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PubMed1998

Tunnel restorations in permanent teeth. A 7 year follow up study.

The aim of the study was to perform a long-time evaluation of tunnel restorations made in a general dental practice concerning survival time and type of failures. 267 Class I (87%) and II (13%) tunnel restorations in permanent teeth on 193 patients--mostly teenagers and young adults--were evaluated at annual recalls. The observation time-span was 1-7 years. The restoration material was a conventional glass ionomer cement in Class I tunnels and a silver cermet glass ionomer cement in Class II tunnels. The yearly failure rate was 7% and the 50% survival time was 6 years. The reasons for replacement were: marginal ridge fracture (41%), recurrent caries (40%) and cavitation in approximal enamel (19%). No differences in failure rate between Class I and II tunnels could be seen, but recurrent caries was more frequent in Class I tunnels. Restorations made during the second year of the study were more successful, indicating a learning effect. Class I tunnel restorations in general practice can be an alternative to conventional Class II restorations with narrow indications, i.e. patients with relatively low caries activity, small approximal lesions in combination with small demineralization zones in the enamel wall.

Adolescent↗

PubMed1996

In vitro study on the dimensional changes of human dentine after demineralization.

Dentine rods measuring approximately 0.7 x 0.7 x 5.0 mm were prepared from dentine of extracted human third molars stored in saline containing 0.5% sodium azide at 4 degrees C until used. Forty specimens were demineralized in 10% citric acid plus 3% ferric chloride (w/w) solution for 8 h, then assigned to four groups (A, B, C and D) of 10 specimens each. Groups A and B were used to investigate volumetric changes after air-drying and further immersion in either water, an aqueous solution of 50% 2-hydroxymethylmethacrylate (HEMA) or 100% HEMA, followed by air-drying. Groups C and D were used to investigate the ability of 100% HEMA or 100% ethylene glycol to prevent shrinkage of demineralized dentine during exposure to air. Demineralization caused a small, non-significant (1.9%) reduction in dentine volume. Air-drying further reduced the volume by 65.6%. When demineralized, shrunken specimens were immersed in water for 24 h, they recovered their original demineralized volume. Immersion in 100% HEMA did not re-expand demineralized shrunken dentine. Specimens immersed in 50% HEMA yielded a 50% volume shrinkage when exposed to air for 24 h. Both 100% HEMA and 100% ethylene glycol were effective in preventing shrinkage of demineralized dentine. The technique used provided useful information about maximal dimensional changes that may occur at a microscopic level during adhesive dental restorative procedures.

Acid Etching, Dental↗

PubMed2006

Denaturation temperatures of dentin matrices. I. Effect of demineralization and dehydration.

The denaturation temperature (T(d)) of dentin collagen in mineralized versus demineralized teeth was examined as a function of dentin age and the extent of dehydration. Using differential scanning calorimetry, T(d) of mineralized dentin was shown to be between 160 degrees C to 186 degrees C, depending on whether it was from young or old dentin that was hydrated or dehydrated, respectively. Demineralized dentin exhibited a T(d) of 65.6 degrees C that increased with dehydration to 176 degrees C. The presence of apatite crystallites or interpeptide bonding increased the T(d) of demineralized matrices. Interpeptide hydrogen bonding seems to stabilize collagen to thermal challenge. Water breaks interpeptide hydrogen bonds making collagen more susceptible to thermal denaturation. Rises in intracanal temperature are unlikely to cause extensive denaturation of mineralized root dentin walls. However, hydrated or partially dehydrated root canal walls that have been partially demineralized with chelating agents or mild acids may be susceptible to thermal denaturation.

Adolescent↗

PubMed1994

Reduction of caries and of demineralization around orthodontic brackets: effect of a fluoride-releasing resin in the rat model.

The effectiveness of fluoride in reduction of caries is well known. This study examined the ability of a fluoride-releasing resin to reduce caries, as well as demineralization around orthodontic brackets, by using the Sprague-Dawley rat as a model. Eighteen-day-old rats were infected with cariogenic Streptococcus sobrinus 6715. After infection was confirmed, standard orthodontic techniques were used to bond miniature orthodontic brackets to the lingual surfaces of maxillary first molars, with either a fluoride-releasing resin (group I) or a conventional resin (group II). A control group was infected but not bonded (group III). Bonding was done at age 34 days. Rats were fed a cariogenic diet and were killed at age 72 days. Lingual surfaces of maxillary first molars were evaluated for area of demineralization, and mandibular molars were scored for caries. Mean percent area of demineralization for group I was 4.7%, for group II 35.7%, and for group III 0%. The difference between groups I and II was statistically significant (p < 0.01). Mean mandibular molar enamel carious lesion unit count for group I was 9.8, for group II 16.3, and for group III 13.7. Group I had significantly fewer lesions than groups II and III (p < 0.01), and group II had significantly more lesions than group III (p < 0.01). These results indicate that a fluoride-releasing resin reduces demineralization at the site of application and reduces caries at distant sites in the experimental rat model.

Animals↗

PubMed1993

Dentin demineralization. The effects of citric acid concentration and application time.

Preliminary work has shown that the rate of dentin demineralization increases with increasing concentrations of citric acid. This rate subsequently diminishes at much higher concentrations. The purpose of this study was to more precisely identify the citric acid concentration which produces peak dentin demineralization and to determine if this demineralization process is time dependent. Flat dentin surfaces were prepared on the buccal and lingual sides of 15 bovine molars. 8 depressions were made in each dentin surface using a #8 round bur in a high-speed handpiece with air-water coolant. Various concentrations of citric acid solutions (weight per cent) were prepared, e.g., 0%, 10%, 20%, 25%, 30%, 35%, 40%, 65% and their respective pH's recorded. 3 microliters of each citric acid solution were placed in individual depressions on the dentin surfaces and left undisturbed for 1, 2 or 3 min. Cotton pellets were used to soak up the citric acid solution, along with any dissolved calcium, and were subsequently placed in 10 ml of 18 Me omega water. The parts per million calcium found in each water sample were determined using atomic absorption spectrophotometry. Peak dentin demineralization for 1-, 2- and 3-min application times occurred at 30% (pH = 1.55), 25% (pH = 1.62) and 25% (pH = 1.62) citric acid concentrations/(pH), respectively. Dentin demineralization was found to be time-dependent for all citric acid solution concentrations. The clinical significance of these findings is discussed.

Analysis of Variance↗

PubMed2000

Studies of dental root surface caries. 1: Comparison of natural and artificial root caries lesions.

Qualitative polarized light microscopy and cross-sectional microhardness testing profiles were used to compare artificial root caries lesions with those naturally present in extracted human teeth. The artificial lesions were produced by immersion of roots with exposed windows in chemical buffers of acetate and lactate with no added enzymes or bacteria. The three buffer systems used produced lesions with the range of histological characteristics of natural lesions. These included a 'body' or 'surface' zone of the lesion when viewed in water, and a 'frontal' zone of reverse birefringence when viewed in quinoline. The 'frontal' zone was noted to first develop after three days of immersion in acetate buffer. Advanced natural lesions exhibited a wide, diffuse, advancing front, which was similar to that produced by 28-60 day lesions in acetate. Microhardness profiles of natural lesions could all be matched by one or more of the artificial lesions. The demineralizing process was seen to reduce mineral content across the lesion from 45 per cent in normal dentine to between 15 and 25 per cent.

Acetic Acid↗

PubMed1992

Increased resistance to artificial caries-like lesions in dentin treated with CO2 laser.

The crowns of 60 permanent human molars were sectioned transversally. The exposed dentin surface was divided into different parts: a first part was kept as control, a second part was immediately varnished, and a third part was irradiated with a CO2 laser using the same irradiation conditions as those applied for caries removal (10 impulses of the same energy; 0.2 s/impulse; energy density/impulse 280-715 J/cm2. After irradiation, a small portion of this area was varnished. The teeth were immersed for 4 weeks in a cariogenic gel (pH = 4.5) at 36 degrees C. Twenty teeth were studied by scanning electron microscopy, and longitudinal sections of the other teeth were prepared for microradiography and microdensitometry measurements. The lased dentin surface appeared smooth for energy densities lower than 425 J/cm2. Longitudinally fractured samples revealed a layer of dentin devoid of tubular structure (20-70 microns thick, depending on the energy density used), whereas below the sealed layer, the dentinal tubules retained their normal aspect. Although the sealed layer showed no demineralization when exposed to acid, demineralization of the underlying dentin occurred, but to a much lesser extent than in the unlased dentin.

Carbon Dioxide↗

PubMed1999

Kinetics of enamel demineralization in vitro.

Previously, we reported that the rate (R) of hydroxyapatite dissolution in acetic, lactic, and phosphoric acid solutions is a function of the degree of saturation with respect to the dissolving mineral, DS (defined as the ratio of the mean ionic activity product for hydroxyapatite [Ca5OH(PO4)3] in solution to its solubility product constant), and the sum of the acid activities (sumBiH) in solution: R = K(1-DS)m(sumBiH)n. The present study was undertaken to explore the general validity of this model in describing the kinetics of enamel demineralization. Thin sections of human enamel were exposed to partially saturated 0.1 mol/L lactic acid solutions, at two different DS levels, and at pH values of 4.3 to 6.0. Thin sections of human enamel were also exposed to solutions with four different concentrations of acetic and lactic acids (pH 4.3) with three different DS values and, at one DS value, to solutions of propionic acid. Mineral loss was monitored by quantitative microradiography. In solutions with pH values of 4.3 and 5.0, "lesions" were formed with well-defined surface layers, whereas, in solutions with pH 6.0, "lesions" were produced with no apparent surface layers. The formation of relatively intact surface layers was consistent with predicted phase transformations. Rates of mineral loss were found to be inversely proportional to both the degree of saturation with respect to enamel mineral, DS(En), and the pH of the solution and increased with increased activities of each organic acid, consistent with the proposed model. However, at the same DS(En) and acid activity, rates of demineralization were the same in the acetic and propionic acid solutions, whereas rates of demineralization in lactic acid were greater. It is suggested that specific interactions of acid species with enamel mineral may modify the rate of enamel demineralization. These in vitro findings suggest that relatively small differences in DS(En) values found in plaque fluid may result in very significant differences in the rate of enamel demineralization in vivo.

Acetates↗

PubMed2005

Linear and logarithmic subtraction for detecting enamel subsurface demineralization.

OBJECTIVE: To compare the diagnostic performance of linear and logarithmically contrast-enhanced subtraction images, acquired with digital and digitized radiographs, in detecting approximal enamel subsurface demineralization. METHODS: Fifty caries-free human third molars were immersed in a demineralizing solution for 60, 75, 90, and 120 days, in order to induce artificial enamel subsurface demineralization. The teeth were coated with nail varnish, leaving only a circular window of approximately 7 mm2 in one of the approximal surfaces, allowing contact with the solution. Standardized radiographs of the teeth were taken prior to and after the demineralization period with three digital systems, CygnusRay MPS, DenOptix and DIGORA, and InSight film. Conventional, digital and digitized radiographs were assessed by three experienced radiologists. Linear and logarithmically contrast-enhanced subtraction images were acquired and then examined by a fourth independent radiologist. For the validation of the radiographic diagnosis, the enamel test areas were submitted to Knoop microhardness profiling. Radiographic interpretation data was evaluated using ROC analysis. The areas under the ROC curves (Az) were compared by the chi-squared test. The level of significance was set at P=0.05. RESULTS: No significant differences were found between linear and logarithmically contrast- enhanced subtraction images, acquired with the four studied modalities: CygnusRay MPSlinear (Az=0.95), CygnusRay MPSlog (Az=0.98), DenOptixlinear (Az=0.97), DenOptixlog (Az=0.99), DIGORAlinear (Az=0.98), DIGORAlog (Az=0.98), digitized radiographylinear (Az=0.99), digitized radiographylog (Az=0.99). CONCLUSION: Linear and logarithmically contrast-enhanced subtraction images, acquired with digital and digitized radiographs, were diagnostically comparable for assessing enamel subsurface demineralization.

Chi-Square Distribution↗

PubMed1994

Fluoride release from alternative restorative materials.

Numerous laboratory studies have been performed to evaluate the fluoride releasing capacity of different restorative materials. The studies have comprised release of fluoride, uptake of fluoride in the dental hard tissues and the inhibitory effect on demineralization. The present paper discusses the results from and the clinical relevance of the laboratory studies especially as regards the glass ionomer materials and resin composites.

Clinical Trials as Topic↗

PubMed2006

Progression of sealed initial bovine enamel lesions under demineralizing conditions in vitro.

The use of sealants for the infiltration of proximal enamel lesions could be a promising alternative to the common strategies of remineralization and operative treatment. The aim of the present study was to compare the progression of sealed initial enamel lesions after exposure to a demineralizing solution in vitro. In each of 54 bovine enamel specimens three subsurface lesions were created. Two of the lesions were etched with phosphoric acid and sealed with either a fissure sealant or with various adhesives (1-5) for 15 s or 30 s, respectively, whereas one lesion remained as the untreated control. Subsequently, half of each specimen was covered with nail varnish (baseline) and the other half was reexposed to a demineralizing solution for 14 days (experimental). The specimens were cut perpendicularly to the surface, infiltrated with a low-viscosity fluorescent resin and observed with a confocal laser scanning microscope (CLSM). For lesions sealed with the fissure sealant and adhesives 1-3, the progression of lesion depth (0-31 microm) was significantly decreased (p<0.01; paired t test) compared with the untreated control (57 microm). For the fissure sealant and adhesives 1 and 3 extended penetration times (30 s) resulted in significantly reduced lesion progression compared to 15 s. It can be concluded that filling of the pores in initial enamel lesions with the fissure sealant and adhesives 1-3 can inhibit further demineralization in vitro.

Acrylates↗

PubMed1997

Relative ability of laser fluorescence techniques to quantitate early mineral loss in vitro.

This in vitro investigation was undertaken to explore two different nondestructive methods to detect very early demineralization. These methods were based on the premise that the clinical detection of caries at a very early stage of formation might permit more efficient reversal of the caries process than may occur when lesions are detected at a more advanced stage, such as a so-called 'white spot'. The methods evaluated in this study were quantitative laser fluorescence (QLF) and an experimental dye-enhanced laser fluorescence (DELF) technique. Prepared and polished bovine enamel specimens were demineralized in a conventional lactic acid-Carbopol solution for varying periods of time between 0 and 24 h with an area of sound enamel retained on each specimen. The coded and randomized specimens were then analyzed for the presence and severity of enamel demineralization using QLF after which they were exposed to a selected dye (Pyrromethene 556) and similarly examined using DELF. The specimens were then sectioned and examined by conventional transverse microradiography and by confocal laser-scanning microscopy. Results were analyzed statistically with sensitivity and specificity determined using sound enamel as the reference. The results indicated that QLF could detect demineralization which occurred as a result of 8 h exposure to the decalcification solution and was able to quantify changes in lesion severity associated with longer demineralization. While DELF was capable of detecting enamel demineralization after only 2 h exposure to the decalcification solution, it was unable to quantify increasing amounts of demineralization associated with longer periods of exposure to the decalcification solution. In summary, while DELF was able to detect very early demineralization, only QLF was capable of detecting and quantifying changes in the extent of the decalcification occurring with demineralization periods up to 24 h.

Animals↗

PubMed2003

Resistance of marginal enamel to acid solubility is influenced by restorative systems: an in vitro scanning electron microscopic study.

The aim of this study was to evaluate the morphology of the enamel surface along margins of class V restorations following exposure to cariogenic solution. Restorations were placed in vitro in human third molars. The specimens were divided into groups according to resin composition: (1) Scotchbond 1 + Filtek Flow, (2) Scotchbond 1 + F2000, and (3) Prompt L-Pop + experimental flowable composite. Samples were stored in a demineralizing solution (lactic acid, pH 4.5, 0.1 M) at 37 degrees for 1-4 weeks or in deionized water (control group). The solution was changed every day. Replicas of the specimens were obtained in order to exclude drying artifacts. Scanning electron microscopy (SEM) of original and replica specimens identified a distinct enamel zone, defined as perimarginal enamel showing numerous fractures, porosities, voids, and pits. After the 4-week treatment, perimarginal prismatic enamel was greatly removed, while interprismatic enamel was still in place and only partially dissolved. Enamel not in relation with composite/compomer margins (0.5-1 mm away) showed minor alterations. Perimarginal enamel fractures probably due to composite/compomer shrinkage or the bur preparation may greatly contribute to this marginal enamel demineralization by increasing the number and size of porosities, that enhance the penetration and diffusion of cariogenic solution and create a sort of demineralized enamel subsurface. Only compomer restorations revealed a thin caries inhibition zone (1-2 micro m) probably related to fluoride release. Below this protected area, we observed the typical alterations of the other samples. These morphological alterations are probably related to secondary demineralization lesions and may affect the clinical life of restorations.

Adult↗

PubMed1996

Morphological field emission-SEM study of the effect of six phosphoric acid etching agents on human dentin.

OBJECTIVES: This study evaluated the effects of six phosphoric acid-etching agents on dentin, the independent variables being two acid concentrations (10% and 32%-37%) and three thickener conditions (no thickener, silica, and polymer). The tested hypothesis was that the use of different etchants with similar concentrations of phosphoric acid would result in similar depths of dentin demineralization. METHODS: Thirty dentin disks were obtained from extracted human teeth by microtome sectioning. The dentin surfaces were etched with one of the etching agents, fixed, dehydrated and dried. The specimens were observed using a FE-SEM. The mean deepest demineralization of intertubular dentin was measured from fracture surfaces of the disks. These values were analyzed by ANOVA and Duncan's Test. The morphological appearance of the dentin surfaces was compared using the following observation criteria: 1) Presence of a cuff of peritubular dentin; 2) Relative thickness of the layer containing residual collagen or smear layer particles; and 3) Formation of a submicron hiatus at the bottom of the exposed collagen network. The pH of each of the etching agents was measured. A correlation analysis was made of the pH vs. the depth of dentin demineralization. RESULTS: Silica-thickened etchants did not demineralize dentin as deeply as did polymer-thickened etchants and unthickened etchants. High magnifications revealed three distinct zones within the demineralized dentin layer; an upper porous zone of residual smear layer or denatured collagen and residual silica particles (in groups etched with silica-thickened etchants), an intermediate area with randomly oriented collagen fibers, and a lower zone with submicron hiatus, few collagen fibers, and scattered hydroxyapatite inclusions. This hiatus was observable in all the specimens etched with the polymer-thickened etchants, in 90% of the specimens etched with the unthickened phosphoric acid liquids, and in 60% of the specimens etched with the silica-thickened gels. SIGNIFICANCE: The results obtained suggest that similar concentrations of phosphoric acid etchants containing distinct thickeners result in different demineralization depths as well as different morphology of etched dentin.

Acid Etching, Dental↗

PubMed1996

Etiology of nursing caries: a microbiologic perspective.

A compelling body of scientific evidence supports the concept that nursing caries is an infectious and transmissible disease. This evidence makes a strong case to support the tenet that infants who are colonized by mutans streptococci, and who have feeding habits characterized by frequent and prolonged oral exposure to cariogenic substrates, are likely to have a drastic increase in their oral mutans streptococci populations. Such an increase is associated with a high risk for rampant dental caries. This evidence strongly suggests that the first step in the etiology of nursing caries is primary infection by mutans streptococci; the second step is accumulation of these organisms to pathogenic levels as a consequence of frequent and prolonged oral exposure to cariogenic substrates; and the third step is rapid demineralization and cavitation of enamel resulting in rampant dental caries. This three-step model might provide an important framework for the design of clinical trials targeted at prevention of nursing caries.

Bottle Feeding↗

PubMed1994

Delayed effect of wheat starch in foods on the intraoral demineralization of enamel.

There is considerable evidence for an association between dental caries and food starches. However, the intraoral utilization of starch may be quite complex, giving rise to conflicting results. Demineralization induced by unsweetened cookies was examined in an intraoral model system that utilized palatal appliances containing blocks of bovine enamel. The enamel surfaces were covered with either a filter paper disc to trap sugars or a layer of Streptococcus mutans to metabolize the sugars and bring about enamel demineralization. Demineralization was determined as an increase in porosity with respect to iodide ions (delta Ip). Measurements revealed a rapid elevation and maintenance of high levels of maltose in the plaque space after ingestion of the unsweetened or sweet cookies. Entrapped food particles appeared to serve as a reservoir of maltose. Unsweetened cookies brought about enamel demineralization, but the pH of the streptococcal plaque fell slowly, and the initiation of demineralization was delayed. Thus, delta Ip and plaque pH were -0.3 +/- 1.3 U and 6.1 +/- 0.3, respectively, after 15 min. The delay was shown to be related to the need to induce the acidogenic streptococci to metabolize maltose. Once induced, delta Ip rose rapidly and reached a maximum at 45 min. Sweet cookies released sucrose and maltose and brought about a rapid onset of demineralization. In summary, the data demonstrated (1) that maltose was released rapidly from unsweetened cookie particles and diffused into the plaque space of the model system and (2) that maltose-dependent demineralization of enamel required time for the induction of the streptococcal cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1997

Bacterial colonization of mineralized and completely demineralized dentine in situ.

The changing environment in a developing root lesion may result in a succession of the microbial flora in the dentine. As demineralization proceeds, the collagenous matrix is exposed, which could be conducive to the growth of specific microorganisms. In this study both sound and completely demineralized dentine were placed together in the partial prothesis of 8 individuals to test whether the type of substrate influenced the composition of the bacterial flora. After 6 weeks the degradation of the collagenous matrix, the demineralization of the dentine and the microbial composition were assessed. The collagen loss varied between 0 and 69 wt%. Mineral loss from the originally sound dentine specimens ranged from virtually none to complete demineralization. Percentages of total streptococci, mutans streptococci, Actinomyces and lactobacilli isolated from both dentinal substrates did not differ significantly. The percentage of lactobacilli in the dentine specimens was positively correlated to the lesion depth. The percentage of Actinomyces species was significantly higher in both the dentine specimens that had been demineralized in vitro and those that were found to be completely demineralized in situ compared to the partially demineralized dentine specimens. In vitro, no collagenolytic activity of the predominant flora isolated from both dentinal substrates could be shown.

Actinomyces↗

PubMed1994

In vitro bond strengths and SEM evaluation of dentin bonding systems to different dentin substrates.

In comparison to enamel, bonding to normal dentin is a greater challenge because of its organic constituents, fluid-filed tubules, and variations in intrinsic composition. Bonding to sclerotic dentin is even more difficult. To evaluate the shear bond strengths of four adhesive systems to dentin substrates with different levels of mineralization, 120 extracted human teeth were randomly assigned to three groups (n = 40). After mid-coronal dentin was exposed, groups of specimens were artificially hypermineralized by immersion in a remineralizing solution, demineralized by means of an acetic acid demineralizing solution, or stored in distilled water to model sclerotic, carious, and normal dentin, respectively. Resin composite was bonded to dentin by use of commercial adhesive systems. After the specimens were thermocycled, shear bond strengths were determined in an Instron universal testing machine. Dentin substrates and resin/dentin interfaces were examined by SEM. For each adhesive system, the mean shear bond strength to normal dentin was significantly higher than that to either of the other substrates. Shear bond strengths to hypermineralized dentin were significantly higher than those to demineralized dentin with all adhesives except Prisma Universal Bond 3.

Analysis of Variance↗