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Objectives: The aim of this study was to compare the 2-year clinical performance of a bulk-fill composite resin and a nano-hybrid-filled composite resin in 6-12-year-old children in a split-mouth design., Materials and Methods: This randomized, split-mouth, and double-blind study was conducted on 89 patients aged 6-12 years with caries on bilateral mandibular first molars. In a split-mouth design, restorations of mandibular permanent molars were completed with nano-hybrid organically modified ceramic (ORMOCER)-based bulk-fill composite resin Admira Fusion x-tra (Voco GmbH, Cuxhaven, Germany) and nano-hybrid composite Grandio (Voco, Cuxhaven, Germany). Futurabond U single dose (Voco, Cuxhaven, Germany) was used with selective enamel etching. The clinical success of the restorations was evaluated using USPHS and FDI criteria at 6, 12, and 24-month follow-up controls., Results: In the 2-year follow-up, all restorations were clinically acceptable. Grandio was significantly worse than Admira Fusion x-tra in terms of surface luster and superficial change (p < 0.05). Surface staining and color match scores increased in Admira Fusion x-tra compared with Grandio significantly (p < 0.05)., Conclusions: Although both materials showed acceptable clinical performance over 2 years, a significant difference was observed between the surface luster, surface staining, marginal adaptation, and staining of the nano-hybrid composite placed with the incremental technique and the bulk-fill ORMOCER-based composite resin., Clinical Relevance: As an alternative to nano-hybrid composite resins, using bulk-fill restorative materials, which can be indicated in the proper case, may contribute to shortening treatment procedures and increasing patient and physician comfort, leading to clinical success., (© 2024. The Author(s).)

Objectives: Biomimetic mineralization mediated by proteins and peptides is a promising strategy for enamel repair, and its specific application model needs more research. In this work, we exploited a liposomal delivery system for a novel peptide (DK5) derived from histatin-1 (DK5-Lips) as a new biomimetic mineralization strategy against initial enamel caries., Materials and Methods: The DK5-Lips was prepared using calcium acetate gradient method and then the in vitro release, salivary stability, and cytotoxicity were studied. Initial enamel caries was created in bovine enamel blocks and subjected to pH-cycling model treated with DK5-Lips. Surface microhardness testing, polarized light microscopy (PLM), and transverse microradiography (TMR) were analyzed. Then the biocompatibility of DK5-Lips was evaluated in the caries model of Sprague-Dawley rats, and the anti-caries effect was assessed using Micro-CT analysis, Keyes scores, and PLM in vivo., Results: DK5-Lips provided a mean particle size of (97.63 ± 4.94)nm and encapsulation efficiency of (61.46 ± 1.44)%, exhibiting a sustained release profile, excellent stability in saliva, and no significant toxicity on human gingival fibroblasts (HGFs). The DK5-Lips group had higher surface microhardness recovery, shallower caries depth, and less mineral loss in bovine enamel. Animal experiments showed higher volume and density values of residual molar enamel, lower Keyes score, and shallower lesion depth of the DK5-Lips group with good biocompatibility., Conclusion: As a safe and effective application model, DK5-Lips could significantly promote the remineralization of initial enamel caries both in vitro and in vivo., Clinical Relevance: The potential of liposome utilization as vehicle for oral delivery of functional peptides may provide a new way for enamel restoration., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: This in situ study aimed to investigate the efficacy of CO 2 laser at a 10.6-µm wavelength combined with 1.23% acidulated phosphate fluoride (APF) and fluoridated dentifrice with 1100 µg F/g (FD) to control enamel caries progression., Materials and Methods: Sixteen volunteers wore palatal appliances containing eight demineralized enamel specimens for four 14-day phases under sucrose exposure. These specimens were submitted to CO 2 laser irradiation and APF alone or combined with FD. Treatment groups were non-fluoridated dentifrice-NFD, NFD + CO 2 laser, NFD + APF, NFD + CO 2 laser + APF, FD, FD + CO 2 laser, FD + APF, and FD + CO 2 laser + APF. Mineral loss, calcium fluoride (CaF 2 ), fluorapatite (FAp), and fluoride in the biofilm were analyzed by analysis of variance followed by the Student-Newman-Keuls test, p < 0.05., Results: The highest mineral loss inhibition was noted when FD and CO 2 laser irradiation were combined, which did not significantly differ from the FD + CO 2 laser + APF group. The CaF 2 , FAp, and F in the biofilm were more pronounced when the FD and APF were combined. The CO 2 laser irradiation promoted a slightly higher concentration of CaF 2 in the enamel and F in the biofilm., Conclusion: Although APF promotes the high formation of CaF 2 and FAp, the combined use of FD with CO 2 laser overcomes the APF effect in inhibiting the progression of artificial caries-like lesions in situ., Clinical Significance: Under the in situ design of this study, remineralization of white spot lesions was achieved through CO 2 laser irradiation and daily use of fluoridated dentifrice. Future clinical trials are encouraged to substantiate this finding., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To investigate the response of pulp cells to the application of silver diamine fluoride (SDF) and potassium iodide (KI) on demineralized dentin., Materials and Methods: The occlusal surfaces of human dentin discs (0.4 mm thick) with similar permeability were subjected to an artificial caries protocol, and then the discs were adapted into artificial pulp chambers. MDPC-23 cells were seeded on the healthy pulp dentin surface, while the demineralized surface was treated with SDF, KI, SDF + KI, or hydrogen peroxide (positive control-PC) (n = 8). The negative control (NC) received ultrapure water. After 24 h, cell viability (alamarBlue) and morphology (SEM) were evaluated. The extracts were then applied to new MDPC-23 cells seeded in culture plates to assess their viability and the formation of mineralized nodules (MN; Alizarin Red) after seven days. The data were analyzed using one-way analysis of variance/Tukey or Games-Howell tests (α = 5%)., Results: SDF and PC significantly reduced the viability of cells seeded on discs (45.6% and 71.0%, respectively). Only cells treated with SDF or PC detached from the dentin substrate, while the remaining cells showed altered morphology. Cells in contact with extracts showed less reduction in viability, but it was still more toxic compared to NC. Only PC reduced MN deposition. SDF + KI or KI alone did not affect the cell response., Conclusions: SDF applied alone showed a mild to moderate transdentinal cytotoxic effect on pulp cells. However, the combination of SDF + KI reduced the cytotoxic effects. Both materials used alone or in combination did not affect the mineralization ability of pulp cells., Clinical Relevance: Besides improving esthetic results, associating potassium iodide with silver diamine fluoride may reduce the transdentinal cytotoxic effects of this cariostatic agent on pulp cells., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: This in vitro study aimed assessing the remineralization potential of three commercial fluoride-based toothpastes in permanent teeth with natural white spot lesions (WSLs). A multidisciplinary approach based on Raman microspectroscopy (RMS), Scanning electron microscopy (SEM), Energy-dispersive x-ray spectroscopy (EDS), and Vickers microhardness (VMH) was exploited., Methods: N = 12 human molars with natural WSLs in the proximal-vestibular zone were selected and divided into 4 groups (n = 3) according to the different treatments: HAF (hydroxyapatite with fluoride ions); SMF (sodium monofluorophosphate with arginine); SF (sodium fluoride with enzymes), and CTRL (untreated group). All toothpastes tested contained 1450 ppm of fluoride. Teeth samples were submitted to the following protocol: a 7-day pH cycling treatment, with two daily exposures (2 min each time) to the commercial toothpastes described above. The surface micromorphology (SEM), the chemical/elemental composition (RMS and EDS), and the Vickers microhardness (VMH) were evaluated. Statistical analysis was performed., Results: A remarkable remineralization of WSLs in SEM images was observed in all treated groups compared to CTRL. In particular, HAF and SF displayed higher values of VMH, phosphates amount (I 960 ), crystallinity (FWHM 960 ), and lower ones of C/P (I 1070 /I 960 ) with respect to CTRL. Intermediate values were found in SMF, higher than CTRL but lower with respect to HAF and SF. As regards the Ca/P ratio, statistically significant differences (p < 0.05) were found between SF and the other groups., Conclusions: All the tested dentifrices have shown to remineralize the WSLs. SF and HAF have comparable capability in hardness recovery and crystallinity; however, SF shows the best remineralizing potential according to both micromorphological and chemical analyses. Clinical relevance The daily use of toothpastes containing hydroxyapatite partially replaced with fluoride, sodium monofluorophosphate with arginine and sodium fluoride toothpaste associated with enzymes represents a preventive, therapeutic, effective, and non-invasive tool for remineralize WSLs., (© 2023. The Author(s).)

Objective: The aim of the study was to evaluate the effect of the addition of 10% nanohydroxyapatite in an experimental resin infiltrant on color stability and mineral loss., Material and Methods: Bovine enamel blocks were randomized into five groups (n = 27/group): SE (sound enamel); ICL (initial caries lesion); I (Icon®); E (experimental infiltrant); EH (experimental infiltrant containing 10% nanohydroxyapatite). Color evaluation (n = 15) was performed and CIEL*a*b* values were obtained at points T 0 (baseline), T 1 (14 days immersed on coffee solution), and T 2 (28 days immersed) and data were calculated ∆E 00 , ∆W ID , ∆L*, ∆a*, and ∆b*. Cross-sectional microhardness (n = 12) was performed and lesion area (∆S) was calculated. Images were obtained with polarized light optical microscopy at 40 × magnification (n = 5)., Results: In color stability results, there was significant difference between time (14 and 28 days); ICL demonstrated significant difference among treated groups in all measures (∆L*, ∆a*, ∆b*, ∆E 00 , ∆W ID ) regardless of time; I and E demonstrated similar behavior on those measures and EH differed from I in ∆L*. For ∆S, ICL group showed a significant difference compared to I and EH groups, but did not differ from E., Conclusion: The nanohydroxyapatite incorporation suggested an effective mineral recovery on initial caries lesion in depth; however, it showed high color variation, such as Icon. In terms of ∆S, I and EH had lower mineral loss, suggesting a reinforcement on initial caries lesion., Clinical Relevance: Commercial and experimental infiltrants containing nanohydroxyapatite present low color stability and might reinforce mineral in initial caries lesion., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: On the basis of a large sample size and a long follow-up period, the objectives of this study were to evaluate the outcomes of direct pulp capping (DPC) in mature permanent teeth with carious pulp exposure using a kind of bioaggregate putty (BP) which commercially named iRoot BP Plus (Innovative Bioceramix, Inc., Vancouver, Canada) and to analyze the potential prognostic factors., Materials and Methods: The design of this research was retrospective regarding treatment procedures and prospective regarding the assessment of outcomes. The preoperative diagnosis of the teeth was either normal pulp or reversible pulpitis. Results were assessed based on clinical and radiographic examinations with at least 12 months of follow-up after DPC. No symptoms or signs, a positive response to electric pulp testing, a normal response to cold pulp testing and radiographs showing no abnormalities were considered to indicate success. Kaplan-Meier survival analysis was used to calculate the cumulative survival of teeth after DPC. Univariate and multivariate Cox proportional hazard regressions were used to analyze potential prognostic factors., Results: Three hundred thirty-four patients, including a total of 354 teeth, were available for the final clinical examination. The follow-up period ranged from 12 to 85 months, with an average of 27.0 ± 0.8 months. The total success rate was 85% (302/354), and the cumulative survival rates at 1, 2, 3, 4, and 5 years were 92%, 87%, 83%, 76%, and 72%, respectively. Univariate analysis indicated a significantly increased risk of failure in patients aged above 40 years and those treated by resident operators (P ≤ 0.01), with hazard ratios of 2.18 and 2.27, respectively., Conclusions: Under appropriate indication selection and treatment procedures, long-term success is possible in mature permanent teeth with carious pulp exposure by DPC using iRoot BP Plus. Patient age and operator experience are potential prognostic factors., Clinical Relevance: Clinical data on iRoot BP Plus as a pulp capping medicament in mature permanent teeth with carious pulp exposure is lacking. This study indicated the efficacy of BP in DPC. Younger patient and sophisticated operator are beneficial for the outcome of DPC., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Radiotherapy (RT) is a kind of head and neck cancer (HNC) treatment, which is associated to the habit of smoking and can develop collateral effects in the oral cavity, such as the increase of caries prevalence. This study evaluated the color alteration, the microhardness, and the remineralizing potential of high fluoride concentration toothpastes on irradiated teeth., Materials and Methods: Forty bovine teeth were used (6 × 6 × 2 mm) and after color (EasyShade, VITA) and microhardness initial readings were separated into two groups: exposed to cigarette smoke and non-exposed. All samples were submitted to RT (30 Gy) and to cariogenic challenge. New color and microhardness readings were done. After RT (60 Gy), the samples were submitted to simulated toothbrushing (73,000 cycles = 5 years of brushing) with two different toothpastes: conventional (1450 ppm) and high fluoride concentration (5000 ppm). Final color and microhardness readings were done after brushing. Data were analyzed with 2-way ANOVA with repeated measures and Tukey's test (p < .05)., Results: There was no color difference after RT, nor after brushing (p > .05). However, after brushing, microhardness values increased for the samples treated with high fluoride concentration toothpaste (p < .05)., Conclusion: Radiotherapy did not influence the teeth color, and the high fluoride concentration toothpaste presented remineralizing potential; therefore, it could be used on the caries prevention related to HNC radiation., Clinical Relevance: Considering its remineralizing potential, toothpastes with high fluoride concentration could be a proper alternative for caries prevention in patients undergoing radiotherapy., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The study aimed to survey current strategies against enamel demineralization during multibracket therapy (MBT) and guide a prevention concept based on existing scientific evidence., Materials and Methods: The survey comprised questions on the prevention and management of white spot lesions (WSL). The questionnaire was sent via email to orthodontists working in practices and universities throughout Germany. The analysis involved descriptive statistics using the chi-square test (p < 0.05)., Results: A prevention protocol was used before MBT by 80.6% of the participants. Less than a quarter of the participants regularly applied topical fluoride (gel or varnish) during MBT. According to the respondents' assessment, the prevalence of WSL during MBT is 11.6%, mainly observed in 12- to 15-year-old male patients. Orthodontists graduating after 2000 tended to recommend and apply fluoride-containing materials more often than their senior colleagues (p = 0.039). Participants from private practices applied fluoride varnish or gel more frequently than those from university clinics (p = 0.013). Fluoridation was the most common (70.7%) treatment for WSL after MBT, followed by resin infiltration (21.2%). The majority (80.9%) of the participants favor a guideline for preventing WSL., Conclusions: WSL prevention during MBT is challenging. Males in puberty are predominantly affected. Younger orthodontists are more concerned about the prevention of WSL during MBT., Clinical Relevance: The non-negligible prevalence of individuals with WSL emphasizes the need for dental education and health care reform. This would help to implement standardized procedures and establish innovative applications., (© 2022. The Author(s).)

Objective: To investigate the antibiofilm and remineralising effects of the dual-action peptide GA-KR12 on artificial enamel caries., Materials and Methods: Enamel blocks with artificial caries were treated with sterilised deionised water as control or GA-KR12. The blocks underwent biochemical cycling with Streptococcus mutans for 3 weeks. The architecture, viability, and growth kinetics of the biofilm were determined, respectively, by scanning electron microscopy (SEM), confocal laser scanning microscopy, and quantitative (culture colony-forming units, CFUs). The mineral loss, calcium-to-phosphorus ratio, surface morphology, and crystal characteristics of the enamel surface were determined, respectively, using micro-computed tomography, energy dispersive spectroscopy, SEM, and X-ray diffraction (XRD)., Results: SEM showed confluent growth of S. mutans in the control group but not in the GA-KR12-treated group. The dead-to-live ratios of the control and GA-KR12-treated groups were 0.42 ± 0.05 and 0.81 ± 0.08, respectively (p < 0.001). The log CFUs of the control and GA-KR12-treated groups were 8.15 ± 0.32 and 6.70 ± 0.49, respectively (p < 0.001). The mineral losses of the control and GA-KR12-treated groups were 1.39 ± 0.09 gcm -3 and 1.19 ± 0.05 gcm -3 , respectively (p < 0.001). The calcium-to-phosphorus molar ratios of the control and GA-KR12-treated groups were 1.47 ± 0.03 and 1.57 ± 0.02, respectively (p < 0.001). A uniformly remineralised prismatic pattern on enamel blocks was observed in the GA-KR12-treated but not in the control group. The hydroxyapatite in the GA-KR12-treated group was better crystallised than that in the control group., Conclusion: The dual-action peptide GA-KR12 inhibited the growth of S. mutans biofilm and promoted the remineralisation of enamel caries., Clinical Relevance: GA-KR12 potentially is applicable for managing enamel caries., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: A systematic review was performed to analyze the clinical performance of class I and II restorations in posterior teeth placed with the incremental or the bulk-filling techniques. The primary outcome was retention/fracture rate, and the secondary outcomes evaluated were anatomical form, surface texture, color match, marginal adaption, marginal discoloration, caries, and postoperative sensitivity., Methods: Electronic and manual searches were performed for randomized clinical trials comparing the clinical performance of composite resin restorations in posterior teeth placed with the incremental or the bulk-filling techniques. The Cochrane Collaboration risk of bias tool was used to assess the quality of the studies and the GRADE tool was used to access the quality of the evidence., Results: Fourteen studies were included in this systematic review and most of them had unclear risk of bias. The risk difference (RD) for retention/fracture was 0.00 (95%CI =  - 0.01, 0.01; p = 0.86) for 1-1.5 years of follow-up; 0.00 (95%CI =  - 0.02, 0.02; p = 0.88) for 2-3 years of follow-up; 0.05 (95%CI =  - 0.08, 0.18; p = 0.46) for 5 or more years of follow-up. The RD for postoperative sensitivity was 0.04 (95%CI =  - 0.02, 0.10; p = 0.18) for up to 30 days; 0.00 (95%CI =  - 0.01, 0.02; p = 0.63) for 1-1.5 years of follow-up; and 0.00 (95%CI =  - 0.01, 0.02; p = 0.71) for 2-3 years of follow-up. For the other secondary outcomes, no significant differences were observed (p > 0.05) between the restorative techniques. The certainty of evidence was graded as moderate., Conclusions: The clinical performance of class I and II restorations in posterior teeth is similar when placed with the incremental and bulk-filling techniques., Clinical Relevance: Based on the results of this study, posterior restorations placed with bulk-filling technique present satisfactory clinical performance, which is similar to direct restorations placed with the conventional incremental technique, considering various follow-up periods evaluated., Trial Registration:  CRD42018108450., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The aim of this study was to present a comparative evaluation of the long-term efficacy of fluoride varnish and pastes containing CPP-ACP and CPP-ACP with fluoride (CPP-ACFP) in the remineralization of creamy-white and yellow-brown defects in permanent first molars with MIH., Materials and Methods: The study included 120 teeth with yellow-brown or creamy-white defects in 67 children (37 girls, 30 boys) aged 6-9 years (mean, 7.2) who were newly diagnosed with MIH with no substance loss or caries or prior restorative treatment. The patients were randomly divided into the experiment groups; control (oral hygiene motivation only), fluoride varnish, and pastes containing CPP-ACP and CPP-ACPF, and followed up for 24 months. The evaluations were made based on the ICDAS criteria and the measurements which were performed using the laser fluorescence method (DIAGNOdent, KaVo, Biberach, Germany) in the follow-ups., Results: The research was completed with 49 patients (23 females, 26 males; mean age, 7.7) and 90 teeth. All remineralization agents increased remineralization rates in both creamy-white and yellow-brown colored defects without presenting any statistically significant difference at the end of the follow-up period (p > 0.05). However, the effects of fluoride varnishes were late to observe when compared to pastes containing CPP-ACP and CPP-ACPF., Conclusions: Pastes containing calcium and phosphate may be recommended for the longer-term preservation of teeth with yellow-brown defects which showed a post-eruptive breakdown in a shorter time., Clinical Relevance: There is a lack of studies investigating MIH treatments in which lesion appearance was recorded. This study evaluated creamy-white and yellow-brown MIH defects separately and reported long-term results of different remineralization agents., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: This study evaluated and compared the effect of silver diamine fluoride (SDF) and silver-modified atraumatic restorative treatment (SMART) sealants for the treatment of initial carious lesions of permanent molars affected by molar incisor hypomineralization (MIH)., Methods: One hundred and twelve hypomineralized permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF and SMART sealant groups (n = 56 teeth/group) in a split-mouth fashion. Hypersensitivity, formation of caries, and enamel breakdown were evaluated in both groups. Hypersensitivity was assessed by Schiff Cold Air Sensitivity Scale (SCASS), and clinical assessments of SMART sealants were performed according to modified USPHS criteria at 1, 6, and 12 months. The data were analyzed statistically using Fisher's exact test, Kaplan-Meier analysis, Mann-Whitney U test, and Friedman test., Results: Twenty-six hypomineralized molars with marked baseline hypersensitivity showed significantly lower SCASS scores at all evaluation periods (p < 0.001). There was no significant difference in hypersensitivity scores between the groups at the repeated applications of SDF at 1, 6, and 12 months. The cumulative survival rates of SMART sealants on occlusal and palatal surfaces were 88.7% and 58.8%, respectively., Conclusions: In hypomineralized molars, both SDF and SMART sealants showed favorable short-term prevention against dental caries while providing effective desensitization. Marginal discoloration was the most common side effect of the SMART sealants as a result of SDF application., Clinical Significance: Both SDF and SMART sealants showed similar short-term effectiveness as non-aerosol procedures in arresting enamel caries and reducing hypersensitivity in hypomineralized molars., Trial Registration: Clinical Trials Registration Number: NCT03862014., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To investigate the therapeutic effect of a novel bioactive glass-ceramics (BGC) called Huaxi BGC (HX-BGC) on early caries lesions., Materials and Methods: A total of 195 patients who meeting inclusion criteria were recruited and randomized to three groups in a 1:1:1 ratio. The patients in the treatment group received fluoride varnish which contained 5% sodium fluoride (NaF) or distilled water which contained 7.5% HX-BGC once a month for 3 months, and the control group received placebos. Quantitative light-induced fluorescence (QLF) images were taken at baseline and at the 1-month and 3-month follow-ups., Results: The three groups had similar baseline characteristics, including age, gender, and QLF parameters (ΔF, area, and ΔQ). Compared with baseline, the ΔQ values were significantly decreased in the HX-BGC and NaF groups at 1 and 3 months (p<0.005), while no statistically significant changes were found in that of the control group. After adjusting for baseline measurements, both of the 5% NaF and 7.5% HX-BGC showed a significant therapeutic effect in the treatment of initial enamel lesions at 1 month and 3 months, when compared to those receiving placebos (ΔQ, p<0.05). Moreover, the ΔQ value of the HX-BGC group decreased by a slightly more amount than that of the NaF group at 1 month (p=0.048). Similar trends were also found for the values of ΔF and area., Conclusion: Our results suggest that HX-BGC may serve as a promising bioactive material for the treatment of early caries lesions., Clinical Relevance: HX-BGC holds a great promise to be used as a novel bioactive material for the treatment of early caries lesions., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: This study aimed to develop an antibacterial and calcium (Ca) and phosphate (P) rechargeable adhesive and investigate the effects of dimethylaminododecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP) on dentin bonding, biofilm response, and repeated Ca and P ion recharge and re-release capability for the first time., Materials and Methods: Pyromellitic glycerol dimethacrylate (PMGDM), ethoxylated bisphenol A dimethacrylate (EBPADMA), 2-hydroxyethyl methacrylate (HEMA), and bisphenol A glycidyl dimethacrylate (BisGMA) formed the adhesive (PEHB). Three groups were tested: (1) Scotchbond (SBMP, 3 M) control, (2) PEHB + 30% NACP, and (3) PEHB + 30% NACP + 5% DMAHDM. Specimens were tested for dentin shear bond strength, and Ca and P ion release, recharge, and re-release. Biofilm lactic acid production and colony-forming units (CFU) on resins were analyzed., Results: The four groups had similar dentin shear bond strengths (p > 0.1). Adhesive with DMAHDM showed significant decrease in metabolic activity, lactic acid production, and biofilm CFU (p < 0.05). The adhesives containing NACP released high levels of Ca and P ions initially and after being recharged., Conclusion: This study developed the first Ca and P ion-rechargeable and antibacterial adhesive, achieving strong antibacterial activity and Ca and P ion recharge and re-release for long-term remineralization., Clinical Relevance: Considering the restoration-tooth bonded interface being the weak link and recurrent caries at the margins being the primary reason for restoration failures, this novel calcium phosphate-rechargeable and antibacterial adhesive is promising for a wide range of tooth-restoration applications to inhibit caries., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Dental caries is closely associated with acid-producing bacteria, and Streptococcus mutans is one of the primary etiological agents. Bacterial accumulation and dental demineralization lead to destruction of bonding interface, thus limiting the longevity of composite. The present study investigated remineralization effectiveness of adhesive containing nanoparticles of amorphous calcium phosphate (NACP) in a stimulated oral biofilm environment., Methods: The enamel blocks were immersed in demineralization solution for 72 h to imitate artificial initial carious lesion and then subjected to a Streptococcus mutans biofilm for 24 h. All the samples then underwent 4-h demineralization in brain heart infusion broth with sucrose (BHIS) and 20-h remineralization in artificial saliva (AS) for 7 days. The daily pH of BHIS after 4-h incubation, lactic acid production, colony-forming unit (CFU) count, and content of calcium (Ca) and phosphate (P) in biofilm were evaluated. Meanwhile, the remineralization effectiveness of enamel was analyzed by X-ray diffraction (XRD), surface microhardness testing, transverse microradiography (TMR) and scanning electron microscopy (SEM)., Results: The NACP adhesive released abundant Ca and P, achieved acid neutralization, reduced lactic acid production, and lowered CFU count (P < 0.05). Enamel treated with NACP adhesive demonstrated the best remineralization effectiveness with remineralization value of 52.29 ± 4.79% according to TMR. Better microhardness recovery of cross sections and ample mineral deposits were also observed in NACP group., Conclusions: The NACP adhesive exhibited good performance in remineralizing initial enamel lesion with cariogenic biofilm., Significance: The NACP adhesive is promising to be applied for the protection of bonding interface, prevention of secondary caries, and longevity prolonging of the restoration., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To evaluate the remineralizing efficacy of fluoride in early carious lesions using a novel microbial pH-cycling model that combines the chemical pH-cycling model with dental microcosm biofilms., Materials and Methods: Artificial carious lesions were formed in 48 bovine incisors. The chemical and microbial pH-cycling models were applied to 24 specimens, respectively; the latter was applied after formation of dental microcosm biofilms for 6 days, based on the human saliva inoculation. The pH-cycling schedule was repeated for 12 days. All specimens were evaluated for fluorescence loss (ΔF) using quantitative light-induced fluorescence-digital before and after the pH-cycling. Specimen biofilms were further analyzed for red/green values (R/G ratios) and colony-forming units (CFUs). One-way analysis of variance and Tukey's post hoc analysis were used to analyze change in fluorescence loss (ΔΔF) according to the pH-cycling model and treatment., Results: When the chemical pH-cycling and microbial pH-cycling models were used, ΔΔF was 1.36 (p = 0.008) and 1.17 (p > 0.05) times higher, respectively, in the fluoride-treated group than that in the distilled water-treated group. In the microbial pH-cycling model, R/G ratios and CFU counts of biofilms were not significantly different between treatments (p > 0.05)., Conclusions: No significant difference was observed in the remineralizing efficacy of fluoride according to the presence of dental biofilms covering early carious lesions., Clinical Relevance: The remineralizing efficacy of fluoride could be overestimated in the absence of dental biofilms. Therefore, for accurate evaluation of the clinical value of remineralizing agents, dental biofilms should be included in in vitro tests.

Objectives: The aim of this study was to compare the antibacterial activity of fluoride varnishes containing different agents in children with severe early childhood caries (S-ECC)., Materials and Methods: The study was conducted in 92 children with S-ECC. Patients who completed dental treatment under general anaesthesia were included in the study. Patients were divided randomly into four groups: 5% sodium fluoride (SF) control group (n = 23), 5% SF with tricalcium phosphate (TCP) (n = 23), 5% SF with xylitol-coated calcium and phosphate (CXP) (n = 23) and 5% SF with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (n = 23). Saliva mutans streptococci (MS) and lactobacilli (LB) levels were evaluated by taking saliva samples at baseline (T 0 ), 1 month (T 1 ) and 3 months (T 2 ) after treatment., Results: All groups showed a significant decrease in MS and LB levels at T 1 (P < 0.05) except the CXP group. Only the TCP group exhibited significantly decrease MS and LB levels indicating less than 10 5  CFU at both T 1 and T 2 compared with the other groups (P < 0.05)., Conclusion: Fluoride varnish with TCP provided significantly more reduction in MS and LB levels than other fluoride varnishes., Clinical Relevance: Fluoride varnish with TCP had a significant antibacterial effect against cariogenic bacteria until the end of the third month. Long lasting antibacterial effect provides additional advantage for reducing bacteria levels in children., Clinical Trials Registration Number: NCT03625310.

Objectives: To achieve in vitro remineralization of enamel white spot lesions (WSLs) via a mesoporous delivery system of amorphous calcium phosphate (ACP) precursors., Materials and Methods: Amine-functionalized expanded pore mesoporous silica (aMSN) was loaded with polyacrylic acid-stabilized amorphous calcium phosphate (PAA-ACP) to develop a carrier-based delivery system (PAA-ACP@aMSN). Thirty-six artificial WSLs samples were created and randomly assigned to three treatments: artificial saliva solution (negative control, n = 12), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) slurry (n = 12), and PAA-ACP@aMSN slurry (n = 12). Surface microhardness, Raman intensity, and color were measured before/after artificial demineralization and after remineralization treatments to evaluate the remineralization level of each sample. SEM images were taken on the surface and cross-section of samples to observe microstructure changes., Results: The surface microhardness recovery ratio (%SMHRR), Raman intensity change ratio (%ICR), and color recovery ratio (%CRR) were not significantly different between CPP-ACP and PAA-ACP@aMSN groups (P > 0.05), but both of them had significantly higher %SMHRR, %ICR, and %CRR values than negative control (P < 0.01). SEM images showed that apparent enamel prism imprints and inter-prism gaps in negative control were masked by mineral deposition in the PAA-ACP@aMSN and CPP-ACP groups., Conclusions: PAA-ACP@aMSN has an ability to remineralize enamel WSLs., Clinical Relevance: The carrier-based amorphous calcium phosphate delivery system has great potential to serve as a remineralizing agent for the treatment of WSLs.

Objectives: The aim of the present study was to evaluate the growth and acid synthesis of cariogenic pathogens in vitro when rebaudioside A was the sole source of carbon, compared to sucrose, xylitol, and a commercial sweetener containing rebaudioside A., Materials and Methods: First, sucrose or sugar substitutes were added to human saliva and the pH was measured over 10 h. Subsequently, the growth and acid synthesis efficiency of Streptococcus mutans, Streptococcus sobrinus, Streptococcus oralis, Lactobacillus rhamnosus, Lactobacillus paracasei, and Candida albicans were investigated: after adding them to minimal culture media containing only one of the carbon sources, the optical density and pH were determined over 10 h., Results: A significant pH drop only occurred in the sucrose group of human saliva whereas no differences were found between the sugar substitute groups. The individual strains of caries pathogens showed significantly lower growth rates and less acid synthesis in the sugar replacement groups, in comparison to sucrose. However, these groups also showed bacterial growth and a decline in pH., Conclusion: Xylitol appeared to be superior to rebaudioside A regarding the inhibition of mutans streptococci. The results for the remaining microorganisms indicate that rebaudioside A causes a similar or lower acid synthesis than xylitol. As saliva contains buffer systems, the metabolism of rebaudioside A did not seem to shift the equilibrium to demineralization., Clinical Relevance: Rebaudioside A may not be suitable as a targeted Streptococcus mutans treatment, but it could contribute to a reduction of caries risk as a replacement for sucrose.

Objectives: This prospective, randomised, split-mouth, clinical trial compared the efficacy of the self-assembling peptide P 11 -4 to fluoride varnish in the treatment of early buccal carious lesions., Materials and Methods: Subjects presenting at least two clinically affected teeth were treated at D0 (day 0) and D90 with P 11 -4 (test) or fluoride varnish (control). At D180, fluoride varnish was applied on all study lesions. Standardised photographs were taken at D0, D30, D90, D180 and D360 and blindly morphometrically assessed. Hierarchical linear models (HLM) under allowance of confounders were used to compare the decrease in size between test and control groups. The visual analog scale (VAS) and Global Impression of Change Questionnaire (GICQ) were used as clinical assessments., Results: Overall, 37 subjects (13-36 years) with 90 early carious lesions were included. HLM analysis showed a significant difference between test and control groups, indicating a decrease in test lesions and stabilisation of control lesions size (p = 0.001). The test lesion's mean size (SD) relative to baseline decreased to D30 = 0.936(0.127), D90 = 0.874(0.173), D180 = 0.844(0.215) and D360 = 0.862(0.352), whereas control lesions remained stable at D30 = 1.018(0.209), D90 = 1.013(0.207), D180 = 1.029(0.235) and D360 = 1.068(0.401). The effect sizes ranged from 0.47 to 0.82., Conclusions: Within the limits of this study, it was shown that the size of early carious lesions treated with P 11 -4 was significantly reduced; this result was superior to that of fluoride varnish treatment (DRKS00012941)., Clinical Relevance: The self-assembling peptide P 11 -4 is the first caries treatment approach aiming to regenerate decayed enamel. P 11 -4 initiates formation of de novo hydroxyapatite in the depth of early carious lesions, adding a new advanced therapy option for preventive dentistry.

Objectives: The purpose of this study was to investigate the effect of five commercially available fluoride varnishes (FV) on caries lesions., Materials and Methods: Ninety bovine enamel specimens were assigned to five varnish groups (n = 18). Early caries lesions were created in the specimens and characterized using Vickers surface microhardness number (VHN). FV was applied to each group of specimens. Immediately afterwards, 7.5 ml of artificial saliva (AS) were pipetted over each group of specimens, collected and renewed every 15 min for 6 h. AS samples were analyzed for fluoride using an ion-specific electrode. Enamel fluoride uptake (EFU) was determined using the acid etch technique. Each group was then subjected to a pH cycling regimen for 5 days after which VHN was determined again. One-way analysis of variance (ANOVA) was used for data analysis., Results: FVs differed in their rehardening capability (highest mean value was for Enamel Pro = 32.3 ± 5.8 and lowest mean value was for Vanish = 18.9 ± 11.3). No significant difference in EFU was found among groups. Total fluoride release over 6 h was in the order of MI Varnish (303 μg/ml) > Enamel Pro (217 μg/ml) > Flor-Opal (153 μg/ml) > PreviDent(84 μg/ml) > Vanish(28 μg/ml)., Conclusions: ΔVHN and fluoride release characteristics differ among FV products. These differences may be attributed to the different compositions and physical properties of the tested FV., Clinical Relevance: Fundamental, comparable research on FV and how different formulations affect early caries lesion rehardening, fluoride release into saliva, and uptake by teeth is scarce.

Objective: This study analyzed the effects of a fluoride (F) varnish supplemented with sodium trimetaphosphate (TMP) on the remineralization of caries-like lesions in situ., Materials and Methods: Twelve subjects used palatal devices with demineralized enamel discs for 3 days, following a double-blind, crossover protocol. Test groups included placebo (no F or TMP), 5% NaF and 5% NaF/5% TMP varnishes. The percentage of surface hardness recovery (%SHR) and cross-sectional hardness (ΔKHN) were determined., Results: Significant differences were observed among all varnishes regarding %SHR and ΔKHN. The highest %SHR and the lowest ΔKHN were seen for the 5% NaF/5% TMP varnish, followed by 5% NaF and placebo., Conclusion: The remineralizing effect of a 5% NaF varnish is significantly enhanced when associated with TMP., Clinical Relevance: The reduction in the subsurface lesion area of enamel treated with the TMP-containing varnish implies that cavities would take longer to develop or might not develop at all depending on individual factors, resulting in lower net caries increments at individual and population levels.

Objectives: This laboratory study aimed to (a) compare the fluoride dose-response of different caries lesions created in human and bovine enamel (HE/BE) under pH-cycling conditions and (b) investigate the suitability of Knoop and Vickers surface microhardness (K-SMH/V-SMH) in comparison to transverse microradiography (TMR) to investigate lesion de- and remineralization., Materials and Methods: Caries lesions were formed using three different protocols (Carbopol, hydroxyethylcellulose-HEC, methylcellulose-MeC) and assigned to 24 groups using V-SMH, based on a 2 (enamel types) × 3 (lesion types) × 4 (fluoride concentrations used during pH-cycling-simulating 0/250/1100/2800 ppm F as sodium fluoride dentifrices) factorial design. Changes in mineral content and structural integrity of lesions were determined before and after pH-cycling. Data were analyzed using three-way ANOVA., Results: BE was more prone to demineralization than HE. Both enamel types showed similar responses to fluoride with BE showing more remineralization (as change in integrated mineral loss and lesion depth reduction), although differences between tissues were already present at lesion baseline. Carbopol and MeC lesions responded well to fluoride, whereas HEC lesions were almost inert. K- and V-SMH correlated well with each other and with the integrated mineral loss data, although better correlations were found for HE than for BE and for MeC than for Carbopol lesions. Hardness data for HEC lesions correlated only with surface zone mineral density data., Conclusion: BE is a suitable surrogate for HE under pH-cycling conditions., Clinical Relevance: The in vitro modeling of dental caries is complex and requires knowledge of lesion behavior, analytical techniques, and employed hard tissues.

Objectives: This study aimed to evaluate saliva and plaque as indicators of intraoral fluoride (F) levels after the use of conventional and high-fluoride dentifrices., Materials and Methods: Subjects were randomly assigned to brush their teeth with conventional (1000 ppm F), high-fluoride (5000 ppm F), and placebo dentifrices (fluoride free) for 10 days, following a double-blind, crossover protocol. Saliva and plaque samples were collected on the morning of the 5(th) and 10th days, respectively at 1 and 12 h after brushing, and analyzed with an ion-selective electrode after HMDS-facilitated diffusion. Data were analyzed by two-way repeated measures ANOVA, Tukey's test and Spearman's correlation coefficient (p < 0.05)., Results: Plaque and salivary F levels were significantly increased after the use of conventional and high-fluoride dentifrices when compared to values obtained for placebo, except plaque 12 h after the use of conventional dentifrice. A positive and significant correlation was found between fluoride concentrations in plaque and saliva for both times of sample collection., Conclusion: Both indicators assessed were able to detect significant differences among treatments and between times after brushing. The use of a high-fluoride dentifrice is able to significantly increase intraoral fluoride levels throughout the day, being therefore a useful therapy for patients at high caries risk., Clinical Relevance: A dentifrice with high fluoride concentration could be regarded as a useful therapy of F delivery for high caries-risk patients, since intraoral F levels were sustained throughout most of the day after using this formulation.

Objectives: The purpose of this review was to summarize recent developments regarding photodynamic therapy (PDT) in the field of dentistry., Materials and Methods: A review of pertinent literature was carried out in PubMED to determine the current position of PDT applications in dentistry. One hundred thirteen relevant articles were retrieved from PubMED by inserting the keywords "photodynamic therapy", "dentistry", "periodontology", "oral surgery", and "endodontics". It is anticipated that this overview will create a specific picture in the practitioner's mind regarding the current status and use of PDT., Results: In spite of different results and suggestions brought about by different researchers, PDT can be considered as a promising and less invasive technique in dentistry., Conclusion: PDT seems to be an effective tool in the treatment of localized and superficial infections. Within the limitations of the present review, it can be concluded that although PDT cannot replace antimicrobial therapy at its current stage, it may be used as an adjunctive tool for facilitating the treatment of oral infections., Clinical Relevance: Oral infections (such as mucosal and endodontic infections, periodontal diseases, caries, and peri-implantitis) are among the specific targets where PDT can be applied. Further long-term clinical studies are necessary in establishing a more specific place of the technique in the field of dentistry.

The purpose of this study was to determine the efficacy of fluoride varnish (5% sodium fluoride, Duraphat(®), Colgate) in reverting white spot lesions (WSLs) after fixed orthodontic treatment. This study was a randomized, parallel group, controlled clinical trial. Using saline solution as control, 110 participants (mean age ± standard deviation: 16.6 ± 3.2 years) ranging from 12 to 22 years old were randomly assigned to either the test group (group 1) or the control group (group 2). Application of fluoride varnish or saline was applied onto tooth surfaces with WSLs every month during the first 6 months after debonding. The labial (buccal) surfaces of the teeth were assessed by the use of a DIAGNOdent pen (DD) at the baseline, 3- and 6-month follow-up visits. After 6 months, 96 subjects with a total of 209 study teeth (47 subjects, 104 teeth in group 1; 49 subjects, 105 teeth in group 2) remained. The WSLs had a mean DD reading at baseline of 17.66 ± 5.36 in group 1 and 16.19 ± 5.70 in group 2, which decreased by 5.78 and 2.44, respectively, at the 3-month follow-up visit and decreased by 7.56 and 3.09, respectively, at the 6-month follow-up visit. The mean baseline DD readings in the two groups were similar (t test, P > 0.05). There was statistically significant differences between the mean DD readings of the two groups at the 3-month (P < 0.05) and at the 6-month follow-up visits (P < 0.01). Topical fluoride varnish application is effective in reversing WSLs after debonding and should be advocated as a routine caries prevention measure after orthodontic treatment.

This study aims to investigate the effect of topical applications of 10% casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on white spot lesions (WSL) detected after treatment with fixed orthodontic appliances. Sixty healthy adolescents with ≥1 clinically visible WSL at debonding were recruited and randomly allocated to a randomised controlled trial with two parallel groups. The intervention group was instructed to topically apply a CPP-ACP -containing agent (Tooth Mousse, GC Europe) once daily and the subjects of the control group brushed their teeth with standard fluoride toothpaste. The intervention period was 4 weeks and the endpoints were quantitative light-induced fluorescence (QLF) on buccal surfaces of the upper incisors, cuspids and first premolars and visual scoring from digital photos. The attrition rate was 15%, mostly due to technical errors, and 327 lesions were included in the final evaluation. A statistically significant (p < 0.05) regression of the WSL was disclosed in both study groups compared to baseline, but there was no difference between the groups. The mean area of the lesions decreased by 58% in the CPP-ACP group and 26% in the fluoride group (p = 0.06). The QLF findings were largely reflected by the clinical scores. No side effects were reported. Topical treatment of white spot lesions after debonding of orthodontic appliances with a casein phosphopeptide-stabilised amorphous calcium phosphate agent resulted in significantly reduced fluorescence and a reduced area of the lesions after 4 weeks as assessed by QLF. The improvement was however not superior to the "natural" regression following daily use of fluoride toothpaste.

Clinical application of ozone gas has been shown to arrest the progression of dentinal caries in children. In this study, we compare the immediate effects of gaseous ozone and chlorhexidine gel on bacteria in cavitated carious lesions in children. Forty children, each with at least two open occlusal carious lesions, were enrolled in the study. Two teeth were chosen randomly. In one lesion, overlying soft biological material was removed, whilst the other lesion was not excavated. Cavities were rinsed with sterile water and dried with air. A standardised sample was taken from the mesial part of each lesion. Then, gaseous ozone (HealOzone) or 1% chlorhexidine gel (Corsodyl) was applied for 30 s on both lesions of 20 children each, and a second sample was taken from the distal part of each lesion. The anaerobic microbiota was cultivated; the number of colony forming units was calculated per milligram sample. The two-sided paired t test showed no significant (P > 0.05) differences in the reduction of total bacterial counts per milligram comparing samples before and after ozone or chlorhexidine application. The tests also showed no statistically significant difference whether the superficial decayed dentine had been removed before ozone or with chlorhexidine treatment or not. It can be concluded that gaseous ozone or chlorhexidine gel application for 30 s to deep occlusal carious cavities had no significant immediate antimicrobial effects whether the superficial decayed layers dentine were removed or not.

The aim was to test the null hypotheses that there is no difference: (1) in carious lesion development at the restoration margin between class II composite resin restorations in primary molars produced through the atraumatic restorative treatment (ART) with and without a chemomechanical caries removal gel and (2) in the survival rate of class II composite resin restorations between two treatment groups after 2 years. Three hundred twenty-seven children with 568 class II cavitated lesions were included in a parallel mouth study design. Four operators placed resin composite (Filtek Z 250) restorations bonded with a self-etch adhesive (Adper prompt L pop). Two independent examiners evaluated the restorations after 0.5, 1, and 2 years using the modified Ryge criteria. The Kaplan-Meier survival method was applied to estimate survival percentages. A high proportion of restorations were lost during the study period. Therefore, the first hypothesis could not be tested. No statistically significant difference was observed between the cumulative survival percentages of restorations produced by the two treatment approaches over the 2-year period (ART, 54.1 +/- 3.4%; ART with Carisolv, 46.0 +/- 3.4%). This hypothesis was accepted. ART with chemomechanical gel might not provide an added benefit increasing the survival percentages of ART class II composite resin restorations in primary teeth.

Carisolv is a minimally invasive method for softening and removing dentine caries. A new, modified Carisolv gel has been developed in order to optimise the efficiency if its chemical caries dissolution. The aim of the present study was to compare the caries removal efficiency of the original gel with that of the new gel, which contains almost double the concentration of sodium hypochlorite. Ten dentists treated 202 cavities in 170 patients; 104 cavities were randomised to the new gel and 98 to the original gel. Their mean treatment times for caries removal were 6.7+/-4.1 min and 7.6+/-4.2 min, respectively ( P>0.05). In close-to-pulp lesions, constituting 32% of the cavities, the mean times for caries removal were 9.0+/-7.0 min and 11.6+/-4.4 min for the new and original gels, respectively ( P<0.01). Questionnaires revealed that 81% of the patients preferred chemomechanical treatment to drilling. In conclusion, the improved efficiency of the modified Carisolv gel did reduce the time for caries removal in deep lesions. However, it still needs more time than conventional drilling.