Grape seed extract as a potential remineralizing agent: a comparative in vitro study

Effects of cross-linking agents on hydroxyproline release and root caries lesion size: Systematic review and network meta-analysis of in vitro studies

A promising approach for managing root caries is the use of cross-linking agents to stabilize collagen. However, despite testing various natural and synthetic agents in vitro, their efficacy remains uncertain. The aim of this review was to examine which cross-linking agent performs better in reducing root caries lesion depth and the release of hydroxyproline, which is a marker of collagen degradation. Studies evaluating the impact of cross-linking agents on dentin were included, while studies performed on enamel surface/cell cultures and studies evaluating collagenase inhibitors were excluded, among others. A comprehensive search covered eight databases, and study quality was assessed using the QUINN Tool for in vitro dental studies. Synthesis of the results was done using a Bayesian network meta-analysis to compare agents. Fifty studies involving 31 cross-linking agents were included for qualitative synthesis. The network meta-analysis for lesion depth involved 284 samples across 36 comparisons and ranked cross-linking agents in terms of their caries lesion depth-reducing effect (from best to worst): naringin > quercetin > riboflavin > proanthocyanidins > hesperidin > glutaraldehyde > cranberry > grape seed extract > untreated controls. Only naringin, quercetin, proanthocyanidins, and glutaraldehyde showed statistically significant efficacy over untreated controls. Cranberry extract excelled in reducing hydroxyproline release, followed by proanthocyanidins. In conclusion, proanthocyanidins positively affected both outcomes, suggesting they are prime candidates for translational research. Clinical studies are now essential to evaluate their real-world effectiveness against root caries. PROSPERO-CRD42023404911.

Evaluation Of The Effect Of Current Remineralization Agents On Enamel By Different Methods

Objectives: In this study, it was aimed to quantitatively evaluate the remineralization capacity of natural medicaments such as ginger, grape seed extract and rosemary, and materials containing casein and hydroxyapatite of initial caries lesions in vitro.. Materials and Methods: 42 enamel samples obtained from human teeth; were divided into six group as; Group-I (10% Casein Phosphopeptide Amorphous Calcium Phosphate [CPP-ACP], GC Tooth Mousse, Group-II (Rosemary Oil), Group-III (ginger+honey), Group-IV (ginger+honey+cocoa), Group-V (grape seed extract) and Group-VI (control group; remineralization solution). After enamel samples were kept in demineralization solution for 72 hours to create initial caries lesion, grouped remineralization agents were applied to enamel samples with caries lesion during the six-day pH cycle. Measurements were made using surface microhardness and DIAGNOdent at three different stages. The data obtained in the research were analyzed using the SPSS 25.0 program. The results were evaluated at the p ginger+honey+cocoa>ginger+honey> rosemary oil > GC tooth mousse. Conclusions: : It is thought that rosemary, ginger + honey + cocoa, grape seed extract materials can be used for remineralization in these working conditions where the initial caries lesions can be remineralized after six days.

Anticaries properties of natural berries: systematic literature review

CONTEXT

Anticariogenic properties have been ascribed to polyphenolic compounds present in high concentrations in numerous fruits. Berries, in particular, have been reported as potentially having an inhibitory effect on the dental biofilm and subsequently on caries, but the evidence is unclear.

OBJECTIVE

The objective of this review was to explore the literature and summarize the evidence for berries having an inhibitory effect on the dental biofilm and an anticariogenic effect.

DATA SOURCES

Following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, the PubMed, Web of Science, and SCOPUS databases were scanned using predefined and accessible terms, with a search strategy based on a structured PICO question.

DATA EXTRACTION

After article selection, 23 studies met the inclusion criteria, most of them being in vitro studies. A risk assessment was performed, and data were extracted and presented in a table for qualitative analysis.

DATA ANALYSIS

Meta-analyses were conducted using standardized mean differences (SMDs) with a 95% confidence interval (CI) by Review manager 5.4.

RESULTS

Only 3 types of berries were found to have a reported anticaries effect: grape seed extract (GSE), cranberry, and sour cherry. Nine studies that fulfilled the eligibility criteria were subjected to quantitative analysis. Meta-analyses showed GSE was associated with enhanced remineralization of dental enamel (SMD = .96 95% CI [.45, 1.46], P < .0002) and of dentin (SMD = .65 95% CI [.13, 1.17], P = .01). Cranberry extracts positively influenced the cariogenic dental biofilm by decreasing the biofilm biomass (SMD = -2.23 95% CI [-4.40, -.05], P = .04), and biovolume (SMD = -2.86 95% CI [-4.34, -1.37], P = .0002), and increasing the biofilm pH (SMD = 7.9 95% CI [3.49, 12.31], P < .0004).

CONCLUSION

Within the limitations of this systematic review and metaanalysis, GSE and cranberries or their active compounds could represent an alternative for caries management. Further clinical trials are needed to verify this effect in a clinical setting.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020223579.

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.

Assessment of the Remineralizing Efficacy of Grape Seed Extract vs Sodium Fluoride on Surface and Subsurface Enamel Lesions: An In Vitro Study

AIM

The aim of this study was to evaluate the efficacy of grape seed extract (GSE) on remineralization of surface and subsurface enamel lesions compared to that of sodium fluoride (NaF).

MATERIALS AND METHODS

A total of 20 intact bovine incisor crowns were separated from their roots and immersed in a demineralizing solution for 96 hours at 37°C to create artificial enamel lesions. The specimens were randomly divided into two groups (n = 10): 6.5% GSE solution and 1000 ppm NaF solution. The specimens were subjected to six daily pH cycles for 8 days. The microhardness test was carried out at three different stages: baseline, after artificial caries formation, and after pH cycling. Raman spectroscopy was used to evaluate the depth of enamel remineralization. Surface morphology and elemental analysis were assessed using a scanning electron microscope (SEM) and an energy dispersive X-ray (EDX) spectroscope, respectively. Statistical analysis was performed using SPSS 22.0 at a significance level of p ≤ 0.05.

RESULTS

There was a significant increase in the mean values of enamel surface microhardness after pH cycles in the two groups compared to after artificial caries formation, but there was no significant difference between both groups. The B-type carbonate/phosphate (Ca/P) ratio at 10 and 40 µm depth revealed no significant difference between the two groups. Scanning electron microscope micrograph revealed occlusion of porosities and particle precipitation on the enamel surface of the two groups, while EDX results for the Ca/P ratio of the GSE and NaF groups were 1.59 and 1.60, respectively.

CONCLUSION

Grape seed extract and NaF are equally effective in remineralizing surface and subsurface artificial enamel lesions.

CLINICAL SIGNIFICANCE

Grape seed extract can be considered a promising herbal material and a safe alternative to traditional NaF for the noninvasive treatment of enamel lesions.

Sealing effects of different Chinese herbal medicines on dentinal tubules: a scanning electron microscopic observation

BACKGROUND AND OBJECTIVES

To evaluate the sealing effects of different Chinese herbal medicines on dentinal tubules, and to provide a reference for the clinical treatment of dentin hypersensitivity.

METHODS

Forty dentin slices prepared by freshly extracted bovine mandibular central incisors were randomly assigned to procyanidins, tannic acid, gallic acid, naringin, epigallocatechin gallate (EGCG), glycyrrhizic acid, paeonol, and blank groups. Dentin slices in each Chinese herbal medicine group were treated three times a day, each for 5 min, and then immersed in a remineralization solution for the rest of the time. Dentin slices in the blank group were directly immersed in the remineralization solution for 7 days. The dentinal tubule sealing effect was observed under the scanning electron microscope (SEM).

RESULTS

SEM results showed that the dentinal tubules were almost completely open in the blank group, which was mostly open in the gallic acid, EGCG, glycyrrhizic acid, and paeonol groups, and were sealed in procyanidins, tannic acid, and naringin groups. Significant differences were detected in mean area, mean diameter of dentinal tubules, and mean plugging rate of dentinal tubules between the remaining Chinese herbal medicine groups and blank group (P < .05). Among them, the dentinal tubule sealing effect of procyanidins, tannic acid, and naringin was obvious.

CONCLUSION

The findings suggested that procyanidins, tannic acid, and naringin can effectively seal dentinal tubules, which provided a basis for clinical treatment of dentin hypersensitivity.

Prevention of dental caries by grape seed extract supplementation: A systematic review

BACKGROUND

Dental caries are the most prominent chronic disease of children and adults worldwide, and facilitating evidence-based, preventative care for their prevention is critical. Caries are traditionally and successfully prevented by regular fluoride use, but there are opportunities to halt and restore caries with alternative agents in addition to fluoride use. Grape seed extract (GSE) is a readily available plant-based supplement that, due to its concentrated levels of proanthocyanidins, has promising characteristics that may assist in dental caries prevention.

AIM

The goal of this review was to investigate whether current research supports use of grape seed extract to prevent dental caries formation.

METHODS

A systematic review of articles related to grape seed extract, prevention of dental caries, inhibition of Streptococcus mutans, and remineralization was conducted. Articles were first chosen by inclusion of dental models that used grape seed extract as an intervention, and then by strength of study design.

RESULTS

Twenty articles were reviewed. Studies overall supported three unique grape seed extract properties facilitating dental caries prevention. In the first articles reviewed, grape seed extract inhibited proliferation of bacterial biofilms on tooth surfaces. In addition, studies reviewed indicated that grape seed extract promoted dental remineralization.

CONCLUSIONS

Caries prevention by grape seed extract may be unique compared with fluoride, and is linked to grape seed extract's bacteriostatic and collagen crosslinking properties. Future research should investigate potential delivery methods, and benefits of combined grape seed extract use with known caries preventative agents, in human participants.

Recent Advances in Dental Hard Tissue Remineralization: A Review of Literature

The dental caries is not simply a continuous and unidirectional process of the demineralization of the mineral phase, but a cyclic event with periods of demineralizations and remineralisation. The remineralization process is a natural repair mechanism to restore the minerals again, in ionic forms, to the hydroxyapatite (HAP) crystal lattice. It occurs under near-neutral physiological pH conditions whereby calcium and phosphate mineral ions are redeposited within the caries lesion from saliva and plaque fluid resulting in the formation of newer HAP crystals, which are larger and more resistant to acid dissolution. Numerous types of remineralizing agents and remineralizing techniques have been researched and many of them are being used clinically, with significantly predictable positive results. The recent researches on remineralization are based on biomimetic remineralization materials, having the capability to create apatite crystals within the completely demineralized collagen fibers.

HOW TO CITE THIS ARTICLE

Arifa MK, Ephraim R, et al. Recent Advances in Dental Hard Tissue Remineralization: A Review of Literature. Int J Clin Pediatr Dent 2019;12(2):139-144.

Grape seed extract: An innovation in remineralization

Aim:

The aim of this study was to determine remineralizing potential of grape seed extract (GSE) compared to casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and calcium glycerophosphate (CaGP) through pH-cycling model and subsequent evaluation using polarized light microscope (PLM).

Subjects and Methods:

Twenty sound human teeth fragments of ten teeth were obtained from the cervical portion of the roots and were stored in demineralizing solution for 96 h at 37°C to induce artificial root carious lesion. The sections then were divided into four treatment groups including: 6.5% GSE, CPP-ACP, 0.5% CaGP, and control group (no treatment). The demineralized samples were then pH cycled through treatment solutions, acidic buffer, and neutral buffer for 8 days at six cycles per day. The samples were subsequently evaluated using PLM.

Statistical Analysis Used:

Data were analyzed using ANOVA and Scheffe post hoc comparison test (P < 0.001).

Results:

PLM data revealed a significantly thicker mineral precipitation band on the surface layer of the GSE-treated lesions compared to the other groups (P < 0.001).

Conclusion:

GSE positively affects the demineralization and/or remineralization processes of artificial root caries lesions.