cementum after gamma irradiation

The purpose of this study was to evaluate the effect of 0.05% sodium fluoride and 0.12% chlorhexidine mouthwashes on the micro-hardness of tooth enamel and cementum that was exposed to therapeutic doses of gamma radiation. Sixty extracted human teeth were divided into two groups, one was irradiated, the other was not irradiated. The two groups were further subdivided into three subgroups, which were each treated either with 0.05% sodium fluoride or with 0.12% chlorhexidine; the third subgroup served as a control. After demineralization-remineralization cycling, teeth from the irradiated groups showed a significantly lower micro-hardness when compared to those from the non-irradiated groups. Both in the irradiated and non-irradiated groups, teeth from the control subgroups showed a significantly lower micro-hardness, as compared to teeth treated with sodium fluoride and chlorhexidine. For non-irradiated enamel samples, those treated with chlorhexidine showed a significantly less micro-hardness compared to those treated with sodium fluoride. In contrast, irradiated enamel showed no significant difference in micro-hardness, whatever treatment (chlorhexidine or sodium fluoride) was applied. For cementum, treatment with chlorhexidine resulted in a significantly lower micro-hardness compared to sodium fluoride, both for the irradiated and non-irradiated groups. It is concluded that gamma irradiation with therapeutic doses typically used for head and neck carcinoma treatment has a direct effect in reducing micro-hardness of tooth enamel and cementum. Mouthwash protocols including, for example, application of 0.05% sodium fluoride or 0.12% chlorhexidine three times per day for 6 weeks, can protect enamel and cementum against the reduction in hardness and demineralization caused by gamma irradiation. Sodium fluoride offers more protection compared to chlorhexidine.

Clinical assessment of non carious cervical lesion using swept-source optical coherence tomography

Non-carious cervical lesions (NCCLs) involve various forms of tooth loss with different etiologies. This study aimed to utilize swept-source optical coherence tomography (SS-OCT) at 1300 nm wavelength range in vitro and in vivo to evaluate and clarify the mechanism of NCCLs. In the in vitro phase, a dentin attenuation coefficient (μt ) derived from the SS-OCT signal at NCCL was compared with mineral loss obtained from transverse microradiography (TMR) to determine a μt threshold to discriminate demineralization of cervical dentin in vivo. In the clinical study, 242 buccal surfaces were investigated in 35 subjects. Presence and dimensions of NCCLs, cervical cracking and the degree of demineralization at the exposed cervical dentin were determined using SS-OCT. Dentin demineralization was observed in 69% of NCCLs. SS-OCT results confirm that dentin mineral loss and occlusal attrition were associated with larger NCCLs, and can be considered as an etiological factor in formation and progress of these lesions. (A) We determined the attenuation coeffcient (μt ) threshold of SS-OCT signal for the detection of demineralization (1.21) from in vitro study. DEM: demineralized dentin, sound: sound dentin. (B) Using the μt threshold, we observed NCCLs in vivo to detect the demineralization in cervical dentin. SS-OCT scanning was performed along the red line. (C) SS-OCT image obtained along the red line in B. In SS-OCT, brightness of dentin beneath the NCCL was increased (arrow) compared with intact zone. The cervical dentin was slightly demineralized (μt : 1.25). e: enamel, d: dentin, g: gingiva.

Imaging analysis of early DMP1 mediated dentine remineralization

OBJECTIVE

This study assessed the micro-morphological changes in demineralized dentine scaffold following incubation with recombinant dentine matrix protein 1 (rDMP1).

DESIGN

Extracted human molar crowns were sectioned into 6 beams (dimensions: 0.50mm×1.70mm×6.00mm), demineralized and incubated overnight in 3 different media (n=4): rDMP1 in bovine serum albumin (BSA), BSA and distilled water. Samples were placed in a chamber with simulated physiological concentrations of calcium and phosphate ions at constant pH 7.4. Samples were immediately processed for transmission electron microscopy (TEM) and field emission-scanning electron microscopy (FE-SEM) after 1 and 2 weeks.

RESULTS

Analysis of the scaffold showed that decalcification process retained the majority of endogenous proteoglycans and phosphoproteins. rDMP1 treated samples promoted deposition of amorphous calcium phosphate (ACP) precursors and needle shaped hydroxyapatite crystals surrounding collagen fibrils. The BSA group presented ACP bound to collagen with no needle-like apatite crystals. Samples kept in distilled water showed no evidence of ACP and crystal apatite. Results from rDMP1 immobilized on dentine matrix suggests that the acidic protein was able to bind to collagen fibrils and control formation of amorphous calcium phosphate and its subsequent transformation into hydroxyapatite crystals after 2 weeks.

CONCLUSION

These findings suggest a possible bio-inspired strategy to promote remineralization of dentine for reparative and regenerative purposes.

Effect of Galla chinensis on the remineralization of two bovine root lesions morphous in vitro

The present study aims to evaluate the effect of Galla chinensis compounds on the remineralization of two artificial root lesions morphous in vitro. Sixty bovine dentine blocks were divided into two groups and individually treated with two levels of demineralization solutions to form erosive and subsurface artificial carious lesions in vitro. Each group was then divided into three subgroups, each of which were treated with a remineralization solution (positive control), deionized water (negative control), or 4 000 mg⋅L(-1) aqueous solutions of Galla chinensis extract. The dentine blocks were then subjected to a pH-cycling regime for 7 days. During the first 4 days, the daily cycle included 21-h deal and 3-h demineralization applications. The dentine blocks were dealt with the entire day during the remaining 3 days. Two specimens from each of the treatment groups were selected and observed under a polarized light microscope. Data collected using a laser scanning confocal microscope were computerized and analyzed. Galla chinensis extract clearly enhanced the remineralization of both erosive lesion and subsurface lesion patterns in the specimens (P<0.05). The level of remineralization of the erosive lesion by Galla chinensis extract was lower than that of the subsurface lesion (P<0.05). In addition, the remineralization of the subsurface lesion by Galla chinensis extract was higher than that of the remineralization solution (P<0.05). No significant difference between the remineralization of erosive lesions by Galla chinensis extract and the remineralization solution was observed (P>0.05). So Galla chinensis extract has the potential to improve the remineralization of artificial root lesions under dynamic pH-cyclic conditions, indicating its potential use as a natural remineralization medicine.

Remineralization of artificial dentinal caries lesions by biomimetically modified mineral trioxide aggregate

Fluoride-releasing restorative materials are available for remineralization of enamel and root caries. However, remineralization of dentin is more difficult than remineralization of enamel due to the paucity of apatite seed crystallites along the lesion surface for heterogeneous crystal growth. Extracellular matrix proteins play critical roles in controlling apatite nucleation/growth in collagenous tissues. This study examined the remineralization efficacy of mineral trioxide aggregate (MTA) in phosphate-containing simulated body fluid (SBF) by incorporating polyacrylic acid and sodium tripolyphosphate as biomimetic analogs of matrix proteins for remineralizing caries-like dentin. Artificial caries-like dentin lesions incubated in SBF were remineralized over a 6 week period using MTA alone or MTA containing biomimetic analogs in the absence or presence of dentin adhesive application. Lesion depths and integrated mineral loss were monitored with microcomputed tomography. The ultrastructure of baseline and remineralized lesions was examined by transmission electron microscopy. Dentin remineralization was best achieved using MTA containing biomimetic analogs regardless of whether an adhesive was applied; dentinal tubules within the remineralized dentin were occluded by apatite. It is concluded that the version of MTA employed in this study may be doped with biomimetic analogs for remineralization of unbonded and bonded artificial caries-like lesions in the presence of SBF.

Influence of fluoride- or triclosan-based desensitizing agents on adhesion of resin cements to dentin

Effect of desensitizers on the bond strength of resin cements to dentin was evaluated. Intact premolars (N = 90) were embedded in polymethyl methacrylate; dentin surfaces were exposed, and they were randomly divided into two main groups of cements (Duolink (D), Variolink II (V); n = 45 per group) and then into three desensitizer subgroups (n = 15 per subgroup). Teeth in controls (C) were treated according to cements' adhesion protocols; the other two groups received either fluoride- [Aqua-Prep F (F)] or triclosan-based [Seal&Protect (T)] desensitizers. Ceramic disks (Empress 2) were adhered; specimens were thermocycled (×5,000 cycles, 5-55 ± 1°C, dwell time 30 s) and subjected to shear bond strength test (MPa ± SD) in a universal testing machine (crosshead speed 1 mm/min). Failure types were classified using scanning electron microscope. For V, application of both desensitizers (29.6 ± 7.8 and 22.8 ± 2.8 for F and T, respectively) did not present significantly different results than that of the VC (21.2 ± 2.3; p > 0.05, one-way ANOVA). In D, F (20.6 ± 2.4) showed significantly higher results (p < 0.05) than those in T (16.1 ± 3.9) and DC group (15.2 ± 2.3). V showed significantly higher results than D (p < 0.05, Bonferroni). F and T did not negatively affect the bond strength results with D and V. Adhesive failures were more frequent with both T (84%) and F (66%) in D; cohesive failures in the cement (88%) were more commonly observed with F in V. Both F and T desensitizers can be safely used prior to final cementation but F in combination with V seems to be more reliable, considering both the bond strength and the failure types.

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.

The effects of child formula toothpastes on enamel caries using two in vitro pH-cycling models

AIMS/OBJECTIVES

To compare, using two pH-cycling models, the de/remineralisation effects of children's toothpastes on primary teeth.

DESIGN

In vitro single-section and pH-cycling models.

METHODS

Primary teeth were placed in demineralising solution for 96 hours to produce artificial carious lesions 60-100 microm deep. They were cut into 100 microm thick sections and assigned to 6 groups. Sections in Groups A and D were exposed to a non-fluoridated toothpaste, those in Groups B and E to half-pea-sized (0.16g) and those in Groups C and F to pea-sized portions (0.32g) of a 500ppm F toothpaste. pH-cycling Model I (Groups A, B, C), without added fluoride, ran for 7 days, while Model II (Groups D, E, F), with 0.25ppm F, ran for 10 days.

OUTCOME MEASUREMENTS

Lesions were evaluated using polarised light microscopy and microradiography.

RESULTS

Lesions in Groups B and E progressed by 64% and 61%, respectively, while those in Groups C and F progressed by only 19% and 23% respectively.

CONCLUSIONS

Both 10-day and 7-day pH-cycling models were suitable for studying carious lesion progression in primary teeth (the demineralising and remineralising solutions of the 10-day cycling model contained 0.25ppm F). A pea-sized portion (0.32g) of 500ppm F toothpaste slowed down the demineralisation progression better than a half-pea-sized portion.

Effect of 2% plain and fluoridated milk on root surface caries in vitro

The caries-protective effect of milk and fluoridated milk on enamel has been reported; however, few data are available concerning the role of milk and/or fluoridated milk on root surfaces. The aim of this study was to compare the effect of plain and fluoridated milk on root surface caries. Artificial root surface lesions were created, sectioned and analyzed using polarized light microscopy (PLM) and microradiography (MRG). The sections were covered except for the original surface and assigned to a treatment group. The samples were immersed in 2% plain milk or fluoridated milk for 40 hours and re-evaluated. Changes were measured and mean differences were compared with an unpaired t-test. Both techniques revealed a reduction in lesion depth for each milk group; however, a significantly greater reduction (p<0.05) was observed with the fluoridated milk. These results suggest that fluoridated milk may have a beneficial effect on the remineralization of root surface caries.

Effect of smear layer on root demineralization adjacent to resin-modified glass ionomer

The cariostatic effect of resin-modified glass ionomer (RMGI) on secondary root caries is well-documented. However, this beneficial effect may be dependent upon the mode of cavity surface treatment. To investigate this relationship, we studied 4 cavity surface treatments prior to the placement of RMGI: no treatment (None), polyacrylic acid (PAA), phosphoric acid (H(3)PO(4)), and Scotchbond Multi-Purpose adhesive (SMP) as a control. Specimens were aged for two weeks in synthetic saliva, thermocycled, and subjected to an artificial caries challenge (pH 4.4). Polarized light microscopy (PLM) and microradiography (MRG) showed significantly less demineralization with the H(3)PO(4) cavity surface treatment as revealed by ANOVA and Tukey's multiple comparisons (p < or = 0.05). Dentin fluoride profiles determined by electron probe microanalysis (EPMA) supported PLM and MRG findings. It may be concluded that removal of the smear layer with phosphoric acid provides significantly enhanced resistance to secondary root caries formation adjacent to RMGI restorations.

Effect of fluoride application on tensile bond strength of self-etching adhesive systems to demineralized dentin

STATEMENT OF PROBLEM

It has been reported that the bond strength of composite to demineralized dentin is lower than that to sound dentin. This can be a problem in the success of so-called sealed restorations.

PURPOSE

The aim of this study was to evaluate the effect of fluoride application on the tensile bond strength of self-etching adhesive systems to demineralized dentin.

MATERIAL AND METHODS

One hundred twenty extracted bovine incisors were ground flat with 600-grit silicone carbide paper. Ninety teeth were then immersed in acetate buffer (pH 4.0) to form demineralized dentin. These teeth were randomly divided into 3 groups of 30 each: surfaces treated with fluoride solution (Group NF), surfaces treated with fluoride solution followed by a water rinse (Group RF), and control surfaces with no pretreatment (Group C). The remaining 30 teeth comprised a group with normal dentin surfaces (Group S). Each group was further divided into 3 subgroups of 10 each to test the bond strength test of Clearfil SE Bond, Unifil Bond, and Mac-Bond II. Tensile bond strengths (in MPa) were measured with a universal testing machine at a crosshead speed of 0.5 mm/min. Mean bond strengths were analyzed by 2-way analysis of variance and Fisher's PLSD (P =.05). SEM observations of the surfaces before and after priming and at resin-dentin interfaces in each group were performed. Elemental analysis of the dentin surfaces before priming was also carried out.

RESULTS

The bond strengths of the adhesives to demineralized dentin in Groups NF, RF, and C were significantly lower than that of the normal dentin in Group S (P <.05). The mean bond strengths of the 3 adhesives in Group NF were higher than those in Groups RF and C, but a significant difference was observed only when Clearfil SE Bond was used (P <.05). In SEM images the open dentinal tubules on the surface and the resin tag formation at the resin-dentin interface were apparent in Group NF but were not observed in Groups RF and C. On elemental analysis, considerable amounts of fluoride and calcium were detected in the surfaces of Group NF.

CONCLUSION

Within the limitations of this study, the surface treatment with fluoride solution supported the resin tag formation at the resin-dentin interface and slightly improved the bond strength of the self-etching adhesive systems tested to demineralized dentin. This result indicated that the fluoride treatment to demineralized dentin might contribute to the success of the sealed restoration.

Influence of cementum on the demineralization and remineralization processes of root surface caries in vitro

The influence of the nature of the root surface on the demineralization and remineralization processes within artificial fluoride-treated caries lesions was investigated using microscopic and X-ray microanalytical methods. Traces of fluoride were detected in the outer parts (about 25 micrometers) of the lesions after the application of fluorides, and a high mineral content was proved for the same region by means of microanalytical calcium estimation. The location of this mineral-rich band in relation to the root surface was deeper into the root depending on the existence and thickness of a cementum layer. However, within the dentine the location and intensity of the mineral content were unaffected by the cementum. Investigation of artificial caries lesions without fluoride treatment showed the following: The degree of mineralization was kept at a higher level near the root surface in the presence of cementum. Consequently, a cementum layer gives some initial caries resistance of the root surface.

Is it time to change state and regional dental licensure board exams in response to evidence from caries research?

State and regional board exams represent the final gateway to dental licensure. One would expect that the requirements for licensure would reflect procedures that are beneficial to each patient's oral health and that are consistent with the teachings of most dental schools. We conducted an Internet survey to determine whether Class 2 tooth preparations based on caries lesions whose radiolucencies were confined to enamel were allowed for state and regional exams. Information obtained for 46 of the 50 states revealed that 33 of the states (72%) allowed teeth with either an E1 or E2 lesion to be restored. Seventeen of these states allowed teeth with an E1 lesion to be restored. Only 12 of the 46 states (26%) covered by these boards did not allow teeth with E1 or E2 lesions to be surgically treated. In contrast, a recent report indicates that only 30% of dental schools permit teeth with enamel lesions to be restored to satisfy clinical requirements and competencies.

Laser-matrix-fluoride effects on enamel demineralization

Laser and fluoride have been shown to inhibit enamel demineralization. However, the role of organic matrix and their interactions remains unclear. This study investigated the interaction among CO2 laser irradiation, fluoride, and the organic matrix on the demineralization of human enamel. Twenty-four molars were selected and cut into halves. One half of each tooth was depleted of its lipid and protein. The other half served as a matched control. Each tooth half had two window areas, treated with a 2.0% NaF gel. All left windows then received a laser treatment. Next, the tooth halves were subjected to a four-day pH-cycling procedure that created caries-like lesions. Tooth sections were cut from the windows, and microradiographs were used for quantification of the demineralization. The combined fluoride-laser treatment led to 98.3% and 95.1% reductions in mineral loss for enamel with and without organic matrix, respectively, when compared with sound enamel.

A novel in vitro model system to grow films of oral bacteria for the study of human tooth root surface caries

AIMS

To develop a simple and flexible novel in vitro model system to grow films of oral bacteria that could be used to study aspects of dental caries.

METHODS AND RESULTS

Standardized suspensions of bacteria were inoculated into Ultrafree-CL (Millipore) ultrafiltration units at various densities. These were incubated for varying time intervals with a range of carbon sources. The bacterial films reproducibly achieved between 107 and 108 cfu cm-2, irrespective of the number inoculated and with no significant changes for 14 d. However, Streptococcus mutans grew through membranes with pores of diameter greater than 0.1 microm after 6 d. Culture of films in sucrose or water for 6 d led to a decreased number of colony-forming units, but returning them to broth reversed this.

CONCLUSION

Reproducible films of oral bacteria can be cultured in Ultrafree-CL units.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study has shown that Ultrafree-CL units can be used as a simple model system to grow biofilms that could be used for dental caries research.

The effect of fluoridated and non-fluoridated rewetting agents on in vitro recurrent caries

OBJECTIVE

This study examined the in vitro caries inhibiting potential of fluoridated and non-fluoridated rewetting agents that are applied to acid-etched enamel and dentine before the use of a water-free, dentine adhesive.

MATERIALS AND METHODS

Twelve caries-free premolars were divided into three groups of four teeth each. 2 x 3 x 1.5 mm cavities were prepared on the mesial and distal surfaces of each tooth, with half of the cavosurface margin in enamel and half in root dentine. In Group I (control), One-Step (Bisco, Schaumburg, USA) was applied without etching or rewetting agents. In Group II, cavities were acid-etched, rinsed, dried, and rewetted with Aqua-Prep (Bisco), a non-fluoridated rewetting agent, and then bonded with One-Step. Treatment for Group III was similar to Group II, except that Aqua-Prep F (Bisco), a fluoridated rewetting agent was used. Bonded cavities were restored with a non-fluoride-containing flowable composite (AEliteFlo, Bisco). Artificial carious lesions were induced in these specimens, from which multiple 100+/-20 microm thick longitudinal sections were prepared, yielding 16 specimens per group for evaluation with polarised light microscopy (PLM) and microradiography (MRG). Representative sections were processed for transmission electron microscopy (TEM) examination and scanning transmission electron microscopy/energy dispersive X-ray (STEM/EDX) analyses.

RESULTS

The differences in demineralisation of dentine among the groups were not statistically significant for 'relative' lesion depth (p > 0.05, ANOVA, Student-Neuman-Keuls test), but highly significant for 'relative' lesion area (p < 0.001). Wall lesions were consistently present in Group I, while inhibition zones were invariably observed in Group III. 87.5% of Group II specimens exhibited neither wall lesion nor inhibition zone. TEM showed that remnant dentine apatite crystallites within the inhibition zones in Group III were larger and denser than those present within the corresponding wall lesions. STEM/EDX analyses confirmed the presence of calcium, phosphorus and fluorine in these plate-like crystallites.

CONCLUSION

When used with a water-free, single-bottle dentine adhesive, a non-fluoridated rewetting agent is able to reduce, but cannot completely prevent recurrent caries. The use of a fluoridated rewetting agent is useful under the situation when microleakage occurs, by providing the additional benefit of fluoride-induced demineralisation inhibition.

Effects of low-energy CO2 laser irradiation and the organic matrix on inhibition of enamel demineralization

In the past two decades, accumulated evidence has clearly demonstrated the inhibitory effects of laser irradiation on enamel demineralization, but the exact mechanisms of these effects remain unclear. The purpose of this study was to investigate the effects of low-energy CO2 laser irradiation on demineralization of both normal human enamel and human enamel with its organic matrix removed. Twenty-four human molars were collected, cleaned, and cut into two halves. One half of each tooth was randomly selected and its lipid and protein content extracted. The other half of each tooth was used as the matched control. Each tooth half had two window areas. All the left windows were treated with a low-energy laser irradiation, whereas the right windows served as the non-laser controls. After caries-like lesion formation in a pH-cycling environment, microradiographs of tooth sections were taken for quantification of demineralization. The mean mineral losses (with standard deviation) of the enamel control, the lased enamel, the non-organic enamel control, and the lased non-organic enamel subgroups were 3955 (1191), 52(49), 4565(1311), and 1191 (940), respectively. A factorial ANOVA showed significant effects of laser irradiation (p = 0.0001), organic matrix (p = 0.0125), and the laser-organic matrix interaction (p = 0.0377). The laser irradiation resulted in a greater than 98% reduction in mineral loss, but the laser effect dropped to about 70% when the organic matrix in the enamel was removed. The results suggest that clinically applicable CO2 laser irradiation may cause an almost complete inhibition of enamel demineralization.