Nano-mechanical properties of fluoride-treated enamel surfaces

Enamel Remineralization and Crystallization after Fluoride Iontophoresis

Early caries lesions consist of noncavitated subsurface demineralization caused by the dissolution of hydroxyapatite from the surface to the subsurface area of the enamel. Such lesions cannot be remineralized effectively by the conventional treatment. Thus, there is a need for a noninvasive technique capable of delivering the remineralizing agent to subsurface sites. For this purpose, fluoride iontophoresis (IP) using weak currents has been investigated with some conflicting results and no information on the crystal structure and composition. Because enamel remineralization involves the role of fluid from dentin, the presence of enamel fluid is necessary to determine the repair associated with the physiological condition. This study aimed to investigate structural and compositional characteristics, including the remineralizing effect of 5% sodium fluoride (NaF) IP with different polarities, cathodal iontophoresis (CIP), and anodal iontophoresis (AIP) for the treatment of natural enamel caries under simulated pulpal pressure. A bulk measurement of the crystal structure inside the lesion was first determined using calcium (Ca) K-edge X-ray absorption spectroscopy. IP with both polarities significantly promoted subsurface remineralization. The CIP generated a significant increase in the Ca/phosphorus ratio, and fluoride at the surface lesion significantly correlated with higher mineral density (MD) and more strengthening crystal structure of the lesion volume, while the lesion's MD and other impurities at the lesion surface, mostly the carbonate ions, affected the significant increase in MD with the unchanged structure of the lesion volume after AIP. The CIP of NaF is an ideal method for rapid enamel remineralization and recrystallization of fluoroapatite/fluorohydroxyapatite.

Evaluation of Fluoride Uptake of Two Fluoride Varnishes into and onto the Enamel Surface at Different Temperatures: An In Vitro Study

Background

Fluoride (F) is an effective anticaries agent and can be delivered through various mediums at different concentrations. The ability to increase the enamel resistance to acid by decreasing solubility through the incorporation of F into the enamel apatite structure is the primary function of these agents. The efficacy of topical F can be determined by measuring the amount of F incorporated in and on human enamel.

Aim

To compare the F uptake into and onto the enamel surface of two different F varnishes at different temperatures.

Materials and methods

In this study, 96 teeth were divided equally and randomly (n = 48) into two experimental groups (group I and group II). Each group was further divided into four equal subgroups (n = 12); depending on the temperature (25°, 37°, 50°, and 60°C) they were subjected to Fluor-Protector® 0.7% and Embrace® 5% F varnishes were allocated to experimental groups I and II, respectively, and every sample was individually treated with the assigned F varnish. After the varnish application, two specimens from each subgroup, the group I and group II (n = 16), were mounted for hard tissue microtome sectioning for scanning electron microscope (SEM) analysis. The remaining 80 teeth underwent potassium hydroxide (KOH) soluble and KOH-insoluble F estimation.

Results

Group I and group II, both, showed maximum F uptake of 2817.07 ppm and 1626.8 ppm at 37°C temperature and the lowest of 1168.9 ppm and 1068.93 ppm at 50°C, respectively. The intergroup comparison was carried out using an unpaired t-test and the intragroup comparison was done using one-way analysis of variance (ANOVA) univariate analysis.Post hoc Tukey test was performed for pairwise comparison between different temperature groups. In group I (Fluor-Protector®), the difference in F uptake was statistically significant when the temperature was increased from 25° to 37° C (mean difference = -9.90, p = 0.016). In group II (Embrace®), a statistically significant difference in F uptake was observed when the temperature was increased from 25° to 50°C (mean difference = 10.00, p = 0.003) and 25° to 60°C (mean difference = 13.38, p = 0.001), respectively.

Conclusion

Fluor-Protector® varnish proved to have better F uptake in comparison to Embrace® varnish on human enamel. Topical F varnishes were most effective at 37°C, which is close to the standard human body temperature. Thus, the application of warm F varnish ensures more uptake of F in and onto the enamel surface for greater protection against dental caries.

How to cite this article

Vishwakarma AP, Bondarde P, Vishwakarma P, et al. Evaluation of Fluoride Uptake of Two Fluoride Varnishes Into and onto the Enamel Surface at Different Temperatures: An In Vitro Study. Int J Clin Pediatr Dent 2022;15(6):672-679.

An Assessment of Mineral Concentration of Dental Enamel Neighbouring Hypothetical Orthodontic Brackets Using X-ray Microtomography

OBJECTIVES

Differences in the mineral concentration (MC) level of dental enamel may represent a precursor of white spot lesions adjacent to fixed orthodontic brackets. The aim of the current in vitro study was to compare the MC level central, occlusal and cervical to orthodontic attachments.

METHODS AND MATERIALS

A total of 16 enamel blocks were obtained from sound human premolar samples extracted for orthodontic reasons. The buccal portion of the dental enamel blocks was divided into central, occlusal, and cervical regions and then imaged and measured to calculate the level of MC using quantitative X-ray microtomography methods (XMT) at each site.

RESULTS

There was a substantial variation in the mineral concentration with the lowest level being detected in the cervical region when compared with other regions. The MC of the gingival zone was significantly lower than that of the middle zone (P<0.05) and was insignificantly lower than that of the occlusal zone.

CONCLUSION

Within the limitations of the current study, it can be concluded that the cervical region of the permanent enamel had the lowest mineral concentration using XMT. The cervical region may therefore be more vulnerable to the development of white spot lesions (WSLs) adjacent to a fixed orthodontic appliance during orthodontic treatment.

CLINICAL SIGNIFICANCE

Using X-ray microtomography lower mineral concentration in the cervical region of the enamel was observed. This may make these areas particularly susceptible to demineralisation during fixed appliance-based orthodontic treatment and may influence the bond strength of fixed orthodontic attachments.

A machine learning approach to investigate the materials science of enamel aging

Understanding aging of tooth tissues is critical to the development of patient-centric oral healthcare. Yet, the traditional methods for analyzing the composition-structure-property relationships of hard tissues have limitations when considering aging and other factors.

OBJECTIVE

To apply unsupervised machine learning tools to pursue an understanding of relationships between the composition and mechanical behavior of aging enamel.

METHODS

Molar teeth were collected from primary (age ≤ 8), young adult (24 ≤ age ≤ 46) and old adult (55 ≤ age) donors. The hardness and elastic modulus were quantified using nanoindentation as a function of distance from the Dentin Enamel Junction (DEJ) within the cervical, cuspal and inter-cuspal regions of the enamel crown. Similarly, a co-located analysis of the chemical composition and structure was performed using Raman spectroscopy. A Self-Organizing Maps (SOMs) algorithm was implemented to identify multi-dimensional composition-property relationships.

RESULTS

The hardness and elastic modulus are positively correlated to crystallinity and negatively correlated with carbonate substitution. Furthermore, the effects from fluoridation on the age-dependent properties of enamel is non-linear and depends on its location. The contributions of fluoridation to the enamel properties are different in the cervical and non-cervical regions and appear to be unique within primary and senior adult teeth.

SIGNIFICANCE

Based on the findings, unsupervised learning methods can reveal complicated non-linear structure-property relationships in tooth tissues and help to understand the materials science of aging and its consequences.

The Impact of CO2 Laser Treatment and Acidulated Phosphate Fluoride on Enamel Demineralization and Biofilm Formation

Introduction: This study evaluated the impact of CO₂ laser treatment and acidulated phosphate fluoride (APF) on enamel demineralization and biofilm formation, using in vitro and in situ designs. Methods: Demineralized enamel slabs were distributed among 8 groups: placebo, placebo + continuous CO₂ laser, placebo + repeated CO₂ laser, placebo + ultrapulsed CO₂ laser, 1.23% APF, APF + continuous CO₂ laser, APF + repeated CO₂ laser and APF + ultrapulsed CO₂ laser. In the in vitro study, 15 enamel slabs from each group were subjected to a pH-cycling regimen for 14 days. In the cross over in situ design, 11 volunteers wore palatal appliances with demineralized enamel slabs for 2 periods of 14 days each. Drops of sucrose solution were dripped onto enamel slabs 8×/day. Biofilms formed on slabs were collected and the colony-forming units (CFU) of Streptococcus mutans and Lactobacillus were determined. Results: For both in vitro and in situ studies, there was no significant difference between treatments (P>0.05). However, all treatments increased microhardness of demineralized enamel (P<0.05). After a further in situ cariogenic challenge, with the exception of the placebo, all treatments maintained microhardness values (P<0.05). Microbiological analysis showed no difference in Streptococcus mutans (P>0.05) or Lactobacillus (P>0.05) counts between groups. Conclusion: The results suggest that APF gel combined with the CO₂ laser, regardless of the pulse emission mode used, was effective in controlling enamel demineralization, but none of the tested treatments was able to prevent bacterial colonization.

Simplified Prediction Model for Accurate Assessment of Dental Caries Risk among Participants Aged 10-18 Years

Dental caries assessment needs to be targeted at specific age groups, as many risk factors are related to patient age. Pre-teen and teenage patients, who are still at risk of occurrence of new carious lesions, need more individualized caries management strategies. Therefore, this study aimed to identify caries-related risk factors and develop a simplified risk prediction model for dental caries. Risk factors for caries were assessed in 171 participants aged 10-18 years, based on a questionnaire survey, previous history of caries, oral hygiene, microorganism colonization, saliva secretion, saliva buffer capacity examinations, and the acidogenicity of dental biofilms. These risk factors were entered into a computer-based risk assessment program (the Cariogram), and correlations between these factors and Cariogram scores were investigated. Significant risk predictors were used to develop a simplified risk prediction model. The performance of this model in predicting dental caries incidence was evaluated using receiver operating characteristic analysis, to determine its applicability to the management of caries. Our simplified prediction model included three predictors that were significantly associated with caries incidence: use of fluoride-containing toothpaste, the acidogenicity of dental biofilms, and saliva secretion (p < 0.001). The resulting model had a sensitivity and specificity of 60.5 and 85.0%, respectively, with a cut-off value of 69.41 as the threshold. The area under the curve of this model was 0.782 (95% confidence interval = 0.681-0.884, p < 0.001). Our new caries risk prediction model is expected to allow clinicians to accurately and easily predict patients' risk of occurrence of new caries.

Retention Improvement in Fluoride Application with Cold Atmospheric Plasma

This study aimed to apply fluoride formulations to enamel with cold atmospheric plasma (CAP) and analyze the fluoride uptake, retention, and acid resistance quantitatively. Human enamel specimens were divided randomly into 2 groups: group APF1, 1.23% acidulated phosphate fluoride (APF) gel; group APF2, 1.23% APF gel with CAP. Fluoride and CAP were applied to the samples 4 times at 1-wk intervals. The specimens were also stored in artificial saliva for 4 wk to evaluate the retention of fluoride. The fluoride content on the fluoride-treated enamel was measured by an electron probe microanalyzer. To detect the resistance to demineralization, the calcium-to-phosphate ratio of the enamel samples was measured after the application of APF gel with or without CAP, followed by soaking in the demineralization solution. In groups APF1 and APF2, the amount of fluoride detected increased depending on the application frequency, and more fluoride was detected in group APF2 than in group APF1. In the experiment examining the maintenance effect, fluoride was not detected in group APF1, whereas fluoride was detected in group APF2 up to the fourth week. As for the resistance to demineralization, the calcium-to-phosphate ratio of the enamel treated with APF and CAP was higher than that treated with APF alone, and it increased with the frequency of treatment. This study suggests that the combination treatment of CAP and fluoride improves retention of fluoride on the enamel and resistance to demineralization when compared with treatment with fluoride alone.

Correlation between micro-hardness and mineral content in healthy human enamel

BACKGROUND

Enamel is the hardest and the stiffest tissue in the human body. The enamel undergoes multidirectional stresses, withstands multimillion chewing cycles, all while protecting the internal dentin and pulp from damage due to mechanical overload and exposure to the harsh chemical environment of the mouth. Raman spectroscopy allows to study enamel mineral content in a non-destructive and site-specific way. While Raman spectroscopy has been applied in other studies to assess tooth mineralization, there are no studies that examine the relationship between micro-hardness and mineral content of the untreated enamel. An understanding of this relationship is extremely important in a clinical context. The effect of various agents on enamel hardness was investigated, though the relationship between healthy enamel mineral content and micro-hardness remains obscure.

MATERIAL AND METHODS

Twenty human incisor teeth were obtained in compliance with the NIH guidelines and imaged site-specifically with a Raman microscope and evaluated with a Brinell hardness measurement device. The front portion of each tooth was divided into apical, medium and cervical regions and subsequently imaged with a Raman microscope in these three locations.

RESULTS AND CONCLUSIONS

The results demonstrated that enamel mineral content varies significantly between individuals and is correlated with the hardness of the enamel. Non-invasive, sample preparation free Raman spectroscopy was successfully employed to measure the mineral content of healthy enamel and it correlated the mineralization score to the hardness measurements of the selected cervical location. The overall level of enamel mineral content may serve as a robust predictor of patients' susceptibility to developing caries, and overall enamels wear resistance, thus allowing for the prevention of caries via clinically available methods of remineralization, fluoride treatment and frequent cleaning. Key words:Enamel, raman spectroscopy, micro-hardness, extracted teeth.

A portable fiber-optic raman spectrometer concept for evaluation of mineral content within enamel tissue

Background

Measurement of tooth enamel mineralization using a clinically viable method is essential since variation of mineralization may be used to monitor caries risk or in assessing the effectiveness of remineralization therapy. Fiber optic Raman systems are becoming more affordable and popular in context of biomedical applications. However, the applicability of fiber optic Raman systems for measurement of mineral content within enamel tissue has not been elucidated significantly in the prior literature.

Material and Methods

Human teeth with varying degrees of enamel mineralization were selected. In addition alligator, boar and buffalo teeth which have increasing amount of mineral content, respectively, were also included as another set of samples. Reference Raman measurements of mineralization were performed using a high-fidelity confocal Raman microscope.

Results

Analysis of human teeth by research grade Raman system indicated a 2-fold difference in the Raman intensities of v1 symmetric-stretch bands of mineral-related phosphate bonds and 7-fold increase in mineral related Raman intensities of animal teeth. However, fiber optic system failed to resolve the differences in the mineralization of human teeth.

Conclusions

These results indicate that the sampling volume of fiber optic systems extends to the underlying dentin and that confocal aperture modification is essential to limit the sampling volume to within the enamel. Further research efforts will focus on putting together portable Raman systems integrated with confocal fiber probe.

Key words:Enamel, mineral content, raman spectroscopy.

Evaluation of mineral content in healthy permanent human enamel by Raman spectroscopy

Background

An understanding of tooth enamel mineral content using a clinically viable method is essential since variations in mineralization may serve as an early precursor of a dental health issues, and may predict progression and architecture of decay in addition to assessing the success and effectiveness of the remineralization strategies.

Material and Methods

Twenty two human incisor teeth were obtained in compliance with the NIH guidelines and site specifically imaged with Raman microscope. The front portion of the teeth was divided into apical, medium and cervical regions and subsequently imaged with Raman microscope in these three locations.

Results

Measured mineralization levels have varied substantially depending on the regions. It was also observed that, the cervical enamel is the least mineralization as a populational average.

Conclusions

Enamel mineralization is affected by a many factors such as are poor oral hygiene, alcohol consumption and high intake of dietary carbohydrates, however the net effect manifests as overall mineral content of the enamel. Thus an early identification of the individual with overall low mineral content of the enamel may be a valuable screening tool in determining a group with much higher than average caries risk, allowing intervention before development of caries. Clinically applicable non-invasive techniques that can quantify mineral content, such as Raman analysis, would help answer whether or not mineralization is associated with caries risk.

Key words:Enamel, Raman spectroscopy, mineral content, dental caries.

Nanoscratch testing for the assessment of enamel demineralization under conditions simulating wine erosion

BACKGROUND

Erosive tooth wear and dentinal hypersensitivity are common problems affecting professional wine tasters. By using nanoscratch testing, the aim of this in vitro study was to assess enamel softening under conditions simulating 10 one-minute episodes of wine erosion.

METHODS

Ten enamel specimens were bathed in artificial saliva for 2 hours before being eroded for 10 episodes, with each episode comprising one minute of wine erosion followed by one minute of remineralization in artificial saliva. Nanoscratches were placed with a spherical tip (20 μm radius) in a nanoindenter under a load of 100 mN at baseline (stage 1), after a one-erosion episode (stage 2) and after 10-erosion episodes (stage 3).

RESULTS

There were significant effects of erosion stages on both scratch depth (p<0.001) and surface roughness (p<0.001). Post hoc tests showed significant differences in both scratch depths and surface roughness between stages 1 and 3 (p<0.001), and between stages 2 and 3 (p<0.01).

CONCLUSIONS

Enamel softening occurs at an early stage of wine tasting, emphasizing the need to implement early preventive strategies in professional wine tasters. Further research elucidating the fundamental mechanisms involved in early stages of erosion has the potential to lead to development of more effective preventive strategies.

Effects of CO2 laser irradiation combined with fluoride application on the demineralization, mechanical properties, structure, and composition of enamel

We investigated the effects of CO2 laser irradiation combined with acidulated phosphate fluoride (APF) application on the demineralization of enamel. APF gel was applied to the buccal enamel of human premolars and CO2 laser was applied. After the specimens were immersed in demineralization solution for 72 h, they were subjected to depth-dependent micro-CT and nanoindentation analyses. Micro-X-ray diffraction and X-ray photoelectron spectroscopy were performed to analyze the surfaces. Some surface regions of the enamel in specimens that were laser-irradiated with low output and APF-treated showed significantly higher values of MD and hardness than specimens treated with APF alone. A higher fluoride concentration in the enamel surface was observed in specimens treated with CO2 laser irradiation plus APF gel application. In conclusion, CO2 laser irradiation with low output is preferable to improve acid resistance.

Atomic force microscopic comparison of remineralization with casein-phosphopeptide amorphous calcium phosphate paste, acidulated phosphate fluoride gel and iron supplement in primary and permanent teeth: An in-vitro study

Context:

Demineralization of tooth by erosion is caused by frequent contact between the tooth surface and acids present in soft drinks.

Aim:

The present study objective was to evaluate the remineralization potential of casein-phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste, 1.23% acidulated phosphate fluoride (APF) gel and iron supplement on dental erosion by soft drinks in human primary and permanent enamel using atomic force microscopy (AFM).

Materials and Methods:

Specimens were made from extracted 15 primary and 15 permanent teeth which were randomly divided into three treatment groups: CPP-ACP paste, APF gel and iron supplement. AFM was used for baseline readings followed by demineralization and remineralization cycle.

Results and Statistics:

Almost all group of samples showed remineralization that is a reduction in surface roughness which was higher with CPP-ACP paste. Statistical analysis was performed using by one-way ANOVA and Mann-Whitney U-test with P < 0.05.

Conclusions:

It can be concluded that the application of CPP-ACP paste is effective on preventing dental erosion from soft drinks.

Topical Laser Application Enhances Enamel Fluoride Uptake and Tribological Properties

Topical fluoride treatment prevents dental caries. However, the resulting calcium-fluoride-like deposits are soft and have poor wear resistance; therefore, frequent treatment is required. Lasers quickly heat surfaces and can be made portable and suitable for oral remedies. We examined the morphology, nanohardness, elastic modulus, nanowear, and fluoride uptake of fluoride-treated enamel followed by CO2 laser irradiation for 5 and 10 sec, respectively. We found that laser treatments significantly increased the mechanical properties of the calcium-fluoride-like deposits. The wear resistance of the calcium-fluoride-like deposits improved about 34% after laser irradiation for 5 sec and about 40% following irradiation for 10 sec. We also found that laser treatments increased fluoride uptake by at least 23%. Overall, laser treatment significantly improved fluoride incorporation into dental tissue and the wear resistance of the protective calcium-fluoride layer.

Correlating in vitro scratch test with in vivo contact free occlusal area wear of contemporary dental composites

OBJECTIVES

The aims of this study are to determine the extent to which the ranking order for clinical Contact-Free-Occlusal-Area (CFOA) wear performance of composites correlates with the ranking based on in vitro scratch hardness, and to analyze the extent to which the microstructure influences the overall trend.

MATERIALS AND METHODS

The patient data and CFOA wear measurements of 16 Tetric-C, 17 Tetric-EC, 16 Gradia-DP, 18 Filtek Supreme, 19 Z100 restorations in 31 subjects (8 males, 23 females) of two randomized clinical trials were fitted in a mixed-effect model. The in vivo performance of the restoratives was summarized by ranking the estimated material-related coefficients in the model. Scratch tests on two specimens per composite were run at a constant speed of 0.05 mm/s under indenter with normal loads of 15, 25, and 35 mN. Scratch width, depth and hardness calculated by imaging the scratch tracks were summarized in a model, the material-related coefficients were ranked and correlated with that of in vivo ranking order.

RESULTS

The best in vivo model included as significant factors (p<0.0001) the variables material, time/month, cavity type, and jaw type. The CFOA wear ranking order - Filtek Supreme, Z100>Tetric-C, Tetric-EC>Gradia-DP-correlated closely (R(2)=0.991) with the order of scratch hardness - Z100>Filtek Supreme>Tetric-C, Tetric-EC>Gradia-DP.

SIGNIFICANCE

Scratch tests could roughly categorize a new material as to whether it will probably exhibit a high or low in vitro scratch resistance and/or clinical CFOA wear rate.

Human enamel rod presents anisotropic nanotribological properties

The AFM combined nanoindentation was performed to observe the ultrastructure of enamel rod from various section plans and positions while probing their mechanical and tribological properties of the area. The nanohardness and the elastic modulus of the head region of the enamel rods are significantly higher than that of the tail region and the axial-sectional plane. Both nanohardness and elastic modulus gradually decrease from enamel surface toward dentino-enamel junction. Such a variation correlates well with the decreasing trend of calcium composition from our element analysis. The friction coefficient and nanowear of the enamel showed an inversed trend to the hardness with respect to their relative topological position in the long axis of enamel rod toward DEJ. The relationship between the nanowear depth and the distance from the outer enamel surface to DEJ presented exponential function. The results presented clarify the basic nanomechanical and nanotribological properties of human enamel rods and provide a useful reference for the future development of dental restorative materials.

Chemical and crystallographic study of remineralized surface on initial carious enamel treated with Galla chinensis

To investigate the morphologic, chemical and crystallographic characters of remineralized surface on initial carious enamel treated with Galla chinensis, scanning electron microscopy equipped with energy dispersive analysis spectroscopy were used, and X-ray microdiffraction (microzone XRD) was used for the first time to analyze in situ the microzone crystallite of remineralized surface on carious enamel. Bovine sound enamel slabs were demineralized to produce initial carious lesion in vitro. Then, the lesions were exposed to a pH-cycling regime for 12 days of remineralization. Each daily cycle included 4x1 min applications with one of the three treatments: distilled and deionized water (DDW); 1 g/L NaF; 4 g/L G. chinensis extract (GCE). After the treatments, some rod-like deposits and many irregular prominences were found on GCE-treated enamel surface, and the intensities of Ca and P signals showed a tendency to increase; Ca:P ratio was significantly higher than that of DDW-treated enamel. X-ray microdiffraction showed hydroxyapatite was still the main component of GCE-treated enamel, and the crystallinity was increased, the crystal lattice changed gently with decreased lattice parameter a. These results indicated the potential of GCE in promoting the remineralization of initial enamel carious lesions, and supported the previous hypothesis about GCE mechanism. Combined with the anti-bacteria and demineralization inhibition properties of GCE, the natural G. chinensis may become one more promising agent for caries prevention.

Effects of Galla chinensis on the surface topography of initial enamel carious lesion: an atomic force microscopy study

To investigate the effect of Galla chinensis on the surface topography of initial enamel carious lesion, atomic force microscope (AFM) was used, and it was a new AFM application in enamel de-/remineralization research. Bovine sound enamel slabs were demineralized to produce initial carious lesion in vitro. Then, the lesions were exposed to a pH-cycling regime for 12 days. Each daily cycle included 4x1 min applications with one of three treatments: negative control group: deionized water; positive control group: 1 g/L aqueous solutions of NaF; experimental group: 4 g/L aqueous solutions of G. chinensis extract (GCE). The surface topography and roughness were investigated on the enamel slabs before and after pH-cycling by AFM. 3D AFM images revealed the surface topographical changes of GCE-treated enamel. Significant difference existed before and after the pH-cycling among the groups. AFM offers a powerful tool for enamel de-/remineralization research. The surface roughness results provide the evidences to remineralization of carious lesion, and indicate the potential of G. chinensis in promoting the remineralization. G. chinensis may become one more promising agent for caries prevention.