Analysis of Dental Enamel Remineralization: A Systematic Review of Technique Comparisons

How to Make Incisor Opacities Disappear in Children and Adolescents With Molar Incisor Hypomineralization? A Systematic Review

OBJECTIVE

Molar-incisor hypomineralization (MIH) is a developmental enamel defect that often leads to aesthetic concerns, particularly when affecting incisors. Various treatment modalities, including microabrasion, bleaching, resin infiltration, and remineralizing agents, have been proposed, but their comparative effectiveness remains unclear. This systematic review aims to evaluate and compare the available aesthetic treatment options for hypomineralized incisors in children and adolescents.

MATERIALS AND METHODS

A systematic search was conducted in MEDLINE via PubMed, Cochrane, Scopus, and ScienceDirect for studies published between 2013 and 2023. The review included randomized controlled trials (RCTs), non-randomized clinical studies, and in vitro studies published in English, focusing on aesthetic treatments for MIH-incisor opacities in pediatric patients (≤ 18 years old). Studies were screened and evaluated independently by two reviewers following PRISMA guidelines. Risk of bias was assessed using ROB 2 for RCTs, ROBINS-I for non-randomized studies, and the QUIN tool for quality evaluation of included studies.

RESULTS

From 1381 identified studies, 12 met the inclusion criteria (four RCTs, six non-RCTs, and two in vitro studies). Seven studies investigated resin infiltration, while five focused on microabrasion, either alone or combined with remineralizing agents. Evidence suggests that microabrasion is effective for superficial lesions, particularly when combined with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) or fluoride-enriched remineralizing agents. Resin infiltration provides immediate and lasting aesthetic improvement, particularly for deeper opacities, with enhanced results when preceded by optimized etching protocols. Some studies suggest sodium hypochlorite pre-treatment enhances resin infiltration outcomes, though further validation is required.

CONCLUSIONS

Both microabrasion and resin infiltration show effectiveness depending on lesion characteristics. Current evidence supports the use of microabrasion, especially when combined with remineralizing agents, for mild or superficial lesions. Resin infiltration demonstrates promising results for deeper lesions; however, given that only two of the four RCTs included patients with mild MIH, the certainty of this evidence remains moderate. Treatment selection should therefore be guided by lesion depth, clinical presentation, and patient-specific factors. Further well-designed, long-term clinical trials are needed to establish standardized protocols and strengthen the evidence base for both interventions.

CLINICAL SIGNIFICANCE

Treatment choice in managing MIH-affected incisors should be tailored to lesion depth, with microabrasion and remineralizing agents suitable for superficial defects and resin infiltration providing superior outcomes for deeper opacities.

Next-Generation Strategies for Enamel Repair and Regeneration: Advances in Biomaterials and Translational Challenges

BACKGROUND

Enamel regeneration and remineralization are critical for restoring enamel integrity, as natural enamel lacks the ability to regenerate due to the absence of ameloblasts. The increasing prevalence of dental caries and the irreversible nature of enamel damage highlight the need for advanced repair strategies.

METHODS

This review examines the latest advancements in enamel regeneration and remineralization, focusing on biomaterials, nanotechnology-based approaches, and bioengineering strategies. Google Scholar, Scopus (Elsevier), and PubMed databases were used for the selection of literature. The search included key terms such as "enamel regeneration," "biomimetic enamel repair," "stem cell-based enamel regeneration," "nanotechnology in enamel repair," "hydroxyapatite enamel remineralization," and "biomaterials for enamel remineralization."

RESULTS

Various strategies have been explored for enamel remineralization, including self-assembling peptides, dendrimers, hydrogels, and electrospun mats, each demonstrating varying success in laboratory and preclinical studies. While casein-phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP) combined with fluoride remains a widely used clinical remineralization agent, integrating CPP-ACP with nanotechnology is an emerging area requiring further research. Enamel bioengineering approaches utilizing stem/progenitor cells offer potential, though challenges remain in achieving clinical translation.

CONCLUSION

Despite advancements, replicating the hierarchical structure and mechanical properties of natural enamel remains challenging. Nanotechnology-driven approaches, bioengineered scaffolds, and interdisciplinary collaboration hold promise for optimizing enamel regeneration techniques. Further research is necessary to enhance clinical applicability and develop scalable, effective treatments for enamel restoration.

Engineering quantum carbon dots unveiling quantum wave entanglement wave function on enamel substrate: A relativistic in-vitro study

OBJECTIVES

As artificial atoms, quantum dots are widely used in quantum information research since their individual energy levels may be precisely controlled using gate voltages. The purpose of the study was to modify carbon quantum dots (CQDs) and evaluate its effects on the structure, crystal orientation and mechanical properties of the enamel substrate along with antibacterial properties of CQDs.

MATERIALS AND METHODS

Enamel specimens of 4 mm × 4 mm × 3 mm were cut and CQD solution was dialyzed in deionized water mixed with urea solution and placed in microwave system (800 W) to obtain *CQD0.1 %-, **CQD0.2 %-, ***CQD0.3 %-, and *****CQD0.5 % for enamel blocks to be immersed for 2 weeks. X-ray diffraction analysis and density-functional theory (DFT) calculations were performed to determine degree of phase purity. Transmission electron microscopy (TEM) was used for imaging of CQDs and treated enamel, with zeta potential measured with Zetasizer. Raman spectra was acquired with spectral range of 400-2000 cm-1. Atomic force microscopy was performed with a peak force set at 200 nN. Lactobacillus biofilm was prepared on treated enamel substrates and analysed using confocal, scanning electron microscopy and TEM.

RESULTS

DFT calculations summarised improved lattice parameters of HAp***CQD0.3 %- and HAp***CQD0.5 %-. Zeta potential is least for salineS and is maximum for *****CQD0.5 %- distributed system. The salineS, and *CQD0.1 %- groups had comparable v₁PO₄³⁻ value, indicating consistent phosphate intensities. TEM successfully verified carbon dots as spherical. Enamel crystals aligned their c-axis perpendicular to the electron beam within 1° with CQDs treated specimens exhibiting misoriented-crystals. *****CQD0.5 %- group had highest elastic modulus and nano hardness with maximum shear stress. Calculated bond length and angles using XRD show higher measures (p < 0.05) in all CQD groups. *****CQD0.5 %- exhibited a fibre texture pattern with an orientational distribution resembling an angle distortion. Most bacteria in the biofilms fluoresced red in CQD groups with no colony chain formations observed with *****CQD0.5 %- group. CQDs assemblies were observed to cause explosive lysis through loss of cell integrity.

CONCLUSION

*****CQD0.5 %- modified enamel substrate displayed significant crystallite changes providing a novel option for fabrication of diverse functional CQDs aimed at modification of enamel tissue while possessing optimum antimicrobial properties.

Effectiveness of Dental Restorative Materials in the Atraumatic Treatment of Carious Primary Teeth in Pediatric Dentistry: A Systematic Review

AIM

This systematic review evaluates the effectiveness and clinical outcomes of Atraumatic Restorative Treatment (ART) in pediatric dentistry, comparing it with other restorative techniques, analyzing material performance, assessing cost-effectiveness, and exploring the long-term success in managing dental caries.

BACKGROUND

ART is a minimally invasive approach that removes decayed tissue using hand instruments and restores teeth with adhesive materials like glass ionomer cement (GIC). ART is particularly valuable in pediatric dentistry due to its simplicity, reduced discomfort, and suitability for resource-limited settings. It eliminates the need for anesthesia and expensive dental equipment, making it accessible in remote and underserved areas. Studies have shown its effectiveness in providing durable restorations while improving patient comfort.

MATERIALS AND METHODS

This systematic review follows the PRISMA guidelines. PubMed, Web of Science, and Scopus were searched for studies published in the last ten years. The inclusion criteria included in vivo studies on children, randomized controlled trials, and case-control studies assessing ART's effectiveness. Quality and risk of bias were evaluated using the ROBINS-I tool.

RESULTS

Eighteen studies met the inclusion criteria. ART effectively managed dental caries, especially with high-viscosity GIC. Comparisons with the Hall Technique and Papacarie showed that ART remains a viable, cost-effective option.

CONCLUSIONS

ART is a reliable, minimally invasive technique for pediatric restorative dentistry. Its accessibility and cost-effectiveness make it suitable for low-resource settings. High-quality materials and technique modifications further enhance restoration longevity.

Histological effect of fluoride varnishes on teeth with caries in the white spot phase: An in vitro study

Background

The aim of this study was to compare the histological remineralization effects of two fluoride varnishes on artificially produced caries lesions in young permanent teeth.

Material and Methods

Twenty longitudinal sections of premolars with artificially produced white spot lesions and evaluated with a polarised light microscope. The sample consisted of 20 tooth fragments, which were divided and assigned to two groups: The first group with application of Clinpro TM White Varnish (20 tooth sections) and the second, with MI Varnish TM (20 tooth sections) subjected for 6 days to conditions similar to the oral cavity. The sections were then re-evaluated by calculating the lesion depth and remineralization area (Image J software). Student' s t-test was used to analyse the data.

Results

MI Varnish TM fluoride varnish achieved a greater remineralization area than Clinpro TM White Varnish (838042.6±140359.3 μm2 and 678313.8±137265.7μm2, respectively), with a statistically significant difference (p<0.05).

Conclusions

MI Varnish TM had a better effect than Clinpro TM White Varnish in remineralizing lesions, in vitro, in the enamel of young permanent teeth with caries in the white-stained phase. Key words:Fluorides varnishes, histological effect, dental remineralization, polarised light microscope.

Color Change and Color Stability of White Spot Lesions Treated with Resin Infiltration, Microabrasion, or Nano-Hydroxyapatite Remineralization: An In Vitro Study

Background: We compared the camouflage effect of three white spot lesion (WSL) treatments (infiltration, nano-hydroxyapatite (nHAP) remineralization, and microabrasion) and color stability of the treated surfaces. Methods: Fifty sound extracted teeth were used in the study. WSLs were created on 40 buccal dento-enamel specimens through the use of acidic methylcellulose gel. These specimens were randomly assigned to treatment groups (n = 10 per group): negative controls, nano-hydroxyapatite (nHAP), resin infiltration, and microabrasion. After the treatment, all 50 specimens were immersed in coffee for 7 days. Color measurements were performed four times: at baseline (T0), after the demineralization procedure (T1), after the treatments (T2), and after immersion in coffee (T3). Results: No restoration of the initial enamel color was observed in any of the groups. The ICON and MA groups exhibited the highest masking effect, with the mean ΔET0-T2 = 7.46, although the differences among the study groups were insignificant. All three treatments increased the resistance of WSLs to discoloration in coffee compared to the negative control group; however, infiltration (∆ET2-T3 = 4.13) and microabrasion (∆ET2-T3 = 3.49) showed a better color stability tendency than nHAP remineralization (∆ET2-T3 = 7.26). Conclusions: Despite its well-known remineralizing and desensitizing effects, nHAP showed the least masking effect for WSLs and lower color stability compared to resin infiltration and microabrasion. However, none of the methods allowed for complete restoration of the original color. After the discoloration procedure, the color changes in the white spots treated with microabrasion and infiltration were comparable to those of the sound enamel.

Effects of Dentifrices With Antierosive Potential on the Surface of Bovine Enamel Submitted to Acidic Beverage

OBJECTIVES

To evaluate the effects of dentifrices containing sodium fluoride (NaF) combined with NovaMin (Sensodyne Repair & Protect-SRP), NaF combined with stannous fluoride (SnF2, Oral-B Pro-Gengiva-OBP), and amine fluoride (AmF, Colgate Elmex-ELM) on enamel subjected to simulated erosive cycling.

MATERIALS AND METHODS

Bovine enamel-dentin discs (n = 10/group) were subjected to erosive cycling with orange juice (pH = 3.29, 5 min, 3x/day), artificial saliva (SA-2 h, 3x/day and overnight) and treated with dentifrice (2 min, 2x/day) or without treatment (CONT). Surface microhardness (SMH) was evaluated at baseline (T0), on the first (T1) and fifth (T5) days. SMH loss (%SHL) was calculated. Surface roughness (Ra, μm) was determined at T0 and T5. Morphology and mineral content were evaluated under scanning electron microscopy and energy-dispersive x-ray spectroscopy. Data were analyzed using ANOVA/Tukey or Bonferroni (α = 5%).

RESULTS

No differences in %SHL were detected among groups at T1. At T5, OBP promoted %SHL, Ra, and ΔRa significantly lower than all the other groups (p < 0.05). All groups exhibited morphological changes in topography and similar Ca/P means before and after treatments.

CONCLUSIONS

Dentifrice containing SnF2 minimized the negative effects on the SMH and Ra caused by exposure to orange juice after 5 days of simulated cycling.

CLINICAL RELEVANCE

Patients who are more exposed to risk factors for dental erosion could benefit from the use of dentifrice containing SnF2.

In Vitro Investigation of Novel Peptide Hydrogels for Enamel Remineralization

This study investigates the microstructure of dental enamel following demineralization and re-mineralization processes, using DIAGNOdent scores and images obtained via scanning electron microscopy (SEM), atomic force microscopy (AFM), and microhardness (Vickers). The research evaluates the effects of two experimental hydrogels, Anti-Amelogenin isoform X (ABT260, S1) and Anti-Kallikrein L1 (K3014, S2), applied to demineralized enamel surfaces over periods of 14 and 21 days. The study involved 60 extracted teeth, free from cavities or other lesions, divided into four groups: a positive group (+), a negative group (-) and groups S1 and S2. The last three groups underwent demineralization with 37% phosphoric acid for 20 min. The negative group (-) was without remineralization treatment. The DIAGNOdent scores indicate that the S1 group treated with Anti-Amelogenin is more effective in remineralizing the enamel surface compared to the S2 group treated with Anti-Kallikrein. These findings were corroborated by SEM and AFM images, which revealed elongated hydroxyapatite (HAP) nanoparticles integrated into the demineralized structures. Demineralization reduced enamel microhardness to about 1/3 of a healthy one. Both tested hydrogels restored enamel hardness, with S1 being more effective than S2. Both peptides facilitated the interaction between the newly added minerals and residual protein binders on the enamel surface, thereby contributing to effective enamel restoration.

Piezosurgery in Third Molar Extractions: A Systematic Review

Background: The aim of this systematic review was to evaluate the clinical efficacy, benefits, and limitations of piezosurgery in tooth extractions compared to conventional methods. Piezosurgery has emerged as a minimally invasive alternative, promoting better preservation of soft tissues and bone structures. Understanding its impact on postoperative outcomes such as pain, swelling, trismus, and bone healing is critical for its application in oral surgery; Materials and Methods: We restricted our search to English-language articles published between 1 January 2004 and 28 August 2024, in PubMed, Scopus, and Web of Science. The Boolean search keywords "piezosurgery AND tooth extraction" were used. Results: A total of 983 articles were identified, and after duplicates were removed, 766 studies were screened. Following the application of inclusion and exclusion criteria, seven articles were selected for qualitative analysis. Conclusions: The literature suggests that piezosurgery offers advantages, such as reduced postoperative pain, swelling, and trismus, despite longer surgical times compared to conventional methods. While piezosurgery shows promise for improved patient comfort and soft tissue preservation, further research is required to validate its long-term impact on bone healing and regeneration.

Surgical Management of Pediatric Obstructive Sleep Apnea: Efficacy, Outcomes, and Alternatives-A Systematic Review

AIM

Obstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder. OSA affects approximately 2 million Italians, although only 3% receive a diagnosis and correct treatment. This review aims to provide an overview to guide clinical decision making, ensuring that patients receive the most appropriate treatment for their specific condition.

MATERIAL AND METHODS

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered at PROSPERO under the ID CRD42024593760. A search on PubMed, Scopus, and Web of Science was performed to find papers that matched the topic, using the following Boolean keywords: ("obstructive sleep apnea" OR "OSA" OR "sleep apnea, obstructive") AND ("surgery" OR "surgical" OR "surgical techniques" OR "surgical treatment" OR "operative" OR "surgical procedures") AND ("treatment" OR "therapy" OR "management").

RESULT

The electronic database search found 20337 publications. After the screening and eligibility phase, 15 papers were chosen for the qualitative analysis.

CONCLUSIONS

Adenotonsillectomy (AT) significantly improves secondary outcomes like behavioral issues and quality of life, compared to watchful waiting with supportive care (WWSC). Alternative approaches such as tonsillotomy and adenopharyngoplasty (APP) offer promising results, with less postoperative discomfort and lower complication rates. However, further large-scale studies are needed to refine surgical techniques, assess long-term outcomes, and optimize individualized treatment strategies for OSA.

The Diagnosis and Management of Infraoccluded Deciduous Molars: A Systematic Review

The infraocclusion (IO) of primary molars, often seen in retained deciduous teeth, is a common condition that presents significant challenges for pediatric oral health. It occurs when primary molars are positioned below the occlusal plane due to the absence of permanent successors, leading to complications such as misaligned teeth, impaired chewing, and long-term dental health issues.

OBJECTIVES

This study examines IO prevalence, diagnosis, and treatment approaches.

METHODS

A systematic review following PRISMA guidelines was conducted, searching PubMed, Web of Science, and Scopus for articles from the last 15 years. Nine articles were included for qualitative analysis.

RESULTS

IO was associated with several complications, including root resorption, altered eruption of adjacent teeth, and space loss within the dental arch. Clinical and radiographic evaluations are key to early detection. Severe cases often require invasive treatments, such as tooth extraction and space maintenance, while mild cases could be monitored.

CONCLUSIONS

IO is prevalent in pediatric dentistry and can lead to significant dental issues if untreated. Early detection and intervention are crucial for preventing complications like tooth misalignment and impacted premolars. Tailored treatment strategies based on severity, along with increased awareness among dental practitioners, are essential to improve long-term outcomes for affected children.

A Novel Nano-Hydroxyapatite Agarose-Based Hydrogel for Biomimetic Remineralization of Demineralized Human Enamel: An in-vitro Study

Purpose

This study aims to investigate the biomimetic effect of agarose hydrogel loaded with enamel matrix derivative (EMD-agarose) alone or in combination with nano-hydroxyapatite (n-HA-EMD-agarose) on the remineralization of human demineralized enamel.

Methods

Extracted human mandibular third molars were sectioned into 54 buccal and lingual halves. Acid-resistant nail varnish was applied to each half, except for two enamel windows. Enamel surface microhardness, energy-dispersive X-ray spectroscopy (EDX), and scanning electron microscopy (SEM) analyses were conducted to evaluate enamel surfaces at baseline, following demineralization with 37% phosphoric acid, and after each hydrogel application and remineralization for two, four, and six days. Remineralization was performed using a phosphate solution at 37°C.

Results

At day 6 following remineralization, a statistically significant higher mean microhardness was recorded in n-HA-EMD-agarose hydrogel (260.87 ± 3.52) as compared to EMD-agarose hydrogel (244.63 ± 2.76) (p = 0.027). Similarly, n-HA-EMD-agarose hydrogel showed a higher mean calcium (46.31 ± 2.78), phosphorous (24.92 ± 0.826), and fluoride (0.909 ± 0.053) weight percentage compared to EMD-agarose hydrogel calcium (19.64 ± 1.092), phosphorous (19.64 ± 1.092), and fluoride (0.7033 ± 0.0624) weight percentage (p < 0.05). Further, SEM analysis revealed a substantial deposition of n-HA following the application of the n-HA-EMD-agarose hydrogel, whereas the EMD-agarose exhibited a relatively smooth enamel surface with less visible enamel rods due to mineral deposition.

Conclusion

The combined n-HA-EMD-agarose hydrogel demonstrated improved surface microhardness of the remineralized enamel and enhanced mineral content deposition, indicating its potential as a biomimetic approach for dental enamel repair.

A Comparison of the Fluoride 'Paint- On' vs Tray Application Techniques for Enamel Remineralisation

BACKGROUND

Fluoride gel treatment is not recommended for children < 6 years old due to its potential toxicity. Hence the aim of this study was to compare the effect of 1.23% acidulated-phosphate fluoride (APF) gel paint-on and the conventional tray application techniques on artificial, deciduous enamel carious lesions embedded on wearable appliances.

METHODS

In a randomised crossover study, the volunteer children (n = 29) wore mandibular removable appliances containing embedded tooth specimens with artificial carious lesions. The volunteers had 3 different treatment protocols: (I) 0.4 mL non-fluoride (control) gel, (II) 0.4 mL paint-on 1.23% APF gel or (III) 5 mL 1.23% APF gel, 4 minutes tray application. After 1 hour, the appliances were removed and the specimens underwent an in vitro, 14 days of pH-cycling. The mean percentage reduction in fluorescence (ΔF, %) at baseline (ΔF0) and after the pH-cycling (ΔF1) were determined using quantitative light-induced fluorescence-digital analysis. The mean ΔΔF (ΔF1-ΔF0) was calculated to compare the differences between groups.

RESULTS

The mean ΔΔF of groups I to III were -1.42 ± 1.49, 1.06 ± 2.11, and 1.12 ± 3.57 and -1.25 ± 1.44, 1.13 ± 1.84 and 1.44 ± 3.62 for the smooth surface and proximal surface lesions, respectively. The mean ΔΔF in the 2 treatment groups were significantly greater compared with the control group (P < .001). There was no significant difference in ΔΔF between the APF gel tray and paint-on groups either in the smooth surfaces, or the proximal surfaces (P = .629 and P = .613, respectively).

CONCLUSION

Our study, for the first time, indicates that the paint-on application of APF gel or the tray application of APF had a similar enamel remineralisation effect. Clinically, this implies that, particularly in younger children, the paint-on application of fluoride is less cumbersome, and possibly more tolerable with a lesser likelihood of fluoride ingestion than the tray application technique.

TRIAL REGISTRATION

Thai Clinical Trial Registry (https://www.thaiclinicaltrials.org/show/TCTR20190724001).

Impact of Calcium Lactate Pretreatment on Enamel Fluoride Uptake: A Comparative In Vitro Study of Different Fluoride Types and Concentrations

(1) Background: This study aimed to establish the effect of calcium lactate enamel pretreatment related to different fluoride types and concentrations on the enamel uptake of alkali-soluble fluorides. (2) Materials: In a blind and randomized in vitro study, a total of 60 teeth are used. The first 30 teeth were cut and randomly allocated into one of the following treatments: (A) calcium lactate pretreatment followed by three different fluoride solutions; (B) the "Fluoride only" group, with slabs treated with three different fluoride solutions; (C) the "Calcium only" group, with slabs treated with calcium lactate solution; (D) slabs treated with deionized water (negative control group). The next 30 teeth underwent all the above described group procedures but were treated with lower fluoride concentrations. Fluoride was extracted from enamel using 1 M KOH solution and analyzed using a fluoride ion-specific electrode. (3) Results: The findings revealed that slabs treated with NaF following calcium lactate pretreatment exhibited significantly greater enamel uptake of alkali-soluble fluoride compared to other substrates. This significant effect was not observed at lower fluoride concentrations. (4) Conclusion: The study demonstrates that pretreatment with calcium lactate followed by treatment with NaF at 226 ppm F significantly enhances the uptake of alkali-soluble fluoride in enamel compared to other fluoride types.

Nanotechnology and Its Application in Dentistry: A Systematic Review of Recent Advances and Innovations

Background: This study looks at the clinical applications of nanotechnology in dentistry, with an emphasis on implantology, preventive care, orthodontics, restorative dentistry, and endodontics. Methods: Following PRISMA criteria and registered in PROSPERO (ID: CRD 564245), a PubMed, Scopus, and Web of Science search was conducted for studies from January 2014 to April 2024. The criteria were English-language research on nanotechnology in dental coatings, with a focus on clinical trials and observational studies. The electronic database search yielded 8881 publications. Following the screening process, 17 records were selected for qualitative analysis. Results: Nanotechnology has revolutionized dentistry. In orthodontics, nanoparticles improve antibacterial characteristics, durability, and biocompatibility, lowering bacterial colonization and plaque. In preventative care, Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) combined with stannous fluoride (SnF2) and nano-sized sodium trimetaphosphate (TMPnano) substantially remineralizes enamel. Nanostructured surfaces in dental implants, particularly those containing calcium, improve osseointegration and stability. Nanoparticles in restorative dentistry improve composite and adhesive strength, aesthetics, and longevity. Conclusions: Nanotechnology improves dental materials and equipment, resulting in better treatment outcomes and increased patient comfort. Its integration provides more effective treatments, which improves dental care and patient outcomes. More research is needed to overcome present problems and expand nanotechnology's medicinal applications.

Remineralizing effect of NSF on artificial enamel caries

INTRODUCTION

Nanotechnology offers new approaches and endless opportunities for remineralizing tooth decay without being toxic or causing allergies. This study aimed to determine the effect of nanosilver fluoride (NSF) on the remineralization potential of enamel caries-like lesions compared to 5% sodium fluoride varnish in permanent teeth.

METHODS

Fifteen teeth (molars and premolars) were gathered, cleaned, and polished using a scaler. After sectioning the teeth mesiodistally and removing the roots, the thirty specimens were subjected to a demineralized solution to induce early enamel lesions and then assigned randomly into two equal groups. The test materials were applied, and then all the specimens were subjected to a pH cycling model for 30 days. DIAGNOdent and surface roughness were investigated, and an evaluation of the enamel Ca and P weight% for Ca/P ratio calculation was done using SEM-EDX to analyze the specimens at the end of the study. The data were analyzed using an independent t-test.

RESULTS

The mean values for the DIAGNOdent measurements for NSF and NaF at baseline and after demineralization were not significantly different (p > 0.05). After treatment, NaF varnish showed a significantly higher mean DIAGNOdent measurement (11.8 ± 5.80) than NSF (4.7 ± 1.6). The mean surface roughness of the NaF group (1.64 ± 0.39) was much higher than NSF's mean surface roughness (1.07 ± 0.21). Specimens treated with NSF had statistically significant smoother surfaces (p < 0.001). The NSF group had a higher mean Ca/P ratio (2.9 ± 0.35) than NaF (2.2 ± 0.11). This difference was statistically significant (p = 0.012).

CONCLUSION

The study reveals that nano silver fluoride is a more effective treatment than sodium fluoride varnish in enhancing teeth's clinical characteristics, particularly in terms of mineral content and surface roughness, suggesting it could be an improved strategy to prevent dental caries and maintain enamel integrity.

Management of Patients Receiving Anticoagulation Therapy in Dental Practice: A Systematic Review

BACKGROUND

Anticoagulant drugs are a valuable tool for minimizing thrombotic risks in at-risk patients. The purpose of this study is to conduct a literature review highlighting the management of these drugs during daily clinical dental practice.

MATERIALS AND METHODS

We limited our search to English-language papers published between 1 January 1989, and 7 March 2024, in PubMed, Scopus and Web of Science that were relevant to our topic. In the search approach, the Boolean keywords "anticoagulant AND dentistry" were used.

RESULTS

Twenty-five clinical trials were included for final review from 623 articles obtained from the databases Web of Science (83), PubMed (382), and Scopus (158), eliminating duplicates and 79 off-topic items, resulting in 419 articles after removing 315 entries and confirming eligibility. Overall, these studies support the use of local hemostatic measures to manage the risk of bleeding in patients on anticoagulant therapy undergoing dental procedures and highlight the importance of greater education and collaboration among healthcare professionals.

CONCLUSIONS

Research and clinical investigation have improved understanding and management of dental procedures in patients undergoing anticoagulant or antiplatelet therapy. Hemostatic agents, clinical protocols, risk factors, and continuous education are essential for navigating the complexities of anticoagulant therapy, ensuring optimal outcomes and enhancing patient well-being.

Evaluating the Remineralizing Effects of Calcium Sucrose Phosphate and Casein Phosphopeptide-Amorphous Calcium Phosphate Toothpastes on Artificial Carious Lesions Using Micro-computed Tomography: An In Vitro Investigation

Background White spot lesions (WSLs) are common early indicators of enamel demineralization, particularly in pediatric orthodontic patients. Effective remineralization of these lesions is crucial for preventing further dental decay. This study aimed to evaluate the three-dimensional remineralization efficacy of two commercial toothpastes, calcium sucrose phosphate (CaSP) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), using micro-computed tomography (micro-CT). Objectives To compare the remineralization efficacy of CaSP and CPP-ACP on artificially created WSLs in human premolar enamel using micro-CT assessment. Materials and methods Freshly extracted, caries-free human premolars were used for the purpose of the study. Teeth with any defects, including caries, non-carious lesions, fractures, or hypocalcifications, were excluded. Teeth were stored in a saline solution with 0.1% thymol at +4°C until experimentation. Enamel slabs (N = 18) of 3 x 3 x 1.5 mm were prepared from the buccal surfaces of the premolars and polished to a mirror-like finish. The slabs were divided into three groups (n=6 each): control, CaSP, and CPP-ACP. Specimens were demineralized in a demineralization solution for 72 hours and then treated with the respective toothpastes or remineralizing solutions for 13 days. Micro-CT scanning was performed to assess changes in enamel volume and mineral density. Statistical analysis included Shapiro-Wilk tests, paired t-tests, and one-way ANOVA with post-hoc Tukey's HSD tests. Results Enamel volume changes were significant between groups (p<0.01), with the CaSP group showing the largest remineralization effect. Enamel mineral density changes were also significant (p=0.004), with the CPP-ACP group showing the greatest improvement in mineral density.  Conclusions CaSP and CPP-ACP are both effective in remineralizing artificial enamel lesions. While CaSP shows comparable efficacy to CPP-ACP, further research is needed to confirm these findings in clinical settings. CaSP paste can be considered a viable, cost-effective alternative for enamel remineralization.

Effect of the use of remineralization agents before resin infiltration on the treatment of initial enamel lesions: an in-vitro study

AIM

This study aimed to evaluate the effect of the use of remineralization agents before the application of resin infiltration on the treatment of initial enamel lesions.

MATERIALS AND METHODS

Eighty buccal enamel samples were prepared from human molars, and artificial initial lesions were formed after 96 h of incubation with a demineralizing solution. The samples were randomly divided into 8 groups (n = 10) including a remineralizing agent (Tooth Mousse, Medical Mineral Gel, Remin Pro), resin infiltration (ICON), and a combined treatment of both. Remineralizing agents were applied in pH cycle for 7 days. Baseline, demineralization, and after-treatment fluorescence (FluoreCam and DIAGNOdent Pen), surface microhardness (HMV-2T), surface roughness (M300C), OCT (Maestro-2) and ultrasonic system (Novascope 4500) data were obtained for all groups. The sample surfaces were examined under SEM/EDX (SU3500) at x1000. Data were statistically analyzed using the Two-Way Robust ANOVA and Bonferroni tests (p < 0.05).

RESULTS

There was no statistically significant difference between the groups for microhardness, roughness, OCT, DIAGNOdent Pen, ultrasound, and FluoreCam size/intensity values (p = 0.582; p = 0.963; p = 0.884; p = 0.923; p = 0.051; p = 0.268; p = 0.793 respectively). The effect of the treatment procedure showed a significant difference (p < 0.001), except for the roughness values (p = 0.984). The lowest Calcium (Ca) ratio (%atomic) was observed in the RI group in the EDX analysis.

CONCLUSION

Remineralizing agents and resin infiltration methods may be used in combination or alone in the treatment of initial enamel lesions. Combining remineralizing agents with resin infiltration does not alter the efficacy of the treatment.

Accumulation and removal of Streptococcus mutans biofilm on enamel and root surfaces in vitro

Objective

This study aimed to quantitatively investigate the accumulation of Streptococcus mutans biofilm on enamel and root surfaces and assess the amount of biofilm removal using (1) experimental toothpaste and (2) water, in a closed system of flow chamber.

Methods

Eight sound premolars were embedded in epoxy resin and polished with silicon carbide grinding papers to display enamel and root surfaces. To mimic biofilm, cultures of Streptococcus mutans were prepared and grown on the tooth surfaces over night before they were exposed to either 2 liters of Milli Q water or 2 liters of 40% experimental toothpaste in the flow chamber. The amount of biofilm was measured and quantified in Fluorescence microscopy. Mean fluorescence values were recorded and analysed using Microsoft® Excel® (MS Excel 2016).

Results

The ability to grow biofilm was equally present at both the enamel and root surfaces. The use of water and 40% experimental toothpaste showed a significant reduction of areas covered with biofilm on both enamel and root dentin in comparison to untreated surfaces (p < 0.01). Significantly more biofilm was removed from enamel compared to root surfaces when treated with either water and toothpaste (p < 0.01). Slightly less biofilm was removed by the use of water compared to toothpaste on both enamel and root dentin surfaces, although the differences were not statistically significant.

Conclusion

The results indicate that less biofilm is removed from the root surfaces than enamel by the use of water and 40% experimental toothpaste in flow chamber. Assessing oral biofilm accumulation and monitoring biofilm formation on enamel and root dentin surfaces give oral health professionals important directions that could strenghten the significance of dental caries prevention. Improving older individuals' oral hygiene practices should therefore be considered an important measure to prevent root caries.

Therapeutic Strategies and Genetic Implications for Periodontal Disease Management: A Systematic Review

The objective of this review is to identify the microbiological alterations caused by various therapy modalities by critically analyzing the current findings. We limited our search to English-language papers published between 1 January 2004 and 7 May 2024 in PubMed, Scopus, and Web of Science that were relevant to our topic. In the search approach, the Boolean keywords "microbio*" AND "periodontitis" were used. A total of 5152 papers were obtained from the databases Web of Science (2205), PubMed (1793), and Scopus (1154). This resulted in 3266 articles after eliminating duplicates (1886), and 1411 entries were eliminated after their titles and abstracts were examined. The qualitative analysis of the 22 final articles is included in this study. Research on periodontal disease shows that periodontitis alters the oral microbiome and increases antibiotic resistance. Treatments like scaling and root planing (SRP), especially when combined with minocycline, improve clinical outcomes by reducing harmful bacteria. Comprehensive mechanical debridement with antibiotics, probiotics, EMD with bone grafts, and other adjunctive therapies enhances periodontal health. Personalized treatment strategies and advanced microbial analyses are crucial for effective periodontal management and antibiotic resistance control.

The interaction between gut microbiome and bone health

PURPOSE OF REVIEW

This review critically examines interconnected health domains like gut microbiome, bone health, interleukins, chronic periodontitis, and coronavirus disease 2019 (COVID-19), offering insights into fundamental mechanisms and clinical implications, contributing significantly to healthcare and biomedical research.

RECENT FINDINGS

This review explores the relationship between gut microbiome and bone health, a growing area of study. It provides insights into skeletal integrity and potential therapeutic avenues. The review also examines interleukins, chronic periodontitis, and COVID-19, highlighting the complexity of viral susceptibility and immune responses. It highlights the importance of understanding genetic predispositions and immune dynamics in the context of disease outcomes. The review emphasizes experimental evidence and therapeutic strategies, aligning with evidence-based medicine and personalized interventions. This approach offers actionable insights for healthcare practitioners and researchers, paving the way for targeted therapeutic approaches and improved patient outcomes.

SUMMARY

The implications of these findings for clinical practice and research underscore the importance of a multidisciplinary approach to healthcare that considers the complex interactions between genetics, immune responses, oral health, and systemic diseases. By leveraging advances in biomedical research, clinicians can optimize patient care and improve health outcomes across diverse patient populations.

Fluoride-amorphous calcium phosphate and biomimetic nano-hydroxyapatite for enamel remineralization: An in-vitro study of surface microhardness and composition

AIM

Fluoride-Amorphous Calcium Phosphate and Biomimetic Nano-Hydroxyapatite for Enamel Remineralization; An In-Vitro Study of Surface Microhardness and Composition.

MATERIAL AND METHODS

Ninety-six extracted human premolars with sound buccal surface were divided using a randomization computer-generating software into four groups; Group I (control) sound untreated enamel, Group II (demineralized) demineralized to create white spot lesions, Group III (biom-n-HA) demineralized and then treated with biomimetic nanohydroxyapatite cream, and Group IV (F-ACP) demineralized and then treated using Fluoride-Amorphous Calcium Phosphate varnish. Each group was divided into two subgroups; subgroup "A" evaluated for mineral content using energy dispersive x-ray spectroscopy (EDX) and for surface microhardness using the Vickers microhardness test and Subgroup "B" evaluated for white spot lesion depth using a polarized light microscope (PLM).

RESULTS

The highest microhardness (VHN) was found in the (F-ACP) group (mean=428.61±54.43) and then in the (Biom-n-HA) group (mean=408.11±70.16) followed by the (Control) group (mean=402.13±53.40) with no significant difference between them and finally in the significantly different (Demineralized) group (mean=256.99±45.83). The weight percentage of Ca (30.29±1.04 and 33.44±1.07) and Ca/P ratio (1.87±0.06 and 2.03±0.05) were significantly different between Group III and Group IV respectively. PLM measurements in Group II (198.83μm), Group III (60.17μm), and Group IV (26.33μm) were significantly different.

CONCLUSIONS

Both the (Biom-n-HA) cream and the (F-ACP) varnish showed promising results for enamel remineralization. The increased enamel surface microhardness was consistent with the mineral content and the changes in the birefringence.

Efficacy of F-ACP-Containing Dental Mousse in the Remineralization of White Spot Lesions after Fixed Orthodontic Therapy: A Randomized Clinical Trial

Fixed appliance (FA) therapy predisposes patients to white spot lesions (WSLs). The F-ACP complex (amorphous calcium phosphate nanoparticles enriched with carbonate and fluorine and coated with citrate) has been effective for in vitro enamel remineralization. The aim of this study was to evaluate the efficacy of the F-ACP complex in remineralizing WSLs after FA therapy. One hundred and six adolescents (aged 12-20 years) were randomized into study and control groups after FA therapy. Patients in the study group were advised to use dental mousse containing F-ACP applied within Essix retainers for six months. The presence of WSLs was recorded at baseline (T0), 3 months (T1), and 6 months (T2) according to the International Caries Detection and Assessment System (ICDAS). Visual Plaque Index (VPI) and Gingival Bleeding Index (GBI) were recorded. Among 106 study participants, 91 (52 and 39 in study and control groups, respectively) completed the study. The results showed that the ICDAS score was significantly lower (p < 0.001) in the study group than in the control group between T0 and T2. The application of mousse containing the F-ACP complex inside Essix retainers for six months is effective in remineralizing white spot lesions in patients after FA therapy without side effects.

Structural and Color Alterations of Teeth following Orthodontic Debonding: A Systematic Review

AIM

The objective of this study was to explore the effects of fixed orthodontic appliances on enamel structure by assessing microfractures, surface roughness, and alterations in color.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of online databases was conducted using the keywords 'enamel' AND 'orthodontic debonding'. Eligibility criteria included both in vivo and ex vivo clinical trials conducted on human teeth.

RESULTS AND DISCUSSION

A total of 14 relevant papers were analyzed. Various instruments and techniques were utilized across different studies to assess surface roughness, color change, and surface fractures.

CONCLUSIONS

The findings of this study suggest that ceramic brackets may lead to an increase in enamel fractures, particularly during bracket removal. The surface roughness of enamel exhibits variability depending on the adhesive substance and polishing methods used post-removal. Fixed orthodontic appliances could induce changes in enamel color, which may be alleviated by the use of nano-hydroxyapatite or specific polishing techniques. Further research is necessary to identify effective strategies for managing these color changes and improving the overall outcomes of fixed orthodontic treatment.

Ultrastructural investigation of the effect of toothpastes containing different remineralizing agents on demineralized enamel

OBJECTIVE

The present study aimed to evaluate the effect of remineralizing agents on demineralized enamel intended for use as fluoride substitutes or supplements for oral hygiene applications.

METHODOLOGY

Enamel samples were obtained from 30 bovine teeth. The enamel blocks were stored in 20 mL of demineralization solution for 72 h. They were then brushed with the following toothpaste for the remineralization protocol: NaF, NaF/SnF2 combination, NovaMin, or nano-hydroxyapatite. SEM/EDX examinations and microhardness measurements of the samples were performed to investigate the remineralization efficacy of the studied toothpaste. One-way analysis of variance (ANOVA) with post hoc Tukey's HSD test was used to analyze the change in microhardness values in different remineralization protocols (p < 0.05).

RESULTS

Differences in the mean remineralization (%RP) and hardness recovery (%HR) were determined between the groups (p < 0.05). Groups 1 and 4 showed significant differences in %RP (p < 0.05). In the SEM/EDX examinations, the samples treated with n-HAp showed an accumulation of crystal deposits on the enamel surface, although at a lower density than those treated with NaF and NaF/SnF2 combination.

CONCLUSION

The remineralization strategy in toothpaste plays an important role in enamel remineralization. NovaMin-containing toothpaste showed positive effects on the enamel surface with better Ca/P ratio. Toothpastes containing n-HAp triggered less change in the increase of microhardness values compared to other toothpastes. The use of SnF2 in toothpaste in combination with NaF significantly increased the binding of fluoride to demineralized enamel compared to toothpaste containing NaF alone.

Preventive management of carious lesions: from non-invasive to micro-invasive operative interventions

Understanding that dental carious lesions occur as a result of the action of micro-organisms in the dental plaque biofilm, where demineralisation on the tooth surface is the first sign of the disease, such incipient lesions can be treated using preventive, non-operative and minimally invasive operative dentistry. If the caries process is left unmanaged, the lesions progress towards cavitation, leading to more invasive treatments. This article discusses the principles of preventive, non-invasive and micro-invasive treatments of early carious lesions, outlining the clinical situations where these therapies can be applied.

The effect of combined use of resin infiltration with different bioactive calcium phosphate-based approaches on enamel white spot lesions: An in vitro study

OBJECTIVES

This in vitro study aimed to evaluate the effect of resin infiltration combined with casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF) or bioactive glass (BAG) on the stability of enamel white spot lesions (WSLs) treatment.

MATERIALS AND METHODS

Eighty-four enamel blocks were prepared from the buccal surfaces of sound human premolars. All enamel blocks were placed in a demineralisation solution for 3 days to establish the artificial enamel WSLs. Enamel blocks with WSLs were randomly divided into three groups (n = 28 each group): RI/B: one-off resin infiltration followed by twice daily BAG treatment; RI/C: one-off resin infiltration followed by twice daily CPP-ACPF treatment; RI: one-off resin infiltration treatment only (as control) and subjected to pH cycling for 7 days. Surface morphology, elemental analysis, crystal characteristics, surface roughness and microhardness of enamel surfaces were investigated by scanning electron microscopy and energy-dispersive spectrometry observation, X-ray diffraction (XRD), atomic force microscope and Vickers' hardness testing, respectively.

RESULTS

Mean values of the surface roughness (mean±standard deviation (nm)) were 24.52±5.07, 27.39±5.87 and 34.36±4.55 for groups RI/B, RI/C and RI respectively (p = 0.003). The calcium to phosphate ratios were 1.32±0.16, 1.22±0.26 and 0.69±0.24 for groups RI/B, RI/C and RI respectively (p < 0.001). XRD revealed apatite formation in all three groups. The mean enamel surface microhardness (kg/mm2) of the groups were 353.93±28.49, 339.00±27.32 and 330.38±22.55 for groups RI/B, RI/C and RI respectively (p = 0.216).

CONCLUSIONS

Resin infiltration combined with CPP-ACPF or BAG remineralisation appears to improve the surface properties of WSLs.

CLINICAL SIGNIFICANCE

The combination of resin infiltration and CPP-ACPF/BAG remineralisation may be a potential treatment for the management of the WSLs.

New generation of orthodontic devices and materials with bioactive capacities to improve enamel demineralization

OBJECTIVE

The article reviewed novel orthodontic devices and materials with bioactive capacities in recent years and elaborated on their properties, aiming to provide guidance and reference for future scientific research and clinical applications.

DATA, SOURCES AND STUDY SELECTION

Researches on remineralization, protein repellent, antimicrobial activity and multifunctional novel bioactive orthodontic devices and materials were included. The search of articles was carried out in Web of Science, PubMed, Medline and Scopus.

CONCLUSIONS

The new generation of orthodontic devices and materials with bioactive capacities has broad application prospects. However, most of the current studies are limited to in vitro studies and cannot explore the true effects of various bioactive devices and materials applied in oral environments. More research, especially in vivo researches, is needed to assist in clinical application.

CLINICAL SIGNIFICANCE

Enamel demineralization (ED) is a common complication in orthodontic treatments. Prolonged ED can lead to dental caries, impacting both the aesthetics and health of teeth. It is of great significance to develop antibacterial orthodontic devices and materials that can inhibit bacterial accumulation and prevent ED. However, materials with only preventive effect may fall short of addressing actual needs. Hence, the development of novel bioactive orthodontic materials with remineralizing abilities is imperative. The article reviewed the recent advancements in bioactive orthodontic devices and materials, offering guidance and serving as a reference for future scientific research and clinical applications.

Dental Caries: Unveiling the State-of-the-art Insights and Crafting Hypotheses for Oral Health

The pathophysiological understanding of dental caries explains that the primary factor responsible is linked to an imbalance in microbial composition within the oral cavity, stemming from both artificial and natural sources. Streptococcus mutans (S. mutans) is the most accountable and prevalent pathogen for caries development among the diverse pool. S. mutans, an acidogenic bacterium, lowers oral pH through the metabolic conversion of dietary sugar into organic acids, leading to enamel demineralization and dental caries. Numerous antibacterial interventions have been employed in the past to address this issue. However, adopting such an approach poses the risk of exacerbating concerns related to Antimicrobial Resistance (AMR) and long-term oral cytotoxicity. In response to this, a sustainable strategy is suggested, involving the utilization of L-Arginine (L-Arg) as a probiotic nutrient supplement for non-pathogenic microbes. It will help in creating a natural competitive environment against the pathogenic microbes responsible for initiating dental caries. The hypothesis involves utilizing a combination of a nutrient supplement and the repurposed drug Piceatannol, specifically for its anti-biofilm properties. This combination synergistically improves the effectiveness of the therapy by converting the complex microbial biofilm into a planktonic state.

Treatment Approaches to Molar Incisor Hypomineralization: A Systematic Review

AIM

This systematic review aimed to comprehensively evaluate the available literature on treating molar incisor hypomineralization (MIH) or enamel hypomineralization published between 2013 and 2023, focusing on identifying relevant studies and their characteristics.

MATERIALS AND METHODS

The search process encompassed reputable academic databases, including PubMed, Scopus, Cochrane Library, and Web of Science, using a precise keyword strategy ("((molar incisor hypomineralization) OR (enamel hypomineralization)) AND (treatment)"). A total of 637 articles were initially retrieved, followed by a strict selection process adhering to PRISMA guidelines. The inclusion criteria encompassed Randomized Control Trials (RCTs), case series with more than five clinical cases (CSs), studies involving human participants, availability as free full-text or accessible with university credentials, and English-language publications. Exclusion criteria included systematic or literature reviews, editorials, single-case reports, studies conducted in vitro, those involving animals, paid articles, and non-English-language publications.

RESULTS

The search yielded 864 articles, of which 23 met the stringent inclusion criteria after a meticulous selection process. These studies will serve as the basis for a comprehensive analysis of MIH treatment approaches. The systematic review ensures the quality and relevance of the chosen studies for a detailed assessment of MIH treatment strategies.

CONCLUSIONS

This systematic review will provide valuable insights into the characteristics of selected studies, patient profiles, and available treatment options for molar incisor hypomineralization, contributing to a better understanding of this dental condition's management.