Should a dental explorer be used to probe suspected carious lesions? No--use of an explorer can lead to misdiagnosis and disrupt remineralization.
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Sets containing of four specimens of intact human enamel of 18 teeth were inserted into volunteers' partial prostheses. The specimens were exposed to the action of oral cariogenic factors during 7, 14, 21 or 28 days. Electron microanalysis was employed to assess the demineralizing loss of calcium and phosphorus concentrations in experimental specimens, in relation to the original enamel of control specimens. Results showed a significant and steady decrease in Ca and P concentrations in all specimens, which was directly proportional to the duration of specimen exposure to oral cavity conditions. In four specimens with a 28-day oral exposure, an increase in Ca and P concentrations was observed in the most superficial enamel layer, which was explained as activation of the process of remineralization.
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With the development of adhesive restorative materials and a far better understanding of the action of the fluoride ion it is suggested that the time has arrived for a reassessment of the traditional cavity classification as set out by G.V. Black over one hundred years ago. When preventive measures and remineralization fail and a carious lesion has progressed through the enamel into the dentine there is a need to remove the infected dentine, and possibly some of the affected dentine as well, to eliminate cavitation and avoid further accumulation of plaque. In most situations this will involve removal of enamel to achieve access to the infected dentine but, in the presence of fluoride, both enamel and dentine are capable of being remineralized and therefore conserved, at least to a degree. The principle of minimal extension must be encouraged to allow maximum preservation of natural tooth structure. A new cavity classification is proposed which is designed to make the most of the potential for healing which is inherent in both enamel and dentine. However, it must be accepted that a considerable proportion of restorative dentistry is carried out to replace failed restorations and, in this case, cavity design will be complicated by existing loss of tooth structure.
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Phosphoprotein appears to play an important role in the mineralization of dentin during tooth development and remineralization after demineralization by dental caries. To better understand this role, we describe the extraction and characterization of phosphoprotein from immature, human root apex dentin during and after EDTA demineralization. The extraction procedure included dissociation of the demineralized dentin matrix by guanidine hydrochloride (Gdn.HCl) followed by subsequent digestion with cyanogen bromide (CNBr) and collagenase. Characterization of these extracts included 'Stains-All' staining of SDS polyacrylamide gels (SDS-PAGE) and amino acid, protein and phosphorus analyses. The ability of these matrices to remineralize was determined by TEM and measuring calcium levels in the remineralized tissue by atomic absorption spectroscopy. The staining of SDS-PAGE gels and amino acid analysis showed that an intact phosphophoryn was extracted from the dentin of the immature apices during EDTA demineralization and that it had an apparent Mr approximately 140,000. In the subsequent extracts and digests, the phosphoprotein has a range of molecular weights, some of which may have been degraded products of the intact phosphoprotein. A greater quantity of phosphoprotein was found in the EDTA-demineralized dentin matrices than in dentin after Gdn.HCl, CNBr and collagenase digests. These EDTA-demineralized matrices also remineralized to a greater extent than those dissociated with Gdn.HCl. The differences in both the quantity and the quality, as defined by the amino acid residue profile, of the phosphoprotein in the sequential extracts of the root apex dentin may be important in affecting the ability of this tissue to remineralize.
The aim of the present investigation was to elucidate structural alternations in enamel subjected to acid etch technique and treatment under remineralizing conditions by means of a new microscopy technique known as confocal laser scanning microscopy (CLSM). Blocks of enamel were treated with 37% phosphoric acid and exposed for 3 weeks to an oral environment. Tomographic CLSM images were subsequently obtained and compared with controls. CLSM proved to be a reliable, highly reproducible and simple method of qualitative assessment of structural changes occurring on the surface of enamel and in areas below the surface as deep as 100 microns or more. Structural alterations associated with acid application were observed to occur up to 100 microns below the surface; these largely remained after exposure to an oral environment. Changes manifested as differential light reflection were detected in experimental samples in the form of a hyper-reflexible zone extending as a 10 to 15 microns wide band below the etched surface. This finding indicates that deposition of salivary material occurs on and below the surface of etched enamel exposed to an oral environment. Once qualitative results of CLSM are correlated with quantitative measurements, this technique may facilitate large scale remineralization studies.
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