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PubMed1994

Brushing-induced effects with and without a non-fluoride abrasive dentifrice on remineralization of enamel surfaces etched with phosphoric acid.

The remineralization of acid-etched enamel after brushing with and without a non-fluoride abrasive dentifrice was investigated using scanning electron microscopy after sodium hypochlorite (NaOCl) or ethylenediamine tetra-acetic acid treatment, of the specimens. Ground enamel pieces were etched with 30% phosphoric acid for 60 s and attached to resin plates. They were exposed to the oral environment of 4 subjects for 8 weeks and brushed for 1 min daily. Paste and brushing caused the acid-etched enamel to erode selectively, i.e., deep grooves were formed in the prism peripheral regions, while projections of the prism bodies showing a relatively low density of crystallites were retained. Brushing without dentifrice, on the other hand, caused about 0.5 micron thick pellicle with tag-like structures to cover the etched enamel. Fine mineral granules, presumably derived from saliva and minute fragments of etched crystallites, were precipitated on the enamel surface as a thin layer with the pellicle. These results indicate that daily brushing without dentifrice induces the remineralization of acid-etched enamel by depositing salivary components, while paste brushing will lead to abrasion of the weakened enamel.

Acid Etching, Dental↗

PubMed1987

The use of saturated DCPD in remineralization of artificial caries lesions in vitro.

Dicalcium phosphate dihydrate (DCPD) may play a significant role in the caries lesion since it is a stable calcium phosphate phase under acidic conditions. The reaction of DCPD and fluoride, forming fluorapatite (FAP), may provide a potentially promising treatment regimen for remineralization of caries lesions in vivo. The purpose of this study was to determine whether a two-step DCPD and inorganic wash with fluoride can remineralize artificial caries-like lesions in vitro. We used the single-section technique to facilitate quantitation of the same tissue before and after the experimental regimen. The two-step remineralizing treatment was repeated three times and consisted of a two-minute saturated DCPD treatment (pH 2.1) followed by a 24-hour inorganic wash. Lesion parameters were recorded before and after treatment by the taking of polarized light photomicrographs of each section after imbibition in several media. The changes in the tissue following treatment were expressed as a percent change in the area of the initial pre-treatment lesion. Significant reductions (p < 0.02) in lesion pore volume were observed in all aqueous media examined. In the lesions after imbibition in quinoline, remineralization was also apparent from the significant increase in the area of the dark zone following treatment. This two-step DCPD treatment appears to remineralize artificial caries-like lesions effectively, but additional work is needed to determine whether it affords any protection against subsequent cariogenic challenges.

Apatites↗

PubMed1995

Hypermineralization of dentinal lesions adjacent to glass-ionomer cement restorations.

Previous reports have shown a release of fluoride from glass-ionomer cement (GIC) restorations into the oral fluids. Fluoride in the ambient fluids has a caries-preventive effect by enhancing remineralization and inhibiting demineralization of the dental hard tissues. Therefore, the current investigation was undertaken to determine whether GIC fillings could contribute to the remineralization of caries lesions in dentin. Small circular preparations were made in disks of dentin which had incipient caries-like lesions in the remaining tissue. The preparations were filled with amalgam or composite materials (as controls) or with GIC. The specimens thus contained a restoration close to a dentinal caries-like lesion. The specimens were placed contralaterally in the buccal surfaces of removable partial dentures and were worn intra-orally by volunteers for a 12-week experimental period, after which the specimens were sectioned and analyzed by microradiography. All specimens with GIC restorations exhibited hypermineralization in the tissue bordering the filling and in the wall of the preparation which had been in contact with the restoration. The (caries-like) lesions were remineralized, even under conditions of heavy plaque formation. In contrast, specimens with amalgam or composite restorations showed further extensive demineralization. This study demonstrates a significant remineralization potential exerted by the fluoride-releasing GIC restorative material. Consequently, the choice of the restorative material might be crucial for the occurrence or prevention of recurrent caries around restorations.

Aluminum Silicates↗

PubMed1990

[Crystallo-chemical problems of dental enamel and new possibilities of in vitro remineralization].

Incipient dental caries according to up-to-date concepts in dental research--means a demineralization without cavity formation. At this stage the carious process is reversible, and remineralization can occur in the presence of locally applied fluorides. In crystal chemical experiments, however, by treating natural apatites with lanthanides (Ce, La, Pr, Nd, Sm, Eu, Tb...Y, Sc) a more resistant complex could be developed. In this study extracted human molar teeth were kept for 60 days in Cerium (III)-nitrate solution, in order to investigate the incorporation of Ce3+ into human sound and carious enamel by light-microscopic-, and electron microprobe methods. Ce3+ was incorporated in sound enamel as well as into the incipient carious lesion, showing the histological characteristics of a remineralizing lesion. The mean values of the microprobe analysis data showed an increase in Ce3+ changing place with the Ca2+ the developing cerium-apatite being more hard and resistant from a mineralo-physical point of view.

Crystallization↗

PubMed1996

Determination of fluoride from fluoride-releasing elastomeric ligature ties.

Unaesthetic white spot lesions or larger unsightly areas of decalcification around orthodontic brackets remain a significant problem during fixed appliance treatment. This study determined the in vitro fluoride release from 200 fluoride-containing elastomeric ligature ties. With the potentiometric analytic method, the fluoride release was determined in distilled water, for 10 groups of 20 elastomerics, representing the clinical usage in a patient. Readings were taken every 24 hours for 5 days and then every second week for 6 months. The data were analyzed with the Wilcoxon matched pairs signed ranks test. Fluor-I-Ties (Ortho Arch Company Inc., Hoffman Estates, III.) released significant amounts of fluoride compared with the control readings. The fluoride release was characterized by an initial burst of fluoride during the first day and second day, followed by a logarithmic decrease. By the end of the second week 88% of the total fluoride had been leached from the elastomerics, but adequate magnitudes of fluoride were released over the remainder of the test period to aid theoretically in the prevention of demineralization and enhance remineralization of enamel through calcium fluoride and fluorapatite formation. For optimum clinical benefit, Fluor-I-Ties should be replaced monthly. Future prospective longitudinal clinical studies are indicated.

Apatites↗

PubMed2001

Development of an enhanced anticaries efficacy dual component dentifrice containing sodium fluoride and dicalcium phosphate dihydrate.

A dual-chamber dentifrice, which contains sodium fluoride (NaF) in one component and dicalcium phosphate dihydrate (dical) in the other, has been developed. The dentifrice is packaged in a dual-chamber tube and is formulated to deliver 1100 ppm F. A series of studies consisting of in vitro fluoride uptake, in vivo calcium labeling, intraoral remineralization-demineralization, and animal caries studies were performed to support the improved anticaries efficacy of this product in comparison to a sodium fluoride/silica dentifrice (NaF/silica). An in vitro fluoride uptake study comparing 1100 ppm F NaF/dical dentifrice to 1100 ppm F NaF/silica showed that NaF/dical delivered significantly more fluoride than NaF/silica, 3.72 +/- 0.36 micrograms/cm2 versus 2.41 +/- 0.10 micrograms/cm2. A 6-day in vivo brushing study with a 44Ca labeled NaF/dical dentifrice showed that calcium from dical penetrated demineralized enamel and was present in plaque up to 18 hrs since the last brushing. An intra-oral remineralization-demineralization study was performed to evaluate NaF/dical's ability to promote remineralization in comparison to three silica-based dentifrices containing 0, 250, and 1100 ppm F as NaF. The percent mineral changes after treatment were +20.44 +/- 17.14 for NaF/dical, +9.27 +/- 19.53 for 1100 ppm NaF/silica, -1.43 +/- 20.57 for 250 ppm NaF/silica, and -12.36 +/- 32.76 for 0 ppm F/silica. A statistical analysis showed that the dual-chamber NaF/dical dentifrice was significantly more effective than the 1100 ppm NaF/silica dentifrice at promoting remineralization. A rat caries study was performed to evaluate NaF/dical ability to prevent caries in comparison to 1100 ppm F NaF/silica, 250 ppm F NaF/silica, silica, and dical dentifrices. The mean smooth surface caries scores were 1.6 +/- 2.8 for NaF/dical, 5.5 +/- 6.2 for 1100 ppm F NaF/silica, 10.6 +/- 6.2 for 250 ppm F NaF/silica, 13.7 +/- 4.7 for 0 ppm F/silica, and 9.5 +/- 7.8 0 ppm F/dical. A statistical analysis showed that the the dual-chamber NaF/dical dentifrice was superior to all other treatments tested in preventing caries in rats. The dical dentifrice was significantly superior to the silica dentifrice in preventing caries, which indicates that dical alone exhibits anticaries efficacy. In conclusion, individual and cumulative results from the fluoride uptake, intra-oral remineralization-demineralization, and rat caries studies from the dual chamber NaF/dical dentifrice support the improved anticaries efficacy of this product.

Animals↗

PubMed1990

Calcium and phosphate uptake of human dental enamel treated with sodium bicarbonate.

Enamel cylinders, submitted to the action of NaHCO3 solutions or kept in water, were immersed in a remineralizing solution containing radioactive calcium and phosphate. The calcium uptake was increased in NaHCO3 treated samples, but not the phosphate uptake. Less calcium adsorption was found in 72 h--NaHCO3 treated samples, than after 1 h and 24 h respectively.

Bicarbonates↗

PubMed2003

In vitro evaluation of fluoride varnish on overdenture abutments.

STATEMENT OF PROBLEM: No clinical study has evaluated the efficacy of fluoride varnish as a topical fluoride agent for the protection of overdenture abutments from dental caries. PURPOSE: This study assessed the efficacy of a fluoride varnish in protecting overdenture abutments from demineralization in an in vitro environment. MATERIAL AND METHODS: Eighty caries-free, extracted teeth were sectioned and domed immediately below the cementoenamel junction, simulating overdenture abutment preparations. Acid resistant nail varnish was painted on all surfaces except for a window (1 x 4 mm) on the prepared occlusal dentin surfaces. Teeth were randomly divided into 4 groups of 20 specimens: control, washed with deionized/distilled water; Daily Gel, treated with Karigel-N (5,000 ppm) for 4 minutes daily; Weekly Gel, treated with Karigel-N for 4 minutes weekly; and Weekly Varnish, treated with Duraflor (22,600 ppm) weekly. The varnish was removed using a blade 24 hours after each application to simulate the clinical loss of the varnish. Teeth were then placed in a cycle of demineralization (2.2 mMol/L CaCl(2)2H(2)O, 2.2 mMol/L KH(2)PO(4), and 50 mMol/L acetic acid at pH 4.3) for 6 hours and remineralization (1.5 mMol/L CaCl(2)2H(2)O, 0.9 mMol/L KH(2)PO(4), and 150 mMol/L KCl at pH 7.0 for 17 hours) for 21 days. Half the teeth in each group were brushed with no dentifrice for 10 seconds, twice daily. Teeth were sectioned at 100 +/- 10 microm buccolingually and evaluated under polarized light microscopy and contact microradiography. The depth of each lesion and the width of the remineralization bands were measured (mm). Analysis of variance models and T-tests were used to assess the effects of different treatments (alpha=.05). Duncan multiple range tests were then chosen as post hoc tests to evaluate the statistical significance of all pairwise comparisons. RESULTS: The control group had the deepest lesions (mean depth 400 +/- 39 microm). The lesions from the varnish and daily gel groups were significantly shallower than the lesions in both the control group and the weekly gel group. The remineralization bands in the varnish group were 52% wider than the control group bands. However, the daily gel group had the largest increase in band width (117% increase) compared with the control group. There were significant differences between all groups for net depth (lesion depth minus the remineralization band) (P<.0001). Daily application of fluoride gel was significantly more effective than the other treatments tested. Brushing was not a significant factor. CONCLUSION: Within the limitations of this in vitro study, treatment of overdenture abutment with various topical fluorides significantly inhibited demineralization and enhanced remineralization of cut occlusal dentin surfaces. Daily use of Karigel-N was the most effective treatment, followed by the weekly application of Duraflor varnish.

Analysis of Variance↗

PubMedDate not supplied

Selection of restorative materials for the atraumatic restorative treatment (ART) approach: a review.

The atraumatic restorative treatment (ART) technique or approach for the restoration of primary and permanent teeth has been widely adopted in, but not limited to, developing countries. However, the requirement for the placement of the restorative materials under often less-than-ideal conditions imposes significant restrictions on their selection; and there have been very few randomized clinical trials or reports comparing different types of restorative materials and treatments. Although conventional glass-ionomer cements (GICs) have relatively poor mechanical and adhesive strengths, their satisfactory biological features, ease of use, and low costs are distinct advantages. Most of the published reports of the clinical performance of the newer, high-strength esthetic conventional GICs specifically marketed for the ART approach have been from short-term studies. Satisfactory clinical performance has been demonstrated for single-surface posterior restorations only, over three years. Findings indicate that further improvements in restorative materials are still required for their use with the ART approach, together with further clinical investigations of the remineralization of shallow open caries lesions, as an alternative to placing definitive restorations.

Cariostatic Agents↗

PubMed1990

In vitro studies on the effects of fluoride on de- and remineralization.

The recent literature extensively describes the role of ambient fluoride in the de- and remineralization of dental enamel. Fluoride in sub-ppm concentrations is effective in promoting mineral deposition and inhibiting mineral dissolution. The latter phenomenon is most likely attributable to the concomitant precipitation of a fluoride-rich mineral phase which inhibits further dissolution. These fundamental processes result in an inhibition of enamel demineralization and an enhancement of enamel lesion remineralization. Alternatively, fluoride may also induce the 'arrestment' of enamel lesions. For the in vivo patterns and the effects of caries-preventive substances to be studied, de- and remineralization can best be examined with a pH-cycling system in which the pH depressions occurring in the oral environment are mimicked in a laboratory model. Such an approach has proved useful in developing optimal fluoride schemes which can be tested in animal, intraoral, and clinical studies.

Dental Caries↗

PubMed1990

[Two-stage method of enamel remineralization].

Two toothpastes were compared in vitro for assessing the effectiveness of a two-stage process of enamel remineralization after damage inflicted by means of acid. One paste contained added free anions essential for the remineralization process, the other paste contained analogous free cations. The remineralization process was based on sorption of free PO4(3-) or Ca2+ ions at the site of damaged enamel and development of calcium phosphate in situ. The study was carried out using phosphorus and calcium radioisotopes, electron microscope and X-ray microanalyzer.

Anions↗

PubMed1999

Incidence and progression of approximal caries from 11 to 22 years of age in Sweden: A prospective radiographic study.

Using annual bite-wing radiographs, the incidence and progression of approximal caries (4d-7m) were assessed longitudinally in teenagers and adolescents whose treatment had been based on remineralizing rather than restorative strategies. A closed cohort of 536 children initially was followed from 11 to 22 years of age. The scoring system was: 0 = no visible radiolucency; 1-2 = radiolucency in the enamel up to the enamel-dentin border; 3 = radiolucency with a broken enamel-dentin border but with no obvious progression in the dentin; 4 = radiolucency with obvious spread in the outer half of the dentin, and 5 = radiolucency in the inner half of the dentin. Caries rates were estimated as the number of new lesions/100 tooth surface-years, and the Kaplan-Meier estimate was used to calculate the cumulative survival time of each approximal surface. Three events were used: the transitions from states 0 to 2, 2 to 4 and 3 to 4. The results showed a considerable variation between the surfaces in both caries rates and survival time. For all surfaces combined, the median caries rate from state 0 to 2 was 3.9 new lesions/100 tooth surface-years; from state 2 to 4, the rate was 5.4, and from state 3 to 4 it was 20.3. Of the sound surfaces (state 0), 75% survived 6.3 years without reaching state 2. Given state 2, 75% survived 4.8 years without reaching the outer half of the dentin (state 4), while given a lesion at the enamel-dentin border (state 3), 75% survived 1.3 years without doing the same. The median survival time of lesions from state 3 to 4 was 3.1 years. The group with DMFSappr>1 at the age of 11-12 years had a risk of new approximal enamel lesions (state 0-2) that was 2.5 times greater than that of the group with DMFSappr = 0-1.

Adolescent↗

PubMed1996

The use of low-tack chewing gum for individuals wearing orthodontic appliances.

A clinical study was carried out to determine the acceptability of a sugar-free, low-tack chewing gum by orthodontic patients undergoing fixed appliance treatment. Twenty-five orthodontic and 25 non-orthodontic control subjects were questioned on their preference between regular-tack and low-tack chewing gum. The orthodontic subjects showed a strong preference for the low-tack gum compared with the regular-tack gum. It was concluded that low-tack, sugar-free chewing gum can be used by orthodontic patients to increase saliva flow, with the potential to promote remineralization and help reduce white spot lesion formation related to fixed orthodontic appliances. This gum should also be of value in patients being treated for xerostomia who are wearing a partial denture.

Adhesiveness↗

PubMedDate not supplied

The remineralization of EDTA-treated human dentine.

The remineralization of whole human dentine treated with a neutral EDTA solution was investigated: the treatment periods were 15, 30 and 120 min. From the literature it is known that EDTA removes noncollagenous proteins (NCPs) from dentine powders. In order to extract more phosphoproteins from dentine lesions, in part of this work samples were also treated with 1 M NaCl or 4 M guanidine chloride solutions. All the dentine samples after the treatments mentioned were immersed subsequently in a remineralizing solution without fluoride for 2 weeks and microradiographed. To investigate the effects of fluoride, samples treated with EDTA for 120 min were also remineralized with 2 ppm fluoride in solution. The results presented show that: (1) Measurable remineralization did not occur when fluoride was free in the remineralizing solution. Because remineralization occurred neither at the lesion front nor in the nonmineral part of the surface-softened tissue, presumably the NCPs (inhibitors) of underlying dentine diffused into the tissue during the remineralization period. (2) 2 ppm fluoride caused remineralization at the lesion front. In this case we assume fluoride either acted as nucleating agent or overcame the NCP effects at the lesion front.

Analysis of Variance↗

PubMed1995

Effect of post-brushing water rinsing on caries-like lesions at approximal and buccal sites.

The aim was to study the effect of two different water rinsing procedures after toothbrushing with an NaF-containing dentifrice on the degree of de- or remineralization of enamel and dentine at approximal and buccal sites. Seven adults, wearing complete dentures, participated in two experimental periods (A and B) in a randomised order. During period A, they brushed with the dentifrice for 2 min, followed by 1-min active mouthrinse with the toothpaste-foam combined with 10 ml of water. No more water was used after the slurry had been spat out. During period B, the brushing was followed by 3 thorough rinsings of approximately 15 ml water each. These two procedures were carried out twice daily, i.e. in the morning (after breakfast) and in the evening (just before bedtime), during 3 months. Demineralized enamel and dentine samples were mounted at two locations--approximally and buccally--in the first molar region of the upper prostheses. Quantitative microradiography (TMR) was used to assess the lesion depth (ld) and the mineral loss (delta Z). The results showed that the approximally located samples continued to lose mineral during both periods A and B. However, the ld and delta Z values for enamel (p < 0.01) and dentine (p < 0.05) increased less during A than B. The buccally located enamel and dentine samples remineralized during the experiment, but no statistically significant differences were found for the ld and delta Z values of either enamel or dentine between periods A and B.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1992

Comparison of fluoride profiles by SIMS with mineral density of subsurface enamel lesions treated intra-orally with a fluoride-releasing device.

A variety of intra-oral model systems has evolved which allows for the study of remineralization of coronal and/or root-surface lesions following application of topical fluoride (F) agents. The problem of interpretation of the results has led to a variety of analytical methods (i.e., microhardness, F biopsy, microradiography, and polarizing light microscopy), each of which provides important but limited information related to the overall understanding of remineralization. Microhardness measures change in mineral content which is more precisely localized by microradiography and polarized light microscopy. F biopsy allows for assessment of the F uptake of lesions, but does not suggest the chemical state of the F. Previous work has demonstrated that patterns of mineral deposition during remineralization do not necessarily parallel the F uptake profiles, and fluoridated apatites cannot be distinguished from non-specifically-adsorbed F (Clark et al., 1988). Because artificial lesions demonstrate variations in depth and mineral content, complementary analytical methods that demonstrate profiles of both F content and mineral density curves on the same section are needed so that the process of remineralization can be more clearly understood. This study used secondary ion mass spectrometry (SIMS) for F profiles and quantitative microradiography for assessment of mineral deposition on the same section. These state-of-the-art methods demonstrate the precision with which information about remineralization can be obtained. Subsurface lesions in human enamel specimens were developed by immersion in 0.1 M lactate buffer with 1% CMC at a pH of 4.5 for 48 h.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2002

Dental adhesives of the future.

The current trend in the development of dentin adhesives attempts to simplify bonding steps and make them more user-friendly. However, optimizing speed and efficiency should be accomplished without major tradeoffs in the quality or durability of resin bonds. Although dentin adhesives have improved tremendously over the past decade, postoperative sensitivity, incomplete marginal seal, premature bond degradation, biocompatibility, and compromised bonding to abnormal substrates are still considered potential problems associated with their use. Advances in different scientific disciplines will enrich the pool from which ideas may be drawn in designing future dentin adhesives. It is probably on the molecular level that we will see the greatest expansion of horizons. With the advances in biomimetics, future dentin adhesive monomers may contain domains derived from protein-based, underwater bioadhesives secreted by aquatic animals such as mussels and barnacles, making them less dependent on the surface energy of the bonding substrates as well as less susceptible to hydrolytic degradation. As adhesive joints produced by contemporary adhesives are brittle in nature, future adhesive design may incorporate biomimetic intermediate-strength domains that can undergo stepwise reversible unfolding in response to varying functional stress levels before ultimate catastrophic failure of the adhesive joint occurs. These domains may also re-establish folded configurations on stress relaxation, making the adhesive both strong and tough. Using the concept of controlled release, future adhesives may contain fluorescent biosensors that can detect pH changes around leaking restorations. They may even have the capacity to heal autonomously, in response to microcracks formed by functional stresses within the adhesive joint. The ability to self-diagnose and self-repair will increase the life expectancy of adhesive restorations. Future dentin adhesives may also assume a more instrumental role in therapeutics apart from caries prevention. These features may include the controlled release of noncollagenous proteins to promote remineralization of collagen matrices in sound and caries affected dentin, and growth factors to induce controlled formation of reparative dentin.

Adhesives↗

PubMed1992

The ICT in situ experimental model in dental research.

The intra-oral cariogenicity test (ICT) in situ experimental model was introduced in 1964 for the study of caries on sample enamel in the human mouth. Slabs of human or bovine enamel are mounted with a Dacron gauze cover in the acrylic flanges of prosthetic appliances. The extent of enamel demineralization or remineralization of lesions is assessed from surface microhardness measurements and microradiography of the enamel sections. The ICT model offers the potential of studying various parameters related to caries. This publication presents a typical ICT study comparing the cariogenicity of 10% sucrose solutions containing 1, 3, 10, and 30 ppm F with that of the control solution, 10% sucrose (without fluoride). The treatments were applied to the ICT as 10-minute extra-oral immersions. The results indicate: (1) a strong effect of F in decreasing demineralization of sound enamel and increasing remineralization of pre-softened enamel in the ICT; (2) pronounced resistance to a subsequent in vitro acid test; (3) pronounced F incorporation into pre-softened enamel; and (4) a characteristic acid-resistant zone, as seen in microradiographs, associated with exposure to F. This in situ model enables one to study experimental caries with repeated testing of enamel that follows the development and/or the regression of subsurface enamel lesions, F incorporation, increased acid resistance, cariogenicity of substrates, and other parameters of caries that can be assessed under standard conditions of tooth substrate and microbial sheltering.

Animals↗