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PubMed2001

Solvent-induced dimensional changes in EDTA-demineralized dentin matrix.

The purpose of this study was to test the null hypothesis that the re-expansion of dried matrix and the shrinkage of moist, demineralized dentin is not influenced by polar solvents. Dentin disks were prepared from midcoronal dentin of extracted human third molars. After complete demineralization in 0.5M of EDTA (pH 7), the specimens were placed in the well of a device that measures changes in matrix height in real time. Dry, collapsed matrices were created by blowing dry N(2) on the specimens until they shrank to a stable plateau. Polar solvents [water, methanol, ethanol, n-propanol, n-butanol, formamide, ethylene glycol, hydroxyethyl methacrylate (HEMA), or mixtures of water-HEMA] as model primers then were added and the degree of re-expansion measured. These same solvents also were applied to moist, expanded matrices and the solvent-induced shrinkages measured. Regression analysis was used to test the correlations between matrix height and Hansen's dispersive, polar, hydrogen bonding, and total solubility parameters (delta(d), delta(p), delta(h), delta(t)). The results indicate that water-free polar solvents of low hydrogen bonding (H-bond) ability (e.g., neat HEMA) do not re-expand dried matrices and that they shrink moist matrices. When HEMA was mixed with progressively higher water concentrations, the model water-HEMA primers expanded the dried matrix in proportion to their water concentrations and they produced less shrinkage of moist matrices. Solvents with higher H-bonding capacities (methanol, ethanol, ethylene glycol, formamide, and water) re-expanded the dried matrix in proportion to their solubility parameters for H-bonding (delta(h)). They also induced small transient shrinkages of moist matrices, which slowly re-expanded. The results require rejection of the null hypothesis.

Biocompatible Materials↗
PubMed1991

Relationship between demineralization events in dental enamel and the pH and mineral content of plaque.

Acid production in dental plaque from fermentation of dietary carbohydrate does not necessarily lead to demineralization of the underlying enamel. In the past it has been understood that pH buffering by plaque constituents must be overcome to allow the pH to fall, and then the fall must be of sufficient magnitude to exceed a critical pH value, i.e. the point where plaque fluid is just saturated with respect to enamel mineral. An evaluation of the literature suggests, however, that the critical pH is not a fixed value. It changes slowly as enamel mineral solubility changes with repeated pH cycling. Further, plaque mineral ion sinks, in which ions are removed from solution (first described by Luoma in 1964) and ion reservoirs from which ions are added to solution, modulate the critical pH value during plaque pH fall and rise so that its exact value is difficult to predetermine. A solid phase calcium phosphate ion reservoir in plaque may saturate plaque fluid with respect to enamel mineral continuously as the pH falls so that the critical pH is never exceeded. Common ion repression of enamel mineral dissolution is likely to be effective in the order pH greater than Ca greater than P. Plaque fluoride influences enamel dissolution in more than one way. Simultaneous dissolution of hydroxyapatite and reprecipitation of fluorapatite, a process which results in apparent dissolution repression, is probably the most important mechanism initially. This process may coat individual enamel crystals with a F-rich layer so that, while the total F content is rather low, its effective solubility is more like that of fluorapatite. Fluoride in plaque fluid may then repress enamel mineral dissolution by common ion repression. If fluoride action follows this sequence efforts to build F into enamel clinically would be just as important as attempts to maintain F levels in plaque and saliva.

Dental Enamel↗
PubMed2006

Deposition of fluoride on enamel surfaces released from varnishes is limited to vicinity of fluoridation site.

The aim of the in-situ study was to determine fluoride uptake in non-fluoridated, demineralized enamel after application of fluoride varnishes on enamel samples located at various distances from the non-fluoridated samples. All enamel samples used were demineralized with acidic hydroxyethylcellulose before the experiment. Intra-oral appliances were worn by ten volunteers in three series: (1, Mirafluorid, 0.15% F; 2, Duraphat, 2.3% F and 3, unfluoridated controls) of 6 days each. Each two enamel samples were prepared from 30 bovine incisors. One sample was used for the determination of baseline fluoride content (BFC); the other was treated according to the respective series and fixed in the intra-oral appliance for 6 days. Additionally, from 120 incisors, each four enamel samples were prepared (one for BFC). Three samples (a-c) were placed into each appliance at different sites: (a) directly neighboured to the fluoridated specimen (=next), (b) at 1-cm distance (=1 cm) and (c) in the opposite buccal aspect of the appliance (=opposite). At these sites, new unfluoridated samples were placed at days 1, 3 and 5, which were left in place for 1 day. The volunteers brushed their teeth and the samples with fluoridated toothpaste twice per day. Both the KOH-soluble and structurally bound fluoride were determined in all samples to determine fluoride uptake and were statistically analyzed. One day, after fluoridation with Duraphat, KOH-soluble fluoride uptake in specimen a (=next) was significantly higher compared to the corresponding samples of both the control and Mirafluorid series, which in turn were not significantly different from each other. At all other sites and time points, fluoride uptake in the enamel samples were not different from controls for both fluoride varnishes. Within the first day after application, intra-oral-fluoride release from the tested fluoride varnish Duraphat leads to KOH-soluble fluoride uptake only in enamel samples located in close vicinity to the fluoridation site.

Adult↗
PubMed1997

Dentin demineralization: effects of dentin depth, pH and different acids.

OBJECTIVES: This investigation sought to determine: 1) if dentin demineralization rates are proportional to acid concentration for demineralization in phosphoric acid (10% or 1.76 M, 0.025 M, 0.0001 M, with pH = 0.95, 2.0, 4.0 respectively); 2) if the etching characteristics are independent of dentin depth; and 3) if the etching characteristics for phosphoric acid were comparable to those for citric acid over a similar pH range. METHODS: Highly polished dentin disks from freshly extracted, non-carious, third molars were prepared with a reference layer. Samples were prepared from either superficial or deep coronal dentin. The samples were etched for periods of up to 30 min using phosphoric acid solutions (pH = 0.95, 2.0, 4.0) in a wet cell of an atomic force microscope (AFM). Depth changes with respect to the reference layer were determined for the intertubular and peritubular dentin to quantify structural changes. The results were compared with similar studies using citric acid (pH = 1.0, 2.15 or 3.4). Etching characteristics were statistically compared using 2-way repeated measures ANOVA at p < 0.05 and the Tukey's multiple comparison test. RESULTS: The relation between time and recession for peritubular dentin was initially linear. The intertubular dentin recession started rapidly but then reached a plateau within a very short interval for etching solutions at pH = 2.0 and 4.0. At the highest concentration, the recession decreased with time, but a clear plateau was not established. There was no statistical difference between peritubular etching rates of superficial and deep dentin surfaces with phosphoric acid at any concentration. There was also no difference in the intertubular dentin recession at the location of the plateau that depended on dentin depth. Etching rates increased dramatically with decreased pH for both phosphoric and citric acids, but were higher for citric acid than for phosphoric acid. SIGNIFICANCE: The AFM allowed quantification of changes during etching of wet dentin. Peritubular dentin etching rates increased with decreasing pH, as expected, but changes were not linear and were different for the two acids studied over a similar pH range. Intertubular dentin surface recession was small and plateaued for low concentrations. The peritubular etching rate and intertubular dentin recession did not depend on dentin depth.

Acid Etching, Dental↗
PubMed1999

Effect of recombinant human platelet-derived growth factor-BB and bone morphogenetic protein-2 application to demineralized dentin on early periodontal ligament cell response.

The purpose of this study is to investigate the early responses of human periodontal ligament cells attached to recombinant human platelet-derived growth factor-BB and bone morphogenetic protein-2 applied EDTA-demineralized dentin. One hundred and seventy-four root-planed flat dentin blocks were prepared from the mid-third of periodontally diseased human tooth roots. After demineralization with 24% EDTA (pH 7.02) 120 dentin blocks were treated with 0.5 and 1 microgram/ml rhPDGF-BB, 1 and 3 micrograms/ml rhBMP-2 and only MEM as control (24/group). Human periodontal ligament cells (HPLC) were seeded on these dentin surfaces and incubated. The alkaline phosphatase (ALP) activity and protein concentration of the attached cell were assessed at d 2, 4 and 7. Fifty-four dentin blocks were seeded with HPLC after application of 1 microgram/ml rhPDGF-BB, 3 micrograms/ml rhBMP-2 and MEM (18/group) and then incubated. At d 2, 4 and 7, the attached cells were stained and counted under light microscope. The results showed a significant increase of protein concentration and cell number in PDGF-BB treated groups than control (p < 0.05, p < 0.01) but not the ALP activity, and a significant increase of ALP activity was observed in BMP-2 treated groups than control (p < 0.05) but protein concentration and cell number remained almost the same over time. Thus, rhPDGF-BB and rhBMP-2 application to EDTA demineralized dentin surfaces promote the early human periodontal ligament cell responses by increasing cell proliferation and differentiation, respectively, which would ultimately enhance periodontal regeneration.

Adolescent↗
PubMed2005

The role of salivary peptides in dental caries.

Dental caries is a complex disease, characterized by demineralization of tooth structure. With a protective role, several salivary phosphopeptides appear to be involved in remineralization processes, delaying the loss of tooth structure. In this work we have correlated peptide saliva composition with dental caries susceptibility through the analysis of saliva and hydroxyapatite-adsorbed salivary peptides samples. Saliva samples were obtained from two groups, a caries-free and a cariessusceptible group, and were analysed using HPLC-MS and a sequential extraction with 6 m of guanidine followed by tri fluoroacetate. Data analysis has allowed us to verify a strong correlation between large amounts phosphopeptides (PRP1/3, histatin 1 and statherin), and the absence of dental caries, which reinforces the importance of these peptides in the maintenance of tooth integrity. In addition, in the caries-susceptible group a high number of peptide fragments was observed, suggesting a high proteolytic activity.

Chromatography, High Pressure Liquid↗
PubMed1997

The process and results of revolution in dental caries treatment.

The traditional system devised by G.V. Black for dental caries treatment has been fundamentally changed by the development of new knowledge about dental caries pathology and chemically adhesive resin composite. The scientific background is first discussed, together with the process of the development of new materials, following which the essence of the latest clinical techniques are described and illustrated. The system of minimal tissue reduction is extremely simple and painless, not requiring anaesthesia and is able to secure maximal longevity of restored teeth. The author describes his personal record in the development of acid etched dentine and composite restoration systems.

Acid Etching, Dental↗
PubMed1997

Hidden caries: what is it? Does it exist? Does it matter?

Hidden caries is a term used to describe occlusal dentine caries that is missed on a visual examination, but is large enough and demineralised enough to be detected radiographically. The detection rate of such lesions will depend upon the prevalence of caries in the population and the frequency with which bitewing radiographic examinations are performed. Whether 'hidden caries' is a distinct clinical entity, reflecting a particular anatomical fissure topography or a different bacterial aetiology, is unknown. It is possible that an improved visual examination, with careful cleaning and drying of teeth, may improve occlusal caries detection to the point where 'hidden caries' no longer exists. However, this possibility has yet to be tested clinically and until it is, practising dentists would be wise to examine bitewing radiographs carefully for occlusal demineralisation. The authors would treat such hidden lesions by removing soft caries and placing sealant restorations.

Dental Caries↗
PubMed2002

Calcium solubility of dental enamel following sub-ablative Er:YAG and Er:YSGG laser irradiation in vitro.

BACKGROUND AND OBJECTIVE: The objective of the present study was to investigate the effect of sub-ablative Er:YAG (lambda = 2.94 microm) and Er:YSGG (lambda = 2.79 microm) laser radiation on the acid solubility of dental enamel. The influence of fluoride application prior to laser irradiation was additionally evaluated. STUDY DESIGN/MATERIALS AND METHODS: To this end, 294 enamel specimens were prepared from bovine teeth and divided into 14 groups of 21 specimens each. The enamel samples were irradiated in their groups with the Er:YAG and the Er:YSGG laser, using energy densities of 4, 6, and 8 J/cm(2) in each case. Irradiation was additionally repeated in the same way on specimens, which had previously been immersed in 1% sodium fluoride solution for 15 minutes. One group was left untreated and served as a control group. A further group was not irradiated, but only immersed in the 1% fluoride solution for 15 minutes. The enamel specimens were demineralised for 24 hours in an acetate buffer solution. The calcium content in the demineralisation solution was subsequently determined with the aid of atomic absorption spectrometry. RESULTS: The results indicate a decline in calcium solubility after laser irradiation. Compared to the control group, a 20% lower calcium content was detected in the demineralisation solution after irradiation with the Er:YSGG laser at 8 J/cm(2). The difference between the laser-irradiated groups and the untreated control group was, however, not statistically significant. A significantly lower calcium content was found in the demineralisation solution after fluoridation of the specimens. Additional laser radiation had no further effect on this result. CONCLUSIONS: In summary, it can be stated that, although the erbium laser wavelengths apparently have the potential to increase acid resistance, their application solely for caries prevention would not appear to be sensible under the prevailing conditions.

Analysis of Variance↗
PubMed1995

Lasers in dentistry.

Since the development of the ruby laser by Maiman in 1960, there has been great interest among dental practitioners, scientists, and patients to use this tool to make dental treatment more pleasant. Oral soft tissue uses are becoming more common in dental offices. The possible multiple uses of lasers in dentistry, beyond soft tissue surgery and dental composite curing, unfortunately, have not yet been realized clinically. These include replacement of the dental drill with a laser, laser dental decay prevention, and laser decay detection. The essential question is whether a laser can provide equal or improved treatment over conventional care. Safe use of lasers also must be the underlying goal of proposed or future laser therapy. With the availability and future development of different laser wavelengths and methods of pulsing, much interest is developing in this growing field. This article reviews the role of lasers in dentistry since the early 1960s, summarizes some research reports from the last few years, and proposes what the authors feel the future may hold for lasers in dentistry.

Adult↗
PubMed1999

Systematic decalcification prophylaxis during treatment with fixed appliances.

In a practical setting, 4 different prophylactic methods were compared with regard to their effects on the incidence of decalcification during orthodontic fixed appliance therapy and on the frequency of premature debonding resulting from imminent or already manifest decalcification. This study showed that the use of a system in which selection and care were oriented solely along the clinical impression was associated with the highest rate of decalcification and premature debonding. The findings were significantly better (p < 0.05), when a prophylactic regimen of oral hygiene was implemented which was based on patient selection (API < 30%) and regular oral hygiene check-ups during the treatment. When the DMFT index was considered in addition to the API value, and the number of the initial lesions at the beginning of treatment were included for selecting patients, the incidence of decalcification was significantly reduced even further (p < 0.05). A more comprehensive or "optimized prophylaxis" utilizing saliva test parameters and active prophylactic interventions implemented by a dental hygienist during the treatment phase also had a favorable impact on the main outcome parameters. The present findings indicate that decalcification can be markedly reduced by using a treatment regimen that targets the decalcification risk and a systematic, individualized prophylaxis during active treatment with fixed appliances.

Dental Debonding↗
PubMed2003

Distribution of the cement film beneath the orthodontic band: a morphometric in vitro study.

BACKGROUND: During orthodontic treatment with a multiband appliance, enamel decalcifications and periodontal irritation may occur due to inevitable plaque retention. Besides the band itself, non-cemented gaps between tooth and band constitute a problem that has not yet been investigated from quantitative aspects. MATERIALS AND METHODS: In this in vitro study, the cement distribution beneath the orthodontic band was investigated on 48 identical transparent resin replicas of upper molars and lower molars, respectively. The replicas with the cemented orthodontic bands were divided into buccal, distal, oral, and mesial segments so that the inner surfaces of the bands could undergo morphometric analysis for areas not covered with cement. Two different molar bands (Dentaform Snap by Dentaurum, Ispringen, Germany, and "Washbon" by Ormco, Orange, CA, USA), and two glass-ionomer cements (OptiBand by Ormco and Ultra Band-Lok Blue by GAC, Gräfelfing, Germany) were used. In this way, 8 test series with twelve specimens each were performed. RESULTS: Not one cement-band combination was without defects in the cement film, with poorer cement flow properties being observed at the upper than at the lower molars. In general, fewer defects were recorded in the occlusal than in the cervical areas. Overall, the buccal surfaces yielded the best results, and the mesial surfaces the poorest. CONCLUSIONS: Since defects in the cement film have so far been unavoidable, the indication for orthodontic treatment with a multiband appliance must continue to be strict. Unless accompanying professional prophylactic care coupled with optimal oral hygiene is ensured, multiband appliances should be used with great caution.

Composite Resins↗
PubMed2005

Fluoride uptake and resistance to further demineralisation of demineralised enamel after application of differently concentrated acidulated sodium fluoride gels.

The objective of this study was to analyse fluoride uptake and microhardness alteration of carious-like demineralised enamel after application of differently concentrated acidulated sodium fluoride gels and to determine the effect of fluoridation on enamel resistance against subsequent demineralisation. Artificial caries-like lesions of bovine enamel specimens were treated with sodium fluoride gels of different concentration (group A: 1.25%, group B: 0.62%, group C: 0.31%, group D: 0.15%; n=20 each group) for 5 min and stored in artificial saliva for 24 h. This cycle was carried out three times. Subsequently, KOH-soluble and structurally bound fluoride (determined at depths of 30, 60, and 90 microm) were analysed. In the second part of the study, for each 12 enamel specimens surface microhardness was determined before and after demineralisation, after fluoridation with the differently concentrated gels A-D, and after a second demineralisation. With all groups uptake of KOH-soluble and structurally bound fluoride resulted in higher levels than baseline content. Statistical analysis revealed significant differences between fluoride uptake among the groups, with highest uptake for the 1.25% gel and lowest for the 0.15% gel. Moreover, with all gels highest uptake was observed in the outermost enamel layer (P<0.05). Microhardness values after second demineralisation increased with increased concentration of the applied sodium fluoride gel. Increasing concentration of the applied gel implies better protection of the enamel specimens against subsequent demineralisation (P<0.05). It is concluded that differently concentrated acidulated sodium fluoride gels resulted in concentration-related significant uptake of fluoride in carious-like demineralised enamel, leading to a better demineralisation protection with increasing fluoride concentration in the gel.

Acidulated Phosphate Fluoride↗
PubMed1993

The effect of different strontium concentrations on the efficacy of chlorhexidine-fluoride-strontium gel in preventing enamel softening in vitro.

The effects were compared of strontium concentrations of 0, 15, 50 and 250 parts/10(6) in chlorhexidine(0.20%)-fluoride(0.16%) gel in preventing the softening of bovine enamel during bacterial fermentation. Fresh Streptococcus sobrinus cells were suspended in a buffer solution (pH 6.0) with 3.3% sucrose and centrifuged as a plaque-like layer on the top of enamel slabs covered with 10 microliters gel. AFter 24 h incubation, the pH fall of the fluid was significantly smaller in all test groups than in the placebo group. Strontium seemed to have an inhibitory effect on the pH fall. All test gels significantly prevented softening and dissolution of enamel during bacterial fermentation, which was directly related to strontium concentration. The amounts of calcium and phosphorus in the cells and fluid after incubation were the smallest in the group with 250 parts/10(6) strontium. In a second experiment without bacteria, new enamel slabs were covered with 10 microliters gel containing chlorhexidine and NaF with 0 and 250 parts/10(6) strontium to study the protective effect of strontium. After 24 h gel treatment, each enamel slab was dissolved in 1 ml 0.1 M lactic acid, pH 5.0, for 2 h. Significantly less calcium and phosphorus were dissolved from the enamel in both test groups than in the control and placebo groups. However, the placebo gel also prevented calcium and phosphorus dissolution significantly. These results suggest that the addition of strontium to chlorhexidine-fluoride gel improves the ability of this combination to prevent caries-like enamel softening. The inhibition of bacterial acid production by the strontium-containing gel may explain this enhanced protection of enamel.

Administration, Topical↗
PubMed1994

Measurement of tooth hypersensitivity and oral factors involved in its development.

The various methods of measurement of dentinal hypersensitivity are based upon the types of stimuli used to elicit a pain response in teeth, which include thermal, tactile, evaporative, electrical and osmotic. Pulpal inflammation in its early stages reduce the threshold of pain response to these stimuli but electrical stimulation may make it possible to assess the possible contribution of such inflammation to sensitivity determinations. Although the magnitude of each stimulus is quantifiable, patient response is subjective, which necessarily makes measurements of dentinal sensitivity semisubjective. Various methods of testing dentinal sensitivity are discussed, along with their advantages and disadvantages. The teeth most suited for measurement in clinical studies are the canines and premolars. This is because approx. 80% of the sensitivity lesions are associated with these teeth, which have similar thicknesses of root dentine. Data from several studies involving the same subjects indicate that individual measurements readily return to baseline and that the commonly seen placebo effect is probably due to some as yet unidentified factor in desensitizing formulations. Possible roles of salivary and plaque environmental factors in the development of dentinal sensitivity are discussed, as well as methods for their measurement.

Beverages↗
PubMed1992

A scanning electron microscopy study of the effect of bleaching agents on enamel: a preliminary report.

The effect of bleaching agents on the enamel surface was examined by scanning electron microscopy. The comparison of treated to untreated enamel revealed that the treated surface had increased surface change and porosity after the equivalent of 30 hours of exposure to the bleaching agent. The degree of alteration of enamel surface was not uniform and was influenced by cleanliness (oral hygiene) of the treated teeth and apparent variation in calcification. The enamel surface developed varying degrees of surface porosity and alteration.

Acid Etching, Dental↗