Evaluation of sodium fluorescein for quantitative diagnosis of root caries

Lesion activity assessment of early caries using dye-enhanced quantitative light-induced fluorescence

We aimed to determine whether dye-enhanced quantitative light-induced fluorescence (DEQLF), wherein porous structure of caries lesions is stained with a fluorescent dye, could quantitatively distinguish between active and inactive caries. A total of 126 bovine specimens were prepared to artificially simulate caries activity. Active caries were demineralized with 1% carbopol solution for 3 (A3), 5 (A5), and 10 days (A10). For inactive caries, half specimens in each group were remineralized with 2% NaF and reallocated into three groups (I3, I5, and I10, respectively). Wet specimens were dried with compressed air for 10 s and then dyed with 100-µM sodium fluorescein for 10 s. Fluorescence images of speicmens were captured with a QLF-digital 2 + Biluminator. Fluorescence intensity (ΔG) was measured in fluorescence images of dyed specimens. ΔG between active and inactive groups was compared using independent t-test, and ΔG among active groups (or inactive groups) were compared using ANOVA (α = 0.05). ΔG in the active groups was 33.7-59.0 higher than that in the inactive groups (P < 0.001). Except between I3 and I5, there was significant differences in ΔG according to the demineralization period (P < 0.001). DEQLF might be used to evaluate early caries activity, and longitudinally monitor changes in lesion activity.

A matched irrigation and obturation strategy for root canal therapy

In root canal therapy, irrigating solutions are employed to eliminate the bacterial load and also prepare dentin for sealer interaction. The aim of this research was to assess how irrigating solutions employed on their own or in sequence affected the tooth structure. The best way to prepare the tooth for obturation using hydraulic calcium silicate cement (HCSC) sealers and gutta-percha, thus guiding clinicians on a matched irrigation-obturation strategy for optimized root canal treatment was investigated. The effect of irrigating solutions on dentine was investigated by assessing changes in dentin microhardness, ultrastructure and mineral content, organic/inorganic matter, surface roughness and Young’s modulus. The interaction of four root canal sealers with the dentin was analysed by assessing the changes in microhardness of the dentin after sealer placement and also the sealer to dentin interface by scanning electron and confocal laser microscopy. The irrigating solutions damaged the dentin irreversibly both when used on their own and in combination. The best sequence involved sodium hypochlorite followed by chelator and a final rinse with sodium hypochlorite and obturation using HCSC sealers that enabled the restoration of dentin properties. The HCSC sealers did not rely on chelator irrigating solutions for a good material adaptation to dentin.

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.

Fluoride bioactive glass paste improves bond durability and remineralizes tooth structure prior to adhesive restoration

OBJECTIVE

The current study aimed at examining a fluoride containing bioactive glass (BiominF®) paste as a temporary filling material capable of remineralizing the demineralized enamel or dentin, and its ability to decrease a simulated dentinal fluids pressure on the resin/dentin interface, without affecting the shear bond strength of a universal bonding agent to enamel and dentin.

METHODS

60 premolars were utilized for the acid resistance, trans-microradiography (TMR) and shear bond strength (SBS) experiments. Enamel and dentin discs were demineralized for 4 days to create a subsurface demineralized zone followed by applying BiominF® paste, 1.23% acidulated phosphate fluoride, or a temporary filling material for 24 h. 30 extracted human non-carious third molars were utilized for the pulpal pressure experiment in which direct communication to the pulp chamber was created by cutting at a level approximately 1 mm below the cemento-enamel junction while the coronal enamel was ground to expose mid coronal dentin. The dentin surface was exposed to a simulated pulpal pressure. The dentin surfaces had BiominF® paste, an oxalate desensitizing agent, or temporary filling material followed by application of a universal adhesive system.

RESULTS

One way ANOVA showed that BiominF® paste remineralized effectively the demineralized enamel or dentin, did not affect the bond strength of the enamel and dentin surfaces to the tested adhesive system p < 0.05, and improved the acid resistance of the demineralized enamel and dentin against a secondary erosive challenge. Moreover, BiominF® paste decreased the nanoleakage expression in the dentin/adhesive interface exposed to a simulated pulpal pressure.

SIGNIFICANCE

BiominF® paste may serve as a temporary filling material that may improve the longevity of adhesive restorations and help to conserve tooth structures by preserving the demineralized enamel and dentin form cutting during cavity preparation.

Inhibitory effect of zinc-containing desensitizer on bacterial biofilm formation and root dentin demineralization

This study compared the effect of a novel zinc containing, Caredyne Shield (CS), and a fluoroaluminocalciumsilicate-based, Nanoseal (NS) desensitizers on dentin tubule occlusion, inhibition of Streptococcus mutans (S. mutans) biofilm growth, and resistance to bacterial demineralization. Desensitizers were applied to simulated hypersensitive bovine dentin, with distilled water used as a control. S. mutans biofilms were grown on the surface of each specimen in an oral biofilm simulator. CS showed the least bacterial count and water insoluble glucan amount followed by NS. Transverse micro radiography revealed that both CS and NS showed significant reduction in mineral loss and lesion depth of the associated lesion. Scanning electron micrographs showed that the two desensitizers formed obvious depositions on the dentin surfaces, occlusion of tubules and mineral tag formation.

Bleaching of simulated stained-remineralized caries lesions in vitro

OBJECTIVE

Non-invasive esthetic treatment options for stained arrested caries lesions have not been explored. This study aimed to develop laboratory models to create stained-remineralized caries-like lesions (s-RCLs) and to test the efficacy of bleaching on their esthetic treatment.

MATERIALS AND METHODS

One hundred twelve enamel/dentin specimens were prepared from human molars, embedded, and had their color measured spectrophotometrically at baseline and after demineralization. They were randomly divided into four groups (n = 14) based on the staining/remineralization protocols for a total of 5 days: G1, no staining/no remineralization; G2, no staining/remineralization in artificial saliva (AS); G3, non-metallic staining/remineralization with sodium fluoride/AS; and G4, metallic staining/remineralization with silver diamine fluoride/AS. The lesion mineral loss (ΔZ) and depth (L) were measured using transverse microradiography along with color change (ΔE). Specimens were bleached and color was re-evaluated. Data were analyzed using ANOVA models followed by Fisher's PLSD tests (α = 0.05).

RESULTS

s-RCLs in G4 were significantly (p < 0.001) darker than G3, G2, and G1 regardless of substrate type and condition. s-RCLs in G2, G3, and G4 showed significantly lower ΔZ and L than G1 (all p < 0.001), confirming occurrence of remineralization. G4 exhibited significantly lower ΔZ and L compared to G2 (p < 0.001). Bleaching was more effective in non-metallic than in metallic stained lesions regardless of substrate type (p < 0.001).

CONCLUSION

The proposed models created distinct s-RCLs. Non-metallic s-RCLs were lighter and more responsive to bleaching compared to metallic s-RCLs.

CLINICAL RELEVANCE

The developed experimental models allow the further investigation of the efficacy and safety of different clinical strategies for the esthetic management of s-RCLs.

In vitro remineralization of hybrid layers using biomimetic analogs

Resin-dentin bond degradation is a major cause of restoration failures. The major aim of the current study was to evaluate the impact of a remineralization medium on collagen matrices of hybrid layers of three different adhesive resins using nanotechnology methods. Coronal dentin surfaces were prepared from freshly extracted premolars and bonded to composite resin using three adhesive resins (FluoroBond II, Xeno-III-Bond, and iBond). From each tooth, two central slabs were selected for the study. The slabs used as controls were immersed in a simulated body fluid (SBF). The experimental slabs were immersed in a Portland cement-based remineralization medium that contained two biomimetic analogs (biomineralization medium (BRM)). Eight slabs per group were retrieved after 1, 2, 3, and 4 months, respectively and immersed in Rhodamine B for 24 h. Confocal laser scanning microscopy was used to evaluate the permeability of hybrid layers to Rhodamine B. Data were analyzed by analysis of variance (ANOVA) and Tukey's honest significant difference (HSD) tests. After four months, all BRM specimens exhibited a significantly smaller fluorescent area than SBF specimens, indicating a remineralization of the hybrid layer (P≤0.05). A clinically applicable biomimetic remineralization delivery system could potentially slow down bond degradation.

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.

Facilitatory effect of AC-iontophoresis of lidocaine hydrochloride on the permeability of human enamel and dentine in extracted teeth

OBJECTIVES

The objectives of the present study were to quantitatively evaluate chemical permeability through human enamel/dentine using conductometry and to clarify if alternating current (AC) iontophoresis facilitates such permeability.

MATERIALS AND METHODS

Electrical impedance of different concentrations of lidocaine hydrochloride was measured using a bipolar platinum impedance probe. A quadratic curve closely fitted to the response functions between conductance and lidocaine hydrochloride. For analysis of the passage of lidocaine hydrochloride through human enamel/dentine, eight premolars that were extracted for orthodontic treatment were sectioned at the cemento-enamel junction. The tooth crowns were held between two chambers with a double O-ring. The enamel-side chamber was filled with lidocaine hydrochloride, and the pulp-side chamber was filled with extrapure water. Two platinum plate electrodes were set at the end of each chamber to pass alternating current. A simulated interstitial pulp pressure was applied to the pulp-side chamber. The change in the concentration of lidocaine hydrochloride in the pulp-side chamber was measured every 2min using a platinum recording probe positioned at the centre of the pulp-side chamber. Passive entry without iontophoresis was used as a control.

RESULTS

The level of lidocaine hydrochloride that passed through enamel/dentine against the dentinal fluid flow increased with time. Electrical conductance (G, mho) correlated closely to the concentration (x, mmol/L) of lidocaine hydrochloride (G=2.16x(2)+0.0289x+0.000376, r(2)=0.999).

CONCLUSIONS

Lidocaine hydrochloride can pass through enamel/dentine. Conductometry showed that the level of lidocaine hydrochloride that passed through enamel/dentine was increased by AC iontophoresis.

Biomimetic approach for root caries prevention using a proanthocyanidin-rich agent

The aim of this study was to evaluate the effects of a proanthocyanidin-rich grape seed extract (GSE) on the in vitro demineralization of root dentine. Root fragments were obtained from sound human teeth. The fragments were randomly assigned to different treatments solutions: GSE, fluoride (F), GSE+F and distilled water (control). Samples were treated daily for 30 min and subjected to a pH cycling artificial caries protocol using demineralization cycles (2.2 mM CaCl(2)×H(2)O, 2.2 mM KH(2)PO(4), 50 mM acetic acid, pH 4.3) for 6 h and remineralization cycles (20 mM HEPES, 2.25 mM CaCl(2)×H(2)O, 1.35 mM KH(2)PO(4), 130 mM KCl, pH 7.0) for 17.5 h. Mineral loss (ΔZ) and lesion depth (LD) were determined after 18 days of treatment/pH cycling, by transverse microradiography. GSE was able to minimize ΔZ and LD compared with the control group (p < 0.0001). The GSE+F and F groups showed the lowest values of ΔZ and LD (p < 0.05), with no statistically significant differences between them (p = 0.554 and p = 0.726, respectively). A biomimetic approach to strengthen root dentine using GSE results in decreased rates of root demineralization and may be used in conjunction with F to prevent root caries.

Estimation of lesion progress in artificial root caries by swept source optical coherence tomography in comparison to transverse microradiography

This study aimed to investigate whether swept source optical coherence tomography (SS-OCT) could estimate the lesion depth and mineral loss quantitatively without the use of polarization sensitivity, and to examine a relationship between OCT data and transverse microradiography (TMR) lesion parameters. Twenty-four bovine root dentin specimens were allocated to three groups of 4-, 7-, and 14-day demineralization. Cross-sectional images of the specimens before and after the demineralization were captured by OCT at 1319 nm center wavelength. Following the demineralization, these specimens were cut into sections for TMR analysis. Correlations between the OCT data and TMR lesion parameters were examined. TMR images of the specimens showed cavitated lesions (lesion depth or LD(TMR): 200 to 500 μm, ΔZ or mineral loss: 10,000 to 30,000 vol % μm). The OCT images showed "boundaries," suggesting the lesion front. Integrated dB values before and after the demineralization and their difference (R(D), R(S), and ΔR, respectively) were calculated from the lesion surface to the corrected depth of boundary (LD(OCT)). A statistically significant correlation was found between LD(OCT) and LD(TMR) (p < 0.05, r = 0.68). Similarly, statistically significant correlations were found between ΔZ and R(D) or ΔR. The OCT showed a potential for quantitative estimation of lesion depth and mineral loss with cavitated dentin lesions in vitro.

An in vitro microbial model associated with sucrose to produce dentin caries lesions

The complexity of the oral environment and ethical issues have prompted the development of an in vitro bacterial model to evaluate the effect of frequency of sucrose exposure on dentin caries formation, biofilm composition, and pH changes. In the experiment, dentin specimens (n=45) were randomly divided into four groups: control (C), negative control (0S), 3S (three sucrose baths), and 6S (six sucrose baths). The specimens then were inoculated with Streptococcus mutans and treated according to the protocol described below. Dentin demineralization and lesion depth were assessed by transverse microradiography. Extracellular polysaccharides that formed in the biofilm were analyzed and counts of microorganisms in the carious dentin were measured. After a 7-day period of growth, the biofilm pH was assessed before and after sucrose baths (n=5). The addition of sucrose led to dentin caries development regardless of the number of sucrose baths performed. The number of colony forming units (cfu) from the carious dentin did not differ among the treatment groups, though the extracellular polysaccharides from both 3S and 6S differed from 0S. The pH decreased immediately after the sucrose bath but increased again after 5 min. We demonstrate here that the in vitro microbial model for the study of dentin caries formation is reproducible and able to produce dentin caries, irrespective of the frequency of sucrose exposure.

Imperfect hybrid layers created by an aggressive one-step self-etch adhesive in primary dentin are amendable to biomimetic remineralization in vitro

Degradation of hybrid layers created in primary dentin occurs as early as 6 months in vivo. Biomimetic remineralization utilizes "bottom-up" nanotechnology principles for interfibrillar and intrafibrillar remineralization of collagen matrices. This study examined whether imperfect hybrid layers created in primary dentin can be remineralized. Coronal dentin surfaces were prepared from extracted primary molars and bonded using Adper Prompt L-Pop and a composite. One-millimeter-thick specimen slabs of the resin-dentin interface were immersed in a Portland cement-based remineralization medium that contained two biomimetic analogs to mimic the sequestration and templating functions of dentin noncollagenous proteins. Specimens were retrieved after 1-6 months. Confocal laser scanning microscopy was used for evaluating the permeability of hybrid layers to Rhodamine B. Transmission electron microscopy was used to examine the status of remineralization within hybrid layers. Remineralization at different locations of the hybrid layers corresponded with quenching of fluorescence within similar locations of those hybrid layers. Remineralization was predominantly intrafibrillar in nature as interfibrillar spaces were filled with adhesive resin. Biomimetic remineralization of imperfect hybrid layers in primary human dentin is a potential means for preserving bond integrity. The success of the current proof-of-concept, laterally diffusing remineralization protocol warrants development of a clinically applicable biomimetic remineralization delivery system.

Bond strength of two total-etching bonding systems on caries-affected and sound primary teeth dentin

AIM

As bond strength of currently available adhesive systems in caries-affected teeth dentin on primary tooth dentin was not well known, the bond strength of two bonding systems (PQI and OptiBond Solo Plus) was evaluated on caries-affected and sound primary molar tooth dentin and observed the micromorphology of the adhesive-dentin interfaces.

METHODS

By grinding both the sound (n = 30) and caries-affected (n = 30) approximal surfaces of teeth, flat dentin surfaces were obtained. The prepared surfaces were bonded with one of the each adhesive systems and a composite resin. After storing the bonded specimens in water at 37 degrees C for 24 h, the samples were sectioned and the bond strength of the adhesive systems was tested by the microshear test method. The data were statistically analysed.

RESULTS

Microshear bond strengths of PQI group for caries-affected and sound primary tooth dentin were 9.43 +/- 2.44 (MPa) and 9.32 +/- 2.95 (MPa) (P > 0.05), respectively, and the bond strengths of OptiBond Solo Plus group for caries-affected and sound primary tooth dentin were 15.33 +/- 3.59 (MPa) and 11.96 +/- 2.30 (MPa) (P < 0.05), respectively. Micromorphological features between sound and caries-affected dentin were similar in both PQI and OptiBond Solo Plus groups.

CONCLUSION

Both the adhesives showed significantly different bond strengths in caries-affected dentin but showed similar bond strengths in sound dentin.

Dentine remineralization by simulated saliva formulations with different Ca and Pi contents

The understanding of the dentine remineralization process and the ability to reproduce it in vitro are essential to the development of preventive and therapeutic measures. This study investigated how simulated saliva formulations with different Ca and P(i) contents and degrees of saturation with respect to biologically relevant calcium phosphates may affect the remineralization of eroded dentine, as a function of time. Slabs of bovine root dentine (n = 8 per group) were flattened, polished, demineralised by 1% citric acid for 30 and 60 min and remineralized for 3, 7 and 14 days, by one of the following buffered (pH 7) solutions [Ca:Pi ratio, Ca/Pi concentrations (mM), ionic strength]: solution A: 1.6, 1.5/0.9, 0.115; solution B: 1.6, 2/1.25, 0.117; solution C: 1.6, 3.2/2, 0.121; solution D: 0.3, 1.11/3.7, 0.118; solution E: 0.3, 1.45/5, 0.122. Integrated mineral loss (30 and 60 min) was quantified by transverse microradiography after each remineralization period. ANOVA and regression analyses (alpha = 0.05) showed, irrespective of the demineralisation time, that the solutions C and E were able to remineralize dentine. This effect increased throughout the remineralization times and was significantly higher for E. Remineralization was successfully shown in vitro, under specific conditions of degree of saturation and Ca and Pi contents of the solutions. Optimum remineralization was observed for the solution E supersaturated with respect to relevant calcium phosphates, with low Ca:Pi ratio and highest Pi concentration.

Rapid penetration of lucifer yellow into vital teeth and dye coupling between odontoblasts and neighbouring pulp cells in the cat

The location and long process of odontoblasts appear well suited to detection of external stimuli. The odontoblasts may transmit the information not individually but as a syncytium via gap junction, which functions as a mechanism for intercellular linking cells and as the route for dye coupling. The aims of the present study were to examine dye penetration through enamel and dentin, and to confirm dye coupling between odontoblasts (OBs) or between odontoblasts and other pulpal cells beneath the odontoblastic layer (PCs). Either lucifer yellow (LY) or borate buffer (control) was applied to etched enamel surface of feline canines for 30 min at atmospheric pressure. In the decalcified sections, lucifer yellow positive cells were found not only in but also beneath the odontoblastic layer (experiment 1). In the isolated pulp cells, all OBs (27/27) and some PCs (6/9) that were immunocytochemically differentiated using two monoclonal antibodies were labelled with LY (experiment 2). These results indicate the remarkably quick movement of LYE through enamel and dentin into the superficial pulp. In experiment 3, fresh OBs and PCs were isolated from feline canines to which LY had not been applied. LY was iontophoretically injected into an OB-like cell that had an oval cell body and a long monopolar process. Some PCs and OBs identified immunocytochemically were labelled with LY, with the exception of a few LY-negative cells. These findings indicate that dye coupling exists not only between OBs but also between OBs and PCs. Thus, the coupling provides evidence for a functional link via which information is transmitted between OBs and PCs.

The use of fluorescein-enhanced quantitative light-induced fluorescence to monitor de- and re-mineralization of in vitro root caries

The use of fluorescein-enhanced quantitative light-induced fluorescence (QLF) in the detection of in vitro root caries demineralization and reminerlization was investigated. Fourteen previously extracted human premolar roots were selected and determined to be caries-free. Cementum was removed and nail varnish applied leaving an exposed window. Positive and negative controls were selected. During a demineralizing regimen, roots were removed at regular intervals (12, 48, 72 and 120 h) and immersed in sodium fluorescein (0.2 mg L(-1)). Following gentle rinsing, each root was examined using QLF before being returned to the demineralizing solution. Following 120 h, each tooth was sectioned through the lesion and one-half retained for transverse micro radiography (TMR) analysis. The remaining half were subjected to a remineralizing regimen undergoing the same fluorescein and QLF examinations at 7, 28 and 36 days. Results showed that QLF effectively monitored demineralization/remineralization of root dentine as represented by fluorescein penetration. TMR analysis showed good correlations with QLF (DeltaZ/DeltaQ) after demineralization (r = 0.89) and remineralization (r = 0.84). The technique could represent an in vivo method for root caries detection and classification.

Visualization of root caries lesions by means of a diazonium dye

A diazonium dye was used to visualize caries lesions in root tissue. Root caries lesions were created in vitro according to a variety of protocols based on methylcellulose gel (6% w/v) and/or lactic acid buffer (0.05 M, pH 4.5). Teeth containing lesions were soaked overnight in an alkaline solution of 2% (w/v) 2-naphthol or resorcinol, rinsed with distilled water, and immersed in a diazonium solution (prepared by titration of aniline with sodium nitrite in 1 M HCl at 5 degrees C) for up to 10 min, prior to being thoroughly rinsed with distilled water. The area of the caries lesion on the anatomical surface was clearly marked with a red/orange color following 5 minutes' incubation in the diazonium solution. The diazonium complex formed with 2-naphthol was found to be more resistant to leaching during rinsing and sectioning than that formed with resorcinol. Microscopic examination of sections taken in the apicalcoronal plane showed that the depth of area of the lesion was also marked by the red/orange coloration. Chemical changes in root mineral monitored during lesion formation showed some degree of correlation between lesion area and mineral dissolution. Visualization of coronal caries by this technique is currently under investigation. The visualization technique provides a simple means of determining the extent and severity of root caries lesions and may be a useful first step in their classification.