Effect of xylitol varnishes on enamel remineralization of immature teeth: in vitro and in situ studies

Effect on mechanical and microbiological properties of adding calcium glycerophosphate and xylitol to glass ionomer cement

This study aimed to evaluate the effect on the mechanical and microbiological properties of incorporating calcium glycerophosphate (CaGP) and/or xylitol into resin modified glass ionomer cement (RMGIC). Six experimental cements were tested: i) RMGIC without additions; and RMGIC with ii) 5% xylitol; iii) 10% xylitol; iv) 3% CaGP; v) 3% CaGP and 5% xylitol, or vi) 3% CaGP and 10% xylitol. The compressive strength, diametral tensile strength and surface hardness were determined (24 h and 7 days). Antimicrobial/antibiofilm activity was evaluated. Compressive strength values after 24 h for +3% CaGP & 5% xylitol were higher and similar to RMGIC. After 7 days, +3% CaGP & 5% xylitol presented the highest compressive strength values. The +3% CaGP & 10% xylitol showed the lowest values of diametral tensile strength values (24 h). The RMGIC with +3% CaGP & 5% xylitol showed the highest diametral tensile strength (7 days). The surface hardness (24 h) were highest for the RMGIC and +10% xylitol. After 7 days, +3% CaGP & 5% xylitol showed the highest value. The +3% CaGP & 5% xylitol or +3% CaGP & 10% xylitol showed the lowest levels of microbial/biofilm formation. The addition of CaGP/xylitol promoted improved the mechanical and antibacterial properties of RMGIC.

Inhibition of incipient caries lesion progression by different fluoridated varnishes

The aim of this in vitro study was to evaluate the potential of different fluoridated varnishes to inhibit the progression of incipient caries lesions after cariogenic challenge. Seventy-five enamel specimens of bovine teeth were prepared and selected based on the initial surface microhardness (SMH). The specimens were first subjected to artificial demineralization (in buffer solution) after which SMH was re-analyzed (SM1). They were then randomly assigned to five experimental groups: 1- CONTROL (pH cycling), 2 - MI VAR (MI Varnish with RECALDENTTM - CPP-ACP), 3 - PROFL (Profluorid®), 4 - CLIN (ClinproTM White Varnish with TCP), and 5 - DUR (Duraphat®) (n=15). The varnishes were applied in a thin layer and the specimens were then subjected to pH cycling for eight days. The SMH and cross-sectional microhardness (CSMH) were then analyzed (SM2). The fluoride and calcium ion concentrations in the solution were analyzed by the indirect method and atomic absorption spectrophotometry, respectively. Data were statistically analyzed by Student's t-test, ANOVA/Tukey-Kramer, or Kruskall-Wallis/Dunn tests for individual comparisons (p˂0.05). All varnishes led to significantly higher surface and subsurface remineralization compared with the control group but did not differ from each other. The varnishes with the highest fluoride release were: PROFL and CLIN, followed by MI VAR and DUR. The varnishes with significantly higher release of calcium were: DUR, CLIN, and PROFL. In conclusion, all commercial fluoridated varnishes tested have good potential to inhibit the progression of demineralization, regardless of the ion release mechanisms.

Xylitol associated or not with fluoride: Is the action the same on de- and remineralization?

OBJECTIVES

This study evaluated the effect of xylitol combined or not with fluoride (F) on reduction of demineralization and increase of remineralization of shallow and deep artificial enamel lesions.

METHODS

Bovine enamel samples were allocated to the following solutions groups: no xylitol (negative control), 5% xylitol, 10% xylitol, 20% xylitol, 500 ppm F (as NaF), 5% xylitol+F, 10% xylitol+F or 20% xylitol+F (n = 12-15). For the demin study, a pH-cycling model (demineralization-6 h, pH 4.7/remineralization 18 h, pH 7.0) was employed for 7 days. Treatments were applied 2 × 1 min. In the remin study, specimens were pre-demineralized for 2, 5 or 10 days. Afterwards, a pH-cycling protocol was conducted (2 h demineralizing and 22 h remineralizing solution/day for 8 days) and the same treatments were done. The response variables were percentage surface hardness loss (%SHL) and transverse microradiography. Data were analyzed by RM ANOVA/Tukey or Kruskal-Wallis/Dunn (p < 0.05) RESULTS: F and Xylitol combined with F reduced the %SHL (23-30%) compared to the negative control (61.5%). The integrated mineral loss and the lesion depth were not reduced by any treatment. Surface hardness recovery was seen only for shallow lesions in case of 20% xylitol+F compared to negative control. No lesion depth recovery, but significant mineral recovery was seen for F (2-days and 10-days lesion).

CONCLUSIONS

All concentrations of xylitol+F reduced enamel surface demineralization, while only 20% xylitol+F improved surface remineralization of shallow lesions in vitro.

CLINICAL SIGNIFICANCE

Our results suggest that while F or any concentration of xylitol + F reduces surface demineralization, only 20% xylitol+F improves surface remineralization of shallow lesions in vitro. Therefore, xylitol may be added into oral products, combined to F, to control dental caries.

Investigating the efficacy of a varnish containing gallic acid on remineralization of enamel lesions: an in vitro study

This study evaluated the efficacy of a formulated remineralizing gallic acid (GA) varnish in treating artificial enamel caries lesions. Fifty-five intact bovine incisors were collected. Enamel blocks (5 × 9 mm) were prepared. A third of each block's surface remained intact. Primary carious lesions were induced on the middle and bottom thirds of the blocks by immersing the samples in a demineralization solution for 6 h. The bottom third of the blocks were further remineralized by randomly applying 0.5%, 2%, or 8% GA varnishes and 2.26% fluoride varnish (V varnish, Vericom, Seoul, Korea), or the varnish base without active ingredients (n = 11 each). The specimens were immersed in a remineralizing solution for 4 h and then subjected to a 2-hour immersion in the demineralizing solution. After six days of pH cycling, the surface microhardness was measured at depths of 30, 75, and 120 μm. The percentage of surface microhardness recovery (SMHR%) was compared among the groups using the Shapiro-Wilk, ANOVA, and Tukey HSD post-hoc tests (α = 0.05). The SMHR% of all experimental groups was higher than the control group at 30 μm (p < 0.05). The 0.5% GA varnish showed the highest SMHR% at all depths; however, the difference with the other experimental groups was significant at a depth of 30 μm (p < 0.05). The SMHR% of the fluoride and the 2% and 8% GA varnishes was comparable at all depths. All treatments potentially remineralize enamel lesions, with 0.5% GA varnish having the greatest effect, particularly on the top surface layer. As such, this newly developed varnish may emerge as a promising alternative to fluoride varnish.

Xylitol Fluoride Varnish: In Vitro Effect Analysis on Enamel by Atomic Force Microscopy

(1) Background: Numerous studies have shown the beneficial role of fluoride in the primary prevention of dental caries. The aim of the present study was to put into evidence the change in the enamel structure immediately after the application of a fluoride varnish. (2) Methods: A xylitol−fluoride varnish was evaluated. The enamel specimens (n = 10) were analyzed by atomic force microscopy on enamel surface and treatment with fluoride varnish applied. The dimensional topographic analysis was performed by 2D and 3D analysis software. Statistical analysis was performed using SPSS Version 26.00 (IBM, Armonk, NY, USA). A one-sample statistics test was used to identify significant differences (p < 0.05). (3) Results: Surface roughness (Ra) measurements ranged from Ra = 0.039 μm (±0.048), to Ra = 0.049 μm (±0.031), respectively (p < 0.05), with an increase in the surface roughness passing from the intact enamel to the enamel exposed to fluoride varnish. When comparing Ra values of the nonfluorinated enamel and fluorinated enamel, significant differences (p < 0.05) were found, suggesting that the varnish had a protective effect on the enamel surface. (4) Conclusions: Xylitol−fluoride varnish, even in one single short-time application, is effective in reducing the surface roughness of enamel structure exposed to abrasion, thus increasing resistance to dental caries.