Remineralization of early enamel lesions using casein phosphopeptide amorphous calcium Phosphate: an ex-vivo study

Safe and Durable Treatment of Dentin Hypersensitivity via Nourishing and Remineralizing Dentin Based on β-Chitooligosaccharide Graft Derivative

Dentin hypersensitivity (DH) is a common symptom of various dental diseases that usually produces abnormal pain with external stimuli. Various desensitizers are developed to treat DH by occluding dentine tubules (DTs) or blocking intersynaptic connections of dental sensory nerve cells. However, the main limitations of currently available techniques are the chronic toxic effects of chemically active ingredients and their insufficiently durable efficacy. Herein, a novel DH therapy with remarkable biosafety and durable therapeutic value based on β-chitooligosaccharide graft derivative (CAD) is presented. Particularly, CAD indicates the most energetic results, restoring the amino polysaccharide protective membrane in DTs, significantly promoting calcium and phosphorus ion deposition and bone anabolism, and regulating the levels of immunoglobulin in saliva and cellular inflammatory factors in plasma. Exposed DTs are occluded by remineralized hydroxyapatite with a depth of over 70 µm, as shown in in vitro tests. The bone mineral density of Sprague-Dawley rats' molar dentin increases by 10.96%, and the trabecular thickness of bone improves to about 0.03 µm in 2 weeks in the CAD group compared to the blank group. Overall, the ingenious concept that modified marine biomaterial can be a safe and durable therapy for DH is demonstrated by nourishing and remineralizing dentin.

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.

Comparison of the Remineralizing Effect of Brushing with Aloe vera versus Fluoride Toothpaste

Objectives  The aim of the present in vitro study is to compare the remineralization brushing effect of three toothpastes and Aloe vera (AV) gel.

Materials and Methods  Forty sound extracted teeth were placed in a demineralizing solution for 4 days and randomly assigned to four groups: group A: 1,450-ppm fluoride toothpaste; group B: AV nonfluoridated toothpaste; group C: AV 1,000-ppm fluoridated toothpaste; and group D: AV gel. A 3-minute pH cycling was performed twice a day for each group for 12 days. Specimens were analyzed before and after by scanning electron microscope—energy dispersive X-ray.

Statistical Analysis  The outcomes were analyzed by Kolmogorov–Smirnov’s tests, repeated-measures analyses of variance followed by univariate analyses, and Bonferroni’s multiple comparisons tests to compare the calcium-to-phosphorus (Ca:P) ratio within time among toothpaste groups.

Results  Following remineralization, the Ca:P ratio increased in all groups. The difference of the Ca:P ratio was not significant between groups C, D, and A. The mean ratio was significantly lower in group B ( p -value = 0.026).

Conclusions  The AV gel demonstrated a remineralization capacity equal to that of the 1,450-ppm fluoride toothpaste. In contrast, fluoride-free AV toothpaste showed a lower remineralization efficiency. Further studies are required to understand its mechanism.

Effect of Casein Phosphopeptide-amorphous Calcium Phosphate and Calcium Sodium Phosphosilicate on Artificial Carious Lesions: An in vitro Study

Aim

To compare new remineralizing agents calcium sodium phosphosilicate paste and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste with that of fluoridated toothpaste in remineralization of early carious lesions using scanning electron microscopy and energy-dispersive X-ray (SEM-EDX) analysis.

Materials and methods

Sixty sound extracted premolars were collected and placed in demineralizing solution for 4 days to produce artificial carious lesions. All specimens were evaluated for any loss of mineral content using SEM-EDX analysis. Samples were randomly assigned to three groups: Group I: Fluoridated toothpaste (control), group II: CPP-ACP paste, and group III: Calcium sodium phosphosilicate paste. Specimens were then treated with above-mentioned remineralizing agents and again measured for mineral content using SEM-EDX analysis.

Results

Group III (calcium sodium phosphosilicate paste) showed highest significant difference followed in descending order by group II (CPP-ACP paste) and group I (fluoridated toothpaste).

Conclusion

Calcium sodium phosphosilicate paste showed maximum remineralizing potential compared with CPP-ACP and fluoridated toothpastes.

How to cite this article

Chaudhary I, Tripathi AM, Yadav G, Saha S. Effect of Casein Phosphopeptide-amorphous Calcium Phosphate and Calcium Sodium Phosphosilicate on Artificial Carious Lesions: An in vitro Study. Int J Clin Pediatr Dent 2017;10(3):261-266.

Efficacy of Milk as a Desensitizing Agent for the Treatment of Sensitivity Following Scaling and Root Planing

Background:

Dentine hypersensitivity (DH) is the most common problem encountered by most of the dentists in their day-to-day clinical practice. It is characterized by a sharp pain or discomfort arising as a response to thermal, chemical, or osmotic stimuli and is caused due to exposure of dentine after the enamel or cementum at the root surface has been lost by the treatment, underlying dental and gingival diseases or physiologic wear and tear of the teeth. This further complicates preventive oral hygiene procedures by the patients, which jeopardize periodontal treatment or may as well aid in periodontal treatment failure.

Aim and Objective:

To evaluate the efficacy of commercially available milk as a desensitizing agent for the treatment of sensitivity following scaling and root planing.

Materials and Methods:

Patients were selected randomly for scaling and then assessed for sensitivity. Those patients having DH were divided into two groups, wherein the Group A (test) patients were advised to rinse with commercially available milk at room temperature and those in Group B (control) with a commercially available mouthwash (Sentosil-SF). A four-point verbal rating scale was designed to record the numerical value of DH and were recalled for follow-up on 4^th, 7^th, and 10^th day posttreatment.

Results:

The study demonstrated that there was a considerable reduction in hypersensitivity in both the groups on the 7^th and 10^th day. In the milk group, eight patients showed a complete reduction in hypersensitivity on 7^th day and 13 patients on 10^th day, while in the mouthwash group, five patients showed the same on 7^th day and ten patients on the 10^th day, thus suggesting that more individuals in the milk group were benefited. However, there was no statistically significant difference between the groups in every visit.

Conclusion:

Although there is a vast literature available which suggests the efficacy of commercially available mouthwash in reducing hypersensitivity, this study is the first of its kind which evaluates the efficacy of commercially available milk in reducing sensitivity which is induced postscaling. Considering that milk rinse is cheap and easily available at home, it can be used as a desensitizing agent, and rinsing with milk for few days is effective and stable in quick reduction of hypersensitivity induced by scaling.

Elastin-Like Protein, with Statherin Derived Peptide, Controls Fluorapatite Formation and Morphology

The process of enamel biomineralization is multi-step, complex and mediated by organic molecules. The lack of cells in mature enamel leaves it unable to regenerate and hence novel ways of growing enamel-like structures are currently being investigated. Recently, elastin-like protein (ELP) with the analog N-terminal sequence of statherin (STNA15-ELP) has been used to regenerate mineralized tissue. Here, the STNA15-ELP has been mineralized in constrained and unconstrained conditions in a fluoridated solution. We demonstrate that the control of STNA15-ELP delivery to the mineralizing solution can form layered ordered fluorapatite mineral, via a brushite precursor. We propose that the use of a constrained STNA15-ELP system can lead to the development of novel, bioinspired enamel therapeutics.

Effects of a Novel Dental Gel on Enamel Surface Recovery from Acid Challenge

Background

Objective was to evaluate the in vivo effects of a novel dental gel (Livionex gel^R) vs. a comparison dental gel on the surfaces of pre-eroded enamel chips.

Methods

On days 1–5, after toothbrushing with dentifrice, nine subjects each wore 8 enamel chips mounted on a palatal appliance for 4 h. Enamel blocks were pre-demineralized daily. After 2 day washout, subjects repeated the protocol using fresh chips and the second toothpaste on days 8–12. Samples were evaluated using electron microscopy.

Results

Ten standardized enamel surface photomicrographs/sample (total 1440 images) were evaluated for signs of erosion visually and on a scale of 0–3 by 1 evaluator. No significant differences were found between the 2 groups (p>0.32, 95% C.I.). Minimal surface erosion on approx. 15% of sample area was visible in both groups.

Conclusion

The enamel surface appeared similar after usage of a test or control dentifrice. Based on this study, the test formulation did not affect enamel surface recovery from an erosive challenge.

Practical implications

Dentifrices can contribute to maintaining a healthy enamel surface. An all-natural dental gel formulation with novel anti-plaque mechanism achieved similar recovery from acid challenge to enamel as a control gel.

A comparative evaluation of remineralizing ability of bioactive glass and amorphous calcium phosphate casein phosphopeptide on early enamel lesion

Background:

This study was done to evaluate remineralizing potential of bioactive glasses (BAGs) and amorphous calcium phosphate-casein phosphopeptide (ACP-CPP) on early enamel lesion.

Materials and Methods:

Twenty freshly extracted mandibular premolars were sectioned sagittally. The buccal half was impregnated in acrylic resin blocks and treated with 37% phosphoric acid in liquid form, to demineralize enamel surface to simulate early enamel lesion. The samples were divided into two groups. The samples in Group I were treated with ACP-CPP (GC Tooth Mousse) and in Group II with BAG (Sensodyne Repair and Protect) and stored in saliva to prevent dehydration. The samples were tested for microhardness. The data obtained was analyzed using ANOVA post hoc multiple comparison and independent sample t- test and presented as a mean and standard deviation.

Results:

All the samples showed a decrease in the microhardness after demineralization. After application of remineralizing agents, Group II showed a highly significant increase in the microhardness (P < 0.05) after 10 days, while Group I showed a significant increase in microhardness after 15 days (P < 0.05).

Conclusion:

Both the remineralizing agents tested in this study can be considered effective in repair and prevention of demineralization. BAG showed better results initially, but eventually both have similar remineralizing potential.

Effect of ACP-CPP Chewing Gum and Natural Chewable Products on Plaque pH, Calcium and Phosphate Concentration

INTRODUCTION

Numerous epidemiological studies have documented dental caries as the major public health problems throughout the world. It is gradually increasing in the underdeveloped and developing countries especially in children due to increasing popularity of refined sugars.

AIM

The aim of the study was to evaluate the effect of natural chewable products (Tulsi, sesame seeds, fennel seeds, coconut) and ACP-CPP chewing gum on plaque pH, calcium and phosphate concentration.

MATERIALS AND METHODS

A randomized controlled trial, with a cross-over study design, was conducted. Ten subjects aged 15-17 years who agreed to refrain from oral hygiene practice for 48 hours prior to the sample collection were selected for the study. The baseline plaque pH, calcium and phosphate was measured and repeated after 5 and 30 minutes. It was ensured that each study participant was subjected to all the products making an effective sample of ten subjects per product. The data was statistically analysed.

RESULTS

The mean pH in all the study groups increased after 5 minutes and 30 minutes compared to baseline, except for coconut group at 30 minutes and fennel group at 5 minutes. Highest increase in plaque calcium concentration was found in fennel group followed by recaldent and sesame, respectively. Whereas, the highest increase in plaque phosphate was found in recaldent group followed by sesame group and fennel group respectively.

CONCLUSION

Plant products can be effective, inexpensive, easily accessible methods of maintaining oral health. Further studies are recommended to confirm long term effects.

Efficacy of amelogenin-chitosan hydrogel in biomimetic repair of human enamel in pH-cycling systems

Amelogenin-chitosan (CS-AMEL) hydrogel has shown great potential for the prevention, restoration, and treatment of defective enamel. As a step prior to clinical trials, this study aimed to examine the efficacy of CS-AMEL hydrogel in biomimetic repair of human enamel with erosive or caries-like lesions in pH-cycling systems. Two models for enamel defects, erosion and early caries, were addressed in this study. Two pH-cycling systems were designed to simulate the daily cariogenic challenge as well as the nocturnal pH conditions in the oral cavity. After pH cycling and treatment with CS-AMEL hydrogel, a synthetic layer composed of oriented apatite crystals was formed on the eroded enamel surface. CS-AMEL repaired the artificial incipient caries by re-growing oriented crystals and reducing the depth of the lesions by up to 70% in the pH-cycling systems. The results clearly demonstrate that the CS-AMEL hydrogel is effective at the restoration of erosive and carious lesions under pH-cycling conditions.

Effect of three nanobiomaterials on the surface roughness of bleached enamel

Background:

The ever-increasing demand for enhanced esthetic appearance has resulted in significant developments in bleaching products. However, the enamel surface roughness (SR) might be negatively affected by bleaching agents. This in vitro study was undertaken to compare the effects of three nanobiomaterials on the enamel SR subsequent to bleaching.

Materials and Methods:

The crowns of six extracted intact nonerupted human third molars were sectioned. Five dental blocks measuring 2 mm × 3 mm × 4 mm were prepared from each tooth and placed in colorless translucent acrylic resin. The enamel areas from all the specimens were divided into five groups (n = 6): Group 1 did not undergo any bleaching procedures; Group 2 was bleached with a 40% hydrogen peroxide (HP) gel; Groups 3, 4, and 5 were bleached with a 40% HP gel modified by bioactive glass (BAG), amorphous calcium phosphate, and hydroxyapatite, respectively. The enamel SR was evaluated before and after treatment by atomic force microscopy. The data were analyzed by Kruskal–Wallis and Mann–Whitney tests.

Results:

SR increased significantly in the HP group. SR decreased significantly in the HP gel modified by BAG group as compared to other groups.

Conclusions:

Within the limitations of this study, incorporation of each one of the three test biomaterials proved effective in decreasing enamel SR subsequent to in-office bleaching technique.

Milk as Desensitizing Agent for Treatment of Dentine Hypersensitivity Following Periodontal Treatment Procedures

BACKGROUND

Dentinal hypersensitivity is a commonly observed problem after periodontal treatment procedures in periodontal patients. This further complicates preventive oral hygiene procedures by patients which jeopardize periodontal treatment, or even may aid in periodontal treatment failure.

AIMS AND OBJECTIVES

The aims and objectives of present study were to assess the problem of dentine hypersensitivity after non-surgical periodontal treatment and selection of cases for evaluation of commercially available milk at room temperature as mouth rinse for the treatment of dentinal hypersensitivity caused by periodontal treatment.

MATERIALS AND METHODS

Patients were selected randomly for nonsurgical periodontal treatment and then were assessed for dentine hypersensitivity. Those having dentine hypersensitivity were assigned in two groups. Group one patients were advised to rinse with commercially available milk at room temperature, group two patients were advised to rinse with luke warm water as control. A four point Verbal Rating Score (VRS) was designed to record the numerical value of dentine hypersensitivity.

RESULTS

The results show incidence of 42.5% and prevalence of 77.5% for dentine hypersensitivity after periodontal treatment procedures. After rinsing with milk following periodontal treatment procedures, there was found a significant reduction of dentine hypersensitivity with probability by unpaired t-test as 0.0007 and 0.0001 at tenth and fifteenth day post periodontal treatment procedures respectively.

CONCLUSION

This study demonstrated that the milk rinse is a suitable, cheaper, fast acting, home-use and easily available solution to the problem of dentine hypersensitivity after non-surgical periodontal treatment. Milk can be used as desensitizing agent and rinsing with milk for few days is effective in quick reduction of dentine hypersensitivity due to periodontal treatment procedures.

[Chitosan-collagen polymer induced remineralization of tooth hard tissue through self-growing methods]

OBJECTIVE

To modify biomacromolecules, such as chitosan and collagen, to synthesize a mineralized template that will induce self-growing remineralization of tooth enamel.

METHODS

Natural polycation polysaccharide chitosan was modified through phosphorylation to synthesize the polyanion derivative ofphosphorylated chitosan. Parent hydrogels com- bined with chitosan and collagen I were built through peptide binding reaction using genipin as a crosslinker. The gels self- assembled on the tooth's inert surface, which was stimulated by ultraviolet radiation. The bionic saliva provided mineralized ion, and then the hydroxyapatite assembled and grew in situ on the tooth.

RESULTS

The functional group P04(3-) (3,446 cm(-1)) was grafted on chitosan as confirmed by the Fourier transform infrared spectroscopy. The porous polyelectrolyte complex hydrogel formed by the interaction between the polycation chitosan and the polyanion phosphorylated chitosan could induce hydroxyapatite crystal nucleation and growth on the hydrogel fiber surfaces. The neonatal crystal was hydroxyapatite as confirmed by X-ray diffraction and was tightly connected to the tooth. A continuous structure of column crystals with sizes ranging from 30 nm to 60 nm was observed. The structure was in parallel direction similar to the direction of the enamel rod, and its hardness was close to dentin.

CONCLUSION

The parent hydrogels that were easily obtained and controlled could mimic the template of the enamel mineralization and induce a self-growing hydroxyapatite, which is an important step in the structural bionics of enamel.

The effect of remin pro and MI paste plus on bleached enamel surface roughness

OBJECTIVE

The growing demand for enhanced esthetic appearance has led to great developments in bleaching products. The exposure of hard tissues of the tooth to bleaching agents can affect the roughness of the enamel surface. The freshly bleached enamel surface exposed to various surface treatments such as fluoride and other remineralizing agents have been assessed in this study. The aim of this experimental study was to compare the effect of Casein Phosphopeptide-Amorphous Calcium Phosphate with Fluoride (MI Paste Plus) and Remin Pro on the enamel surface roughness after bleaching.

MATERIALS AND METHODS

Thirty enamel samples of sound human permanent molars were prepared for this study. After initial roughness measurement with profilometer, the samples were exposed to 37% carbamide peroxide bleaching agent 20 minutes twice, and randomly divided into three groups of ten. In group 1, a CPP-ACPF containing paste (MI Paste Plus) and in group 2, Remin Pro were applied to the teeth during a 15 day period for 5 minutes, twice a day. Samples of group 3 (control) were immersed in artificial saliva for 15 days. The roughness of all samples were measured at the beginning, after bleaching and after the study intervention and statistically analyzed.

RESULTS

The surface roughness significantly increased in all groups following bleaching, and then it showed a decrease after application of both Remin Pro and CPP-ACPF in comparison to using bleaching agent (P<0.005). The surface roughness after using Remin Pro and CPP-ACPF was statistically similar to each other (P>0.05).

CONCLUSION

There was no difference between surface roughness of MI Paste Plus and Remin Pro groups. Also the surface roughness was decreased compared to the initial enamel surface roughness.