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PubMed1981

The kinetics of mineralization of human dentin in vitro.

The prospect of restoration of damaged dental tissues has recently attracted great interest. An understanding of the remineralization of human dentin in vitro was attempted by using super-saturated calcium phosphate solutions at sustained supersaturation by means of a constant solution composition method. The direct growth of HAP from solutions of low supersaturation on powdered whole human dentin was confirmed. Moreover, it was found that the kinetics were similar to those of the seeded growth at synthetic HAP. A high apparent activation energy pointed to a surface-controlled mechanism.

Calcium Phosphates↗

PubMedDate not supplied

Molar incisor hypomineralization: review and recommendations for clinical management.

Molar incisor hypomineralization (MIH) describes the clinical picture of hypomineralization of systemic origin affecting one or more first permanent molars (FPMs) that are associated frequently with affected incisors. Etiological associations with systemic conditions or environmental insults during the child's first 3 years have been implicated. The complex care involved in treating affected children must address their behavior and anxiety, aiming to provide a durable restoration under pain-free conditions. The challenges include adequate anaesthesia, suitable cavity design, and choice of restorative materials. Restorations in hypomineralized molars appear to fail frequently; there is little evidence-based literature to facilitate clinical decisions on cavity design and material choice. A 6-step approach to management is described: (1) risk identification; (2) early diagnosis; (3) remineralization and desensitization; (4) prevention of caries and posteruption breakdown; (5) restorations and extractions; and (6) maintenance. The high prevalence of MIH indicates the need for research to clarify etiological factors and improve the durability of restorations in affected teeth. The purpose of this paper was to describe the diagnosis, prevalence, putative etiological factors, and features of hypomineralized enamel in molar incisor hypomineralization and to present a sequential approach to management.

Child, Preschool↗

PubMed1980

The resistance of superficially sealed enamel to wear and carious attack in vitro.

The resistance to wear and carious attack has been investigated in vitro for enamel that has been subjected to several stages of the sealing procedure: etching, etching and remineralization in whole saliva and etching followed by sealing. After partial mechanical removal of the sealant, the remaining surface enamel proved to be resistant to carious attack as long as the resin tags were present. An estimation is made of the thickness of the affected layer. Pretreatment with monofluorophosphate has proved to influence the extent of the histological changes due to etching. A discussion on these phenomena is given.

Acid Etching, Dental↗

PubMed1988

Increased permeability of enamel to iodide ions following the ingestion of cookies varying in sucrose or fat content.

Experiments showed that the intraoral iodide permeability (Ip) method can be used in a reproducible and sensitive manner with solid foods. Ingestion of 5-gram portions of cookies made with defined concentrations of sucrose or fat led to an increased Ip (due to demineralization) of Streptococcus mutans-covered bovine enamel blocks in vivo. Demineralization increased with time to a maximum of 45 min, and the pH of the plaque dropped accordingly. Continued exposure in the mouth beyond 45 min led to an elevation of the pH and a decrease in delta Ip consistent with remineralization of the enamel. Control blocks worn without ingestion of cookies exhibited negative delta Ip values. Demineralization increased with increasing sucrose content of the cookies and reached a plateau when cookies containing 1.08 g sucrose per morsel were administered. Cookies prepared without added sucrose gave a high delta Ip. High fat content raised the delta Ip when sucrose was low. These findings are consistent with clinical and other observations, and emphasize the complex relation between foods and enamel demineralization.

Animals↗

PubMed1983

Remineralization of softened human enamel in mucin- or CMC-containing artificial salivas.

The rehardening properties of four saliva substitutes on artificially softened human enamel have been investigated by microhardness measurements. The saliva substitutes were all based on the same formula, containing calcium, phosphate and fluoride as the main electrolytes, and mucin or carboxymethylcellulose as the main macromolecules. It has been shown that a rehardening potential exists in the saliva substitutes when calcium and phosphate are present. Omitting F- greatly reduces the rehardening potential. The rehardening is better in case of the CMC-containing saliva than in that containing mucin.

Carboxymethylcellulose Sodium↗

PubMed1985

Fluoride in sugar.

Results of caries model studies in vitro and in animals suggest that the tooth-protective potential of fluoride may be best utilized if fluoride is brought to the local caries milieu at the moment of each caries attack. Two clinical trials performed so far indicate that a reduction in caries increment of about 40 per cent can be obtained within 3 years through small (0.5-1.0 mg) daily intakes of fluoride when it is incorporated in highly cariogenic sucrose products or in tablets having a sucrose base. When incorporated in sucrose products, fluoride caused a complete arrest of caries during the third year. There was substantial accumulation of the supplemental fluoride in surface and subsurface enamel beneath the plaque fermenting the F-supplemented sucrose. This may be one of the preventive mechanisms involved. In plaque fluid, the supplemental fluoride, together with fluoride released from the plaque material and by the action of acid on the surface enamel of high fluoride content, may strongly reduce further enamel dissolution and promote its remineralization. Further metabolism of the plaque bacteria including their acid production may also be inhibited. Among the many advantages of using this principle are that: the supplemental fluoride in sugar automatically seeks the caries risk subjects who use sugary products; the amount of fluoride needed per kg of sugar may remain low and thus the risk of excessive intake of fluoride may also be low; the technical process is low in cost and easily performed; and the products are easily distributed nationwide. Furthermore, non-fluoridated sugary products may still be distributed to those who may continue to prefer them.

Adult↗

PubMed2005

Measurement of the severity of natural smooth surface (interproximal) caries lesions with polarization sensitive optical coherence tomography.

BACKGROUND AND OBJECTIVES: Previous studies have demonstrated that polarization sensitive optical coherence tomography (PS-OCT) can be used to image early dental caries. The purpose of this study was to compare the measured reflectivity of natural caries lesions found on smooth surfaces (interproximal lesions) with the mineral loss measured using digital microradiography (DM) in order to determine if PS-OCT can be used as a non-destructive method to measure the severity of dental decay and resolve the internal structure of caries lesions. MATERIALS AND METHODS: A PS-OCT system operating at 1,310 nm was used to acquire polarization resolved images of natural white spot lesions and pigmented lesions on the smooth surfaces of extracted teeth. The integrated reflectivity from lesion areas was compared to polarized light microscopic images (PLM) and to the integrated mineral loss from the same lesion area measured using high resolution DM. RESULTS: The frequently complex internal structure of caries lesions could be resolved with PS-OCT. Such structural information is potentially useful for determining whether or not the lesion is active and progressing or whether it has become arrested and remineralized and does not require intervention. There was a strong correlation between the integrated mineral loss of the caries lesions measured using DM and the integrated reflectivity in the perpendicular polarization axis of the PS-OCT system. CONCLUSIONS: The integrated reflectivity in the perpendicular polarization channel can be used to represent the severity of demineralization in natural early caries lesions. Therefore, PS-OCT has considerable potential as a non-destructive clinical probe of early caries lesions to assess their severity, monitor their progression over-time and potentially assess lesion activity.

Dental Caries↗

PubMed1979

Enamel apatite nucleation and crystal growth.

The course of enamel remineralization in aqueous solution is markedly dependent upon factors such as ionic medium supersaturation, pH, ionic strength, and the relative concentration of mineralizing surface. Although numerous attempts have been made to determine the mechanism of both the spontaneous and seeded precipitation reactions, it is only recently, through the use of a constant solution composition technique, that quantitative information can be obtained concerning the intermediate calcium phosphate phases which are formed during mineralization. Studies of surface phases in the presence of potential anti-calculus and anti-caries agents are facilitated using this approach.

Apatites↗

PubMed1992

Composition of pooled plaque fluid from caries-free and caries-positive individuals following sucrose exposure.

The composition of pooled plaque fluid from five population samples was determined before and at selected times (7, 15, 30, and 60 min) after a 10% sucrose rinse. Subjects were grouped according to caries status (caries-free, CF, DMFS = 0; caries-positive, CP, DMFS > 10). Samples were also studied from white-spot surfaces and from sound surfaces of the same mouths of two additional CP groups. Plaque fluid was isolated by centrifugation and analyzed for organic acids, inorganic ions (ion chromatography), and pH (microelectrodes). Prior to sucrose exposure, plaque fluids from the CF subgroups and from sound surfaces of the CP subjects had higher pH values than samples from CP subgroups and from white-spot surfaces, respectively; the ionic compositions were otherwise similar. Starved plaque fluids were also found to be supersaturated with respect to enamel and to a significantly greater degree in the CF samples, suggesting that CF plaque fluid may have a greater remineralization potential than CP samples. Following sucrose exposure, a rapid decrease in plaque fluid pH was observed, which corresponded primarily to lactic acid production. For all times examined, mean pH and DS(En) values were lower and lactic acid concentrations were higher in the CP samples than in the CF samples; noted differences were statistically significant at 7 min for pH and DS(En), and at 7, 15, and 30 min for lactic acid. Lower values of DS(En) suggest that plaque fluid from CP subjects had a measurably greater cariogenic potential.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2004

The challenges of validating diagnostic methods and selecting appropriate gold standards.

Caries diagnostic methods are usually methods for caries lesion detection and measurement. Caries lesions occur on a continuous scale of tissue damage, from subclinical surface changes to macroscopic cavities reaching the pulp. Any change of a lesion on this continuous scale offers the opportunity for the diagnosis of disease activity or remission. Research aimed at remineralizing agents may focus on lesions that are amenable to remineralization, and select a method that will measure small changes in early lesions. General caries management strategies depend on detecting all stages of lesion development, and methods covering early to late stages are preferred. This paper addresses some methodological issues in validating caries diagnostic methods. The available gold standards for caries lesions are discussed, with their suitability in different applications, and their "validity" as far as it is known or can be inferred. The gold standards are compared as far as their measurement of lesion parameters and reproducibility is concerned. Tentative conclusions are formulated, and recommendations for future research are given.

Cariostatic Agents↗

PubMed1988

Iron and dental caries.

Studies of human and animal caries, experiments in vitro and laboratory reports initiated the present study of a possible caries preventing effect of iron. The study comprises two sections. (I) Coatings on teeth of hamsters treated with iron salts and films formed on various solutions containing ferrous ions were examined with scanning electron microscopy and x-ray fluorescence analysis. (II) Enamel surface layers, remineralized caries lesions, fluorosed rat bone, coatings on teeth of hamsters treated with iron salts and films formed on solutions containing ferrous ions were examined with transmitting electron microscopy and electron diffraction. Based on the findings the following effects were visualized. When brought into the mouth, even in small amounts, iron ions will be precipitated on the enamel surface as thin acid resistant coatings containing gels and crystals of hydrous iron oxides. In addition, by adsorbing salivary calcium and phosphate ions these iron compounds seem to be able to nucleate the formation of apatites, thus mediating a replacement of minerals, which have been dissolved during the acid phases of the caries process.

Animals↗

PubMedDate not supplied

Variations in bone regeneration adjacent to implants augmented with barrier membranes alone or with demineralized freeze-dried bone or autologous grafts: a study in dogs.

A study was performed in two large hound dogs to evaluate the bone-induction potential of demineralized freeze-dried bone (DFDBA) placed into defects adjacent to implants that were placed into extraction sockets. Two implants were untreated controls, two implants received only Gore-Tex Augmentation Membrane (GTAM), two implants received GTAM and autologous bone, and six sites received GTAM and DFDBA. DFDBA was prepared from the long bones of a dog of the same breed as the experimental dogs. P2, P3, and P4 were extracted bilaterally, and buccal defects were created and measured. Twelve commercially pure titanium Brånemark implants were placed. At 12 weeks, clinical measurements were taken and the dogs were sacrificed. The untreated control defects had a mean clinical bone fill of 1.75 mm (37%). Sites treated with autologous bone had a mean of 5.0 mm (95%) of clinical bone fill within the original defects. Sites treated with DFDBA and barriers had 3.8 mm (75%) of bone fill, while sites treated with membranes alone had a mean of 4.2 mm (80%) of bone fill. Histologic evaluation revealed that DFDBA sites had retained nonviable bone chips in 45.4% of the bone matrix, and only 8.3% was lamellar bone. Autologous graft sites had 26.2% retained bone chips within the bone matrix, and 61% percent of the matrix consisted of lamellar bone. For GTAM-only sites, 70.2% of the matrix was lamellar bone and 29.8% was woven bone. Retained DFDBA bone chips were nonviable, occasionally surrounded by woven bone, and appeared to break up and then remineralize without the presence of osteoclastic or osteoblastic activity. Retained autologous bone chips were surrounded and incorporated by the host bone. The autologous bone grafts and DFDBA implants were considered to be osteoconductive. For the three treatment groups, within the defects there were sparse bone-implant contacts. The results indicate that GTAM barriers alone or with autologous bone grafts produced the best clinical and histologic results. DFDBA did not appear to induce bone formation in any of the evaluated specimens.

Alveolar Process↗

PubMed2005

Toothbrush abrasion, simulated tongue friction and attrition of eroded bovine enamel in vitro.

OBJECTIVES: Enamel erosion results in the formation of a softened layer that is susceptible to disruption by mechanical factors such as brushing abrasion, tongue friction and attrition. The aim of this study was to investigate the individual contribution of those mechanical insults to the enamel loss caused by dental erosion. METHODS: Forty two bovine enamel samples were randomly divided into seven groups (n=6 per group) that were submitted to 3cycles of one of the following regimes: erosion and remineralization (er/remin); toothbrush abrasion and remineralization (abr/remin); erosion, toothbrush abrasion and remineralization (er/abr/remin); attrition and remineralization (at/remin); erosion, attrition and remineralization (er/at/remin); simulated tongue friction and remineralization (tg/remin); erosion, simulated tongue friction and remineralization (er/tg/remin). Erosion took place in a demineralization solution (50mM citric acid, pH 3) for 10min under agitation. Brushing abrasion, tongue friction and attrition were simulated for 1min using a home-made wear device. Remineralization was carried out in artificial saliva for 2h. Enamel loss was quantified using optical profilometry. RESULTS: One-way ANOVA indicated a significant difference between the amounts of enamel lost due to the different wear regimes (p<or=0.001). Multiple comparisons with Bonferroni procedure showed that the wear depths found for the er/at/remin (p<or=0.001) and er/tg/remin (p<or=0.001) were significantly higher than the amount found for the er/remin group (4.4+/-0.7microm). This was not the case for er/abr/remin group (p=0.075). CONCLUSIONS: The results suggest that the three forms of mechanical insults remove to varying extent the softened layer formed by the erosion challenges.

Animals↗

PubMed2005

In vitro cariostatic effect of whitening toothpastes in human dental enamel-microhardness evaluation.

OBJECTIVE: The aim of this study was to evaluate, in vitro, the cariostatic effect of whitening toothpastes. METHODS AND MATERIALS: Ninety-five dental fragments were obtained from nonerupted third molars. The fragments were embedded in polystyrene resin and sequentially polished with abrasive papers (400-, 600-, and 1,000-grit) and diamond pastes of 6, 3, and 1 microm. The fragments were assigned in five groups according to toothpaste treatment: G1 = Rembrandt Plus with Peroxide; G2 = Crest Dual Action Whitening; G3 = Aquafresh Whitening Triple Protection; and the control groups: G4 = Sensodyne Original (without fluoride); G5 = Sensodyne Sodium Bicarbonated (with fluoride). The initial enamel microhardness evaluations were done. For 2 weeks the fragments were submitted daily to a de-remineralization cycle followed by a 10-minute toothpaste slurry. After that, the final microhardness tests were done. The percentage of mineral loss of enamel was determined for statistical analysis. Analysis of variance and the Tukey test were applied. RESULTS: The results did not show statistically significant differences in mineral loss among groups G1, G2, G3, and G5, which statistically differ from G4 (toothpaste without fluoride). G4 showed the highest mineral loss (P < or = .05). CONCLUSION: The whitening toothpastes evaluated showed a cariostatic effect similar to regular, nonwhitening toothpaste.

Cariostatic Agents↗

PubMed2006

Brushing abrasion of eroded bovine enamel pretreated with topical fluorides.

Topical fluorides have been proposed for the prevention of erosive dental wear. This study evaluated the in vitro effect of a single professional application of 4% titanium tetrafluoride (TiF4), 1% amine fluoride (AmF) and 0.1% difluorosilane varnish (FV) in preventing wear due to combined erosion and brushing abrasion. One hundred and eight bovine enamel samples were used. Control groups were not pretreated with any product (C), pretreated with a fluoride-free varnish (FV-bl) or pretreated with fluoride varnish and subsequently submitted to varnish removal (FV-r). Wear was modeled by submitting the fluoride-treated and control groups to 3 cycles of the following regimens: erosion/remineralization (er/remin), abrasion/remineralization (abr/remin) or erosion/abrasion/remineralization (er/abr/remin). Erosion was simulated by immersion of the samples for 10 min in citric acid 50 mM (pH 3). Abrasion was carried out for 1 min (200 strokes, load 150 g) in a wear device. Remineralization (2 h artificial saliva) took place between the cycles. Two-way ANOVA showed that there was a significant interaction (p<or=0.001) between the fluoride treatments and the wear regimens. Under er/remin a significant wear protective effect was found for the FV, FV-r and FV-bl groups. Abr/remin resulted in some enamel loss for the TiF4 and AmF groups, but the amounts lost were not statistically significant (p=0.185 and p=1.000, respectively). Under er/abr/remin all products showed a significant protective effect, except for TiF4. It was concluded that FV and AmF protected bovine enamel against erosion followed by brushing abrasion in vitro.

Analysis of Variance↗

PubMed1996

Modeling the caries-inhibitory effects of dental materials.

The objectives of this review are to compare the models that are used to simulate the caries process in cardiology research and to suggest how these models might be used to assess caries-inhibitory properties of dental materials. Available caries-simulation models fall into the following classifications: 1) in vitro demineralization using acid buffers, 2) in vitro demineralization using bacterially generated acids, 3) in vitro demineralization/remineralization using a pH-cycling system, 4) an artificial mouth where a bacterially generated acid challenge is interspersed with a "saliva" treatment, 5) in vivo animal model (generally with rats), 6) in situ demineralization and/or remineralization using enamel or dentin blocks or slices in the human mouth, and 7) in vivo studies using teeth scheduled for extraction in the human mouth. Most dental materials studies have used simple in vitro demineralization models or component release experiments, each of which is inadequate to answer the questions that are being asked about the caries-inhibitory properties of the material being tested. Experimental methods must be chosen with care to ensure that the material to be tested is examined in an appropriate mode. The ultimate goal is to correctly predict clinical outcomes. The design or redesign of a model must eventually be tied to documented clinical outcomes to improve the model and allow for future successful development of new materials.

Animals↗

PubMed2005

Impact of modified acidic soft drinks on enamel erosion.

OBJECTIVE: To evaluate the enamel erosive potential of modified acidic soft drinks under controlled conditions in an artificial mouth. MATERIALS AND METHODS: From each of 144 bovine incisors one enamel sample was prepared. Labial surfaces of the samples were ground flat, polished and covered with adhesive tape, leaving an exposed area. The samples were distributed among four (A-D) groups for treatment with A: Coca-Cola, B: Sprite; C: Sprite light, D: orange juice. Either 1.0 mmol l(-1) calcium (Ca) or a combination (comb.) of 0.5 mmol l(-1) calcium plus 0.5 mmol l(-1) phosphate plus 0.031 mmol l(-1) fluoride was added to the beverages. Samples of each group were subdivided into three subgroups (-original; -Ca and -comb.) for treatment with original and modified drinks. De- and remineralization cycles were based on a standard protocol described earlier. Surface loss of the specimens was determined using profilometry after test procedure. RESULTS: In all subgroups, loss of enamel was observed. The enamel loss recorded for the samples rinsed with original Sprite and original orange juice was significantly higher compared with all other solutions (P = 0.001). Lowest enamel loss was recorded for the original Coca-Cola group (P = 0.001). With the exception of Coca-Cola, demineralization with the modified beverages led to significantly lower losses compared with the respective original solutions. CONCLUSION: Modification of the test soft drinks with low concentrations of calcium or a combination of calcium, phosphate and fluoride may exert a significant protective potential with respect to dental erosion.

Animals↗

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↗