A single-section model for enamel de- and remineralization studies. 1. The effects of different Ca/P ratios in remineralization solutions

Remineralization potential of varying concentrations of two plant-based extracts of Cocos nucifera on white spot lesions using SEM and EDAX analysis: An in vitro study

Aim

To evaluate the remineralization potential of varying concentrations of two plant-based extracts of Cocos nucifera on white spot lesions using SEM and EDAX in vitro testing methods.

Materials and Methods

The pulp was freshly obtained from coconut and divided into two. Then, coconut milk was obtained by blending, while the next portion was freeze-dried and lyophilized. Third molar teeth were processed into tooth slabs (N = 40) and split equally into five groups by block randomization. After demineralization, one tooth slab was taken from each, and SEM analysis was done. Remineralization was then performed among the various groups that included Group 1, which acted as a control and consisted of the remineralization solution. Groups 2 and 3 comprised 1:1 and 2:1 concentrations of the coconut milk, whereas Groups 4 and 5 consisted of 1:1 and 2:1 concentrations of the lyophilized extract. SEM and EDAX testing were done post-remineralization. Ca and phosphate values were tabulated, and statistical significance was determined for the obtained values using ANOVA.

Results

Among the control and treatment groups, surface remineralization was better observed in 1:1 coconut milk and 2:1 coconut milk than in the 2:1 lyophilized coconut, control, and 1:1 lyophilized coconut. Between the control and treatment groups, Ca and phosphate percentages (P < 0.001) showed statistical differences. The lowest value of 2.3% was noted in the 2:1 lyophilized coconut group.

Conclusion

Coconut extracts exhibit remineralization potential on the artificial carious lesion. Coconut milk exhibited significant improvement in the surface properties than lyophilized coconut.

Strategies and Challenges in the Treatment of Dental Enamel

Enamel tissue, the hardest body tissue, which covers the outside of the tooth shields the living tissue, but it erodes and disintegrates in the acidic environment of the oral cavity. On the one hand, mature enamel is cell-free and, if damaged, does not regenerate. Tooth sensitivity and decay are caused by enamel loss. On the other hand, the tissue engineering approach is challenging because of the unique structure of tooth enamel. To develop an exemplary method for dental enamel rebuilding, accurate knowledge of the structure of tooth enamel, knowing how it is created and how proteins interact in its structure, is critical. Furthermore, novel techniques in tissue engineering for using stem cells to develop enamel must be established. This article aims to discuss current attempts to regenerate enamel using synthetic materials methods, recent advances in enamel tissue engineering, and the prospects of enamel biomimetics to find unique insights into future possibilities for repairing enamel tissue, perhaps the most fascinating of all tooth tissues.

Indirect caries-preventive effect of silver diamine fluoride on adjacent dental substrate: A single-section demineralization study

This study assessed the indirect effect of 38% silver diamine fluoride (SDF) on demineralization of adjacent untreated sound and pre-demineralized enamel and dentine using a single-section model for digital transverse microradiography (TMR-D). Forty-eight bovine dentine single sections were demineralized, stratified (n = 12) according to integrated mineral loss (ΔZ), and treated with SDF or deionized water (DIW). Each "treated dentine" section was attached between untreated sound and pre-demineralized enamel or dentine and then subjected to demineralization. ΔZ and lesion depths (LD) of all specimens at baseline, 24 and 48 h demineralization, and after treatment of "treated dentine" were quantified using TMR-D. Fluoride in the demineralization solution of SDF clusters was determined using an ion-selective electrode. ΔZ and LD of sound and ΔZ of pre-demineralized enamel adjacent to SDF-treated dentine did not increase over time. All untreated dentine demineralized significantly; however, ΔZ of sound dentine adjacent to SDF-treated specimen was still significantly lower than control. SDF-treated dentine remineralized and released fluoride even after 48 h. Consistent with clinical findings, when applied only to demineralized teeth in this chemical model, 38% SDF completely inhibited demineralization in adjacent untreated sound enamel. Demineralization prevention was observed to a lesser extent in adjacent pre-demineralized enamel but not in dentine.

A Comparative Evaluation of Remineralizing Potential of Three Commercially Available Remineralizing Agents: An In Vitro Study

Aim

An in vitro study to evaluate and compare the remineralization potential of commercially available remineralizing agents containing silver diamine fluoride (SDF), casein sucrose phosphate (CSP), casein phospho peptide-amorphous calcium phosphate (CPP-ACP) using DIAGNOdent.

Materials and methods

Thirty freshly extracted premolars for orthodontic treatment were collected. Specimens were randomly divided into 3 groups of 10 each: group I: SDF, group II: CSP, group III: CPP-ACP. The samples were subjected to DIAGNOdent analysis for recording the baseline values. Specimens were placed in demineralizing solution incubated at 37°C for 72 hours. DIAGNOdent values were recorded after demineralization. Following this, remineralization procedure was carried out using 3 different remineralizing agents: group I samples with SDF, group II with CSP, and group III with CPP-ACP. The remineralization procedure was performed to group I once and repeated for 14 days for group II and group III and storage solution was changed every 24 hours. The samples were subjected to DIAGNOdent analysis after 72 hours, 7 days, and 14 days and values were recorded.

Results

The data were analysed using Statistical Package for the Social Sciences (SPSS) with analysis of variance (ANOVA) and post hoc test. Intragroup comparison of DIAGNOdent readings showed a highly significant difference between baseline, postdemineralization, and postremineralization values. Among intergroup comparison, SDF showed maximum remineralization values followed by CSP and CPP-ACP, respectively.

Conclusion

Silver diamine fluoride, CSP, and CPP-ACP are proven to possess remineralization potential.

Clinical significance

A comparative evaluation of these three remineralizing agents will aid in identifying most potent and effective agent in treating initial caries lesions in an effective noninvasive and child-friendly manner.

How to cite this article

Vinod D, Gopalakrishnan A, Subramani SM, et al. A Comparative Evaluation of Remineralizing Potential of Three Commercially Available Remineralizing Agents: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(1):61–65.

Phosphoryl oligosaccharides of calcium enhance mineral availability and fluorapatite formation

OBJECTIVES

Phosphoryl oligosaccharides of calcium (POs-Ca) are a highly soluble calcium source and can keep the solubility of calcium and fluoride ions. The aim of this study was to investigate the effect of calcium (from POs-Ca) and fluoride ions penetrate into subsurface enamel lesions in vitro.

DESIGN

Demineralized bovine enamel slabs were remineralizedin vitro for 24 h at 37 °C with artificial saliva (AS) containing POs-Ca and various fluoride concentrations (0-100 ppm), or AS containing different levels of POs-Ca adjusted to a Ca/P ratio of 0.4-3.0 and fluoride, then were analyzed using Transversal microradiography. From those results, remineralization effects with optimal conditions were compared between POs-Ca and calcium chloride (CaCl₂). To determine the form of incorporated fluoride, we analyzed the chemical state and local structure of fluorine atoms integrated into enamel subsurface lesions using micro X-ray absorption near-edge structure (μ-XANES) spectroscopy.

RESULTS

A significant mineral recovery rate was observed with POs-Ca and fluoride at 0.5 or 1.0 ppm (n = 6, p < 0.05), as well as a Ca/P molar ratio of 1.67 (n = 5, p < 0.05). Under those conditions, the mineral recovery rate of AS containing POs-Ca (37.9 ± 7.3%) was significantly greater than that of CaCl₂ (15.0 ± 9.6%) (n = 5, mean ± SD, p < 0.05). μ-XANES spectra analysis of the samples indicated that the dominant form of fluorine atoms in enamel subsurface lesions was fluorapatite.

CONCLUSIONS

POs-Ca with fluoride-derived diffusion into subsurface enamel lesions facilitated formation of fluorapatite phases.

Randomised in situ clinical trial investigating self-assembling peptide matrix P11-4 in the prevention of artificial caries lesions

The aim was to investigate the ability of self-assembling Peptide P11-4 Matrix (SAPM) to remineralize artificial initial caries lesions compared to the use of fluoride varnish. Volunteers were recruited for this randomised, cross-over in situ trial. Bovine specimens, half including orthodontic brackets, were recessed on the buccal aspects of mandibular appliances. Specimens included internal sound enamel control, a demineralised control and a part exposed during the in situ phase. Each phase lasted four weeks, followed by a one-week washout. Treatment groups were: A: negative control, no treatment,B: positive control, 22,600 ppm fluoride varnish,C: test group, 1,000 ppm SAPM. Laser fluorescence values (LF) were measured before/after demineralisation, and after the in situ period. Micro-CT analysis was used to assess mineral changes within the specimens after the in situ phase. In specimens without brackets, ΔLF values after in situ phase were: A: +5.28, B: +0.85, C: −2.89. Corresponding ΔLF for specimens with brackets were: A: +5.77, B: +1.30, C: −3.15. LF-values between groups significantly differed from each other (p < 0.0001) after the in situ phase. Micro-CT analysis yielded no significant difference among groups for specimens without brackets. For specimens with brackets, the test group showed significantly more remineralisation than the negative (p = 0.01) and positive control (p = 0.003). Within the limitations of the study, SAPM showed prevention of caries and remineralisation of enamel around orthodontic brackets.

Remineralization ability of sodium fluoride on the microhardness of enamel, dentin, and dentinoenamel junction: An in vitro study

Aim:

Dental tissues such as enamel, dentinoenamel junction (DEJ), dentin, and root dentin can react differently to demineralization and remineralization. The aim of this study was to evaluate the remineralization ability of sodium fluoride on the microhardness of enamel, dentin, and dentinoenamel junction.

Materials and Methods:

Ten extracted third molar teeth were sectioned mesiodistally to form control and test groups. For the test group, initial demineralization was done with acetic acid for 24 h followed by remineralization for 28 days by application of sodium fluoride (226 ppm) for 2 min twice a day. Vickers microhardness test was done to control and test groups at different sites after initial demineralization and on the 3^rd, 5^th, 7^th, 14^th, and 28^th day of remineralization.

Statistical Analysis Used:

Data were analyzed with one-way analysis of variance and post hoc test with a significance level of P < 0.001 with SPSS (21) software.

Results:

Microhardness values in the demineralization group were significantly lower than controls (P < 0.001). Evaluation of remineralization samples showed that microhardness similar to control values were achieved at the 3^rd day in root predentin and on the 5^th day in coronal dentin and coronal predentin. On the 7^th day, remineralization coronal predentin was significantly higher than the control (P < 0.001). On the 14^th day, DEJ axial zone and root dentin were similar to control and coronal dentin was significantly higher than the control (P < 0.001). Enamel was similar to control on the 28^th day. Microhardness of DEJ-cusp tip and DEJ-center of the fissure was significantly lower than control even at the 28^th day (P < 0.001).

Conclusion:

Long-term repeated application of sodium fluoride (226 ppm) can improve the microhardness of demineralized dental tissues on enamel, dentin, and DEJ-axial zone, except in the DEJ-cusp tip and DEJ-center of fissure.

In vitro dentine remineralization with a potential salivary phosphoprotein homologue

OBJECTIVE

Advantages of introducing a salivary phosphoprotein homologue under standardized in vitro conditions to simulate the mineral-stabilizing properties of saliva have been proposed. This study longitudinally investigates the effects of casein, incorporated as a potential salivary phosphoprotein homologue in artificial saliva (AS) solutions with/without fluoride (F) on in vitro dentine lesion remineralization.

DESIGN

Thin sections of bovine root dentine were demineralized and allocated randomly into 6 groups (n=18) having equivalent mineral loss (ΔZ) after transverse microradiography (TMR). The specimens were remineralized using AS solutions containing casein 0μg/ml, F 0ppm (C0-F0); casein 0μg/ml, F 1ppm (C0-F1); casein 10μg/ml, F 0ppm (C10-F0); casein 10μg/ml, F 1ppm (C10-F1); casein 100μg/ml, F 0ppm (C100-F0) or casein 100μg/ml, F 1ppm (C100-F1) for 28days with TMR taken every 7 days.

RESULTS

Surface mineral precipitation, evident in group C0-F1, was apparently inhibited in groups with casein incorporation. Repeated measures ANOVA with Bonferroni correction revealed higher ΔZ for non-F and non-casein groups than for their counterparts (p<0.001). Subsequent multiple comparisons showed that mineral gain was higher (p<0.001) with 10μg/ml casein than with 100μg/ml when F was present in the earlier stages of remineralization, with both groups achieving almost complete remineralization after 28 days.

CONCLUSION

Casein is a potential salivary phosphoprotein homologue that could be employed for in vitro dentine remineralization studies. Concentration related effects may be clinically significant and thus must be further examined.

Effect of casein phosphopeptide-amorphous calcium phosphate (cpp-acp) on caries-like lesions in terms of time and nano-hardness: An in vitro study

CONTEXT

Time bound increase in the nanohardness of the enamel after remineralization with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) in a regular interval of 1 h has not been explored in the literature to a greater extent.

AIMS

To determine and compare the maximum hardness of the remineralized caries-like lesions, in terms of nanohardness and the rate of achieving maximum hardness at 1-h interval, after treatment with artificial saliva and CPP-ACP, over 12 h.

MATERIALS AND METHODS

Fifty longitudinal sections of extracted sound permanent maxillary central, lateral incisors were immersed in demineralizing solution for 4 days. The samples were then randomly divided into three groups, consisting of 12 sections each for soaking them in three different media-isotonic saline, artificial saliva, and CPP-ACP for 12 h. The nanohardness was measured on the labial surface, at baseline, after erosion, and after remineralization at 1-h interval.

STATISTICAL ANALYSIS USED

The data was analyzed with paired t-test, one-way analysis of variance (ANOVA) and post-hoc analysis.

RESULTS

CPP-ACP increased the enamel hardness significantly (P < 0.001), at an increased rate, than artificial saliva.

CONCLUSIONS

This study has provided an insight into the frequency of use of CPP-ACP, once per day, as the nanohardness of enamel samples increased within 1 h of application and remained within the normal limits after 12 h.

An approach to normalizing micro-CT depth profiles of mineral density for monitoring enamel remineralization progress

To indicate the possibility of a new approach to creating mineral density profiles, and to examine longitudinal changes in 'the rate of remineralization (RA)' and 'the mineral density (DAs) at 4 different depths' (surface zone: SZ, lesion body: LB, middle zone: MZ, deep zone near to sound area: DZ) in enamel subsurface lesions, eight demineralized bovine enamel-dentin blocks were remineralized for 1 to 4 week and investigated using Micro-focus X-ray CT (micro-CT). After CT scanning, mineral density profiles were created.Mineral densities at each depth after demineralization were SZ is approximately equal to LB<MZ<DZ. Increase in RA was the greatest in the first week of remineralization and it decreased over time. Increments of the mineral density were greater in the order of SZ is approximately equal to LB>MZ>DZ. This study indicated a new approach to create a mineral density profile and suggested the greater the value of the mineral density before the remineralization, the smaller the mineral density increments.

Optimization of calcium concentration of saliva with phosphoryl oligosaccharides of calcium (POs-Ca) for enamel remineralization in vitro

OBJECTIVE

Phosphoryl oligosaccharides of calcium (POs-Ca) are highly soluble calcium source made from potato starch. The aim of this study was to investigate the optimal concentrations of POs-Ca for the remineralization of subsurface enamel lesions in vitro.

DESIGN

Demineralized bovine enamel slabs (n=5) were remineralized in vitro for 24h at 37°C with artificial saliva (AS) containing 0-0.74% POs-Ca to adjust the Ca/P ratio to 0.4-3.0, then sectioned and analysed by transversal microradiography (TMR). The data were analysed by Scheffe's post hoc test. The Ca/P ratio with most remineralization was used to investigate the effect of calcium on enamel remineralization (n=11). The demineralized slabs were treated with AS with calcium-chloride- (CaCl2-) or POs-Ca with an identical calcium content, and sectioned for TMR and wide-angle X-ray diffraction (WAXRD) analyses to evaluate the local changes in hydroxyapatite (HAp) crystal content. The data were analysed using the Mann-Whitney U-test.

RESULTS

The highest mineral recovery rate resulted from addition of POs-Ca to adjust the Ca/P to 1.67. At this ratio, the mineral recovery rate for AS containing POs-Ca (24.2±7.4%) was significantly higher than that for AS containing CaCl2 (12.5±11.3%) (mean±SD, p<0.05). The recovery rate of HAp crystallites for AS containing POs-Ca (35.7±10.9%) was also significantly higher than that for AS containing CaCl2 (23.1±13.5%) (p<0.05). The restored crystallites were oriented in the same directions as in sound enamel.

CONCLUSIONS

POs-Ca effectively enhances enamel remineralization with ordered HAp at a Ca/P ratio of 1.67.

Grape seed extract as a potential remineralizing agent: a comparative in vitro study

OBJECTIVE

Remineralization is an effective treatment that may stop or reverse early tooth decay. Grape seed extract (GSE) is the potential remineralizing agent under investigation.

MATERIALS AND METHODS

Sound human tooth sections were obtained from the cervical portion of the root and stored in demineralizing solution at 37°C for 96 hours to induce artificial root caries lesions. The sections were divided into four treatment groups including 6.5% grape seed extract, sodium monofluorophosphate (220 ppm) with 0.05% calcium glycerophosphate, 0.5% calcium glycerophosphate and control (no treatment). An in vitro pH cycling model was used to cycle the demineralized specimens through treatment solutions, acidic buffer and neutral buffer for 8 days at 6 cycles per day. Subsequently, they were evaluated using confocal laser scanning microscope. Data were analyzed using analysis of variance (p < 0.05).

RESULTS

GSE revealed less demineralization and more remineralization compared with other groups.

CONCLUSION

GSE promotes remineralization of artificial root caries lesions.

CLINICAL SIGNIFICANCE

The search for the perfect remineralizing agent continues to this day. GSE could be a welcome addition to the remineralization armamentarium.

pH-cycling models for in vitro evaluation of the efficacy of fluoridated dentifrices for caries control: strengths and limitations

Despite a plethora of in situ studies and clinical trials evaluating the efficacy of fluoridated dentifrices on caries control, in vitro pH cycling models are still broadly used because they mimic the dynamics of mineral loss and gain involved in caries formation. This paper critically reviews the current literature on existing pH-cycling models for the in vitro evaluation of the efficacy of fluoridated dentifrices for caries control, focusing on their strengths and limitations. A search was undertaken in the MEDLINE electronic journal database using the keywords "pH-cycling", "demineralization", "remineralization", "in vitro", "fluoride", "dentifrice". The primary outcome was the decrease of demineralization or the increase of remineralization as measured by different methods (e.g.: transverse microradiography) or tooth fluoride uptake. Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were solved by discussion and consensus or by a third party. One hundred and sixteen studies were included, of which 42 addressed specifically the comparison of dentifrices using different pH-cycling models. The other studies included meta-analysis or reviews, data about the effect of different fluoride sources on de-remineralization, different methods for analysis de-remineralization and chemical variables and characteristics of dental hard tissues that might have influence on de-remineralization processes. Generally, the studies presented ability to detect known results established by clinical trials, to demonstrate dose-related responses in the fluoride content of the dentifrices, and to provide repeatability and reproducibility between tests. In order to accomplish these features satisfactorily, it is mandatory to take into account the type of substrate and baseline artificial lesion, as well as the adequate response variables and statistical approaches to be used. This critical review of literature showed that the currently available pH-cycling models are appropriate to detect dose-response and pH-response of fluoride dentifrices, and to evaluate the impact of new active principles on the effect of fluoridated dentifrices, as well as their association with other anti-caries treatments.

Effect of various Ca2+/PO4(3-) concentrations of linseed-based saliva substitutes on enamel in vitro

Remineralization might be hampered by various polymers used in saliva substitutes. Thus, the present study evaluated the effects of various calcium and phosphate concentrations of linseed-based solutions on the mineral loss of pre-demineralized bovine enamel in vitro. A commercially available saliva substitute (Salinum) based on linseed was tested as well. Enamel specimens were prepared from bovine incisors and embedded in epoxy resin. One-third of each sample was covered with nail varnish (control of sound enamel). After demineralization (37 degrees Celsius; pH 5.0; 14 days) another third of the samples was nail-varnished again. Subsequently, the specimens (n = 10) were exposed to 12 linseed-based solutions (Ca(2+) addition 0-2 mM; PO4(3-) addition 0-3.2 mM) at pH 5.5 and 6.5 as well as to Salinum) for 14 days (37 degrees Celsius). The differences in mineral loss between the values prior to and after the storage in the various solutions were evaluated from microradiographs of thin sections (100 mum). The general linear model revealed a significant dependency for the mineral loss on 'calcium' (P = 0.003), but not on 'pH' (P = 0.397) and 'phosphate' (P = 0.094). Salinum) induced a significant greater mineral loss compared with equivalently saturated solutions (P < 0.05; anova, Bonferroni). The solution with the highest calcium and phosphate concentration showed the greatest mineral gain (P = 0.033; paired t-test). The addition of calcium and phosphate seems to have a positive effect on the remineralizing qualities of linseed-based saliva substitutes.

Effect of Lesion Characteristics and Mineralising Solution Type on Enamel Remineralisation in vitro

The aim was to study the effect of lesion preparation technique and solution composition on remineralization of artificial lesions in vitro. Lesions were prepared with similar total mineral loss, but different mineral distribution, i.e., low (14.0) or high R (34.8) values. Lesions from both groups were remineralized (10 days, 37 degrees C) in two different solutions, with similar supersaturation with respect to hydroxyapatite (St), but calcium:phosphate ratios representing either hydroxyapatite stoichiometry or plaque fluid (PF). Remineralization was quantified microradiographically, mineral distribution was compared with natural white-spot lesions. Mineral loss and depth decreased significantly, and surface-zone mineral content (Zmax) increased significantly, in all lesions. Overall there was a significant relationship of decreasing remineralization with increasing Zmax, but not within either lesion type. PF was significantly more efficient than St in high-R lesions, with lesions remineralizing almost completely in PF. Remineralization was not significantly different in PF or St for low-R lesions but in high-R lesions, PF was more efficient than St, possibly through differences in relative saturations with respect to different calcium phosphates. Differences in area:solution ratios and baseline Zmax values may also have explained the different response to PF. Low-R lesions were similar to natural white-spot lesions in terms of mineral distribution, whereas high-R were not. Concluding, both lesion and remineralizing solution type had a marked influence on remineralization. It is proposed that use of low-R lesions would be more appropriate where more physiologically relevant mineral distribution is required, whereas high-R lesions would be appropriate for studying inherent remineralizing efficiency.

Linseed based saliva substitutes and their effect on mineral dissolution of predemineralized bovine dentin in vitro

OBJECTIVES

Polymers used in saliva substitutes might inhibit remineralization. The present study evaluated the effects of various calcium, phosphate, and fluoride concentrations of linseed based solutions on the mineral loss of predemineralized bovine dentin in vitro.

METHODS

Dentin specimens were prepared, embedded and polished. The specimens were demineralized (pH 5.6; 6 d; 37 degrees C) and half of each sample was covered with nail varnish. Subsequently, the specimens (n=10) were exposed to 14 linseed based solutions (calcium 0-1.1 mM; phosphate 0-7.7 mM, fluoride 0-0.03 mM) at pH 5.5 and 6.5 as well as to Salinum for 14 days (37 degrees C). The differences in mineral loss (DeltaDeltaZ) between the values prior to and after storage in the solutions were evaluated from microradiographs of thin sections.

RESULTS

After the exposure to the various solutions decreased mineral contents compared to those after demineralization could be observed (p<0.05; paired t-test) whereas for the specimens stored in solution with the highest calcium and phosphate concentration no significant change in mineral loss could be evaluated (p>0.05). Salinum induced a significantly greater mineral loss compared to the equivalent saturated solution (p<0.05; ANOVA, Bonferroni). The general linear model revealed a significant dependency for DeltaDeltaZ on 'phosphate' (p=0.000) and 'fluoride' (p=0.001), but not on 'calcium' (p=0.397) and 'pH' (p=0.368).

CONCLUSIONS

The addition of calcium, phosphates, and fluorides seems to have a positive effect on the remineralizing qualities of linseed based saliva substitutes.

The Effect of Fluoride at Plaque Fluid Concentrations on Enamel De- and Remineralisation at Low pH

The aim was to study the effect of fluoride, at concentrations typical of plaque fluid, on de- and remineralisation of subsurface lesions at low pH. Artificial lesions in human enamel were microradiographed to quantify mineral loss and placed in acid-gel systems at pH 4.8, 5.0 and 5.2. Calcium and phosphate were added to give initial Ca and Pi concentrations of either 4.1 and 8.0 mM, or 4.7 and 9.7 mM, at each pH value. Further, at each pH and combination of Ca and Pi, fluoride was added to the gels to give initial concentrations of 1, 2 or 5 ppm, with a non-fluoride control group. The lesions were removed after 10 days and change in mineral content quantified. Those in the non-fluoride control groups had demineralised further. Those exposed to fluoride had remineralised, the amount increasing with increasing fluoride concentration, up to a maximum value of approximately 75%. Calcium activity in the gels was reduced significantly, to levels similar to those reported for plaque fluid at low pH. Fluoride activity was also reduced, though to a lesser extent. These findings contrast with those from studies which have simulated conditions on smooth surface sites and which used experimental solutions composed to reflect salivary fluoride concentrations, where net demineralisation was observed at low pH. This reflects the need for further study of de- and remineralisation under plaque-fluid conditions. In conclusion, subsurface lesions were remineralised at low pH by fluoride at concentrations found in plaque fluid during a cariogenic challenge.

The anti-caries efficacy of calcium carbonate-based fluoride toothpastes

AIM

To summarise clinical support for the anti-caries efficacy of fluoride toothpastes containing sodium monofluorophosphate (SMFP) and to discuss the possible means by which the abrasive particles in calcium carbonate-based SMFP toothpastes might complement and/or enhance fluoride efficacy.

BACKGROUND

The anti-caries efficacy of fluoride has been proven beyond any reasonable doubt, and the efficacy of SMFP, when incorporated into a variety of compatible toothpaste formulations, has been established in numerous clinical trials. Calcium carbonate-based toothpastes may also influence caries by effecting an increase in plaque calcium levels; an inverse relationship between plaque calcium and caries is well-established. It has also been reported that plaque fluoride levels are dependent on plaque calcium levels. Hence elevated plaque calcium resulting from the use of calcium carbonate-based toothpastes has the potential to elevate plaque fluoride, itself linked to reduced caries experience. It has been shown that calcium carbonate particles are retained by plaque and this may also influence caries by neutralising harmful plaque acids and concurrently liberating calcium.

CONCLUSION

Fluoride delivered from calcium carbonate-based SMFP toothpastes is an effective means of reducing caries. Further, calcium carbonate may confer additional benefits through elevation of oral calcium levels and neutralisation of plaque-acids.

Effect of fluoride-releasing adhesive system on decalcified dentin

The aim of this study was to evaluate the effect of fluoride-releasing adhesive systems on human decalcified dentin in vitro. Two fluoride-releasing adhesive systems, Reactmer bond (RB, Shofu) and ABF (AF, Kuraray), an experimental system, and a commercial adhesive system without fluoride release, SE bond (SE, Kuraray), were used in this study. The amount of fluoride release from adhesive in deionized water was measured every week for 10 weeks. Class V cavities were prepared on extracted human pre-molars and decalcified dentin was promoted by using a bacterial caries induction system at the cavity floor. The cavities preserving decalcified dentin were restored with resin composite (AP-X, Kuraray) after treatment by each adhesive system. The specimens without treatment by adhesive system and restoration were used for control. The specimens with restoration were then incubated for 4 weeks at 37 degrees C, 100% humidity. Microradiographs of the specimens showed that the radiopacities of the decalcified dentin layers in RB and AF groups with fluoride release were significantly higher than those in SE or control groups without fluoride release. This result suggested that the fluoride-releasing adhesive systems enhanced mineralization of decalcified dentin.

[Effect of sucrose-containing gum and fluoridated dentifrice on in situ remineralization of artificial caries]

The aim of this study was to evaluate the remineralization of incipient carious lesions in bovine enamel in situ. Artificial carious lesions were produced and fixed in removable lower appliances in the region of the lingual surfaces of first molars, in six volunteers with ages between 18 and 22 years, who were subjected to 3 distinct experimental periods of 1 week each. In the first period (control group), patients brushed their teeth with a non-fluoridated dentifrice 4 times a day (after meals), and, in the second period (group I), patients used a dentifrice containing 1,500 ppm of fluorine (in the form of MFP). In the third period (group II) volunteers brushed their teeth with non-fluoridated dentifrice and used chewing gum containing 60% of sucrose during 20 minutes, 4 times a day (after meals). Before and after each treatment, the specimens underwent Vicker's hardness test (200 g of load), and the remineralization percentage (alpha) was calculated. The control group showed 2.78% of demineralization, and groups I and II showed 3.36 and 5.21% of remineralization, respectively. Statistical analysis (with Kruskal-Wallis and Miller's tests) showed significant difference (p < 0.05) between the control and experimental groups (I and II). Group II showed greater alpha than group I, but this difference was not significant. These results suggest that the use of sucrose-containing chewing gum and fluoridated dentifrice has a considerable effect on the remineralization of incipient carious lesions and may be a valuable alternative for their prevention.

Reproducibility of TMR for the determination of longitudinal mineral changes in dental hard tissues

Transverse microradiography (TMR) of thin sections is the principal method for determining mineral changes in experimental lesions. Because it has become also the standard by which newly-developed methods are validated, demands on all steps of the procedure are high. Thin sections of enamel and dentin require high-precision cutting or lapping to preserve surface structures, but their different brittleness and elasticity preclude a uniform procedure. Image analysis permits the measurement of fine details at a micron scale, but because most studies are aimed at overall mineral changes, they are usually lost on broadening of the scan areas and averaging of experimental groups. Small errors in repositioning of the scan areas for repetitive measurements may yield distorted lesion profiles, while quantitative data such as the integrated mineral loss are hardly influenced. A major reason for "irreproducibility" of TMR are the different definitions of the lesion parameters as used by various research groups. We recommend that these definitions be agreed on if the full potential of TMR as an international standard is to be utilized.

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.

Lipoteichoic acid inhibits remineralization of artificial subsurface lesions and surface-softened enamel

Dental plaque produces not only acids by which underlying enamel is demineralized but also compounds which may inhibit repair of the lesions. The aim of this study was to determine how lipoteichoic acid, a bacterial compound that is abundant in dental plaque and inhibits calcium phosphate precipitation in vitro, affects the remineralization of incipient enamel lesions. Subsurface and surface-softened lesions were made in thin sections of bovine enamel, incubated with various amounts of lipoteichoic acid (isolated from Lactobacillus casei), and remineralized in 1.5 mmol/L CaCl2, 0.9 mmol/L KH2PO4, 130 mmol/L KCl, and 20 mmol/L Hepes, pH 7.0. Remineralization was followed during several weeks by repeated microradiography of the sections, and characterized by the changes in the integrated mineral loss of the lesions and the differential mineral profiles. The results showed that: (1) the effects of lipoteichoic acid on lesion remineralization were dose-dependent; (2) in subsurface lesions only the highest dose of lipoteichoic acid affected remineralization, which was delayed throughout the lesions; and (3) in surface-softened enamel, lipoteichoic acid did not affect the remineralization of the deeper parts, but remineralization of a surface zone of from 25 to 30 microns was increasingly inhibited with increasing doses. These effects were explained by different permeabilities of the surfaces of both types of lesions for the inhibitor: In subsurface lesions, lipoteichoic acid may have mainly clogged the porosities in the surface layer, whereas it could penetrate substantially into surface-softened enamel.