Enamel remineralization assessment after treatment with three different remineralizing agents using surface microhardness: An in vitro study

Comparative Evaluation of the Increase in Enamel Hardness Post-External Bleaching after Using Casein Phosphopeptide Amorphous Calcium Phosphate Fluoride (CPP-ACPF) and 5% Sodium Fluoride (NaF) Remineralizing Agents

OBJECTIVE

 The purpose of this study was to analyze the increase in enamel hardness post-external bleaching after remineralized with casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) and 5% sodium fluoride (NaF) and the difference in increased enamel hardness between CPP-ACPF and NaF materials.

MATERIALS AND METHODS

 The study was true experimental in vitro using 30 samples of mandibular premolars. All samples were bleached using 40% hydrogen peroxide. The samples were divided into three groups of 10 samples each; group I as a control without application of remineralization material, group II was given an application of CPP-ACPF (GC Tooth Mousse Plus: GC Europe, Lot #201130B), and group III was given an application of 5% NaF (Clinpro White Varnish: 3M ESPE, Lot #NA62322) Then the entire samples were stored in artificial saliva. The hardness of the samples was measured using a Vickers hardness tester before bleaching, after bleaching, and after remineralization for 7, 14, and 21 days.

STATISTICAL ANALYSIS

 Analysis of the data used was an analysis of variance test to assess differences in the increase in enamel hardness between groups and paired t-tests and to determine differences in enamel hardness in each group.

RESULTS

 This study showed that there was an increase in the enamel hardness after bleaching which was remineralized with CPP-ACPF and 5% NaF. There was a difference in the increased enamel hardness between teeth remineralized with CPP-ACPF and 5% NaF. The enamel hardness of CPP-ACPF was higher compared with 5% NaF after remineralization of 7, 14, and 21 days.

CONCLUSION

 There was an increase in the enamel hardness after external bleaching that was remineralized with CPP-ACPF and 5% sodium fluoride (NaF). There was a difference in the increased enamel hardness between teeth remineralized with CPP-ACPF and 5% sodium fluoride (NaF). CPP-ACPF showed a higher enamel hardness value than 5% NaF.

Comparative evaluation of remineralization potential of four different remineralization agents on human enamel: An in vitro study

Aim

The study aimed to assess the remineralizing potential of four different commercially available agents using a Scanning Electron Microscope (SEM), energy dispersive X-ray (EDX) analysis, and Vickers Microhardness (VMH) Test.

Materials and Methods

Forty-four specimens (n = 11 per group) were prepared from extracted teeth. A window of 6 mm × 4 mm was made on all the specimens that represented three zones, namely, sound enamel, demineralized enamel, and remineralized enamel. The zone for demineralized enamel was subjected to four different remineralizing agents; casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), tricalcium phosphate fluoride (TCP-F), calcium sucrose phosphate (CSP), and self-assembling peptide (P11-4). Remineralization (REM) was assessed using VMH; the structural changes were assessed using SEM that was analyzed using EDX analysis. The specimens were subjected to a newer regimen of demineralization. One-way ANOVA followed by post hoc Tukey test was used with a level of significance at P ≤ 0.05.

Results

There were no significant differences in VMH between the groups for sound enamel (P = 0.472) and demineralized enamel (P = 0.116). VMH was statistically significantly more for P11-4 and the least for CPP-ACPF (P = 0.011). A post hoc analysis revealed higher VMH for P11-4 compared to CPP-ACPF (P = 0.014) and TCP-F (P = 0.035). SEM showed a homogeneous layer of minerals for all groups except CPP-ACPF. TCP-F reported a higher degree of REM, followed by P11-4 as assessed using EDX analysis.

Conclusion

Self-assembling peptide (P11-4) exhibited a higher degree of REM than other remineralizing agents followed by CSP.

An In-Vitro Comparative Study of Fluoride Varnish and Two Calcium-Containing Fluoride Products on the Remineralization of Primary Teeth Enamel

Objectives: To compare the effectiveness of fluoride varnish and two calcium-based fluoride products on the remineralization of primary teeth enamel. Materials and Methods: Surface-microhardness (SMH) of 36 extracted anterior primary teeth was measured by Vickers test (50gr/5 seconds) to provide a baseline for later comparisons. All teeth were immersed in demineralizing solution for 96 hours to create caries-like lesions and SMH was determined for the artificially-induced caries. The teeth were randomly assigned to three groups consisting of 5% fluoride varnish once daily/10 seconds, Clinpro™ 5000 toothpaste once daily/2 minutes, and Remin Pro cream once daily/3 minutes for 28 days. All specimens were kept in artificial saliva with pH cycling during the study period. After remineralization, SMH was evaluated for the last time. Data were analyzed by one-way ANOVA, Mauchly's sphericity, and RM-ANOVA with Bonferroni correction for inter-and- intra-group comparisons at the three stages of the study. Results: Neither the baseline SMH nor the SMH of the artificially created caries showed significant differences among the samples (P>0.05). The post-treatment SMH was highest in the Clinpro group (296.4±73.1kgf/mm2), followed by Remin Pro (283.8±119.3kgf/mm2), and varnish (270.9±78.3 kgf/mm2). There was no significant difference among the groups after treatment (P>0.05). We also did not observe a significant difference among the three different study stages (P>0.05). Conclusion: Within the limitations of this in-vitro study, daily application of low fluoride-calcium compound seems to be as effective as the professional use of fluoride varnish or high-content fluoride toothpaste in remineralizing initial caries of primary teeth.

Effect of remineralizing agent on laser and nonlaser bleached enamel surfaces subjected to erosion: An in vitro study

Aim

Assessment of remineralizing agent's effect on laser and nonlaser bleached enamel surfaces subjected to erosion.

Materials and Methods

In this study, 80 extracted human permanent anteriors were collected and divided into 4 groups with 20 teeth per sample. Enamel specimen of 3 mm × 3 mm were made using polyvinyl chloride rings and acrylic and randomly divided into four groups. Then the specimens were subjected to initial microhardness test using Vicker's hardness tester (AVK-CO, Mitutoyo, Japan). Two indentations were placed at 100 mm from one another in the center of all the samples. Bleaching with laser and without laser using hydrogen peroxide was performed followed by remineralization in the groups (Groups 1a and 2a) and then were subjected to erosion. The final hardness was measured using the above method used for initial microhardness.

Results

Microhardness in the remineralized groups showed least variation. The group in which laser bleaching was performed along with remineralization as compared with nonlaser bleaching group with remineralization showed improvement in microhardness but the data was not statistically significant. A significant difference was noted between the laser and remineralization group when compared with the groups in which no remineralization was done.

Conclusion

After bleaching the enamel surface is more prone to erosion, so to improve the microhardness of bleached enamel a remineralizing agent should be used. A combination of diode laser bleaching and remineralizing agents leads to improved microhardness of the bleached enamel thus proving this combination to be efficacious.

Effect of bleaching on color and surface topography of teeth with enamel caries treated with resin infiltration (ICON®) and remineralization (casein phosphopeptide-amorphous calcium phosphate)

Background

Dental bleaching is not recommended on teeth with enamel caries.

Aim

The study aimed to assess the efficacy of in-office bleaching on demineralized enamel managed by resin infiltration (RI) as well as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP).

Methodology

Forty-eight sound enamel specimens were divided into four groups based on the surface treatment performed before in-office bleaching. Group I consisted of no caries and no treatment (NT); Group II had artificial caries (AC) and NT; Group III had AC treated with RI, and Group IV had AC remineralized with CPP-ACP. Pre- and postbleaching teeth color and surface topography were evaluated using spectrophotometer and scanning electron microscope (SEM), respectively.

Statistical Analysis Used

One-way analysis of variance and Tukey's post hoc test were performed for inter-group comparisons.

Results

The color change postbleaching was the least in Group IV; and this was significantly less than Group I (P < 0.05) and Group II (P < 0.001). The bleaching efficiency in Group III was not significantly different from the control group. In addition, the enamel topographic changes were less in the surface-treated group.

Conclusion

RI can be considered a treatment modality for teeth with enamel caries requiring tooth whitening as the bleaching efficiency was like that of sound enamel.

Assessment of the Remineralizing Potential of Biomimetic Materials on Early Artificial Caries Lesions after 28 Days: An In Vitro Study

This study aimed to evaluate the loss of mineral content in the enamel surface in early artificial lesions and to assess the remineralizing potential of different agents by means of SEM coupled with energy-dispersive X-ray analysis (EDX). The analysis was performed on the enamel of 36 molars divided into six equal groups, in which the experimental ones (3-6) were treated using remineralizing agents for a 28-day pH cycling protocol as follows: Group 1, sound enamel; Group 2, artificially demineralized enamel; Group 3, CPP-ACP treatment; Group 4, Zn-hydroxyapatite treatment; Group 5, NaF 5% treatment; and Group 6, F-ACP treatment. Surface morphologies and alterations in Ca/P ratio were evaluated using SEM-EDX and data underwent statistical analysis (p < 0.05). Compared with the sound enamel of Group 1, the SEM images of Group 2 clearly showed loss of integrity, minerals, and interprismatic substances. Groups 3-6 showed a structural reorganization of enamel prisms, interestingly comprising almost the entire enamel surface. Group 2 revealed highly significant differences of Ca/P ratios compared with other groups, while Groups 3-6 showed no differences with Group 1. In conclusion, all tested materials demonstrated a biomimetic ability in remineralizing lesions after 28 days of treatment.

Effect of self-assembling peptide and other remineralizing agents on preventing initial enamel lesions around orthodontic brackets: An in vitro comparative study

OBJECTIVE

To investigate and compare the effect of self-assembling peptide SAP (P_11-4), casein phosphopeptide-amorphous calcium phosphate fluoride paste (CPP-ACPF), and fluoride varnish (FV) on preventing enamel demineralization around orthodontic brackets.

MATERIAL AND METHODS

Orthodontic brackets were bonded to the buccal surfaces of 80 freshly extracted human maxillary premolars. Teeth were randomly assigned to four groups (n=20) according to the remineralizing agent used as follows: SAP (P_11-4) group (Curodont™ Protect/Credentis), CPP-ACPF group (MI Paste Plus®/Recaldent™), fluoride varnish group (Profluoride varnish®/VOCO), and control group. All products were applied according to the manufacturer's instructions. Specimens were cycled in daily refreshed demineralizing and remineralizing solutions for 8h and 16h, respectively, for 28 days. The calcium/phosphorus ratio (Ca/P) and surface microhardness (SMH) were evaluated at baseline and at two and four weeks. Two-way ANOVA (analysis of variance), one-way ANOVA and repeated measures ANOVA were used for statistical analysis.

RESULTS

Two-way ANOVA demonstrated significant differences between remineralizing agents and time points. After 4 weeks, the SAP (P_11-4) group had had significantly higher Ca/P ratio and SMH (1.68±0.11 and 346.47±55.38) compared to other groups, followed by CPP-ACPF (1.52±0.19 and 283.53±64.75), FV (1.37±0.14 and 262.80±82.98), and the control group (1.31±0.10 and 213.00±41.95). Significantly higher Ca/P ratio and SMH were observed at 2 weeks in the control group (1.44±0.10 and 269.63±57.37) and FV group (1.52±0.09 and 321.17±55.24) compared to 4 weeks. No significant differences were found regarding Ca/P ratio and SMH at 2 weeks in the CPP-ACPF (1.55±0.15 and 295.14±53.88) and SAP P_11-4 groups (1.64±0.10 and 320.18±58.04) compared to 4 weeks.

CONCLUSION

SAP (P_11-4) had the greatest remineralizing efficacy compared to FV and CPP-ACPF. Moreover, extended period of time improved the preventive efficacy of SAP (P_11-4) compared to the other regimens.

Regenerative biomineralization potential of commercially available remineralizing agents as a preventive treatment approach for tooth erosion - An in vitro laser-induced breakdown spectroscopy analysis

Context

In today's era, erosion is the most prevalent type of tooth wear. The prevention of demineralization with biomineralization is the most desired treatment.

Aim

The aim of this study is to evaluate and compare the surface remineralization potential of two remineralizing agents - self-assembling peptide P11-4 (SAP P11-4) and calcium silicate plus sodium phosphate (CSSP) salts on intact and demineralized enamel using laser-induced breakdown spectroscopy (LIBS).

Subjects and Methods

Sixteen maxillary premolars were decoronated and split into buccal and palatal halves embedded in acrylic resin with a total sample size of 32 designated into Group 1 (intact teeth) and Group 2 (demineralized teeth). Further subdivision into Groups 1a and 2a (SAP P11-4 group [n = 8]); Groups 1b and 2b (CSSP group [n = 8]), Group 2 was first exposed to Coca-Cola. Then, all groups were subjected to experimental LIBS. Groups 1a and 2a were treated with SAP P11-4 based product, i.e., CURODONT™ PROTECT gel. Groups 1b and 2b were treated with CSSP-based products regimen, i.e., REGENERATE Enamel Science™ Advanced Toothpaste and Advanced Enamel Serum. The LIBS assessment was redone for all groups to attain a change in Ca and P values.

Statistical Analysis Used

Inferential statistics were done using Wilcoxon signed-rank test (Before-After product application) and Mann-Whitney U-test (between the groups).

Results

According to the statistical evaluation there was a statistically significant difference (P < 0.05), in Ca and P values in demineralized teeth when both SAP P11-4 and CSSP groups were evaluated. Although Ca values exhibited a significant difference in intact teeth, P did not exhibit a significant difference on the application of both remineralizing agents. The remineralizing potential between the two agents, SAP P11-4 and CSSP groups. There was no statistically significant difference ( P <0.05) observed between the two agent's remineralization potential for intact and demineralized teeth.

Conclusion

SAP P11-4 and CSSP have the potential to remineralize both intact and demineralized enamel. There was increased remineralization in demineralized samples subjected to erosion.

Evaluation of Remineralization Potential of Natural Substances on Artificially Induced Carious Lesions in Primary Teeth: An In Vitro Study

Aim

To evaluate the remineralizing potential of natural substances on artificially induced caries lesions in primary teeth.

Materials and methods

A total of 50 primary molar teeth were selected and subjected to a demineralization process. Then samples were randomly divided into five groups for the remineralization process. Group I-colophony, group II-5% sodium fluoride (NaF) + colophony, group III-grape seed extract (GSE) + colophony, group IV-5% NaF + colophony + 10% peptide, and group V- GSE + colophony + 10% peptide. All the groups were subjected to remineralization using a brushing stimulator for 3,000 cycles. Assessment was done using Vickers hardness testing machine for evaluating the enamel surface microhardness (SMH) and scanning electron microscopy-energy dispersive X-ray analysis (SEM-EDX) for evaluating the surface morphology and mineral content, before and after demineralization and after remineralization, the obtained data was analyzed statistically using IBM Statistical Package for the Social Sciences (SPSS) software version 25.

Results

The enamel microhardness results of this study revealed that remineralization of enamel was highest in group V (212.83 ± 64.416) and least in group II (137.83 ± 26.324) p-value of 0.038. SEM-EDX analysis revealed high calcium (Ca) and fluoride (F) content in groups II and IV, which was significant (p-value of 0.001) from other groups. Surface morphology evaluated with SEM revealed spherical globular agglomerates and scaffolding deposits on the enamel surface in groups III and V resembling the remineralization process.

Conclusion

Grape seed extract (GSE) with colophony and peptide is a superior natural alternative to NaF. Colophony also exhibited remineralizing potential in primary enamel.

Clinical significance

Natural remineralizing agents like GSE, colophony, and its combination serves as a potential alternative to overcome the toxic effect on long-term usage of F. These natural substances can be applicable in clinical conditions by incorporating toothpaste and varnish, which can be used as an alternative or adjuvant to the topical application of F.

How to cite this article

Pooja V Ravi, Rajakumar S, Kavitha Ramar. Evaluation of Remineralization Potential of Natural Substances on Artificially Induced Carious Lesions in Primary Teeth: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(2):244-250.

Effect of Remineralizing Agents on Shear Bond Strength of Orthodontic Brackets-In Vitro Study

Orthodontic treatment can be effective only with the proper adhesion strength of the bonded elements on the teeth. The aim of the study was to analyze the influence of different remineralization products on the brackets (Evolve Low Profile Brackets 0.022 Roth prescription (DB Orthodontics Ltd., Silsden, England) shear bond strength (SBS)). In all, 40 teeth were investigated for this study; n = 30 demineralized (immersed in 0.1% citric acid for 30 min, twice a day, for 20 consecutive days) and n = 10 immersed only in artificial saliva. After the demineralization process, remineralization agents were applied to each group (n = 10): Group I: Elmex Sensitive professional^® toothpaste (CP, Gaba GmbH, Witten, Germany) and GC MI Paste Plus^® (GC, Leuven, Belgium), Group II: Elmex Sensitive professional^® toothpaste (CP, Gaba GmbH, Germany) and GC Tooth Mousse^® (Leuven, Belgium), Group III: Elmex Sensitive professional^® toothpaste (CP, Gaba GmbH, Germany). For the teeth in control group C, Elmex Sensitive professional^® toothpaste was used. SBS tests were performed by means of an advanced materials-testing machine that generated maximum load and tensile strength values. The data obtained underwent statistical analysis (ANOVA and Tuckey test) with a statistical threshold of p < 0.05. The SBS values were higher for group II (14.20 MPa) and I (10.36 MPa) and lower for group III (4.25 MPa) and C (4.11 MPa), with statistically significant differences between groups I and II when compared with groups III and C (p < 0.05). In conclusion, GC Tooth Mousse^® and MI-Paste Plus^® have no adverse effect on brackets SBS and are recommended to be used for enamel remineralization during orthodontic treatment.

Ex-vivo effects of propolis quantum dots-nisin-nanoquercetin-mediated photodynamic therapy on Streptococcus mutans biofilms and white spot lesions

BACKGROUND

White spot lesions (WSLs) remain one of the most critical adverse sequelae of fixed orthodontic treatment, despite materials and techniques advances in orthodontics. WSLs seem to be a multi-factorial interaction including increased microbial plaque due to intrabuccal appliances that limit the oral-cleansing mechanism and change in the oral microbiome during fixed appliance wear. The aim of this study was to investigate the synergistic effect of propolis quantum dots (PQD), nisin (Nis), and quercetin nanoparticles (nQCT)-mediated photodynamic therapy (PQD-Nis-nQCT-mediated aPDT) in the eradication of Streptococcus mutans biofilms and the remineralization of WSLs ex-vivo.

MATERIALS AND METHODS

The cytotoxicity of PQD-Nis-nQCT composite on human gingival fibroblasts was evaluated using neutral red. Intracellular reactive oxygen species (ROS) generation following PQD-Nis-nQCT-mediated aPDT was measured. Enamel slabs were prepared and demineralized using a demineralization solution containing S. mutans. Demineralized enamel slabs were divided into 9 groups (n = 10) and treated in the following groups: 1) Artificial saliva (negative control), 2) 2% neutral sodium fluoride gel (NSF; positive control or treatment control, 3) PQD, 4) Nis, 5) nQCT, 6) Nis-nQCT, 7) PQD-Nis-nQCT 8) Blue laser irradiation (light), 9) PQD-Nis-nQCT with irradiation (PQD-Nis-nQCT-mediated aPDT). Then, the surface changes, microhardness, and surface topography of the demineralized slabs were examined following each treatment using DIAGNOdent Pen reading, digital hardness tester, and SEM, respectively. After the determination of minimum biofilm eradication concentration (MBEC) of PQD, Nis, and nQCT by microtiter plate assay, the synergistic antimicrobial effects of PQD and Nis-nQCT were determined via evaluation of fractional biofilm eradication concentration (FBEC) index. The anti-biofilm effects of each treatment on S. mutans were assessed using a colorimetric assay. The virulence‑associated gtfB gene expression was assessed following PQD-Nis-nQCT-mediated aPDT by quantitative real‑time PCR.

RESULTS

PQD-Nis-nQCT at 2048 µg/mL had no significant cell cytotoxicity on human gingival fibroblasts compared to the control group (P > 0.05). A significantly increased (7.6 fold) in intracellular ROS was observed following PQD-Nis-nQCT-mediated aPDT (13.9 ± 1.41) when compared to the control (1.83 ± 0.13). Following each treatment, the microhardness of the demineralized enamel surface significantly increased except for the artificial saliva (negative) and blue laser irradiation groups. The highest change in microhardness improvement was detected in the PQD-Nis-nQCT-mediated aPDT group (P < 0.05). Also, DIAGNODent Pen reading revealed the highest significant improved change in the level of mineralization degree in the PQD-Nis-nQCT-mediated aPDT group. Nis and blue light irradiation groups, like the artificial saliva-treated demineralized enamel slabs (control group), did not lead to remineralization (P > 0.05). Also, the PQD-Nis-nQCT-mediated aPDT treatment results obtained from SEM revealed that remineralization of demineralized enamel slabs in that group has significantly improved compared to the others. Light-activated nQCT, PQD, Nis-nQCT, and PQD-Nis-nQCT composite significantly reduced pre-formed biofilms of S. mutans compared with unactivated forms of test materials. The relative expression level of the virulence gtfB gene was significantly decreased (7.53-fold) in the presence of PQD-Nis-nQCT-mediated aPDT (P < 0.05).

CONCLUSION

PQD-Nis-nQCT-mediated aPDT can be used for the eradication of S. mutans biofilms and remineralization of WSLs. The found in vitro efficacy should be tested further through clinical studies.

Evaluation of the Efficacy of CPP-ACP Remineralizing Mousse in Molar-Incisor Hypomineralized Teeth Using Polarized Raman and Scanning Electron Microscopy-An In Vitro Study

Remineralization of tooth enamel can be achieved by applying a complex of casein phosphopeptides and amorphous calcium phosphate (CPP-ACP). However, the efficacy and optimization of this agent in molar−incisor hypomineralization (MIH) lacks evidence. The purpose of this study is to evaluate the efficacy of CPP-ACP tooth mousse in remineralizing MIH-affected enamel in an optimized 28-day protocol using polarized Raman microscopy and scanning electron microscopy. The protocol was applied to two types of MIH opacities, white and yellow, and compared against sound enamel specimens before and after treatment. Data was analyzed using a one-way ANOVA and LSD post hoc multiple comparisons test (p < 0.05) for the Raman analysis. Hypomineralized enamel showed an improvement of its structure after CPP-ACP supplementation. In addition, Raman spectroscopy results showed a decrease in the depolarization ratio of the symmetric stretching band of phosphate (p < 0.05 for both groups). In conclusion, there was an improvement in mineral density and organization of the hypomineralized enamel after treatment with CPP-ACP tooth mousse.

Evaluation of the Efficacy of CPP-ACP Remineralizing Mousse in MIH White and Yellow Opacities-In Vitro Vickers Microhardness Analysis

Remineralization of tooth enamel can be partially achieved by the application of a casein phosphopeptides and amorphous phosphate (CPP-ACP) complex. However, evidence to support its effectiveness in Molar-incisor-hypomineralization (MIH)-affected teeth is scarce. The study’s aim is to evaluate the efficacy of CPP-ACP mousse in remineralizing MIH-affected enamel using a Vickers microhardness test. Two groups of enamel opacities of hypomineralized permanent teeth, white (group A) and yellow (group B) lesions (n = 14), went through a 28-day treatment protocol with GC Tooth Mousse. Before and after treatment, microhardness was measured in three different areas of each tooth (hypomineralized, transition, and outside the hypomineralized area). Data were analyzed using parametric and non-parametric tests with a significance of p < 0.05. The mean microhardness values increased in the hypomineralized and transition areas in both groups after the treatment protocol (in group A, 105.38 ± 11.70 to 158.26 ± 37.34; 123.04 ± 22.84 to 156.33 ± 35.70; in group B, 108.63 ± 14.66 to 143.06 ± 22.81; 132.55 ± 20.66 to 146.00 ± 12.88) and the differences pre/post-treatment were statistically significant within each group (p < 0.001 for both groups). Between groups, there was a statistically significant difference in the same areas (hypomineralized: p = 0.003; transition: p = 0.008) with a higher improvement in enamel hardness in group A. Topical application of CPP-ACP showed an increase in the physical strength of the hypomineralized and transition areas of MIH-affected enamel, likely due to an increase in mineral content.

Effect of Silver Diamine Fluoride and Potassium Iodide Solution on Enamel Remineralization and Discoloration in Artificial Caries

Silver diamine fluoride (SDF) is a strong fluoride agent for caries control, remineralization, and reducing the incidence of dental caries. This study used 38% SDF with potassium iodide (KI) on enamel remineralization and compared it with the currently used 38% SDF and 5% sodium fluoride (NaF) varnish to treat artificial caries. Bovine incisors were demineralized for 120 h and randomly distributed for treatment by the remineralization agents for 120 h as follows: control (n = 15), SDF/KI (n = 15), SDF (n = 15), and NaF (n = 15). Colorimetric analysis was performed using the ΔE value. The Vickers microhardness (VHN) was determined to evaluate the enamel remineralization of the specimens. Polarized light microscopy (PLM) and scanning electron microscopy (SEM) were performed to confirm the surfaces precisely and histologically. SDF/KI caused no significant difference in discoloration between the control and NaF groups. There was also no significant difference in the VHN after remineralization, but SDF/KI exhibited the highest mean microhardness. PLM revealed that SDF/KI had the greatest remineralization ability. In conclusion, SDF/KI is effective for dental enamel remineralization even with KI, which reduces discoloration.

Comparison of Remineralization Potential of Casein Phosphopeptide: Amorphous Calcium Phosphate, Nano-hydroxyapatite and Calcium Sucrose Phosphate on Artificial Enamel Lesions: An In Vitro Study

Aim and objective

To evaluate and compare the remineralization potential of CPP-ACP, nano-hydroxyapatite, and calcium sucrose phosphate toothpaste on artificial enamel caries lesions by means of microhardness testing.

Materials and methods

Twenty sound human primary molars, extracted for therapeutic reasons were selected for this study. From each tooth, two enamel specimens were prepared and embedded in acrylic resin blocks, and each block contains five tooth samples. After polishing, the baseline hardness of the enamel surface (KHN) was determined by Knoop microhardness testing. Then the specimens were randomly assigned into four groups (n = 10), according to the remineralizing agent used: group I: Control, group II: GC Tooth Mousse^TM (CCP-ACP), group III: Acclaim^TM (nano-HAP), and group IV: EnaFix (CaSP). The specimens were then immersed in a demineralizing solution and post-lesion KHN values were obtained as baseline measurements. Later remineralizing agent was applied and after 7 days of remineralization, posttreatment KHN tests were conducted.

Results

Data were analyzed using paired t- test, analysis of variance, and Tukey HSD test. Mean enamel surface microhardness (KHN) values after remineralization shows that group IV (EnaFix^TM) had maximum hardness number (114.71 ± 12.27) followed by group III (Acclaim) (85.14 ± 22.82) and group II (GC Tooth Mousse) (56.42 ± 19.90). The difference was statistically significant (p < 0.001). Similarly the %SMHR was also highest in group IV (EnaFix), followed by group III (Acclaim) and group II (GC Tooth Mousse).

Conclusion

EnaFix (calcium sucrose phosphate) shows a maximum increase in the enamel surface microhardness followed by Acclaim (nano-HAP) and GC Tooth Mousse.

Clinical significance

Calcium Sucrose Phosphate in toothpaste strengthened the enamel more than nano hydroxyapatite and CPP-ACP, and can be an alternative to the use of fluoride toothpaste in children.

How to cite this article

Sebastian R, Paul ST, Azher U, et al. Comparison of Remineralization Potential of Casein Phosphopeptide: Amorphous Calcium Phosphate Nano-hydroxyapatite and Calcium Sucrose Phosphate on Artificial Enamel Lesions: An In Vitro Study. Int J Clin Pediatr Dent 2022;15(1):69-73.

An alkasite restorative material effectively remineralized artificial interproximal enamel caries in vitro

OBJECTIVE

To evaluate the remineralization of artificial interproximal enamel caries (AIEC) adjacent to alkasite, high viscous glass ionomer cement (HVGIC), and resin composite in class II restorations.

MATERIALS AND METHODS

Human enamel specimens were randomly assigned to 3 groups (n = 22): Filtek™ Z350, EQUIA Forte^®, and Cention N^®. The baseline hardness was determined using a Knoop microhardness assay. AIEC was formed in the specimens, and they were placed in contact with the proximal restorative materials then subjected to a 7-day pH cycling. Microhardness was determined post-artificial caries formation and post-pH cycling. The differences in the percentage of surface hardness recovery (%SHR) between the groups were compared using the Kruskal-Wallis test. The Dunn's test was used for between-group comparisons (p < 0.05). Specimen surface morphology was evaluated using scanning electron microscopy (SEM), and the calcium, phosphorus, and fluoride contents were analyzed by energy-dispersive spectroscopy (EDS). ANOVA with the post hoc Tukey multiple comparison test was used to evaluate the differences between groups (p < 0.05).

RESULTS

The Cention N^® %SHR was the highest, followed by EQUIA Forte^®, and Filtek™ Z350. There was a significant difference in the %SHR between Cention N^® and Filtek™ Z350 (p < 0.05). In contrast, there were no significant difference between Cention N^® and EQUIA Forte^®. Significantly increased enamel surface fluoride content was observed in the Cention N^® compared with Filtek™ Z350 specimens (p < 0.05). The SEM image of the Cention N^® specimens demonstrated the greatest mineral deposition.

CONCLUSIONS

Cention N^® markedly increased the surface hardness and fluoride content of adjacent AIEC compared with Filtek™ Z350 restorations.

CLINICAL RELEVANCE

Cention N^® is a promising alternative restorative material to remineralize initial enamel lesions in approximal adjacent surfaces, especially in high-risk caries patients.

Comparative evaluation of the remineralizing potential of different calcium and fluoride-based delivery systems on artificially demineralized enamel surface; an in vitro study

BACKGROUND

Enamel is the hardest and vastly mineralized structure of the human body. Inorganic salts make up the majority of it. Water and ions pass right through the enamel. The enamel undergoes demineralization and remineralization cycle throughout life. Recently, the interest in the development of calcium, phosphate, and fluoride remineralization technology has been increased leading to the development and reintroduction of various remineralizing agents such as fluoride, casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), nano-hydroxyapatite (nano-HA), xylitol, bioglass, Ozone, etc.

AIM

The aim of this study is to evaluate and compare the potential remineralization of CPP-ACPF, calcium sucrose phosphate (CaSP), amine fluoride (AmF), and nano-HA.

SETTINGS AND DESIGN

The design of this research is experimental. This is an in vitro study. The research was carried out at the Dental Teaching Institute. This study involved human teeth. No demographic data were obtained. One hundred and twenty premolars were selected from the tooth bank of the Department of Oral and Maxillofacial Surgery. The teeth included in the study were noncarious, nonrestored, and nonfractured extracted teeth. Teeth excluded from the study were extracted teeth with any visible or detectable caries, white spot lesions, microcracks, attrition, abrasion, erosion, or abfraction.

MATERIALS AND METHODS

One hundred and twenty enamel samples were taken; they were divided into six groups (n = 20). The demineralization process was carried out on Groups II, III, IV, V, and VI. The remineralization process was carried out on Groups III, IV, V, and VI for 14 days using CASP, AmF, and nano-HA, respectively. No surface treatment was performed in Group I causing it a positive control group, whereas Group II was considered a negative control with only enamel surface demineralization and no remineralization. The microhardness of enamel was measured using Vickers microhardness testing machine after a 14-day remineralization regimen.

STATISTICAL ANALYSIS

In the statistical analysis, one-way analysis of variance and post hoc Tukey's tests were performed.

RESULTS

The mean microhardness values in declining order: positive control > nano-HA > AmF > CaSP > CPP-ACPF > negative control.

CONCLUSION

All remineralizing agents exhibited enhanced surface remineralization. Nano-HA showed the highest remineralization potential followed by AmF, CaSP, and CPPACPF.

Quantitative Analysis and Effect of SDF, APF, NaF on Demineralized Human Primary Enamel Using SEM, XRD, and FTIR

Introduction

Topical fluoride therapy has proven benefits in the prevention of demineralization. Tooth enamel has shown a great potential for remineralization with an application of topical fluorides if administered at an appropriate time. In an effort to find an effective remineralizing agent, a novel fluoride agent silver diamine fluoride (SDF) has emerged as a potent caries arresting as well as caries preventing agent.

Aim and objective

The present study was aimed at determining the primary tooth enamel resistance to demineralization after topical application of three fluoride agents SDF, APF, and NaF.

Materials and methods

Enamel specimens were prepared from 40 caries-free primary molars. These specimens were randomly allocated into three groups of 10 specimens each and they were treated by different topical fluorides namely: Group I-SDF, group II-Acidulated phosphate fluoride (APF), group III-Sodium fluoride. Three enamel specimens from each group were placed on custom-made acrylic blocks with 5 × 5 mm of an exposed window for scanning electron microscope (SEM) evaluation and rest of the specimens were ground into a fine powder for X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR) analysis. The tooth blocks and treated samples were subjected to the demineralization process for 168 hours. They were then qualitatively assessed to evaluate their resistance to demineralization using SEM, XRD, and FTIR.

Results and conclusion

Morphologically, the enamel of all groups specimens was mostly smooth with some groves and microporosities. Chemically, the Ca/P molar ratios of all groups were similar with slight variations. Structurally, the crystalline phases found in enamel by powder XRD were hydroxyapatite and carbonate apatite; and there was a higher amount of incorporated type B carbonate than type A carbonate as evidenced by FTIR. The study concludes that topical application of a 38% SDF solution can inhibit demineralization of enamel.

How to cite this article

Jabin Z, Nasim I, Vishnu Priya V, et al. Quantitative Analysis and Effect of SDF, APF, NaF on Demineralized Human Primary Enamel Using SEM, XRD, and FTIR. Int J Clin Pediatr Dent 2021;14(4):537-541.

Rehardening of Eroded Enamel with CPP-ACFP Paste and CO2 Laser Treatment

BACKGROUND

Diet and lifestyle can destroy tooth structure due to the dissolution of enamel by acidic beverages. The present study evaluated the effect of CO2 laser irradiation and CPP-ACFP (casein phosphopeptide and amorphous calcium phosphate with fluoride) paste on the remineralization of enamel eroded by carbonated soft drinks.

METHODS

In the present in vitro study, 46 human sound premolar teeth were sectioned mesiodistally to achieve 84 samples. Fourteen samples were assigned to the positive control group (G1), and the remaining samples were immersed in 500 mL of cola drink for 2 minutes, followed by rinsing with distilled water for 10 seconds. This procedure was carried out three times to create erosive lesions. Then, the 60 eroded samples were randomly assigned to five groups of G2 to G6 in terms of the treatment as follows: negative control (G2), CO2 laser irradiation (G3), CPP-ACFP paste (G4), CO2 laser irradiation followed by CPP-ACFP paste application (G5), and CPP-ACFP paste application followed by CO2 laser irradiation (G6). The mean surface microhardness of the enamel surface was evaluated and determined at three points for each sample. Data were analyzed with one-way ANOVA and Tukey HSD tests (α = 0.05).

RESULTS

The highest and the lowest hardness values were recorded in the G1 (314 ± 12 kg/mm2) and G2 (213.7 ± 12 kg/mm2) groups, respectively. ANOVA revealed significant differences between the study groups (P < 0.001). Two-by-two comparisons showed significant differences between the G2 group and the other groups, indicating the efficacy of all the treatment modalities in tooth remineralization and rehardening procedures (P < 0.05). Only in group G6, the enamel microhardness was not significantly different from the G1 positive control group (P > 0.05).

CONCLUSION

Considering the parameters used in the present study, CO2 laser irradiation or CPP-ACFP paste application alone increased eroded enamel's surface hardness; however, their sequential application was more effective in rehardening the eroded enamel's surface to near-normal levels.

The Influence of Enzymatic Hydrolysis of Whey Proteins on the Properties of Gelatin-Whey Composite Hydrogels

Amino-acids, peptides, and protein hydrolysates, together with their coordinating compounds, have various applications as fertilizers, nutritional supplements, additives, fillers, or active principles to produce hydrogels with therapeutic properties. Hydrogel-based patches can be adapted for drug, protein, or peptide delivery, and tissue healing and regeneration. These materials have the advantage of copying the contour of the wound surface, ensuring oxygenation, hydration, and at the same time protecting the surface from bacterial invasion. The aim of this paper is to describe the production of a new type of hydrogel based on whey protein isolates (WPI), whey protein hydrolysates (WPH), and gelatin. The hydrogels were obtained by utilizing a microwave-assisted method using gelatin, glycerol, WPI or WPH, copper sulfate, and water. WPH was obtained by enzymatic hydrolysis of whey protein isolates in the presence of bromelain. The hydrogel films obtained have been characterized by FT-IR and UV-VIS spectroscopy. The swelling degree and swelling kinetics have also been determined.

Comparative evaluation of the spectral-domain optical coherence tomography and microhardness for remineralization of enamel caries lesions

This study aimed to evaluate the Cirrus high-definition (HD) spectral-domain optical coherence tomography (SD-OCT) for the remineralization of artificial enamel caries and to compare it with the comparison surface microhardness (SMH) analysis. Artificial caries lesions were produced on forty human enamel samples. Then, three different remineralization agents containing casein phosphopeptide amorphous calcium phosphate; casein phosphopeptide amorphous calcium fluoride phosphate; calcium glycerophosphate, magnesium chloride, and xylitol; and remineralization solution (control) were applied with pH cycling for six days. The optical depth of backscattered light and microhardness of enamel were measured using SD-OCT and SMH. All remineralization agents were significantly efficient in reducing optical lesion depth on enamels (p₁=0.001, p₂=0.002, p₃=0.006, p₄=0.025), and in increasing the SMH of enamels (p_1-3=0.005, p₄=0.017). However, the optical lesion depths of the enamel showed no correlation with the SMH in the groups. In conclusion, demineralization and remineralization of artificial lesions can be assessed with both SD-OCT and SMH.

The effect of Remin Pro on the microhardness of initial enamel lesions in primary teeth: An in vitro study

BACKGROUND

Remineralization is currently considered a treatment option for many clinicians. The present study was conducted to compare the effect of three remineralizing agents on microhardness of initial caries lesions in primary teeth.

MATERIALS AND METHODS

In this in vitro study, 96 enamel samples were prepared. Microhardness was first measured for all the samples using the Vickers microhardness test. After developing the initial caries lesions, the microhardness of all the demineralized samples was measured, and the samples were then divided into four groups (n = 24). Casein phosphopeptide-amorphous calcium phosphate in Group 1, Remin Pro in Group 2, and acidulated phosphate fluoride gel in Group 3 were placed on the samples for 4 min. The control group received no treatments. The microhardness of the samples was measured again following a pH cycle of 5 days. The data were analyzed by ANOVA and the post hoc test at the significance level of P < 0.05.

RESULTS

The mean microhardness reduced significantly in all the groups following the development of initial caries lesions and after the pH cycle of 3 days (P < 0.001). After the remineralization and pH cycle of 5 days, the mean microhardness was significantly lower in the control group compared to the other three groups (P < 0.001) and had increased in the three treated groups. The microhardness recovery rate also increased in the treated groups compared to the control group, but no significant differences were observed between the three groups themselves (P > 0.05).

CONCLUSION

Remin Pro can be used as an effective substance for preventing tooth caries in children.

Comparative evaluation of qualitative and quantitative remineralization potential of four different remineralizing agents in enamel using energy-dispersive X-ray: An in vitro study

Background:

The principles of minimally invasive dentistry clearly tells us the need for clinically effective measures to remineralize the early enamel caries lesions.

Aims and Objectives:

The aim of this study was to evaluate the remineralisation potential of four different remineralisation agents used quantitatively by surface microhardness and qualitatively by energy dispersive X ray analysis.

Materials and Methods:

Artificial enamel lesions were created on the buccal surfaces of 60 extracted mandibular second premolar. Specimens were randomly assigned to four groups (n=15) according to the remineralisation agents used: Group 1-Nano Hydroxyapatite, Group 2-Fluoride, Group 3-CPP ACP, Group 4-Chitosan 5mg. All products were applied according to the manufacturer's instructions and specimens were stored in daily renewed artificial saliva. Surface microhardness was assessed using Rockwell hardness test and change in mineral content was evaluated using Energy Dispersive X ray analysis.

Statistical Analysis:

One way analysis of Variance test and post-hoc Tukey test were conducted for multiple group comparison.

Results:

There was remarkable remineralisation in Hydroxyapatite treated comparatively to the other three groups.

Conclusion:

All remineralising agents showed improved surface remineralisation. However complete remineralisation did not occur within 7 days. Nanohydroxyapatite showed the highest potential for remineralisation followed by CPP-ACP, Chitosan and Fluoride.

Combined effect of casein phosphopeptide-amorphous calcium phosphate and sodium trimetaphosphate on the prevention of enamel demineralization and dental caries: an in vitro study

OBJECTIVE

To evaluate the effect of treatment with fluoridated toothpaste supplemented with a combination of sodium trimetaphosphate (TMP) and casein phosphopeptide-amorphous calcium phosphate (MI Paste Plus^®) on the demineralization of dental enamel.

METHODS

Bovine enamel blocks selected by initial surface hardness (SHi) were randomly allocated into six groups (n = 12), according to the test toothpastes: (1) without F-TMP-MI Paste Plus^® (Placebo); (2) 1100 ppm F (1100F); (3) MI Paste Plus^®; (4) 1100F + MI Paste Plus^® (1100F-MI Paste Plus), (5) 1100F + 3 % TMP (1100F-TMP); and (6) 1100F-TMP + MI Paste Plus^® (1100F-TMP-MI Paste Plus). Blocks were treated two times per day with slurries of toothpaste (1 min), and groups 4 and 6 received an application of MI Paste Plus (3 min). Next, the samples were subjected to five pH cycles (demineralizing/remineralizing solutions) at 37 °C, to produce subsurface enamel lesions.Thereafter, the blocks were maintained for 2 days in fresh remineralizing solution. After pH cycling, the following were obtained: percentage of surface hardness loss (%SH); integrated loss of subsurface hardness (ΔKHN); profile analysis and lesion depth subsurface through polarized light microscopy (PLM); scanning electron microscopy (SEM); and fluoride (F), calcium (Ca), and phosphorus (P) in the enamel. The data were subjected to ANOVA (1-criterion), followed by the Student-Newman-Keuls test (p < 0.001).

RESULTS

The 1100F-TMP-MI Paste Plus group showed better results for SHR, ΔKHN, and PLM (p < 0.001). The F concentration was similar among all groups (p > 0.001). The 1100F-TMP-MI Paste Plus group showed the highest concentration of Ca and P in the enamel (p < 0.001).

CONCLUSION

The application of 1100F-TMP-MI Paste Plus promoted a higher inhibitory effect against enamel demineralization.

CLINICAL SIGNIFICANCE

The combination of treatments with F, TMP, and MI Paste Plus^® can be an effective alternative to improve the oral health of individuals, especially those with high activity of dental caries and at high risk for its development.

In vitro remineralization of primary teeth with a mineralization-promoting peptide containing dental varnish

Mineralization-promoting peptides are attractive candidates for new remineralization systems. In previous studies, peptides have been applied as aqueous solutions, which is not a clinically relevant form.

OBJECTIVE

This study aims to investigate the efficiency of a mineralization-promoting peptide, applied in varnish, on remineralizing artificial caries on primary teeth.

METHODOLOGY

55 primary molars were collected. Specimens were immersed in a demineralizing solution for 7 days and then, divided into 7 groups: Baseline: No-remineralization, Placebo: Blank colophony, F: Colophony 5% fluoride, P: Colophony 10% peptide, P+F: Colophony 5% fluoride and 10% peptide, Embrace: Embrace™ varnish, Durashield: Durashield™ varnish. A mixture of 35% w/v colophony varnishes were prepared in ethanol and applied accordingly. Specimens were immersed in a remineralization solution for 4 weeks and it was evaluated using PLM and SEM. Lesion depth reduction was examined by one-way ANOVA.

RESULTS

There was no significant difference in mean lesion depths between baseline (147.04 ± 10.18 μm) and placebo groups (139.73 ± 14.92 μm), between F (120.95 ± 12.23 μm) and Durashield (113.47 ± 14.36 μm) groups and between P (81.79 ± 23.15 μm) and Embrace (90.26 ± 17.72 μm) groups. Lesion depth for the P+F group (66.95±10.59 μm) was significantly higher compared to all other groups. All groups contained samples with subsurface demineralized regions. Number of subsurface demineralized regions were higher in fluoride-containing groups.

CONCLUSIONS

We conclude that the mineralization-promoting peptide (MPP3) is effective in this in vitro study and the peptide shows benefits over fluoride as it yields less subsurface demineralized regions.

Effect of Two Methods of Remineralization and Resin Infiltration on Surface Hardness of Artificially Induced Enamel Lesions

Statement of the Problem:

The progression of incipient carious lesions may be simply prevented by non-invasive remineralization of lesions, eliminating the need for invasive and high-cost restorative procedures.

Purpose:

This study aimed to assess the effect of two commonly used remineralizing agents and resin infiltration on surface micro hardness of incipient enamel lesions at different time points.

Materials and Method:

In this in vitro study, 45 intact human maxillary central incisors were selected. After disinfection, enamel samples measuring 5x5x2.5 mm were cut out of the labial surface of the teeth. The surface of samples was polished and they were mounted in auto-polymerizing acrylic resin. According to Amaechi’s method, samples were immersed in acidified hydroxyethylcellulose system (pH= 4.5) for 96 hours to induce white spot lesions (WSLs). The baseline value of surface micro hardness of samples was measured using a Vickers hardness tester, then the samples were randomly divided into three groups (n=15) based on different remineralization methods: MI-Paste Plus, Remin Pro and ICON-Infiltrant according to the manufacturer’s instructions. All samples were stored in anti-dry mouth treatment agent during the experiment and their surface hardness was measured at 15 days (T1) and 20 weeks (T2).

Results:

The hardness of samples in MI-Paste Plus and Remin Pro groups significantly increased at both T1 and T2 (p< 0.001) but this increase was not significant in ICON group (p> 0.05).

Conclusion:

MI-Paste Plus and Remin Pro can efficiently increase the hardness of incipient enamel lesions.

The Effect of the Er:YAG Laser and MI Paste Plus on the Treatment of White Spot Lesions

Introduction: White spot lesions (WSLs) occurring after orthodontic treatment lead to patient dissatisfaction and aesthetic problems. The role of calcium-phosphate demineralization systems and the Er:YAG laser in the treatment of these lesions has recently been taken into account. This study aimed to investigate the effect of the Er:YAG laser and MI Paste Plus on the treatment of WSLs. Methods: A total of 65 premolars extracted due to orthodontic treatment were studied in this research. To create enamel lesions, the teeth were placed in a demineralizing solution. The teeth were then randomly divided into five groups (n=13) as follows: first group, control; second group, saliva; third group, MI Paste Plus; fourth group, Er:YAG laser; and fifth group, MI Paste Plus together with the Er:YAG laser. The teeth were kept in artificial saliva between treatment processes. Artificial saliva was replaced daily with fresh artificial saliva. The teeth were sectioned longitudinally by a disc from the middle of the exposed enamel and each section was mounted in polyester resin. The surface of the samples was serially polished and the microhardness of the teeth was measured at depths of 0, 50, 100, and 150 µm. Results: The microhardness was significantly higher in the fifth group than other groups at depths of 50 and 150 µm (P <0.005). Using the laser or MI Paste Plus alone did not significantly increase the microhardness. Conclusions: The combined application of the Er:YAG laser and MI Paste Plus is effective in the treatment of WSLs.

Complementary remineralizing effect of self-assembling peptide (P11-4) with CPP-ACPF or fluoride: An in vitro study

Background

Self-assembling peptide has been recently introduced to promote hard tissue regeneration for treating early non-cavitated carious lesions. This study investigates the efficacy of biomimetic self-assembling peptide (P11-4) on enamel remineralization combined with CPP-ACPF or fluoride.

Material and Methods

Artificial enamel lesions were created on buccal surface of 60 specimens and were randomly assigned to six groups according to the remineralizing agent: G1-(Control, artificial saliva), G2-(Fluoride varnish), G3-(CPP-ACPF varnish), G4-(Self-assembling peptide), G5-(Self-assembling peptide+fluoride varnish), G6-(Self-assembling peptide+CPP-ACPF varnish). All products were applied according to manufacturer’s instructions and specimens were stored in a daily renewed artificial saliva. Surface microhardness (SMH) and scanning electron microscope (SEM) were assessed at baseline, after demineralization, 1 week and 4 weeks storage. SMH values were analyzed using ANOVA and Tukey’s post-hoc test.

Results

The highest statistically significant SMH values were found in G6 followed by G5, G4, G2 and G3 while the lowest values were found in G1. No statistically significant difference was found between G5 and G6. Also, no statistically significant difference was found between G2 and G3. SEM showed that G4, G5, G6 resulted in more pronounced remineralization, reversing the demineralized enamel fish scale pattern compared to G2 and G3 after 1 week and 4 week remineralization.

Conclusions

Complementary effect was obtained after combining self-assembling peptide with CPP-ACPF or fluoride showing the highest remineralizing potential early after 1 week and even after 4 weeks compared to when each agent used alone. Added benefits can be obtained through combining self-assembling peptide with other remineralzing agents allowing faster and enhanced regeneration of non-cavitated caries lesions.

Key words:Enamel regeneration, biomimetic remineralization, self-assembling peptide, CPP-ACPF, fluoride.

Nanoparticles as Anti-Microbial, Anti-Inflammatory, and Remineralizing Agents in Oral Care Cosmetics: A Review of the Current Situation

Many investigations have pointed out widespread use of medical nanosystems in various domains of dentistry such as prevention, prognosis, care, tissue regeneration, and restoration. The progress of oral medicine nanosystems for individual prophylaxis is significant for ensuring bacterial symbiosis and high-quality oral health. Nanomaterials in oral cosmetics are used in toothpaste and other mouthwash to improve oral healthcare performance. These processes cover nanoparticles and nanoparticle-based materials, especially domains of application related to biofilm management in cariology and periodontology. Likewise, nanoparticles have been integrated in diverse cosmetic produces for the care of enamel remineralization and dental hypersensitivity. This review summarizes the indications and applications of several widely employed nanoparticles in oral cosmetics, and describes the potential clinical implementation of nanoparticles as anti-microbial, anti-inflammatory, and remineralizing agents in the prevention of dental caries, hypersensitivity, and periodontitis.

Effectiveness of polyacrylic acid-bioactive glass air abrasion preconditioning with NovaMin remineralization on the microhardness of incipient enamel-like lesion

Background:

Bioactive glass (BAG) remineralization is a promising method for dental hard tissue regeneration. The aim of this study was to evaluate the microhardness of incipient enamel-like lesions with or without preconditioning by air abrasion using polyacrylic acid (PAA)-BAG before application of NovaMin remineralizing agent.

Materials and Methods:

Forty extracted human molars were selected, sectioned mesiodistally obtaining buccal and lingual halves, and embedded in resin molds. Specimens were randomly assigned to four groups (n = 10) according to the remineralization protocol: G1 (control, artificial saliva), G2 (preconditioning), G3 (NovaMin), and G4 (preconditioning and NovaMin). Enamel windows 4 mm × 4 mm were done on the buccal and lingual surfaces. Specimens were immersed in a daily renewed demineralizing solution to create white spot lesions. Remineralizing agents were applied according to the manufacturer's instructions, and specimens were stored in a daily renewed artificial saliva. Microhardness was assessed using Vickers hardness number (VHN) at baseline (positive control), after demineralization (negative control), and after 24-h and 1-month remineralization.

Results:

The preconditioning/NovaMin group after 1 month showed a statistically significant high VHN, with no statistically significant difference between it and the positive control. This was followed by the NovaMin group after 1 month, while the lowest VHN was found in the demineralized group, with no statistically significant difference between it and the preconditioning group, whether after 24 h or 1 month.

Conclusions:

Enamel preconditioning with PAA-BAG air abrasion play a major role in enhancement of remineralization when it is accompanied with NovaMin. Furthermore, an extended period of time had helped to attain more benefits from NovaMin remineralization.

Clinical Significance:

Enamel remineralization with NovaMin after conditioning by bioactive glass air abrasion, provides the patients with a fast and durable treatment of incipient enamel lesions, which would reduce the possibility of future progression of demineralization and caries occurrence.

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.

Effects of Fluoride and Calcium Phosphate Materials on Remineralization of Mild and Severe White Spot Lesions

Fixed orthodontic treatments often lead to enamel demineralization and cause white spot lesions (WSLs). The aim of this study was to evaluate the mineralization degree of 2 types of WSLs based on ICDAS index and compare the remineralizing efficacy of 3 oral hygiene practices after 1 month and 3 months. 80 mild demineralized and 80 severe demineralized enamel specimens were randomized into three treatments: fluoride toothpaste (FT), fluoride varnish plus fluoride toothpaste (FV+FT), and CPP-ACP plus fluoride toothpaste (CPP-ACP+FT). Microhardness tester, DIAGNODent Pen 2190, and scanning electron microscope were used to evaluate the changes of mineralization degree. Both qualitative and quantitative indicators suggested that the mild and severe white spot lesions were different in the degree of mineralization. Severe WSLs demineralized much more seriously than mild lesions even after 3 months of treatment. Despite the variation in severity, both lesions had the same variation trend after each measure was applied: FT had weak therapeutic effect, FV + FT and CPP-ACP + FT were effective for remineralization. Their remineralizing efficacy was similar after 1 month, and combined use of CPP-ACP plus F toothpaste was more effective after 3 months. In order to fight WSLs, early diagnosis was of great importance, and examination of the tooth surface after air-dry for 5 seconds was recommended. Also, when WSLs were found, added remineralizing treatments were required.

Prevention of white spot lesions using three remineralizing agents: An in vitro comparative study

Background. Enamel demineralization around orthodontic brackets is an important clinical problem. This study sought to compare the efficacy of sodium fluoride (NaF), casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACP-F; MI Paste Plus) and a water-based cream (Remin Pro), which contains hydroxyapatite and fluoride for prevention of enamel demineralization.

Methods. Fifty-six sound human premolars extracted for orthodontic purposes were collected. After cleaning, the crowns were mounted in acrylic resin and all the surfaces were coated with nail varnish except for a 3×4-mm window on the buccal surface. The samples were randomly divided into four groups of 14 and subjected to pH cycling for 14 days, during which the teeth were immersed in artificial saliva for 21 hours and in demineralizing agent for three hours daily. Before transferring the samples from the saliva to the demineralizing solution, the remineralizing agent (0.05% NaF, MI Paste Plus or Remin Pro Paste, depending on the group) was applied on the samples once a day for five minutes. No remineralizing agent was used in the control group. Surface microhardness of samples was measured by Vickers microhardness tester at baseline and after the intervention. The data were analyzed using one-way ANOVA, ANCOVA, Bonferroni test and Tukey test. Statistical significance was set at P<0.05.

Results. The mean microhardness was significantly different between the test and control groups (P<0.0001). Other differences were not significantly different (P>0.05).

Conclusion. The results showed that 0.05% NaF was more efficient than Remin Pro and MI Paste Plus for prevention of white spot lesions (WSLs). Remin Pro and MI Paste Plus were not significantly difference from the control group in this regard.

Comparison of remineralization by fluoride varnishes with and without casein phosphopeptide amorphous calcium phosphate in primary teeth

OBJECTIVE

To compare MI (5% NaF with 2% CPP-ACP) and Prevident (5% NaF) varnishes in remineralizing caries-like lesions in primary teeth regarding calcium and phosphate enamel content and lesion depth.

MATERIAL AND METHODS

Caries-like lesions were created in 48 primary teeth which were divided into 2 halves; one left untreated (control) and the other half treated with MI or Prevident varnishes. Calcium and phosphate content was assessed using energy dispersive X-ray spectrometer and reduction in lesion depth was assessed using polarized light microscopy. Demineralization and remineralization values in each group were compared using paired t test and percentage change between groups was compared using t test and Mann Whitney U test.

RESULTS

A greater percentage increase of calcium was observed in MI than Prevident specimens (median = 8.97 and 2.67, p < .0001), with greater calcium phosphate ratio percentage increase (median = 28.96 and 7.40) and phosphate percentage reduction (median = 15.5 and 4.51). The mean (SD) percentages reduction in lesion depth in the MI varnish was significantly greater than in Prevident varnish (44.41 (7.12) and 22.73 (9.35), p < .0001).

CONCLUSIONS

MI varnish had better remineralization effect in primary teeth than Prevident varnish in terms of higher mineral content and shallower lesion depth.

The effect of diode laser irradiation associated with photoabsorbing agents containing remineralizing materials on microhardness, morphology and chemical structure of early enamel caries

Background

This study investigated the effects of laser irradiation associated with photo-absorbing agents containing sodium fluoride (NaF), MI paste Plus or Remin Pro® on microhardness and surface structure of white spot lesions (WSLs).

Material and Methods

Fifty-six premolars were divided into two halves, then immersed in a demineraling solution to induce WSLs. The samples were divided into 8 groups by treatment (n=12) : (1) control, (2) diode laser (810 nm, 500 mW, 90 s), (3) NaF, (4) MI Paste plus, (5) Remin Pro®, (6) NaF + Laser, (7) MI Paste Plus + Laser, (8) Remin Pro® + Laser. Microhardness was measured before and after remineralization treatments. Two samples from each group were selected for SEM analysis.

Results

Microhardness increased significantly after all treatments with the exception of control, Laser and Remin Pro® groups (p >0.05). ANOVA revealed no significant difference in initial microhardness (P=0.21), whereas a significant difference was noted after treatment (P=0.009). The application of sodium fluoride with or without laser irradiation produced the highest microhardness among the groups (p<0.05). SEM analysis revealed some cracks on lased enamel and non-homogenous coatings of minerals after the use of remineralizing products.

Conclusions

The use of NaF either alone or combined with laser irradiation was the most effecttive strategy for increasing microhardness of WSLs. The application of diode laser through photoabsorbing agents containing sodium fluoride or MI Paste Plus did not produce any additional effects in enhancing remineralization of WSLs, whereas the combined application of diode laser with Remin Pro® was effective.

Key words:CPP-ACP, Enamel caries, fluoride, Hydroxyapatite, Low level laser, Microhardness, Remineralization, casein phosphopeptide amorphous calcium phosphate.

Enamel Anti-Demineralization Effect of Orthodontic Adhesive Containing Bioactive Glass and Graphene Oxide: An In-Vitro Study

White spot lesions (WSLs), a side effect of orthodontic treatment, can result in reversible and unaesthetic results. Graphene oxide (GO) with a bioactive glass (BAG) mixture (BAG@GO) was added to Low-Viscosity Transbond XT (LV) in a ratio of 1, 3, and 5%. The composite’s characterization and its physical and biological properties were verified with scanning electron microscopy (SEM) and X-ray diffraction (XRD); its microhardness, shear bond strength (SBS), cell viability, and adhesive remnant index (ARI) were also assessed. Efficiency in reducing WSL was evaluated using antibacterial activity of S. mutans. Anti-demineralization was analyzed using a cycle of the acid-base solution. Adhesives with 3 wt.% or 5 wt.% of BAG@GO showed significant increase in microhardness compared with LV. The sample and LV groups showed no significant differences in SBS or ARI. The cell viability test confirmed that none of the sample groups showed higher toxicity compared to the LV group. Antibacterial activity was higher in the 48-h group than in the 24 h group; the 48 h test showed that BAG@GO had a high antibacterial effect, which was more pronounced in 5 wt.% of BAG@GO. Anti-demineralization effect was higher in the BAG@GO-group than in the LV-group; the higher the BAG@GO concentration, the higher the anti-demineralization effect.

A novel antimicrobial and remineralizing toothpaste containing CaCl₂/chitosan microspheres

PURPOSE

To investigate the feasibility of exploiting amorphous calcium phosphate (ACP) formed in situ from chitosan calcium microspheres and phosphate ions in water during brushing for caries control.

METHODS

A prototype toothpaste, namely Chi-ACP paste, was specially formulated containing CaCl₂/chitosan microspheres. The efficiency of Chi-ACP paste for remineralization on human tooth enamel was evaluated via an in vitro pH cycling approach. After 15 demineralization/remineralization cycles, the treated teeth were analyzed using scanning electron microscope (SEM) /energy dispersive X-ray spectroscopy (EDX), and polarized light microscope (PLM).

RESULTS

EDX analysis showed the treated enamel in the Chi-ACP paste group had statistically significantly higher calcium content and Ca/P weight ratios than those in the negative control group, while the MI plus group had a slightly higher Ca content and a slightly higher Ca/P weight ratio. PLM analysis revealed that the Chi-ACP paste group had a larger remineralization band in treated enamel than the negative control group, although there was no statistically significant difference on the demineralization depths in the enamel among the three groups.

CLINICAL SIGNIFICANCE

Antibacterial chitosan could be used to encapsulate CaCl₂ and then formulated into toothpaste for caries control through in-situ formed amorphous calcium phosphate (ACP) during brushing.

Comparative evaluation of remineralizing efficacy of biomimetic self-assembling peptide on artificially induced enamel lesions: An in vitro study

Background

The biomimetic self-assembling peptide technology is a paradigm for dental hard tissue regeneration.

Aim

To investigate the efficacy of biomimetic self-assembling peptide (P₁₁-4) on enamel remineralization compared to casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) and fluoride-based delivery systems.

Materials and Methods

Artificial enamel lesions were created on buccal surfaces of 40 extracted human molars. Specimens were randomly assigned to four groups (n = 10) according to the remineralizing agent used: G1 - control: artificial saliva, G2 - fluoride varnish, G3 - CPP-ACPF varnish, G4 - self-assembling peptide agent. All products were applied according to the manufacturer's instructions and the specimens were stored in daily renewed artificial saliva. Surface microhardness (SMH) was assessed at baseline, after demineralization, after 1 week and after 4 weeks storage. SMH values were analyzed using ANOVA and Tukey's post hoc test.

Results

Self-assembling peptide showed the highest statistically significant mean SMH followed by fluoride and CPP-ACPF while the lowest mean SMH was found in artificial saliva. However, no statistically significant difference was found between fluoride and CPP-ACPF. Higher statistically significant mean SMH was found after 4 weeks compared to 1 week remineralization in all groups.

Conclusions

Self-assembling peptide confers the highest remineralizing efficacy compared to fluoride and CPP-ACPF, showing a promising, noninvasive regeneration potential. Furthermore, extended period of time helped attain more benefits from the remineralizing regimens applied.

Optimization of Adhesive Pastes for Dental Caries Prevention

Dental caries prevention products available on the market contain only remineralizing agents or antibacterial agents. This study aimed to develop adhesive pastes containing calcium phosphate and α-mangostin for dental caries prevention using the optimization technique. Calcium phosphate was used as a remineralizing agent, and extracted α-mangostin was used as an antibacterial agent. The effect of the independent variables, which were fumed silica, Eudragit^® EPO, polyethylene glycol, and ethyl alcohol, on the responses was investigated. The drying time, erosion rate, calcium release rate, and α-mangostin release rate were established as the measured responses. An equation and a model of the relationship were constructed. An optimal formulation was obtained, and its effect on dental caries prevention was investigated using the pH-cycling model. The quadratic equation revealed that the drying time, calcium release rate, and α-mangostin release rate tended to decrease when increasing the fumed silica and decreasing other factors. The erosion rate tended to increase when decreasing Eudragit^® EPO and increasing other factors. The observed responses of the optimal adhesive pastes were not significantly different from the predicted responses. This result demonstrated that optimization is an efficient technique in the formulation development of the adhesive pastes. In addition, the optimal adhesive pastes could enhance acid resistance activity to the tooth enamel.

Farnesol inhibits development of caries by augmenting oxygen sensitivity and suppressing virulence-associated gene expression inStreptococcus mutans

Streptococcus mutans is a primary etiological agent of dental caries. Farnesol, as a potential antimicrobial agent, inhibits the development ofS. mutans biofilm. In this study, we hypothesized that farnesol inhibits caries development in vitro and interferes with biofilm formation by regulating virulence-associated gene expression. The inhibitory effects of farnesol to S. mutans biofilms on enamel surfaces were investigated by determining micro-hardness and calcium measurements. Additionally, the morphological changes ofS. mutans biofilms were compared using field emission scanning electron microscopy and confocal laser scanning microscopy, and the vitality and oxygen sensitivity ofS. mutans biofilms were compared using MTT assays. To investigate the molecular mechanisms of farnesol's effects, expressions of possible target genesluxS, brpA, ffh, recA, nth, and smx were analyzed using reverse-transcription polymerase chain reaction (PCR) and quantitative PCR. Farnesol-treated groups exhibited significantly higher micro-hardness on the enamel surface and lower calcium concentration of the supernatants as compared to the-untreated control. Microscopy revealed that a thinner film with less extracellular matrix formed in the farnesol-treated groups. As compared to the-untreated control, farnesol inhibited biofilm formation by 26.4% with 500 µmol/L and by 37.1% with 1,000 µmol/L (P<0.05). Last, decreased transcription levels of luxS, brpA, ffh, recA, nth, and smx genes were expressed in farnesol-treated biofilms. In vitrofarnesol inhibits caries development and S. mutans biofilm formation. The regulation of luxS, brpA, ffh, recA, nth, and smx genes may contribute to the inhibitory effects of farnesol.

Decalcification prevention around orthodontic brackets bonded to bleached enamel using different topical agents

BACKGROUND

The present study was conducted to evaluate the effect of different topical agents utilized for prevention of enamel decalcification around orthodontic brackets bonded to bleached and non-bleached enamel.

METHODS

Human maxillary premolars (n = 120) were divided into two equal groups. Teeth in group I were left without bleaching while those in group II were bleached with Vivastyle gel. Metal brackets were bonded to all the teeth using light-cured adhesive. Each group was divided into six equal subgroups (A, B, C, D, E, and F). In subgroup A, no material was applied (control). In subgroups B, C, D, E, and F, the following materials were applied respectively: Profluorid varnish, Enamel Pro Varnish, Ortho-Choice Ortho-Coat, GC Tooth Mousse, and GC MI Paste Plus. All teeth were cycled in a demineralization solution/artificial saliva for 15 days. Laser fluorescence was used to measure the level of enamel mineralization. The data were statistically analyzed.

RESULTS

Regarding the non-bleaching subgroups, all studied material revealed significant demineralization reduction in comparison to the control subgroup (P < 0.05). Ortho-Choice Ortho-Coat revealed the highest significant effect while GC Tooth Mousse showed the least effect. In bleached subgroups, Profluorid varnish, Enamel Pro Varnish, and Ortho-Choice Ortho-Coat significantly reduced demineralization (P < 0.05) while either GC MI Paste Plus or GC Tooth Mousse had no significant effects (P > 0.05).

CONCLUSIONS

Ortho-Choice Ortho-Coat, and Profluorid and Enamel Pro varnishes could be utilized successfully to reduce enamel demineralization around brackets bonded to either bleached or non-bleached enamel. GC MI Paste Plus and GC Tooth Mousse were effective only in non-bleached enamel.

Quantitative Analysis of Remineralization of Artificial Carious Lesions with Commercially Available Newer Remineralizing Agents Using SEM-EDX- In Vitro Study"

INTRODUCTION

The basic principle of remineralization is by advocating a biological or non-invasive approach rather than the surgical approach for early enamel lesions. There are relatively newer products available for remineralization, latest being the resin-infiltration technique, commercially available as Icon.

AIM

The aim of the study was to evaluate the remineralizing potential of Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP), Vantej and Icon by the quantitative evaluation of mineral gain.

MATERIALS AND METHODS

Seventy eight maxillary premolars were decoronated at Cemento-Enamel Junction (CEJ) and then sectioned mesio-distally using diamond disc into two halves. Mineral content of the sound specimens were recorded using Energy Dispersive X-ray (EDAX) micro-analyser. The samples were then subjected to demineralization by using demineralizing solution. The samples were grouped (n=26) based on the remineralizing agent used, Group 1: Vantej, Group 2: CPP-ACP, Group 3: Icon. After the application of remineralizing agent, the mineral content was measured using EDAX.

RESULTS

After remineralization, there was a significant difference between the groups when calcium and phosphorous ratios (Ca:P) were compared, showing greater potential of remineralization for CPP-ACP followed by Vantej and Icon group.

CONCLUSION

CPP-ACP performed better than Vantej and Icon in remineralizing the demineralized enamel.

Assessment of Enamel Remineralisation After Treatment with Four Different Remineralising Agents: A Scanning Electron Microscopy (SEM) Study

INTRODUCTION

Decades of research has helped to increase our knowledge of dental caries and reduce its prevalence. However, according to World Oral Health report, dental caries still remains a major dental disease. Fluoride therapy has been utilised in a big way to halt caries progression, but has been met with limitations. This has paved the way for the development of newer preventive agents that can function as an adjunct to fluoride or independent of it.

AIM

The purpose of the present study was to evaluate the ability of Casein Phosphopeptide-Amorphous Calcium Phosphate Fluoride (CPP ACPF), Bioactive Glass (BAG), fluoride enhanced Hydroxyapatite (HA) gel and self-assembling peptide P₁₁-4 to remineralise artificial carious lesions in enamel in vitro using a 30 day pH cycling model through surface microhardness analysis and SEM.

MATERIALS AND METHODS

Sixty enamel samples were divided into five groups of 12 samples each. The control Group A consisted of intact enamel samples, Group B: CPP-ACPF (Tooth Mousse Plus), Group C: BAG (SHY- NM), Group D: fluoride enhanced HA gel (ReminPro) and Group E: Self-assembling peptide P₁₁-4 (Curodont Protect). All groups excluding the control group were subjected to demineralisation following which four of these groups were remineralised using the four remineralising agents. The treated groups were subjected to pH cycling over a period of 30 days. This was followed by assessment of surface microhardness and SEM for qualitative evaluation of surface changes. The results were analysed by One-Way Analysis Of Variance (ANOVA). Multiple comparisons between groups were performed by paired t-test and post-hoc Tukey test.

RESULTS

The results of the study revealed that remineralisation of enamel was the highest in samples of Group E (Self assembling peptide P₁₁-4) followed by Group B (CPP-ACPF), Group C (BAG) and Group D (fluoride enhanced HA gel). There was a significant difference (p<0.05) in the remineralising ability between the self assembling peptide P₁₁-4 group and BAG and fluoride enhanced HA gel group. Although no significant difference was observed between the self assembling peptide P₁₁-4 and CPP-ACPF group, the self assembling peptide P₁₁-4 remineralised the enamel lesions more effectively. SEM photomicrographs of the test groups demonstrated either amorphous crystals or particles scattered on the surface or lines of remineralisation along the prismatic borders.

CONCLUSION

Self assembling peptide P₁₁-4 demonstrated promising results by effectively and significantly remineralising the enamel lesions as compared to other test agents.

Comparison of the effect of resin infiltrant, fluoride varnish, and nano-hydroxy apatite paste on surface hardness and streptococcus mutans adhesion to artificial enamel lesions

Introduction

Dental caries is a major public health problem, and Streptococcus mutans is considered the main causal agent of dental caries. This study aimed to compare the effect of three re-mineralizing materials: resin infiltrant, fluoride varnish, and nano-hydroxy apatite paste on the surface hardness and adhesion of Streptococcus mutans as noninvasive treatments for initial enamel lesions.

Methods

This experimental study was conducted from December 2015 through March 2016 in Babol, Iran. Artificial enamel lesions were created on 60 enamel surfaces, which were divided into two groups: Group A and Group B (30 subjects per group). Group A was divided into three subgroups (10 samples in each subgroup), including fluoride varnish group, nano-hydroxy apatite paste group (Nano P paste), and resin infiltrant group (Icon-resin). In Group A, the surface hardness of each sample was measured in three stages: First, on an intact enamel (baseline); second, after creating artificial enamel lesions; third, after application of re-mineralizing materials. In Group B, the samples were divided into five subgroups, including intact enamel, demineralized enamel, demineralized enamel treated with fluoride varnish, Nano P paste, and Icon-resin. In Group B, standard Streptococcus mutans bacteria adhesion (PTCC 1683) was examined and reported in terms of colony forming units (CFU/ml). Then, data were analyzed using ANOVA, Kruskal-Wallis, Mann-Whitney, and post hoc tests.

Results

In Group A, after treatment with re-mineralizing materials, the Icon-resin group had the highest surface hardness among the studied groups, then the Nano P paste group and fluoride varnish group, respectively (p = 0.035). In Group B, in terms of bacterial adhesion, fluoride varnish group had zero bacterial adhesion level, and then the Nano P paste group, Icon-resin group, intact enamel group, and the de-mineralized enamel group showed bacterial adhesion increasing in order (p < 0.001).

Conclusion

According to the study among the examined materials, the resin infiltrant increased the tooth surface hardness as the intact enamel and fluoride varnish had the highest reduction level for bacterial adhesion. Nano P paste had an effect between the two materials, both in increasing surface hardness and reducing bacterial adhesion.

Salivary Proteins-A Barrier on Enamel Demineralization: An in vitro Study

AIM

The aim of this study is to evaluate the protective effect of the salivary proteins on the demineralization of enamel.

MATERIALS AND METHODS

Twenty freshly extracted human molar teeth were used in this study. Enamel samples (2 mm thickness) were prepared from the buccal and lingual surfaces of the teeth selected. An acid-resistant nail varnish was used to cover every aspect of the sample, except an area of 5 * 5 mm limited by an adhesive tape. After drying, the adhesive tape was removed, exhibiting a rectangular area on the enamel surface. Samples were divided into two groups: Group I (10 samples): Each sample was coated by 100 μg of albumin for 2 hours at 37°C. Group II (10samples): Each sample was exposed to 100 μL of deionized water.Samples were washed by dipping once in deionized water. They were then disposed into individual tubes containing demineralization solution for 1, 2, 3, and 4 minutes at 37°C with gentle agitation. The demineralization solution was utilized to determine the calcium loss from specimens at 1, 2, 3, 4 minutes using an ultraviolet-visible spectrophotometer.

RESULTS

Calcium loss was less from the albumin-coated samples than control group at all times and was statistically significant (p < 0.05). Also, calcium loss was maximum at the end of 1 minute, and it decreased as time interval increased and was statistically significant (p < 0.001).

CONCLUSION

Albumin has provided a strong protection against enamel demineralization at all times compared to the one without it.

HOW TO CITE THIS ARTICLE

Hegde MN, Sajnani AR. Salivary Proteins-A Barrier on Enamel Demineralization: An in vitro Study. Int J Clin Pediatr Dent 2017;10(1):10-13.

In vitro evaluation of remineralization efficacy of different calcium- and fluoride-based delivery systems on artificially demineralized enamel surface

Background:

Caries is the most common dental disease facing the world population. Caries can be prevented by remineralizing early enamel lesions.

Aim:

To evaluate remineralization efficacy of stannous fluoride (SnF₂), casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF) and calcium sucrose phosphate (CaSP).

Materials and Methods:

Fifty enamel samples were taken; they were divided into five groups (n = 10). Demineralization was carried out with Groups A, B, C, and E. Remineralization was carried out with Groups A, B, and C for 7 days using SnF₂, CPP-ACPF, and CaSP, respectively. In Group D, no surface treatment was carried out, to mark as positive control whereas Group E was kept as negative control with only surface demineralization of enamel. Enamel microhardness was tested using Vickers's microhardness tester after 7 day remineralization regime.

Statistical Analysis:

One-way analysis of variance and post hoc Tukey tests were performed.

Results:

The mean microhardness values in descending order: Positive control > SnF₂> CaSP > CPP-ACPF > negative control.

Conclusion:

All remineralizing agents showed improved surface remineralization. However, complete remineralization did not occur within 7 days. SnF₂ showed the highest potential for remineralization followed by CaSP and CPP-ACPF.