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Effects of fluoride in remineralized human surface enamel on dissolution resistance.

Remineralized surfaces of human tooth enamel were dissolved at constant rates in 10 mM acetic acid at pH 4.0, and in 10 mM EDTA at pH 7.4 in a system that prevented redistribution of dissolved F-. Surfaces remineralized 25 hours in 0.4 mM NaF (8 ppm F-) dissolved slower in acid or in EDTA than those remineralized in the absence of F-. The F- in three-hour remineralized surfaces had no effect on rates of mineral dissolution. Resistance to EDTA, as well as acid of 25-hour remineralized surfaces, indicates the occurrence of a maturation process, which may involve F- exchange for OH- ions in newly formed crystals. The results indicated that F- may slow caries by its action on remineralization if given sufficient time for this maturation.

Acetates↗

[Effects of dentine phosphoprotein on remineralization of demineralized dentine].

OBJECTIVE: To investigate the relationship between dentine phosphoprotein (DPP) and remineralization of demineralized dentine. METHODS: (1) Soluble DPP was extracted with 1 mol/L NaCl from demineralized dentine and was evaluated. (2) Soluble DPP was removed with 0.1 mol/L NaCl or was not removed from demineralized dentine sections in human tooth roots. Then all sections were subjected to remineralization treatment, and remineralization degrees were compared by atomic absorption spectrum, SEM and microradiography. RESULTS: (1) Soluble DPP was extracted with 1 mol/L NaCl. (2) Removal of soluble DPP resulted in significantly lower calcium concentration in remineralization solution (P < 0.01), less mean light-absorbed value in demineralized dentin sections by microradiography (P < 0.01). CONCLUSIONS: Soluble DPP may have an inhibiting effect on remineralization of demineralized dentine, this study suggests that the remove of soluble DPP from root caries lesions may enhance their remineralization potential.

Adolescent↗

Remineralization of caries lesions extending into dentin.

Remineralization is one aspect of the overall process of tooth decay. However, it is primarily studied in shallow lesions. The aim of this study was to explore whether caries lesions in enamel and extending into the dentin can be remineralized. A single-section model was developed for the longitudinal and non-destructive monitoring of changes in enamel and dentin. Lesions at least 200 microm into dentin were formed in undersaturated acetate buffers. Next, the lesions were divided into groups (three treatment and one control) and remineralized. The treatments were: weekly immersion in 1,000 ppm fluoride, single treatment with methanehydroxybisphosphonate, and a constant level of 1 ppm fluoride. De- and remineralization was assessed by transverse microradiography. Remineralization was observed in enamel, but also in dentin, indicating that, deep into dentin, the pores become supersaturated to apatite formation. Treatments affected remineralization only in the outer part of enamel. Both findings are explained by a relatively fast diffusion of mineral ions, with precipitation being rate-limiting. The results suggest that dentin remineralization, underneath enamel, can be achieved and could possibly be used in clinical treatment strategies.

Analysis of Variance↗

A model for dentinal caries progression by digital subtraction radiography.

Extracted teeth with preexisting carious lesions were incubated in vitro at 37 degrees C in an artificial saliva buffer. Four teeth were exposed to buffer alone, four to buffer containing 5% glucose, and four to buffer containing 5% sucrose. Time-lapse radiographs were made of the carious lesions using an orienting device that fixed the position of the tooth, x-ray film, and x-ray tube collimator. The radiographs were analyzed over a period of 8 weeks using digital subtraction radiography. The subtracted images revealed that three of the four teeth incubated in saliva alone showed an increase in radiodensity (remineralization) at the depths of the lesion; one tooth showed no detectable change. Three of the four teeth incubated in the presence of 5% glucose showed increased radiolucency (demineralization); one showed no detectable change. The four teeth incubated in the presence of 5% sucrose exhibited results similar to those teeth incubated in 5% glucose.

Aged↗

Biological factors in dental caries enamel structure and the caries process in the dynamic process of demineralization and remineralization (part 2).

Dental caries is a complex disease process that afflicts a large proportion of the world's population, regardless of gender, age and ethnicity, although it does tend to affect more indivduals with a low socioeconomic status to a greater extent. The physicochemical properties of the mineral comprising the tooth surface and subsurface modulate the development, arrestment and remineralization of dental caries. Post-eruption maturation of enamel surfaces and exposed root surfaces is important in order for more susceptible mineral phases to be modified by incorporation of soluble fluoride from the plaque into dental hydroxyapatite. The chemical reactions that occur during acidic conditions when tooth mineral dissolves (critical pH) are determined by the supersaturation of calcium and phosphate within plaque and saliva, as well as if fluoride is present.

Apatites↗

Effect of fluoride toothpastes on enamel demineralization.

BACKGROUND: It was the aim of this study to investigate the effect of four different toothpastes with differing fluoride compounds on enamel remineralization. METHODS: A 3 x 3 mm window on the enamel surface of 90 human premolars was demineralized in a hydroxyethylcellulose solution at pH 4.8. The teeth were divided into 6 groups and the lower half of the window was covered with varnish serving as control. The teeth were immersed in a toothpaste slurry containing: placebo tooth paste (group 1); remineralization solution (group 2); Elmex Anticaries (group 3); Elmex Sensitive (group 4); Blend-a-med Complete (group 5) and Colgate GRF (group 6). Ten teeth of each group were used for the determination of the F- content in the superficial enamel layer and acid solubility of enamel expressed in soluble phosphorus. Of 6 teeth of each group serial sections were cut and investigated with polarization light microscopy (PLM) and quantitative energy dispersive X-ray analysis (EDX). RESULTS: The PLM results showed an increased remineralization of the lesion body in the Elmex Anticaries, Elmex Sensitive and Colgate GRF group but not in the Blend-a-med group. A statistically significant higher Ca content was found in the Elmex Anticaries group. The fluoride content in the superficial enamel layer was significantly increased in both Elmex groups and the Blend-a-med group. Phosphorus solubility was significantly decreased in both Elmex groups and the Blend-a-med group. CONCLUSION: It can be concluded that amine fluoride compounds in toothpastes result in a clearly marked remineralization of caries like enamel lesions followed by sodium fluoride and sodium monofluorophosphate formulations.

Journal Article↗

A new classification and techniques for simple restorative dentistry.

It is nearly one hundred years since G. V. Black proposed a simple, five-stage classification for carious lesions based upon the site of the lesion and the type of restorative material likely to be used for restoration. In the absence of both effective preventive measures and a knowledge of remineralization his approach was essentially surgical: having identified a lesion remove it surgically, as well as all surrounding susceptible tooth structure, to prevent recurrence. Surgery is no longer regarded as the primary choice for treatment of a disease and there are many factors which suggest that this system is out of date. Preservation of natural tooth structure should be the principal aim and this is best achieved through remineralization. Remaining cavitated areas can then be restored more conservatively, thus assisting in maintaining aesthetics as well as strength in the tooth crown. If the profession is to adopt a new approach to operative dentistry it is suggested that the psychology of introducing a new classification for carious lesions is a desirable move.

Dental Cavity Preparation↗

Remineralization of root surfaces demineralized in solutions of differing fluoride levels.

The beneficial effects of fluoride on enamel have been well documented. However, limited data are available concerning the amount of fluoride required for beneficial effects on tooth root. Although studies have shown that fluoride inhibits root demineralization, the aim of this study was to investigate the location, extent and amount of remineralization on root dentin substrates after demineralization has occurred. The root surfaces of extracted human teeth were demineralized in a pure chemical buffer containing varying concentrations of sodium fluoride. After this lesion initiation, the same root sections were then placed into a remineralizing solution. The root sections were characterized after demineralization, and again after remineralization, by polarized light microscopy (PLM) and microradiography (MRG). Lesion depths after the demineralization phase were found to be inversely proportional to the fluoride concentration. When fluoride was present, bands or lines within the body of the lesion were observed with PLM and MRG. Using quantitative MRG, variations in mineral content and distribution were recorded. Examination of the root sections after the remineralization phase showed remineralization to have occurred on the remaining mineral and not on organic matrix devoid of mineral. The amount and location of mineral deposition may be of great significance in the arrestment and treatment of in vivo root surface caries.

Buffers↗

Reaction characteristics of a tooth-bleaching agent containing H2O2 and NaF: in vitro study of crystal structure change in treated hydroxyapatite and chemical states of incorporated fluorine.

This in vitro study was performed to elucidate the reaction mechanism of sodium fluoride (NaF), which is added to tooth-bleaching agents to lessen the adverse effect of hydrogen peroxide (H2O2) on teeth. Both hydroxyapatite (HAP) and dihydrated dicalcium phosphate (DCPD), model substances for dental hard tissues, dissolved easily in a simple H2O2 solution. In the H2O2/NaF solutions, however, fluorine compounds that could not be identified by X-ray diffraction (XRD) due to the smallness of the products were formed on the surface of the HAP. X-ray photoelectron spectroscopy (XPS) studies demonstrated that fluoridated hydroxyapatite (FHAP) was formed on HAP, and that calcium fluoride (CaF2) formation was accelerated by increasing the concentrations of fluorine and H2O2 along with the partial dissolution of HAP. In H2O2/NaF solution, DCPD also transformed easily to FHAP and CaF2, which are favorable to the remineralization process on the tooth surface. Thus, the mechanism of NaF was elucidated, and its use together with H2O2 for tooth bleaching was proved to be effective. Methodologically, the XPS two-dimensional plot made it possible for the first time to directly estimate the ratio of FHAP and CaF2 in the reaction products, in contrast to the conventional wet-analytical method, which is simply based on the difference in solubility of the two components.

Crystallization↗

Relationship between mineral distributions in dentine lesions and subsequent remineralization in vitro.

Though the mineral distribution of the dentine carious lesion varies largely from tooth to tooth and from patient to patient, there are two main distribution profiles that characterize natural carious lesions in dentine. These profiles include softened and subsurface lesion types. The mineral distribution relationship between the starting profile and the profile after remineralization is not known. In order to study the relational aspects, we have produced demineralized dentine samples in vitro with mineral profiles similar to those of typical natural carious lesions, and subsequently remineralized the samples in a remineralizing solution with various fluoride concentrations (0, 2 and 10 ppm F). The mineral distributions were obtained by using an improved microradiographic technique. In addition, the nature of deposited mineral was analyzed by diamond-coupled total internal reflectance spectroscopy. Definite relationship was observed between the original lesion mineral distribution and the mineral distributions following remineralization. The amount of mineral present in approximately the first 50 microm of the lesion influenced the overall mineral profile after remineralization, possibly through influencing ion transport. If the amount was high (> approximately 10 vol%), the deposited mineral was confined to the surface (0-50 microm). The original mineral at those depths acted like a nucleus of mineral regrowth when the amount of residual mineral was intermediate, and like a transport barrier when the surface layer was well mineralized. If a surface barrier was not present, mineral was deposited at deeper depths in the lesion. Fluoride effect on dentine remineralization was dependent on the original mineral content and its distribution in the lesion. Although a high concentration of fluoride was very effective in low-mineral lesions, it produced hyperremineralization on well-mineralized subsurface lesions so that it prevented effective remineralization especially in deeper lesions.

Acetic Acid↗

Assessment of the accuracy of dental enamel thickness measurements using microfocal X-ray computed tomography.

Tooth enamel thickness has long been an important character in studies of primate and especially hominin phylogeny, taxonomy, and adaptation. Current methods for accurately assessing enamel thickness involve the physical sectioning of teeth, because measurements of enamel thickness using some radiographic techniques are unreliable. However, because destructive methods limit sample sizes and access to important fossil specimens, it is desirable that they be replaced with nondestructive techniques. Although microfocal X-ray computed tomography (mCT) has been used recently in studies of enamel thickness, the accuracy of this technique has yet to be established. The present research compares physical sections to computer-generated mCT sections of teeth from a variety of primate and nonprimate, recent and fossil taxa to examine whether enamel thickness, tooth size, and diagenetic remineralization (fossilization) impact the ability of mCT to measure enamel thickness accurately. Results indicate that recent teeth of varying size and thickness are clearly and accurately depicted in mCT scans, with measurements from nearly identical planes in physical and mCT sections differing by 3-5%. A fossil papionin molar (ca. 2 Myr) was also accurately measured using mCT scans, although thinner enamel in much older therapsid (ca. 263-241 Myr) teeth could not be distinguished from dentine. mCT is thus an accurate technique for measuring enamel thickness in recent taxa, although heavily mineralized teeth pose an obstacle to the ability of mCT to distinguish dental tissues. Moreover, absolutely thin enamel (less than approximately 0.10 mm) is difficult to resolve adequately in raw mCT images based on pixel values alone. Therefore, caution must be exercised in the application of mCT to the study of fossilized teeth.

Animals↗

Measurement of enamel remineralization using microradiography and confocal microscopy. A correlational study.

Tooth minerals are lost and regained constantly in a normal, human oral environment. Different methods have been developed to measure this gain and loss in enamel minerals; however, these methods deal with different problems, such as being time consuming or involving the use of X-rays. The aim of this study was to determine if remineralization measured in a thin enamel section (TS) by transversal microradiography (MR) can be reliably monitored by measuring lesion parameters (area, total and average dye fluorescence) on the same TS or on half a tooth (HT) with confocal laser scanning microscopy (CLSM). Thirty-six human enamel specimens were demineralized for 96h, and then half of each specimen was covered with an acid-resistant nail varnish. Specimens were divided into three groups (12/group) and subjected for 20 days to a cyclic remineralization regimen with consisted daily of a 4-hour acid challenge, four 1-min treatment periods with 0, 250 or 1,100 ppm F dentifrice slurries (1:2; dentifrice:water) and 20 h in pooled, human saliva, at room temperature. Specimens were cut and analyzed by MR, then stained with a fluorescent dye (0.1mM rhodamine B) for 1 h and analyzed using CLSM. Both MR and CLSM detected significantly greater remineralization (p<0.05) in the specimens treated with the fluoride-containing dentifrices than in the specimens treated with 0 ppm F. Significant differences were detected between specimens treated witht the fluoride-containing dentifrices by MR and CLSM (HT area and total fluorescence). Statistically significant (p<0.05) Pearson correlation coefficients were calculated between the MR and CLSM data: difference in MR mineral content (DeltaM) versus HT lesion area = 0.71; DeltaM versus HT total fluorescence = 0.70; DeltaM versus HT average fluorescence = 0.61; DeltaM versus TS lesion area = 0.88; DeltaM versus TS total fluorescence = 0.63, and DeltaM versus TS average fluorescence = 0.40. It is concluded that confocal microscopy in either TS or HT may provide valid surrogates (area and total fluorescence) for MR measurements in enamel remineralization studies.

Analysis of Variance↗

[In vivo study of remineralization with trace elements by laser scanning confocal microscope].

OBJECTIVE: To evaluate in vivo the remineralization containing trace elements. METHODS: The volunteers were selected by pre-designed criteria of adopting and eliminating. Caries-like lesions were prepared in the enamel of extracted human premolars with the use of demineralizing solution. Sections of the normal and lesion enamel (approximately 2 mm x 2 mm) were prepared, with the cut surfaces protected by nail varnish. 2 enamel specimens were mounted in a removable appliance. By measuring lesion parameters (area, total and average dye fluorescence) on a tooth with confocal laser scanning microscopy (CLSM), the effect of remineralization was assessed. Specimens were cut and stained with a fluorescent dye (0.1 mmol/L rhodamine B) for 1 h and analyzed using CLSM. RESULTS: CLSM detected significantly greater remineralization (P < 0.05) in the specimens treated with the trace elements fluoride-containing solution and only containing fluoride (P < 0.05), especially more obvious difference was shown upon remineralized solution with trace elements, which means it produced a greater remineralization. CLSM data of remineralized solution with trace elements were showed: delta Z vs. Area = -50.4 +/- 8.1; delta Z vs. TF = -27.8 +/- 3.8; delta Z vs. AF = -91.5 +/- 8.9. CONCLUSIONS: The ability of remineralization of the new solution is better than that only containing fluoride in in vivo study. It can potentially prevent initiation of caries. This study provides not only the theoretical foundation for clinical application, but also shows a new kind of experimental method in the study of demineralization and remineralization.

Dental Caries↗

Influence of constant fluoride levels in solution on root hard tissue de- and remineralization measured by 125I absorptiometry.

To study the effect of fluoride on de- and remineralization of root hard tissue, an automatic pH-cycling caries model, simulating Stephan curves, was used for 21 days. From each of 13 unexposed human roots, four cementum/dentin blocks were prepared. Four experiments were carried out: one block from each tooth as subjected to pH cycling without and with fluoride at the concentrations of 0.02 ppm (1.0 mumol/l), 0.20 ppm (10.5 mumol/l) and 2.00 ppm (105.3 mumol/l) in the de- and remineralizing solutions, respectively. Mineral change in the specimens was monitored by 125I absorptiometry. When no fluoride was added to the solutions the change in transmission (delta T) increased continuously over 21 days, indicating loss of mineral. In the 0.02-ppm F experiment, there was a marked decrease in delta T, but almost no change in the 0.20-ppm F experiment. pH cycling with 2.00 ppm F in the solutions resulted in a gain of mineral in or most likely on the surface of the cementum/dentin blocks, indicated by a continuously decreasing delta T. The fluoride level in the solution significantly influenced the change in the mineral content of the specimens. Microradiographs of the sectioned blocks showed radiodense surface zones, varying degrees of subsurface demineralization and signs of remineralization or mineral deposition.

Absorptiometry, Photon↗

Remineralization effect of a low-concentration fluoride rinse in an intraoral model.

A previous study showed that a sodium hexafluorosilicate-calcium chloride-based two-solution fluoride (F) rinse containing 6 mmol/l of F was more effective than a 12 mmol/l F sodium fluoride rinse in depositing F on tooth surfaces and increasing oral F levels. The present study compared the remineralization effects of these two rinses in an intraoral de- and remineralization model. The results showed that the 6 mmol/l F two-solution rinse produced greater remineralization in increasing lesion mineral contents and reducing lesion depths. The results demonstrated that the effectiveness of an F regimen depends less on the F dose and more on the ability of the treatment to utilize F efficiently for remineralization.

Analysis of Variance↗

Remineralization of natural carious lesions with a glass ionomer cement.

Remineralization of carious lesions at the histological level is of great benefit since this will arrest lesion progression. The ability of glass ionomer cement (GIC) to (1) release fluoride it originally contains and (2) release "loosely bound" fluoride acquired from its surroundings have been previously demonstrated. This in vitro study examined the potential for caries remineralization if the lesion was placed near a GIC. Sixteen mesiodistal sections were cut through extracted deciduous molars exhibiting approximal white spot lesions. Sections were "linked" to a plastic tooth restored with a GIC to simulate the abutting surfaces of adjacent teeth. Lesions were photographed in water under polarized light initially and after one- and two-week exposures to artificial saliva. The photographs were digitized, lesion body outlined, and the area corresponding to the body of the lesion was determined to provide a comparison over time. Sixty-two percent of the sections showed a quantitative reduction in lesion body size by an average of 43% after the first week and an additional 14% reduction after the second week. All but two sections demonstrated a qualitative change thereby illustrating that a reduction in pore volume size of the lesion body had also occurred. Therefore, fluoride released from a GIC has the potential to enhance remineralization of the early carious lesion in vitro. The greatest remineralization occurred during the first week of artificial saliva exposure.

Cariostatic Agents↗

An in vitro evaluation of the prevention of caries on overdenture abutments.

Teeth prepared as overdenture abutments are susceptible to caries, and it has been shown that brushing by itself is not sufficient to prevent this process. This study evaluated the preventive effect of a remineralization gel which has a low fluoride concentration and compared its effects with those of a phosphate fluoride gel (Karigel), which has a much higher concentration of fluoride. Twenty extracted anterior teeth from patients aged 50 to 70 years were prepared as for overdenture abutments. Each tooth was sectioned into three fragments. An acidified gel system was used to produce artificial caries lesions on the occlusal and root surfaces of each fragment. One fragment of each tooth was treated with the remineralizing gel, the second fragment with a high-fluoride gel, and the third fragment served as the control. Ten teeth were removed at two weeks and again at four weeks, and were sectioned and prepared for histological examination. The depth of the lesions was measured from standardized photomicrographs by means of a sonic digitizer. The conclusions were: (1) Lesions on the occlusal tended to be deeper than those on the root surfaces at four weeks but not at two weeks; and (2) the high-fluoride gel was more protective than the low-fluoride remineralizing solution at both time periods on the occlusal but not on the root surface.

Aged↗

Effect of a two-solution fluoride mouthrinse on remineralization of enamel lesions in vitro.

A previous study showed that a two-solution fluoride (F) rinse deposited significantly more loosely-bound F on the tooth surface than did a sodium fluoride (NaF) rinse with the same F concentration (12 mmol/L). In the present study, this experimental rinse was evaluated for its ability to cause remineralization of enamel lesions in an in vitro pH-cycling model. Caries-like lesions were formed in the enamel of extracted human molars by means of a pH 4 demineralizing solution. Fifty-one approximately 120-microns-thick sections containing lesions were randomly divided into (1) control, (2) NaF rinse, and (3) two-solution F rinse groups. With the cut surfaces protected, the control samples were immersed in a pH 7 remineralizing solution for 12 days, and twice daily the sections were also exposed to a pH 4 demineralizing solution for 30 min. Samples in the NaF group received an additional one-minute rinse with a NaF (12 mmol/L) solution twice daily. Samples in the two-solution rinse group received the rinse treatment with a 12 mmol/L F solution prepared by combination of a Na2SiF6 and phosphate-containing solution with a calcium solution just before use. The mineral contents of the lesions were assessed by quantitative microradiography. The results showed that (1) no significant de- or remineralization was detected in the controls; (2) a 46% decrease in mineral loss (delta Z) of the lesion was produced by the NaF rinses; and (3) a 94% decrease in delta Z and a 20-microns-thick, mineral-dense surface-coating were produced by the two-solution F rinse treatment.

Apatites↗