The effect of study design on in situ treatment of carious enamel lesions

Investigation of Factors Influencing Stain Formation Utilizing an in Situ Model

In order to understand the factors of extrinsic stain formation more fully, we have developed an in situ stain model. This consists of polished bovine enamel blocks attached to partial or full dentures worn by adult volunteers for 24 h per day. The dentures were cleaned twice daily with a commercial dentifrice and toothbrush, with care taken to avoid brushing the inserts. A Minolta CR321 Chroma Meter in the L*a*b* mode was used for taking reflectance measurements of the stain formed on the enamel inserts. From these values, changes in the color of the inserts were calculated and the level of stain determined. In general, the stain formed on the enamel inserts was yellow and increased in intensity and darkness with time. The enamel inserts with the largest stain increases were from smokers rather than non-smokers. No correlation was observed between amount of stain and quantity of tea and coffee consumed. When the effects of surface roughness on in situ stain formation were considered, the major variable in this study was found to be the location of the enamel insert in the denture rather than the surface roughness.

Role of models in assessing new agents for caries prevention--non-fluoride systems

While fluoride is an effective anti-caries agent, the search for more effective alternative therapies continues. A wide range of non-fluoride anti-caries agents has been postulated, and this paper reviews some of the pre-clinical models that have been utilized in their evaluation and some of the pitfalls that must be avoided. Using data on the potential anti-caries efficacy of phosphopeptides obtained from casein, the caution that must be applied in extrapolating laboratory data to predict clinical performance is discussed. Evaluation strategies that focus on only one potential mode of action (e.g., inhibition of demineralization) may overestimate the true clinical efficacy which may arise from a combination of two or more effects (e.g., inhibition of demineralization and stimulation of remineralization). Although laboratory and in situ data predict anti-caries efficacy for sodium trimetaphosphate in combination with fluoride, this was not found in three-year clinical trials. A possible reason for this, the lack of suitable calibration methods, is discussed. Finally, some comments on the appropriateness of laboratory evaluation strategies are made.

In situ models, physico-chemical aspects

In situ (intra-oral) caries models are used for two purposes. First, they provide information about oral physiological processes. Such information helps to detail our knowledge of the oral ecosystem and to verify conclusions from in vitro experiments. Second, in situ models are utilized to test preventive agents in the phase between laboratory testing and clinical trials. Most investigations involving enamel inserts have been aimed at testing new dentifrices. The experimental designs of such studies usually do not allow one to draw conclusions on physico-chemical processes, e.g., because of single point measurements. Studies of model parameters (lesion type, lesion severity, and de/remineralization in time) constitute only a minority of the research reports. The most striking observation obtained with in situ models has been the significant differences in de/remineralization observed among individuals and, more importantly, within one individual during different time periods and between different sites in the same mouth (for review, see ten Cate et al., 1992). Regardless of this, some general findings can be inferred: During in situ demineralization, up to 62 vol% microns/day may be removed from enamel. For dentin specimens, this value may be as high as 89 vol% microns/day. For remineralization, during fluoride dentifrice treatment, a median deposition rate of 0.7%/day (for lesions with integrated mineral loss values between 2000 and 4000 vol% microns) is found. The rate of deposition seems to be correlated with the extent of the pre-formed lesion. This suggests that the number of sites (crystallite surface) available for calcium phosphate precipitation is an important parameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Patient selection and appliance design in intra-oral models

The conclusions derived from in situ studies are influenced by the choices made with respect to parameters of the intra-oral model systems. In an attempt to reach a consensus, this paper considers the variables (a) selection of panelists and (b) appliance design. On both topics, a short review of available systems is given. The objectives of the intra-oral study may vary from the determination of oral physiological parameters to assessment of the effects of caries-preventive treatments. This objective is a factor influencing the choice of experimental conditions. Recommendations for panelist selection and appliance design are given for different types of studies. It is concluded that relatively little information is available about the effects of individual parameters on the performance of a model. Therefore, for an assessment of caries-preventive effectiveness, an intra-oral model should be validated against clinical trials. In addition, conditions should be chosen such as to limit the degree of artificiality of the model.