In vitro evaluation of the efficacy of laser fluorescence (DIAGNOdent) to detect demineralization and remineralization of smooth enamel lesions

A Comparison of NovaMin™ and Casein Phosphopeptide-Amorphous Calcium Phosphate Fluoride on Enamel Remineralization - An In vitro Study Using Scanning Electron Microscope and DIAGNOdent®

Aim:

The aim of this study was to compare the efficacy of NovaMin^™ (SHY-NM) and casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) (tooth mousse plus^™) on enamel remineralization using DIAGNOdent^® and scanning electron microscope (SEM).

Methodology:

Eighty-six natural permanent maxillary first premolars were selected and randomly divided into two groups of 43 each, Group A (NovaMin^™) and Group B (CPP-ACPF). All the samples were assessed using DIAGNOdent^® (KaVo) at the baseline, after demineralization, and remineralization after 7 days. Two samples were randomly selected from each group after remineralization to evaluate the surface changes using SEM at × 1000 and × 2000.

Results:

The mean value of remineralization was highest for Group A NovaMin^™ (6.56 ± 0.93) compared to Group B, CPP-ACPF (tooth mousse plus^™) (6.02 ± 1.09). The maximum demineralization to remineralization value within the groups showed that the mean values in Group B CPP-ACPF (7.02 ± 3.02) was higher than Group A NovaMin^™ (6.42 ± 2.21). The difference in remineralizing potential between the groups and demineralization to remineralization value in within-group comparison was not found to be statistically significant.

Conclusion:

On comparing Group A NovaMin^™ and Group B CPP-ACPF, Group B CPP-ACPF showed a higher amount of remineralization than Group A NovaMin^™. From the present study, it can be inferred that both the experimental groups have the potential for remineralization.

Comparison of the effects of toothpastes containing nanohydroxyapatite and fluoride on white spot lesions in orthodontic patients: A randomized clinical trial

BACKGROUND

Studies show that fluoride (F) and nano-hydroxyapatite (nano-HA) would result in remineralization of white spot lesions (WSLs), which are among the most prevalent consequences of fixed orthodontic treatment. The present study evaluates and compares the clinical effects of an Iranian toothpaste containing nano-HA with F-containing one on early enamel lesions.

MATERIALS AND METHODS

In this randomized clinical trial study, 50 patients who had received fixed orthodontic treatment were recruited immediately after debonding. Three photographs, including frontal, lateral right and left views of occlusion, were obtained. Moreover, surfaces with WSLs were recorded using DIAGNOdent. Plaque index of each patient determined using disclosing agents. At first visit, each patient was asked to select one type of toothpaste (nano-HA containing vs. F containing named A or B), randomly and were instructed how to brush their teeth (25 patients in each group). Examination was done at 1, 3, and 6 months' intervals. Finally, photographs were analyzed by Digimizer (V5) software, and the lesion extent was recorded in pixels. SAS 9.4 was used to analyze data and was set at 0.05.

RESULTS

According to data, lesion extent showed a significant decrease (P < 0.001). At baseline, the difference between the two groups regarding the lesion extent was 268 pixels while it dropped to 89 pixels after 6 months. DIAGNOdent results showed that at baseline, fluorescence difference was 0.3 while it reached the number of 0.8 after 6 months, indicating the outperformance of nano-HA containing toothpaste.

CONCLUSION

The Iranian nano-HA containing toothpaste performed better than F-containing one in terms of the amount of remineralization and diminishing the lesion extent.

Comparative evaluation of enamel microhardness after using two different remineralizing agents on artificially demineralized human enamel: An in vitro study

AIM

The purpose of this study was to compare the remineralization outcomes of two agents using the Vickers microhardness test (VMHT) on artificially induced enamel subsurface lesions.

MATERIALS AND METHODS

Forty sound extracted premolars were selected as samples for the current study and divided into four groups of 10 teeth each: Clinpro (group 1), Remin Pro (group 2), untreated positive control (group 3), and a demineralized negative control (group 4). All the sample groups were assessed first at baseline then after demineralization and remineralization using DIAGNOdent. After the remineralization process, VMHT was performed on all sample groups to assess surface microhardness (SMH). The results obtained were then compared using a one-way analysis of variance (ANOVA) for the difference in SMH.

RESULTS

Vickers microhardness number values were analyzed using one-way ANOVA and samples in the experimental groups 1 and 2 showed a statistically significant difference compared to the control groups (P < 0.05). Remineralization was higher in the Remin Pro group, followed by Clinpro group.

CONCLUSIONS

The results of this in vitro study show that both Remin Pro and Clinpro are equally effective as remineralizing agents. Although Remin Pro tended to yield a higher microhardness, no significant differences were observed between the two agents.

RELEVANCE FOR PATIENTS

Enamel mineral loss leads to the degradation of the surface and subsurface structures of teeth. Natural remineralization that occurs physiologically is not sufficient to overcome the hurdles of mineral loss a tooth undergoes due to changes in food habits and lifestyle. A thought on remineralization and management such as prescribing remineralizing agents and regular professional topical fluoride applications would definitely render satisfactory results by a strong healthy enamel.

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

Aim

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

Materials and methods

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

Results

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

Conclusion

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

Clinical significance

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

How to cite this article

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

The Efficacy of Soprolife® in Detecting in Vitro Remineralization of Early Caries Lesions

Objectives

This randomized controlled in vitro 4-arm trial study aimed to evaluate the efficacy of SoproLife^® in detecting and quantifying in vitro remineralization with early caries lesions.

Material and Methods

Sixty human teeth were randomly assigned into four equal groups. Groups 1 and 2 were prophylactically cleaned; groups 3 and 4 were not. Group 1 received treatment with MI Varnish^® and Recaldent™ for 30 days. Group 2 was treated similarly, but without MI Varnish^®. Group 3 was treated as 1 and Group 4 as 2. Mineral composition was obtained using scanning electron microscopy with energy dispersive X-ray analysis SoproLife^® camera images on the occlusal surfaces were analysed for grey value distribution and difference in mean intensity values (DI). Paired t-test and Mann-Whitney-U test were used for intragroup comparison between baseline and T1. Kruskal-Wallis followed by Mann-Whitney-U tests were used for inter-group comparisons at T1.

Results

All groups exhibited a significant increase in calcium content and calcium-to-phosphorus ratio (P < 0.05), except Group 4 (Group 1 showed the greatest increase, then Groups 3 and 2). Grey intensity values decreased in all groups (P < 0.05). Group 1 showed the greatest change in DI (16.82 [SD 12.07]), followed by Group 3 (12.46 [SD 9.41]), 2 (10.45 [SD 7.76]), and 4 (6.46 [SD 6.21]). The difference in DI was different between the compared groups (P = 0.038); Groups 1 and 3 exhibited a greater DI compared with 4 (P < 0.01).

Conclusions

Within the limitations of this study, SoproLife^® is effective for early detection and for longitudinally monitoring the remineralization after Recaldent™ therapy.

HMU Fluorinze Mouthwash Enhances Enamel Remineralization: An In Vitro Study

BACKGROUND:

Fluoride therapy has long been used extensively to prevent dental caries. Fluoride appears in a variety of dental care products such as mouth rinses, dentifrices, gels, etc. HMU Fluorinze is the first mouthwash containing fluoride in Vietnam.

AIM:

This research was conducted to evaluate the efficacy of HMU Fluorinze mouthwash on remineralizing enamel in laboratory conditions.

METHODS:

20 third molar teeth were cleaned and covered with nail polish, except for a 3 x 3 mm square on their buccal surfaces. These teeth underwent two steps: demineralization using Coca-cola and remineralization for 20 daysusing standard calcifying solution (control group) and standard calcifying solution + HMU Fluorinze mouthwash 2 times/day (experimental group). The index measured of enamel structure after demineralization and remineralization was assessed by a DIAGNOdent pen 2190.

RESULTS

The indices measured of the control group and experimental group at baseline were 3.65 ± 0.76 and 3.35 ± 0.64 respectively. After demineralization the control group measured 21.78 ± 4.48 and the experimental group, 20.25 ± 2.26. Following remineralization, the control group scores were 6.30 ± 1.03 and the experimental group, 3.90 ± 1.24, demonstrating statistical significance (p < 0.01) between the two groups. After 20 days, the results for the experimental group did not differ from the original results (p = 0.272), in contrast with the control group (p < 0.01).

CONCLUSION

Results show that HMU Fluorinze mouthwash is better at remineralizing than standard calcifying solution.

The effect of different re-mineralizing agents and diode laser irradiation on the microhardness of primary molar enamel: An in vitro study

Background and Aims

Dental caries is a global concern and different materials and methods were proposed for its prevention.The aim of this study was evaluation of the effect of different demineralizing agents with and without diode laser radiation on the microhardness of primary molars enamel.

Materials and Methods

48 primary molar teeth were used in this study. The enamel blocks were prepared. Primary microhardness values were also measured. All samples were demineralized, then demineralization was approved by a DIAGNOdent pen. The remineralization was done into the buccal and lingual surfaces of the samples as follows:Group 1: CPP-ACP, Group 2: CPP-ACPF, Group 3: MI varnish, Group 4: NaF varnish. The lingual surfaces received diode laser irradiation. Finally, a secondary microhardness test was performed on all samples. Statistical analyses were done and a P-value less than 0.05 was considered to be statistically significant.

Results

A comparison between the primary and the secondary microhardness values showed significant differences (P = 0.003). The highest secondary microhardness values belonged to the MI varnish +laser group.

Conclusion

Application of the agents, containing the combination of Ca, P, and F, was significantly better than others in increasing the microhardness of the enamel. Although the application of diode laser increased the hardness of the enamel.

Comparison of Visual Examination and Magnification with DIAGNOdent for Detection of Smooth Surface Initial Carious Lesion-Dry and Wet Conditions

Objective

The aim of this study was to assess the effectiveness and reliability of magnification, DIAGNOdent in detection of smooth surface white spot lesions.

Study design

Three hundred children aged 5–10 years were examined by two examiners for presence of smooth surface white spot lesions using naked eye and magnifying loupes in wet and dry conditions followed by DIAGNOdent analysis. Data was analysed using Cohen's kappa coefficient, Friedman test and Paired t test. Accuracy was assessed by sensitivity and positive predicted values.

Results

Significant difference was found between naked eyes and magnifying loupes with and without air drying. While insignificant difference was found between DIAGNOdent and loupes.

Conclusion

Magnifying loupes with air drying is an effective method in detection of smooth surface white spot lesion.

Clinical significance

With the increased knowledge about the pathogenesis of dental caries and its ability to be remineralisable if detected early, makes it all the more important for the clinician to be vigilant in detection of early lesion to prevent the avoidable restorative approach for the same. Incorporation of magnification to routine dental examination by general dentist can help in early diagnosis and treatment of dental decay. This could prevent further progression of dental caries and reduces the incidence of tooth decay

How to cite this article

Gupta N, Sandhu M, et al. Comparison of Visual Examination and Magnification with DIAGNOdent for Detection of Smooth Surface Initial Carious Lesion—Dry and Wet Conditions. Int J Clin Pediatr Dent 2019;12(1):37–41.

Evaluation of laser fluorescence in combination with photosensitizers for detection of demineralized lesions

BACKGROUND AND OBJECTIVES

Early detection of caries plays an important role in its prognosis. This study sought to assess the efficacy of laser fluorescence alone and in combination with photosensitizers for detection of demineralized smooth-surface lesions of permanent teeth.

MATERIALS AND METHODS

This in vitro experimental study was conducted on 60 extracted sound premolars. Four windows measuring 2 x 2 mm were created on each tooth. Forty out of 60 teeth were subjected to demineralization cycle. All teeth were then sectioned and subjected to DIAGNOdent Pen (Kavo, Biberach, Germany) alone and in combination with 0.2-mM tetrakis N-methylpyridyl porphyrin (TMPyP) fluorescent dye, 2% methylene blue and 2% new methylene blue photosensitizers. The results of histological analysis of sections served as the gold standard. The correlation of the results with the gold standard was assessed using the Pearson's correlation coefficient and receiver operating characteristic (ROC) curve. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the four techniques were evaluated as well.

RESULTS

The correlation between the results of DIAGNOdent laser with TMPyP dye and the gold standard was significant (P < 0.05). Also, this technique had the highest sensitivity while DIAGNOdent laser alone had the highest specificity.

CONCLUSION

Laser fluorescence with TMPyP fluorescent dye has suitable efficacy for early detection of initial enamel lesions.

Optimal power settings of aluminum gallium arsenide lasers in caries inhibition - An in vitro study

Context:

Incipient carious lesions are characterized by subsurface dissolution due to more fluoride ions in the 50-100 microns of the tooth's outer surface.

Aims:

To determine an optimal power setting for 810 nm aluminum gallium arsenide laser for caries inhibition.

Materials and Methods:

Fifty-four caries-free extracted teeth were sectioned mesiodistally. The samples were divided into 18 groups for each power setting being evaluated. Each group had six samples. The laser used is 810 nm aluminum gallium arsenide laser with power setting from 0.1 watts to 5 watts. Laser fluorescence based device was used to evaluate the effect of irradiation.

Statistical Analysis Used:

Paired “t” test, one-way analysis of variance (ANOVA), Tukey's post hoc test, and the Pearson's correlation test.

Results:

The paired t-test showed that there is minimum divergence from the control for 3.5 watts. Tukey's post hoc test also showed statistically significantly results for 3.5 watts. The Pearson's correlation test showed that there was negative correlation between the watts and irradiation.

Conclusions:

The power setting that gave statistically significant results was 3.5 watts.

Effectiveness of Fluorescence-based Methods in Monitoring Progression of Noncavitated Caries-like Lesions on Smooth Surfaces

Although there has been a significant decrease in caries prevalence in developed countries, the slower progression of dental caries requires methods capable of detecting and quantifying lesions at an early stage. The aim of this study was to evaluate the effectiveness of fluorescence-based methods (DIAGNOdent 2095 laser fluorescence device [LF], DIAGNOdent 2190 pen [LFpen], and VistaProof fluorescence camera [FC]) in monitoring the progression of noncavitated caries-like lesions on smooth surfaces. Caries-like lesions were developed in 60 blocks of bovine enamel using a bacterial model of Streptococcus mutans and Lactobacillus acidophilus. Enamel blocks were evaluated by two independent examiners at baseline (phase I), after the first cariogenic challenge (eight days) (phase II), and after the second cariogenic challenge (a further eight days) (phase III) by two independent examiners using the LF, LFpen, and FC. Blocks were submitted to surface microhardness (SMH) and cross-sectional microhardness analyses. The intraclass correlation coefficient for intra- and interexaminer reproducibility ranged from 0.49 (FC) to 0.94 (LF/LFpen). SMH values decreased and fluorescence values increased significantly among the three phases. Higher values for sensitivity, specificity, and area under the receiver operating characteristic curve were observed for FC (phase II) and LFpen (phase III). A significant correlation was found between fluorescence values and SMH in all phases and integrated loss of surface hardness (ΔKHN) in phase III. In conclusion, fluorescence-based methods were effective in monitoring noncavitated caries-like lesions on smooth surfaces, with moderate correlation with SMH, allowing differentiation between sound and demineralized enamel.

A study of the fluorescence characteristics of common cariogenic microorganisms

OBJECTIVE

To explore the fluorescence characteristics of common cariogenic bacteria: Streptococcus mutans, S. sanguis, Actinomyces viscosus, Prevotella intermedia, Lactobacillus acidophilus, and Candida albicans.

METHODS

The bacteria were cultured on brain heart infusion (BHI) agar and BHI blood agar, and bacterial colonies were collected for further amplification in liquid medium. Bacterial suspensions in physiological saline were equally divided into three parts for bacteria counting, fluorescence spectrometry detection, and fluorescence microscope examination.

RESULTS

The optimal excitation wavelength of the bacteria was 350 nm; their characteristic fluorescence peak position was at 436 ± 4 nm. There was a significant linear correlation between fluorescence intensity and bacterial concentration. The mean optical density (MOD) of S. mutans and L. acidophilus cultivated in BHI blood was significantly higher than that cultivated in BHI agar (110 ± 10 vs. 57 ± 20; 94 ± 16 vs. 31 ± 12, respectively, P < 0.05). The MOD of S. sanguis, A. viscosus, and P. intermedia cultivated in BHI blood agar was higher than that cultivated in BHI agar (37 ± 12 vs. 36 ± 11; 43 ± 17 vs. 38 ± 6; 86 ± 21 vs. 72 ± 8, respectively, P > 0.05); the opposite was observed for C. albicans.

CONCLUSION

At 350 nm excitation wavelength, 436 ± 4 nm is an indicator for detecting six cariogenic bacteria. The fluorescence energy, Q, is a valuable index reflecting bacterial concentration under fluorescence spectrometry detection. Exogenous fluorescence groups have greater influence on fluorescence intensity and little influence on fluorescence peak position detection.

Cut off values of laser fluorescence for different storage methods at different time intervals in comparison to frozen condition: A 1 year in vitro study

Aims:

The aim of the following study is to evaluate the change in laser fluorescence (LF) values for extracted teeth stored in different solutions over 1 year period, to give cut-off values for different storage media at different time intervals to get them at par with the in vivo conditions and to see which medium gives best results with the least change in LF values and while enhancing the validity of DIAGNOdent in research.

Materials and Methods:

Ninety extracted teeth selected, from a pool of frozen teeth, were divided into nine groups of 10 each. Specimens in Groups 1-8 were stored in 1% chloramine, 10% formalin, 10% buffered formalin, 0.02% thymol, 0.12% chlorhexidine, 3% sodium hypochlorite, a commercially available saliva substitute-Wet Mouth (ICPA Pharmaceuticals) and normal saline respectively at 4°C. The last group was stored under frozen condition at −20°C without contact with any storage solution. DIAGNOdent was used to measure the change the LF values at day 30, 45, 60, 160 and 365.

Statistical Analysis Used:

The mean change in LF values in different storage mediums at different time intervals were compared using two-way ANOVA.

Results:

At the end of 1 year, significant decrease in fluorescence (P < 0.05) was observed in Groups 1-8. Maximum drop in LF values occurred between day 1 and 30. Group 9 (frozen specimens) did not significantly change their fluorescence response.

Conclusions:

An inevitable change in LF takes place due to various storage media commonly used in dental research at different time intervals. The values obtained from our study can remove the bias caused by the storage media and the values of LF thus obtained can hence be conveniently extrapolated to the in vivo condition.