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Abstract Background White spot lesions are a widespread undesirable effect, especially prevalent during fixed orthodontic treatments. The study compared the in vitro enamel remineralization potential of undemineralized dentin matrix (UDD) versus chicken eggshell powder (CESP) for artificially induced enamel lesions. Methods 100 caries-free and sound maxillary premolars were randomly divided into four groups each contain 25 teeth: Group I (Baseline): No treatment was done to the enamel surface. Group II (Negative control ): The enamel surface of the teeth underwent demineralization using demineralizing solution to create artificial carious lesions then kept in artificial saliva. Group III (CESP treated): After demineralizing the tooth surface, the teeth have been suspended in the CESP remineralizing solution. Group IV (UDD treated): After enamel demineralization, the teeth were suspended in UDD remineralizing solution. The remineralization potential was assessed by Vickers microhardness testing, scanning electron microscopic examination (SEM), and energy dispersive X-ray (EDX). Results The current study demonstrated an increase in the mean microhardness of CESP and UDD-treated groups; however, It was nearer to the baseline level in the UDD group. SEM imaging revealed greater enamel remineralization in the UDD group compared to the remaining groups. The UDD group disclosed complete coverage for the prismatic enamel compared to the CESP group, which revealed a partially remineralized enamel surface. Interestingly, the Ca/P ratio increased significantly in the CESP group compared to the negative control group. In contrast, a higher significant increase in the mean Ca/P ratios was recorded in the UDD group compared to the test groups. Conclusion biomimetic UDD and CESP powder should be utilized to treat enamel early carious lesions. However, UDD demonstrated the most significant remineralization potential.

Purpose Evaluation of the efficacy of two novel formulations of arginine and theobromine in remineralizing artificial enamel defects using in vitro testing techniques- Microhardness and SEMMaterials and methods Enamel slabs measuring 3 mm by 3 mm by 1.5 mm were created using 11 healthy premolars that were excised for orthodontic treatment. Group 1 (control, treated with merely a remineralization solution), Group 2 (0.05% arginine in 10 ml distilled water), and Group 3 (2% theobromine in 10 ml distilled water) were the three groups to which the slabs were randomly allocated (n = 7 per group). The pH cycle was run for 14 days, starting with a 72-h demineralization period and ending with 11 days of remineralization in the corresponding solutions. Prior to and during remineralization, microhardness was measured, and surface features were assessed using scanning electron microscopy (SEM). Statistical analysis, including Paired T Test, one-way ANOVA, and post hoc Tukey tests, determined that the mean values were significant at the 0.05 level.Results The control group showed a mean microhardness increase from 192.09 ± 19.30 to 208.58 ± 5.76. The arginine group increased significantly from 217.20 ± 4.24 to 304.00 ± 15.96, and the theobromine group from 214.09 ± 7.67 to 283.14 ± 10.91. Statistical analysis indicated that both arginine and theobromine groups had significantly greater microhardness improvements compared to the control (p

Sunil Mankar,1 Bennett T Amaechi,1 Kannan Kanthaiah,1 Nahid Iftikhar,1 Amos C Obiefuna2 1Department of Comprehensive Dentistry, University of Texas Health San Antonio, San Antonio, Texas, USA; 2ANCOSTAT Statistical Consulting, San Antonio, Texas, USACorrespondence: Bennett T Amaechi, Department of Comprehensive Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas, 78229-3900, USA, Tel +1 210 567 3185, Email amaechi@uthscsa.eduPurpose: This study investigated the influence of nanohydroxyapatite-containing (nanoHAP) lozenge on plaque pH following sucrose intake.Patients and Methods: Sixteen adult subjects were enrolled in this double-blind crossover study composed of four interventions: (1) 10% w/v sucrose solution, (2) 10% w/v sorbitol solution, (3) nanoHAP lozenge, and (4) 10% w/v sucrose solution challenge followed by nanoHAP lozenge. Following the determination of each subject’s resting plaque pH, the pH was measured at different time intervals from 3 to 30 minutes from the start of intervention, with 7 days interval between the applications of different interventions. The data were analyzed using the analysis of variance and Tukey’s test (α < 0.05).Results: While sorbitol produces no change in plaque pH, nanoHAP-lozenge increased the plaque pH from a baseline of 7.0 ± 0.3 (mean ± sd) to 7.8 ± 0.2 (mean ± sd) within 30 minutes. Sucrose lowered the plaque pH from a baseline of 7.0 ± 0.4 (mean ± sd) to the lowest minimum of 5.1 ± 0.1 (mean ± sd) at the 7th minute, rising above the critical pH of enamel dissolution (5.5) at 12th minute and the baseline pH in more than 30 minutes. With lozenge intervention following sucrose challenge, plaque pH rose to 5.5 in 8 min, and to the baseline pH in 24 min. The cH area (Hydrogen ion concentration area) produced by sucrose (1.82 sq. units) was significantly (p < 0.05) greater than that produced when sucrose was challenged with lozenge (0.48 sq. units).Conclusion: Nanohydroxyapatite-containing lozenge increased plaque pH, reduced plaque pH drop in the presence of sucrose, and facilitated the rapid recovery of plaque pH after sucrose intake.Keywords: dental plaque, nanohydroxyapatite, demineralization, buffering, lozenge

Abstract Objectives The objective of this study was to evaluate the effect of acidic beverages on the surface topography and elemental composition of human teeth. Methods A total of five highly acidic beverages (Red Bull, Pepsi, Apple Cidra, Tang Mosambi, and Tang Orange) were investigated. The tooth specimens of experimental groups were submerged in each beverage and incubated at 37 °C for 7 days, whereas, the tooth specimens of control groups were placed in distilled water. Afterwards, tooth specimens were analyzed using scanning electron microscopic (SEM), stereomicroscopic, and energy dispersive x-ray (EDX) techniques. Results All experimental groups revealed a decline in the tooth elements compared to controls, however, such decline was not statistically significant. Nevertheless, comparing the experimental groups, the Red Bull beverage caused a marked reduction in the percentage of both calcium and phosphorus elements compared to the Pepsi, Apple Cidra, Tang Mosambi, and Tang Orange beverages but it was insignificant as well in contrast to its control counterpart. All five acidic beverages demonstrated erosive potential under SEM analysis; however, each group of specimens showed a diverse amount of demineralization. In addition, all experimental groups exhibited significant discoloration of tooth specimens compared to their respective control counterparts. Conclusions Within the limitations of study, all five acidic beverages demonstrated erosive potential in the simulated in vitro conditions under SEM analysis; however, each group of specimens exhibited a different extent of demineralization. In addition, the overall effect of all beverages was insignificant under EDX analysis as no substantial difference was revealed between the elemental composition of experimental and control group specimens.

Objectives: The objective of this study is to evaluate the ability of the bioactive glass (BAG)-Bonds to inhibit the demineralization surrounding the orthodontic brackets when being exposed to an in vitro caries challenge and also simultaneously evaluate the physical and mechanical properties in order to be accepted as an orthodontic bonding agent. Materials and Methods: Preparation of mesoporous bioactive glass (MBG) used an improved sol-gel method, combining with sacrificial liquid template to MBGs with controllable particle size. Tetraethyl orthosilicate, triethyl phosphate, calcium nitrate tetrahydrate, ethanol absolute, ethyl acetate, hexadecyltrimethylammonium bromide, deionized water, and ammonium hydroxide were used. The microstructure was analyzed using a field emission gun-based scanning electron microscope (SEM). The debonding and adhesion characteristics were analyzed using an Instron Universal Testing Machine. Results: SEM analysis shows that the prepared MBG particles possess spherical morphology with generally uniform size. Novel orthodontic bonding material (BG) provides adequate mechanical and physical properties in order to be accepted as an orthodontic bonding agent since its bond strength both at the time of bonding and after 6 months in simulated salivary conditions is significantly higher than conventional bonding resin (TBXT). The bond strength was also evaluated both initially at the time of bonding as well as 6 months after being kept in simulated salivary conditions. Conclusion: These novel adhesives result in reduced demineralization surrounding orthodontic brackets and possess optimal physical and mechanical properties to be accepted as an orthodontic adhesive.

Biotechnology and artificial intelligence have sparked a revolution in dentistry, with a focus on restoring natural tissue functions. This transformation has given rise to bioactive materials, inspired by biomimetics, aimed at replicating the processes found in nature. As synthetic biology advances, there is a heightened focus on signaling systems crucial for bio-based diagnostics and therapeutics. Dentistry now harnesses synthetic proteins for tissue regeneration and dental material enhancement. A current research priority is bacterial biofilm inhibition, vital for dental health. Given the role of Streptococcus mutans in dental caries, the development of synthetic antimicrobial peptides targeting this bacterium is underway. The balance of dental enamel between demineralization and remineralization impacts caries formation. Factors such as the presence of hydroxyapatite and salivary peptides influence enamel health. Recent studies have spotlighted salivary protein-inspired peptides for enhanced remineralization. In the realm of bone regeneration, synthetic proteins like bone morphogenetic proteins (BMP) have been spotlighted, earning FDA approval. Research is currently delving into peptides such as cementum protein 1 peptide (CEMP-1-p1) and parathyroid hormone variants like PTH (1-34), underscoring their potential in advancing dental and bone health. [ABSTRACT FROM AUTHOR]

IntroductionSilver Diammine Fluoride (SDF) is a clinical minimal intervention to manage dentin caries. Its chemistry in demineralization conditions has been investigated widely, but far less in remineralization conditions. The aim was to investigate and compare the chemical reactions when SDF is added to remineralization and demineralization solutions.Methods0.01 ml SDF (Riva Star) was added to deionized water (DW); demineralization (DS = pH4) and remineralization (RS = pH7.0) solutions. The time sequence of concentrations of NH4+, F−, and Ag+ were measured using ion selective electrodes (ISEs) every 2 min. The pH was also measured. Precipitates were characterized using x-ray Diffraction (XRD) and, 31P and 19F nuclear magnetic resonance spectroscopy (NMR).ResultsThe concentrations of NH4+ and Ag+ showed decreasing trends in DW (−0.12 and −0.08 mM/h respectively), and in DS (−1.06 and −0.5 mM/h respectively); with corresponding increase in F− concentration (0.04 and 0.7 mM/h respectively). However, in RS, NH4+ concentration showed little change (0.001 mM/h), and Ag+ and F− concentrations were negligible. XRD results showed that precipitates (in RS only) contained AgCl, and metallic Ag. NMR showed that fluorapatite/carbonated fluorapatite (FAP/CFAP) were formed. The pH increased after SDF addition in all three solutions.DiscussionSDF dissolved to release NH4+, F− and Ag + . In DW and DS, NH4+ combined with Ag+ to form diamminesilver, causing an increase of F− and pH. In RS, F− reacted with Ca2+ and (PO)43− to form FAP/CFAP, and Ag+ reacted with Cl− to form AgCl/Ag. These suggests why SDF is effective in managing dentin caries.

Background: The acidic component of liquid medicinal syrups used by pediatric patients may cause erosion and partial demineralization. This study aimed to evaluate the effect of cheese and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on erosive lesions of primary teeth enamel following exposure to amoxicillin and ibuprofen syrups. Materials and Methods: In this in vitro study, 60 noncarious deciduous molars were used. After measuring the surface microhardness of the samples, they were randomly separated into two groups and immersed in either amoxicillin or ibuprofen for 1 min three times per day. CPP-ACP, cheese, and artificial saliva were then applied to each of the three subgroups (n = 10). After each immersion time, 10 min of therapy was given. Between treatment intervals, the samples were kept in artificial saliva. The microhardness was remeasured after 1 week. Data were analyzed using SPSS software through repeated-measures ANOVA (α = 0.05). Results: All samples’ microhardness reduced considerably after immersion in liquid pharmaceuticals (amoxicillin [84.9 kgf/mm2] and ibuprofen [75.1 kgf/mm2]), but increased significantly following exposure to therapeutic solutions. There was no difference between the amoxicillin-cheese and amoxicillin-CPP-ACP subgroups (P = 0.975). A statistically insignificant difference was found between the ibuprofen group and the ibuprofen-CPP-ACP subgroup (P = 0.499). Conclusion: As a result, cheese and CPP-ACP can be utilized to remineralize erosive lesions caused by amoxicillin or ibuprofen exposure.

White spot lesions, pathologically characterized by enamel demineralization, present a significant challenge in dentistry. Notably, intervention at the white spot stage is crucial to impede further lesion progression. Recent advances studies have demonstrated the effectiveness of flowable resin infiltration as a minimally invasive alternative to traditional treatment modalities. This technique allows for the concurrent treatment of multiple lesions in a single appointment, circumventing the necessity for local anesthesia or extensive cavity preparation. Clinically, this method has shown consistent stability, evidenced by maintained enamel integrity, enhanced rigidity, and preservation of adjacent healthy dental tissues. Additionally, the aesthetic outcomes of this approach are noteworthy, with a gradual diminution of lesion visibility over time. The present case report elucidates the long-term clinical outcomes and the efficaciousness of the Icon kit in the targeted management of specific white spot lesion pathologies. [ABSTRACT FROM AUTHOR]

Abstract Background Orthodontic treatment is associated with numerous adverse side effects, such as enamel discoloration, demineralization or even caries. The presence of microleakage between the enamel and the adhesive and between the adhesive and the base of the orthodontic bracket allows penetration of the bacteria, molecules, and liquids into the enamel and can lead to unpleasant “white spot lesions” or secondary caries beneath and around the brackets. The aim of this in vitro study was to evaluate microleakage in five adhesive systems commonly used in orthodontic practice for bonding brackets. Methods One hundred extracted premolars were divided into five groups of twenty teeth. Stainless steel Legend medium metal brackets were bonded to teeth using five adhesive systems: resin-reinforced glass ionomer cement GC Fuji Ortho LC (GCF) and composite materials Light Bond (LB), Transbond XT (TB), Trulock™ Light Activated Adhesive (TL), and GC Ortho Connect (GCO). The specimens were subjected to thermal cycling, stained with 2% methylene blue, sectioned with low–speed diamond saw Isomet and evaluated under a digital microscope. Microleakage was detected at the enamel-adhesive and adhesive-bracket interfaces from occlusal and gingival margins. Statistical analysis was performed using generalized linear mixed models with beta error distribution. Results Microleakage was observed in all materials, with GCF showing the highest amount of microleakage. Composite materials GCO, TB, and LB exhibited the lowest amount of microleakage with no statistical difference between them, while TL showed a statistically significantly higher amount of microleakage (p

Aim: This randomised controlled split-mouth study was aimed to evaluate and compare the efficacy of a fluoride-containing adhesive (Clearfil Tri-S Bond Plus, Kuraray Noritake, Otemachi, Japan) and a conventional adhesive (3M Unitek Transbond XT, Maplewood, USA) on enamel demineralisation in orthodontically treated patients. Methods: Sixteen healthy patients who had need for correction of dental crowding were included in the study. Bracket bonding was performed using different adhesives (fluoride-containing and conventional) at random for opposite half jaw in a split-mouth design. 190 control, 190 experimental teeth were examined for bracket failure, gingival index, plaque index and enamel mineralisation parameters. Enamel mineralisation levels for each tooth for pre- and post-treatment time periods were examined using ICDASII (International Caries Detection and Assessment System) criteria and the DIAGNOdent Pen (KaVo, Biberach, Germany). Results: DIAGNOdent scores were statistically higher in the left half jaw which were control group (C) in left handed patients (p=0.038), while the scores were found to be significantly higher in the right handed patient which ipsilateral jaw were experimental group (E) (p=0.003). Conclusions: The effect of fluoride-containing adhesive on enamel demineralization and WSL (white spot lesion) formation was found to be no different than the conventional adhesive.

Abstract Background This study aimed to investigate the remineralization efficiency of Sensodyne Promine containing Sodium flouride (NaF), GC Tooth Mousse containing CPP-ACP, and Agarta herbal toothpaste on initial caries and erosion using micro-computed tomography (CT) and scanning electron microscopy (SEM). Methods Forty-five third-molar teeth for micro-CT were divided into three main groups after initial scans (T 1) were completed. Artificial caries lesions were created with the demineralization cycle (group 1, n = 15) and artificial erosion lesions were created with orange juice (group 2, n = 15) and Cola (group 3, n = 15), and second scans (T 2) were performed. The groups were divided into three subgroups within themselves. Sensodyne Promine toothpaste (subgroup 1a, 2a, 3a), GC Tooth Mousse topical cream (subgroup 1b, 2b, 3b), and Agarta herbal toothpaste (subgroup 1c, 2c, 3c) were applied using soft-tipped brushes for 2 min, twice per day for 15 days, and then a third scan (T 3) was performed. Mineral density, surface area, and lesion volume and depth were calculated using micro-CT. Changes in the surface morphology of the teeth were examined using SEM in 13 samples representing each group, subgroup, and healthy enamel. In the analysis of the data obtained from the scans performed at three different times (T 1, T 2, T 3), one-way analysis of variance (ANOVA) with the post-hoc Tukey test, repeated measures ANOVA with the post-hoc Bonferroni test, and paired sample t-test analyses were used. Results All three agents caused a statistically significant increase in mineral density, and a decrease in surface area and lesion volume and depth (p 0.05). A statistically significant difference was found between the groups regarding the mineral density of the tissue that increased after remineralization (NaF > CPP-ACP > He; p

Aim: The aim of this study was to assess and compare the cariogenicity of indigenous sugars (palm sugar, jaggery, and brown sugar) and refined sugar at different frequencies of exposure through a biofilm caries model. Methodology: This in vitro study was conducted on 60 extracted human premolar teeth which were randomly divided into four groups (refined sugar, jaggery, palm sugar, and brown sugar) with each group being exposed to their respective sugars at one, three, and five frequencies for 5 min at defined time periods with five sample teeth for each exposure (4 × 3 × 5 = 60). The acidogenicity of biofilm was found by a 5-day pH cycling model. After 5 days, enamel demineralization, protein content, and polysaccharide formation of the biofilm following exposure to various sugars at various frequencies were assessed and compared. Statistical analyses were done using a one-way analysis of variance for intergroup comparisons between various sugars at various levels of frequencies. Results: The enamel demineralization was found to be least in palm sugar with mean percentage surface hardness loss of 8%, 17%, and 25% at one, three, and five frequencies of exposures and this was found to be statistically significant compared to other sugars (P < 0.001). The acidogenicity of biofilm increased with an increase in the frequency of exposures, but none of the indigenous sugars had a drop below 5.5 (critical pH) at a single frequency of exposure indicating less acid production at minimal exposure. The protein content of the biofilm exposed to palm sugar was less on comparison with other sugars and it was found to be statistically significant (P < 0.001). The polysaccharide formation of all sugars was similar at each frequency of exposure and was statistically nonsignificant. Conclusion: From the results obtained, it was concluded that though cariogenicity increased in all sugars with an increase in frequency of exposure, the level of cariogenicity was least in palm sugar compared to other sugars used in the study. Hence, it is recommended to use palm sugar as an alternative to refined sugar.

Background: Partially demineralized dentin is remineralizable when mineral ions are made available in the near vicinity. Nanoparticles (NPs) have wide applications in remineralization process. Zinc promotes remineralization and has a synergistic effect when combined with fluoride. Hence, zinc oxide and calcium fluoride NPs were considered for dentin remineralization. Aim: The aim of this study was to evaluate the remineralizing ability of zinc oxide and calcium fluoride NPs on demineralized dentin individually and in combined form. Settings and Design: This was an in vitro study. Materials and Methods: Forty-eight dentin disks were prepared from the crowns of 12 extracted human molars and were allocated into four groups of 12 each, i.e., Group I – nano zinc oxide (nZnO), Group II – nano calcium fluoride (nCaF2), Group III – combined group (nZnO + nCaF2), and Group IV – artificial saliva (AS, control group). The specimens were demineralized with 37% phosphoric acid and placed in the respective remineralizing solutions for 24 h and 1 month. Calcium (Ca) and phosphorous (P) uptake was measured using energy-dispersive X-ray spectrometry, and structural changes were analyzed using scanning electron microscopy (SEM). Statistical Analysis: One-way analysis of variance, Student's t-test, and post hoc Tukey's test were used for statistical analysis. Results: At 1-month interval, all the groups showed an increase in Ca/P ratio, with highest being the combined group (4.24), followed by nCaF2 (3.30), nZnO (1.71), and AS (1.31) groups, and these differences were statistically significant (P = 0.000). On SEM analysis of dentinal samples at 1 month, depositions were evident in intertubular regions, wherein the highest deposits were observed in the nZnO group, followed by nZnO + nCaF2 and nCaF2 groups. Conclusion: Dentin samples subjected to remineralization with aqueous solutions of nZnO and nCaF2 showed an increase in calcium and phosphorous uptake and also dense granular depositions were evident in intertubular regions of dentin.

Oral mucosa inflammation can cause severe pain and interfere with eating, reducing quality of life. However, few options for self-care are available. An oral liquid bandage forms a protective film over the affected area. We aimed to assess the acid erosion risk when a newly developed oral liquid bandage (ORAPLA) is accidentally deposited on teeth and to examine the relative acid erosion risk at multiple time points of the maximum recommended duration of continuous use. ORAPLA was applied to both enamel and dentin blocks from 45 bovine anterior mandibular teeth, and an acid challenge was performed in a simulated oral cavity with artificial saliva, with one exposure cycle lasting 6 h. The enamel showed substantial defects and a decrease in Vickers hardness after nine cycles, with no change in surface roughness. Dentin showed an increase in parenchymal defects and surface roughness and a trend toward decreased Vickers hardness with increasing exposure time. We found no significant acid corrosion in enamel after up to nine times the upper limit of normal use time or in dentin after up to six times the upper limit. We conclude that the acid erosion risk due to accidental attachment to teeth is low, and in the human oral cavity with salivary buffering and remineralization, likely even lower.

Purpose: The aim of this study is the in vitro evaluation of the effect of fluoride varnish application at different frequencies on initial enamel lesions by surface microhardness (SMH) measurements. Material and Methods: This in vitro experimental study was performed on 80 extracted unerupted third molar teeth. The teeth were divided randomly into 4 groups: Group 1: Fluoride varnish application once a year, Group 2: Fluoride varnish application 4 times at 1 week intervals, Group 3: Fluoride varnish application 4 times a year with an interval of 3 months, Group 4: Application of fluoride varnish twice a year at 6-month intervals. Artificial enamel carious lesions were created by inserting the specimens in demineralization solution for 96 hours. The Vicker’s microhardness number (VHN) was measured at baseline, after demineralization and after fluor varnish application and 1 year after fluoride treatments of each group. The percent change in surface microhardness (% SMH change) was also calculated. Anova and Kruskall-Wallis H test, t-test and/or Wilcoxen sign test were used with 95% confidence levels to compare differences. Results: The surface microhardness values and recovery of surface hardness values of the groups were found as follows: Group 3 gt; Group 2 gt;Group 4 gt; Group 1. VHN of Group 3 was statistically significantly higher than other groups (p lt;0.05). Conclusion: Fluoride varnish application 4 times a year with an interval of 3 months showed significantly higher enamel SMH than that of the other groups (p lt;0.05).

Introduction: The aim of the study was to evaluate the effect of disinfection and storage solutions, and time periods on the fracture strength of whole teeth and tooth sections. Method: One hundred and sixty extracted teeth were divided into 16 groups based on disinfection methods, storage times and tooth types. Teeth samples were measured, and areas calculated. Specimens groups were 1. 10% buffered formalin, 2. 0.2% thymol-in-saline, 3. 5.25% sodium hypochlorite (NaOCl), 4. OHCWA disinfection protocol, 5. Distilled-water. Each group had storage subgroups of 14, 90 and 180 days. Group 6 (control) were frozen in distilled water for 14 days. Specimens were tested using an Instron Universal tester and load at fracture was analyzed for statistical significance. Results: The NaOCl group showed significantly lower loads at fracture compared to all other storage solutions at corresponding storage times. Distilled-water storage for 90 and 180 days had significantly lower fracture loads, except specimens stored in NaOCl for 14 and 90 days. The area of the specimen, was significantly associated with the magnitude of load at fracture. Conclusions: NaOCl storage significantly affected the fracture strength of teeth. Fracture resistance of teeth was inversely proportional to the storage time and directly proportional to the area of the specimen.

Abstract Background The main purpose of this experimental study was to determine the in vitro effects of two calcium phosphate‐containing agents (Remin Pro® and GC Tooth mousse™) on the enamel resistance of permanent molars to demineralization. Methods Fifty extracted human third molars were randomly divided into four groups; that is the control group and three case groups treated with Remin Pro®, GC Tooth mousse™, and sodium fluoride gel. The three case groups were treated with 0.25 ml of the paste associated with each experimental group for 5 min, kept in fluoride‐free artificial saliva, and incubated at 37°C for 28 days. After the treatment regimen, 10 samples of each case group were subjected to demineralization using an acetic acid‐containing solution, and remineralization using a remineralizing solution. The morphology of enamel was observed via scanning electron microscopy and their enamel calcium/phosphorus (Ca/P) ratios were measured before/after the demineralization cycle with energy‐dispersive X‐ray analysis. Data were statistically analyzed using one‐way analysis of variance and post hoc Tukey tests. Results The enamel Ca/P ratios in the case study groups were significantly higher than that of the control group before/after the demineralization regimen (p .05). Conclusion The outcomes of the current study indicated that all three agents seemed to increase the enamel resistance of permanent molar teeth to demineralization.

The aim of this study was to compare the demineralizations of the enamel surfaces around different types of orthodontic brackets in an artificial cariogenic environment. A total of 90 extracted human maxillary first premolar teeth were used in this in vitro study. The teeth were divided into 6 groups, 5 study and 1 control, each consisting of 15 samples. Victory metal, Gemini metal, Clarity self-ligating ceramic, APC Clarity Advanced ceramic and Clarity Advanced ceramic brackets (3M Unitek, Monrovia, Calif) used in the study groups were bonded to the teeth with the direct technique. The gingival, occlusal and proximal enamel surfaces adjacent to the brackets were measured with a DIAGNOdent pen (KaVo, Biberach, Germany) (T0). Then, the teeth were placed in a cariogenic suspension environment containing Streptococcus mutans, sucrose and artificial saliva. The teeth were removed from the cariogenic suspension at the end of 28 days. Enamel surfaces were remeasured with DIAGNOdent and the values were recorded (T1). Whether the obtained data were homogeneously distributed or not was determined by the Kolmogorov–Smirnov test, within-group comparisons were performed with the Wilcoxon test, and between-group comparisons were performed with Mann–Whitney U and Kruskal–Wallis tests. Significance level was accepted as p < 0.05. In all groups, the demineralization values of the enamel surfaces in the gingival, proximal and occlusal surfaces adjacent to the brackets were significantly higher in the T1 period than in the T0 period (p < 0.05). In the T1 period of Gemini metal, Clarity self-ligating ceramic and Clarity advanced ceramic bracket groups, the demineralization values of the proximal enamel surfaces were found to be significantly higher than the Victory metal and APC Clarity Advanced ceramic bracket groups (p < 0.05). In the T1 period, the demineralization values of the occlusal enamel surfaces of the Victory metal, APC Clarity Advanced ceramic bracket groups and control group were significantly lower than the Gemini metal, Clarity self-ligating ceramic and Clarity Advanced ceramic bracket groups (p < 0.05). Significant increases in enamel demineralization values were observed as a consequence of increased retention areas for microbial dental plaque on enamel surfaces adjacent to the bracket. Considering the importance of minimizing enamel demineralization in fixed orthodontic treatments, less enamel demineralization in Victory metal and APC Clarity Advanced ceramic bracket groups showed that these brackets can be preferred in patients with poor oral hygiene. [ABSTRACT FROM AUTHOR]

The aim of this study was to review the role of amorphous calcium phosphate (ACP) and ACPbased products in remineralization of enamel and dentin. An automated search was conducted for articles and data published on ACP-based remineralization systems. References of the selected articles were also searched manually for related articles. In the present study, the focus was placed on in-vitro studies on ACP-based remineralization systems published from 2011 to 2020. Out of the 600 articles, 11 articles were found to be suitable for our systematic review. These articles were analysed and together proved that ACP is a promising non - fluoride-based remineralizing agent, which furthermore can be combined with organic molecules, polymers, proteins, and ions for enhancing its stability and its remineralizing effect. ACP readily dissolves in saliva and acts as a reservoir of calcium and phosphate ions which are taken up by demineralized tissues; induce remineralization and balance the pH of the oral cavity. ACP is turning out to be more and more essential in dentistry. It remineralizes enamel and dentin better than crystalline calcium phosphates, and the new mineral deposit is similar in structure and composition to the dental tissues. It is considered that ACP will be put into use even more comprehensively soon due to the rapid growth of tissue engineering and applied material science. However, more long-term clinical studies are essential to compare the remineralization efficacy of ACP compared to other remineralizing systems. [ABSTRACT FROM AUTHOR]

This review discusses both preventive measures and clinically implemented therapy procedures that have been developed recently for the prevention and treatment of tooth erosion. Methods: The databases PubMed, Scopus, and Web of Science were used for a thorough search. Studies on the prevention and treatment of dental erosion that were conducted in English and used in vitro were among the inclusion criteria. Results: The search turned up 391 papers in total, with 34 of those publications matching the requirements for inclusion. Varnishes, toothpastes, and solutions containing fluoride and other substances were used as preventive measures. Conclusions: Dental erosion is a significant issue, and taking preventative steps is crucial to lessening the disease’s spread and its effects. Interventions based on fluoride seem to be successful at halting erosion and encouraging remineralization. To effectively address severe tooth erosion, therapeutic methods, including composite restorations, prosthetic crowns, and veneers, are available. Dental erosion causes aesthetic and functional issues that are best addressed with less invasive treatments like direct composite restorations. To improve and broaden the range of available treatments for this common dental issue, additional research and development are required.

Background. The use of sports and energy drinks has drastically increased in the adolescent population. This population often is in orthodontic treatment, and the use of such drinks with poor oral hygiene promotes the development of white spot lesions (WSLs). Quantifying the degree of the lesion has been limited in the past. The hypothesis was that the Canary Caries Detection System could be used to quantify the degree of WSLs caused by different commercial beverages. Methods. A total of 105 extracted human premolars were divided into seven groups (n=15). Each group was tested in one of six beverages or a phosphate-buffered solution (control). The teeth were exposed to its beverage three times a day for 15 minutes for 28 days. Canary numbers and ambient light and fluorescent photographs were collected at baseline (T0 ) and on days 14 (T1 ) and 28 (T2 ). Results. The paired t test and one-way ANOVA found that T0 to T1 measurements were statistically significant (P

Background and Aims: Different factors play a role in causing tooth decay. Modern dentistry is looking for a way to prevent tooth decay and suggests different ways to increase remineralization. The aim of this study was to evaluate the effect of nanohydroxyapatite toothpaste and mouthwash on remineralization of primary enamel lesions and obstruction of tubules. Materials and Methods: In this study, 90 human extracted central teeth were used. Artificial decay was induced by placing the specimens for 72 hrs in a demineralization solution in an incubator at 37 °C. Hardness of the specimens was determined by a microhardness test before any surface treatment. The specimens were then divided randomly into 6 groups of 15. For 1-6 groups, the specimens were subjected to a pH cycling for 14 days, which included 3 hrs of demineralization and 21 hrs of remineralization. At the same time, 1-3 groups were in contact with diluted toothpaste in a ratio of 1:3 with deionized water at a rate of 5 ml twice a day for two min. Eac specimen of 4-6 groups was exposed to 5 ml of three types of mouthwashes for one min. Then, the specimens were cut in the buccolingual direction in order to simultaneously evaluate the dentinal tubules and Vickers microhardness test was performed again and the before and after microhardness values were compared. Then, the percentage of deposition on the surface and tubule obstruction were analyzed using SEM (Scanning electron microscope) (P=0.006). Data were analyzed using SPSS24 software bu the descriptive statistics, ANOVA analysis of variance, and multiple Tukey comparisons. Results: The results of analysis of variance test showed that there was a statistically significant difference in the microhardness changes between study groups (P=0.006). Also, in-group analysis of microhardness changes, there was a significant difference (P

AIM: The aim of the present study was to examine the effect of alkasite material on the pH of the environment when used as a restorative material in different cavity preparations and prepared as a single block in standard sizes. METHODS: Alkalizing potential of the alkasite material was evaluated by restoring extracted teeth with three different restorative materials and preparing edentulous blocks. For this purpose, 30 extracted premolar teeth and silicone molds of standard size (2x2x4 mm) were used. One of the study groups consisted of edentulous alkasite blocks of standard size and the other three groups (O, OM, MOD) were alkasite restorations of cavities of different sizes. The teeth were divided into three groups according to the type of cavity preparation. Restoration of cavities and preparation of the blocks were performed according to Cention N (Ivoclar Vivadent) manufacturer’s instructions. All restorations and blocks were immersed individually in distilled water at pH 4. pH measurements were obtained using a pH meter (Sartorius, France) at 10-min, 20-min, 30-min and 60-min timepoints following immersion. Measurements were repeated for all four groups at the end of 24 hours, 48 hours and 7 days. RESULTS: Alkalizing effect was observed in all groups. pH changes after 24 hours, 48 hours and 7 days showed a significant difference among the groups at the measurement timepoints (p

Background: Probiotics are live microorganisms which that provide various health benefits to the host upon administration in adequate amounts. Lactobacilli, Propionibacterium, and Bifidobacterium are common “Lactic Acid-producing bacteria (LAB)” present in various probiotic formulations. These probiotic bacteria release many organic acids, mainly lactic acid, acetic acid, and propionic acid into their surrounding environment. Increased concentration of these inorganic and organic acids reduces the saliva’s critical pH to below 5.5, and initiates demineralization. Thus, the present review aims to critically appraise the existing evidence on this emerging clinical perspective and double edged nature of the probiotic bacteria, and explain as to how probiotic supplements increase the risk of tooth decay. Results: Lactobacilli and Bifidobacterium were associated with rampant caries in preschool children and progression of caries. All probiotics were acidogenic as they decreased the pH of the saliva, demineralized and eroded the enamel. Probiotics also release extracellular polysaccharides that help to release essential elements like calcium and phosphorous from the enamel surface. The lactic acid-producing efficiency of probiotics is increased when combined with supragingival plaque. Low pH was attributed to the interaction of Lactobacilli with other microorganisms. Conclusion: Acids release from probiotics bacteria can lower the critical pH of the oral cavity to below five, and play a role in demineralization of the tooth and progression of caries.

Introduction: Evidence shows that people from different regions have different teeth characteristics based on their daily water consumption. This exploratory study aimed to measure the mineralization potential of mineral water and fresh milk on the demineralized enamel surface. Methods: The enamel surface was softened for 10 min in 100 ml of 1% citric acid under 150 rpm agitation in all specimens. Afterward, the specimens were mineralized with 100 ml of mineral water and milk under 150 rpm agitation. The mineral content of the enamel surface before and after the treatment in nanoscale was measured using an energy-dispersive X-ray spectrometer (EDXS). Before and after treatment, the results of EDXS were analyzed using a one-way ANOVA test. Results: The results showed that initial treatment with citric acid significantly increased the surface roughness of the enamel surface. Moreover, in treatment with fresh milk, the potassium and sodium content of the enamel surface increased. It was also reported that mineral water treatment increased the sodium content of the enamel surface. Conclusion: The findings suggested that milk and mineral water might slightly recover the damage induced by citric acid on the enamel surface.

Dental caries is a global oral health problem caused due to localized demineralization of the enamel. Chemical plaque control is used as an adjuvant to mechanical plaque control in removing biofilm, thereby preventing dental caries. In recent times, there has been a renewed interest in nature-based products. This systematic review aimed to analyse the existing literature to compare the effectiveness of herbal and conventional dentifrices on prevention of dental caries. A search was done in the databases of PubMed and Google Scholar in July 2020 for the related topic. A hand search was done from the references of primary studies and other clinical trial registry sites. Randomized control trials, comparative clinical trials, and in vitro studies in which the effectiveness of herbal and conventional dentifrices on prevention of dental caries were included after review by the reviewers. The systematic search revealed a total of thirty-two publications from which ten publications were included. Five studies were clinical studies and five were in vitro studies. All the studies used microbiological analysis for the determination of cariogenic microorganisms in plaque and saliva, whereas one study used pH of plaque and saliva. Among the included studies, all studies had a high risk of bias with level 2 evidence. With the evidence available, it can be concluded that herbal dentifrices and fluoride dentifrices have similar antimicrobial activity against cariogenic microorganisms.

Context: Early childhood caries is a major health problem affecting children worldwide. Although incorrect feeding practices hold a prime position in the etiology, there are gaps in the literature pertaining to the physical properties of milk. Aim: To assess the viscosity of human breast milk (HBM) versus infant milk formulae, with and without the addition of sweetening agents. Materials and Methods: All commercially available infant milk formulae (60 samples) and breast milk from 30 donor mothers were assessed for viscosity using Brookfield DV2T viscometer. The study period was from April 2019 to August 2019. Viscosity of infant milk formulae sweetened with sugar, honey, and brown sugar was further investigated and compared with that of HBM. Statistical Analysis: Inter-group and intra-group mean viscosity was compared using independent t-test and repeated-measures ANOVA. Results: Viscosity of HBM ranged from 18.36 centipoise (cP) to 91.30 cP, the mean viscosity being 45.7 cP. Viscosity values varied for each formula group, the least being as low as 5.1 cP and the highest being 89.3 cP. The mean viscosities of each group were in the range of 33 to 49 cP. Conclusions: HBM was found to have a tendency toward higher viscosity than most of the infant milk formulae. Also, varied viscosity values were obtained when commonly used sweetening agents were added to infant milk formulae. Greater viscosity of HBM might increase its adherence to enamel surface leading to prolonged demineralization and potentially altering the caries risk, needs to be investigated further.

ObjectivesAcetate and lactate are important cariogenic acids produced by oral bacteria. They produced different residual dentin structures in artificial lesions of similar depth. We evaluated if such lesions responded in the same way to a polymer-induced-liquid-precursor (PILP) remineralization.DesignDentin blocks obtained from human third molars, divided into 6 groups (n=3). Blocks were demineralized with acetate (66h) or lactate (168h) buffer at pH 5.0 to create 140μm target lesion depths. A-DEM and L-DEM groups received no remineralization. Other groups were remineralized for 14days. 100μg/mL polyaspartate was added into the remineralizing buffer for A-PIL and L-PIL, whereas A-CAP and L-CAP were treated with the same solution but without polyaspartate. Cross-sectioned blocks were examined for shrinkage and AFM-topography. Line profiles of reduced elastic modulus (Er) were obtained by AFM-based nanoindentation across the lesion. Ultrastructures were examined with TEM.ResultsA-PIL and L-PIL recovered in shrinkage to the original height of the dentin and it appeared normal with tubules, with increases in Er at both outer flat and inner sloped zones. At the sloped zone, acetate lesions lost more Er but recovery rate after PILP was not statistically different from lactate lesions. A-CAP and L-CAP showed surface precipitates, significantly less recovery in shrinkage or Er as compared to PILP groups. TEM-ultrastructure of PILP groups showed similar structural and mineral components in the sloped zone for lesions produced by either acid.ConclusionsThe PILP process provided significant recovery of both structure and mechanical properties for artificial lesions produced with acetate or lactate.

Abstract Background To this day, the effects of sodium hypochlorite and chelating agents on the smear layer and on the dentine’s surface, remain not fully examined. The study is aimed to analyze the dentine's surface treated with 40% citric acid and 5.25% sodium hypochlorite according to two irrigation protocols. Materials and methods The study employed a computer-controlled Nikon Eclipse LV100 optical microscope. Ten roots split longitudinally with canals prepared mechanically using the MTwo system to a size of 40/04 were observed. The root halves were divided into two study groups, one half in each of the groups. According to two irrigation protocols, the dentine's surface was irrigated with 40% citric acid and 5.25% sodium hypochlorite, separated with water. Dentine surface was observed in a fixed place and photographed in 500 × magnification after each irrigation stage. The obtained images were then analyzed using computer software (NIS-Elements AR, GIMP-2.6, ImageJ 1.45s). Results Various speed of removal of the smear layer and varied morphological changes of the dentine's surface were observed in both examined groups. Double irrigation of the dentine with citric acid for 30 s resulted in complete removal of the smear layer, and double irrigation for 60 s resulted in increased mean diameter of the dentine tubules (degradation of the dentine's surface). Conclusions Double alternating irrigation with citric acid and sodium hypochlorite for 30 s yielded satisfactory results, while double irrigation for 60 s resulted in increased mean diameter of the dentine tubules. A real time assessment of the dentine’s surface changes after both tested solutions can improve understanding of the phenomena that occur during the irrigation and as a result it might help to improve clinical outcomes in root canal treatment.

Bennett Tochukwu Amaechi,1 Thais Santiago Phillips,1 Veronica Evans,1 Chidera Precious Ugwokaegbe,2 Minh Nguyet Luong,1 Linda Oge Okoye,3 Frederic Meyer,4 Joachim Enax4 1Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, San Antonio, TX, 78229-3900, USA; 2Department of Biology, University of Texas at San Antonio, San Antonio, TX, USA; 3Department of Restorative Dentistry, Faculty of Dentistry, College of Medicine, University of Nigeria, Enugu, Nigeria; 4Research Department, Dr. Kurt Wolff GmbH & Co. KG, Bielefeld, GermanyCorrespondence: Bennett Tochukwu AmaechiDepartment of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USATel +1 210 567 3185Email amaechi@uthscsa.eduPurpose: The effectiveness of a hydroxyapatite (HAP) toothpaste and a fluoride toothpaste in preventing root tissue demineralization (root caries) was compared using an established pH-cycling caries model.Materials and Methods: Sixty dentin blocks were produced from the root tissue of extracted human teeth and were assigned to 3 test groups (n=20/group): 10% hydroxyapatite toothpaste (HAP), 1450 ppm fluoride toothpaste (fluoride), and artificial saliva (artsaliva). Early root caries lesions were developed in each sample by 7-day demineralization using a pH-cycling caries model. The daily cyclic treatment regimen consists of two 2-minute toothpaste-slurry treatment periods, one 6-hour acid challenge using acidified gel (pH 4.5), and then storage in remineralizing solution (artsaliva) for the rest of the time. Demineralization was assessed as the amount of mineral loss (∆z) using transverse microradiography (TMR). Pairwise comparisons (between treatments) were performed using analysis of variance (ANOVA), and then Tukey’s HSD for multiple comparisons. All p-values are considered significant if p< 0.05.Results: Both ANOVA and Tukey’s HSD indicated no significant (ANOVA; n=20) difference in mean ∆z among the groups, with least ∆z (±Sd) in the HAP (1117± 366) compared to fluoride (1392± 334) and artsaliva (1406± 223). Relative to control, HAP and fluoride inhibited root demineralization by 21% and 6%, respectively.Conclusion: Within the limit of the present study, the tested toothpaste containing 10% HAP is an effective root caries control toothpaste. Toothpaste containing 10% HAP was slightly more effective in preventing tooth demineralization than 1450 ppm fluoride provided as sodium fluoride. Thus, this study shows that HAP toothpastes can serve as an effective alternative to fluoride toothpastes for root caries management.Keywords: hydroxyapatite, fluoride, pH cycling, artificial saliva, demineralization, toothpaste

ABSTRACT Objective: This study aimed to investigate the antimicrobial activity and shear bond strength (SBS) of orthodontic brackets to bovine enamel using experimental composites with different concentrations of silicon dioxide-coated silver nanoparticles (Ag@SiO2 NPs). Methods: Fifty bovine incisors were divided into five groups according to the composite (n = 10): G1 - Control Group (Transbond XT Resin), G2 - Experimental composite without Ag@SiO2 NPs; G3 - Experimental composite with 0.5% of Ag@SiO2 NPs; G4 - Experimental composite with 1% of Ag@SiO2 NPs; G5 - Experimental composite with 3% of Ag@SiO2 NPs. The SBS test was performed using a universal mechanical testing machine, and the adhesive remnant index (ARI) was analyzed by optical microscopy. For the antimicrobial activity evaluation, Streptococcus mutans (S. mutans) biofilm was formed for three days in hydroxyapatite discs. Posteriorly, S. mutans colony forming units (CFU) were evaluated. For SBS analysis, Analysis of Variance was used, followed by the Tukey test, at a 5% statistical significance level. The CFU data were analyzed by Kruskal-Wallis, followed by Dunn as a post-hoc test. The ARI results were analyzed descriptively. Results: There was no statistically significant difference in SBS values between the experimental and control groups (p>0.05). A 3% incorporation of Ag@SiO2 NPs statistically reduced the SBS values (p

OBJECTIVES:The objective of this study was to evaluate the in vivo effects of a 2.6% edathamil gel (Livionex® Dental Gel) on surface microhardness and microstructure in 180 pre-eroded enamel chips. METHODS:This was a double-blind, randomized study. Two enamel chips each were cut from 90 healthy sterilized extracted teeth. One chip from each pair underwent microhardness testing and scanning electron microscopy (SEM) to establish baselines. The remaining 90 samples were demineralized, and then mounted onto intra-oral retainers worn by nine subjects, with five chips mounted on each retainer for each of the two study arms. In one two-week study arm subjects brushed with the control toothpaste; in the other they used the test gel. Study arms were separated by a two-week washout. Sequence of toothpaste use was randomized. At the end of each study arm, samples underwent microhardness measurements (Knoop) and SEM visualization. RESULTS:After intraoral wear, enamel chips recovered fully from demineralization, with no significant difference in microhardness between the two treatments (p > 0.05). In SEM images, enamel surfaces at study's end also appeared comparable in the two groups. CONCLUSIONS:Pre-eroded enamel chips remineralized intra-orally to a similar level after using a control or a test toothpaste containing 2.6% edathamil.

ObjectiveThe goal of this study was to evaluate the in vivo effects of a novel mouthwash on enamel remineralization.Materials and methodsTen healthy volunteers wore removable intra-oral appliances for three study arms with duration of 5 days each. In 1 study arm, subjects used Oral Essentials Sensitivity FormulaR mouthwash; in another arm they used SensodyneR mouthwash, and in the third arm they used no mouthwash at all. Sequence of mouthwash use was randomized, and study participants and researchers were blinded throughout the study. Subjects used Crest Total CareR toothpaste throughout the study. During a one week washout period before study begin and between each study arm, subjects also used Crest Total CareR toothpaste. A total of 300 enamel samples were included in this study, 150 served as baseline controls, and 150 as test samples subjected to demineralization prior to intra-oral wear. At the end of each study arm, enamel chips were removed from the appliance and underwent standard Microhardness (Knoop) measurements, as did the control samples. Enamel microhardness in the test vs the 2 control groups was compared using the Kruskal-Wallis one-way analysis of variance with post-hoc Tukey's test to test for differences in remineralization between the 3 treatments.ResultsBoth mouthwashes demonstrated similar levels of recovery from demineralization as the "no mouthwash" arm of the study, with no significant differences for all groupings and comparisons (p>0.05).ConclusionA novel mouthwash for sensitive teeth supports enamel recovery from demineralization.

Introduction: The systematic review presented here aims to determine and find out the clinical efficacy of various remineralization agents for early enamel caries. Materials and methods: An aggregate of 240 articles has been retrieved from PubMed, Cochrane Library, Trip, and Google scholarly databases from 2010 to 2020, of which 18 randomized controlled trials (RCTs) have been integrated into this systematic review, and six of which were considered for meta-analysis. The risk of bias in each study was evaluated using the Cochrane collaboration’s tool. Results: Ten of the 18 studies suggest that carious lesions are successfully minimized by remineralization. Four studies showed superior efficacy of casein phosphopeptide and amorphous calcium phosphate (CPP-ACP) in the remineralization of white spot lesions. There was no statistically significant difference (standard mean difference = −0.18, 95% confidence interval: −0.48 to 0.12, P = 0.23) between the experimental and control groups. Conclusion: This review has demonstrated an absence of dependable proof supporting the clinical adequacy of remineralizing agents. Therefore, RCTs in well-designed forms are needed to enhance all sorts of evidence in this field.

Abstract Quantification of collagen degradation is an important parameter to evaluate dentin caries for preventive aid. Objectives: Evaluate preventive methods against root collagen degradation by the hydroxyproline assay (HYP) and microradiography technique (MRT). Methodology: Five bovine root dentin blocks were obtained and subjected to an artificial demineralization process by acetate buffer (pH 5) to induce carious lesion formation. Samples were subjected to the following therapeutic treatments: 1) 0.12% chlorhexidine for 1 min, 2) 2% fluoride for 1 min, 3) Nd:YAG Laser (400 μm diameter optical fiber, 10 Hz frequency, 60 mJ/pulse energy, 48 J/cm2 energy density, in noncontact mode for 10 s), 4) deionized water (control) for 1 min, 5) MRT control group (without treatment and removal of collagen). Samples were exposed to degradation by a collagenase enzyme for five days. The enzyme solution was collected, by colorimetry in a spectrophotometer, from the collagen matrix for the hydroxyproline release analysis. The same samples were subjected to an additional two days of demineralization to induce the progression of mineral loss. Samples were analyzed by MRT for the visualization of their degraded areas (estimation of lesion depth and mineral loss). ANOVA was applied to compare hydroxyproline release rates. MRT data were subjected to the Kruskal-Wallis test, followed by the Dunn’s test. Comparisons between the initial five-day and the subsequent two-day demineralization processes were performed by repeated t-test or Wilcoxon (p

Background: The aim of this study is to quantitatively evaluate the remineralization potential of three remineralizing systems as follows: fluoride, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and CPP-ACP with fluoride, under scanning electron microscope with energy-dispersive X-ray analysis. Materials and Methods: In this in vitro study A total of 40 enamel specimens were prepared from the buccal or lingual surfaces of human premolars extracted for orthodontic reason. Specimens were then placed in demineralizing solution for 96 h, to produce artificial caries-like lesion. Calcium and phosphate weight percentage of demineralized specimens was measured. Specimens were divided into four groups as follows: (a) control, (b) CPP-ACP, (c) CPP-ACP with fluoride, and (d) fluoride varnish. Except for the control group, the entire specimens were subjected to remineralization using respective remineralizing agents of their groups. The prepared specimens were assessed for calcium and phosphate weight percentage using scanning electron microscopy-energy dispersive X-ray spectroscopy. One way analysis of variance (ANOVA), followed by Tukey's test, was performed with the help of critical difference (CD) or least significant difference at 5% and 1% level of significance. P ≤ 0.05 was taken to be statistically significant and P < 0.001 as statistically highly significant. Results: The mean weight percentage of calcium and phosphorus of specimens treated with CPP-amorphous calcium phosphate nanocomplexes plus fluoride (ACPF) was significantly higher than other groups. Conclusion: All the groups showed statistically significant remineralization. However, because of added benefit of fluoride, CPP-ACPF showed statistically significant amount of remineralization than CPP-ACP.

Background: Fluoride varnish is one of the professionally applied topical fluoride agents. The ease of application of fluoride varnishes has led to its popularity in pediatric dentistry. Aim: The aim of the study is to evaluate and compare the effect of varnish containing casein phosphopeptides-amorphous calcium phosphate (CPP-ACP) and fluoride (MI Varnish®) with that of varnish containing only fluoride (Fluor Protector®) on surface microhardness (SMH) of enamel. Materials and Methods: Enamel blocks were cut from the 90 premolar teeth samples. The samples were divided into three Groups (A, B, and C) consisting of 30 blocks each. Varnish containing CPP-ACP with fluoride was applied on samples of Group A and varnish containing only fluoride was applied on the samples of Group B. Group C was used as control group; without any varnish application. After varnish application, these samples were subjected to pH cycling. Following, SMH was assessed using SMH tester machine. Results: The mean values of SMH for Group A were 488 ± 6 vickers hardness number (VHN), Group B were 485 ± 12 VHN, and Group C were 448 ± 12 VHN. Conclusion: There was no significant difference in the SMH of enamel between the varnish containing CPP-ACP and fluoride, with that of varnish containing only fluoride.

Background: Caries is common problem found in children. Caries prevalences increased mainly in developing countries such as Indonesia. Theobromine is an alkaloid compound in metilxantin group which can be found in the cocoa bean. Theobromine is believed to prevent caries by restoring the rough surface of email as the result of demineralisation. This research is aimed to analyze the effect of theobromine gel on the surface roughness of deciduous teeth after demineralization. Method: It was laboratory experiments. Sample of research were 20 incisive cariesfree deciduous teeth. Samples divided into fve groups of treatments (concentration of gel theobromine 1%, 2%, 3%, 4%, and 5%). Each group consists of 4 samples. All samples were demineralized with 37% phosphoric acid for 60 seconds. Samples were immersed in artifcial saliva for 60 minutes in temperature 37⁰. Roughness examination before and after treatment was conducted using Surface Roughness Tester. Result: This experiment showed that surface roughness is decreasing after treated by fve different concentrations of theobromine. There is a signifcant difference compared to other treatments (p

Abstract Objective this study evaluated the mineral and microbiological response of biofilms originating from different types of saliva inoculum with distinct levels of caries activity. Methodology the biofilms grown over enamel specimens originated from saliva collected from a single donor or five donors with two distinct levels of caries activity (caries-active and caries-free) or from pooling saliva from ten donors (five caries-active and five caries-free). The percentage surface hardness change (%SHC) and microbiological counts served as outcome variables. Results the caries activity of donors did not affect the %SHC values. Inoculum from five donors compared to a single donor showed higher %SHC values (p=0.019). Higher lactobacilli counts were observed when saliva from caries-active donors was used as the inoculum (p=0.017). Pooled saliva from both caries activity levels showed higher mutans streptococci counts (p

Background and objectivesEarly demineralization appears with high contrast at near-IR wavelengths due to a 10- to 20-fold difference in the magnitude of light scattering between sound and demineralized enamel. Water absorption in the near-IR has a significant effect on the lesion contrast and the highest contrast has been measured in spectral regions with higher water absorption. The purpose of this study was to determine how the lesion contrast changes with lesion severity and depth for different spectral regions in the near-IR and compare that range of contrast with visible reflectance and fluorescence.Materials and methodsForty-four human molars were used in this in vitro study. Teeth were painted with an acid-resistant varnish, leaving a 4 mm × 4 mm window on the occlusal surface of each tooth exposed for demineralization. Artificial lesions were produced in the unprotected windows after 12-48 hours exposure to a demineralizing solution at pH 4.5. Near-IR reflectance images were acquired over several near-IR spectral distributions, visible light reflectance, and fluorescence with 405-nm excitation and detection at wavelengths >500-nm. Crossed polarizers were used for reflectance measurements to reduce interference from specular reflectance. Cross polarization optical coherence tomography (CP-OCT) was used to non-destructively assess the depth and severity of demineralization in each sample window. Matching two-dimensional CP-OCT images of the lesion depth and integrated reflectivity were compared with the reflectance and fluorescence images to determine how accurately the variation in the lesion contrast represents the variation in the lesion severity.ResultsArtificial lesions appear more uniform on tooth surfaces exposed to an acid challenge at visible wavelengths than they do in the near-IR. Measurements of the lesion depth and severity using CP-OCT show that the lesion severity varies markedly across the sample windows and that the lesion contrast in the visible does not accurately reflect the large variation in the lesion severity. Reflectance measurements at certain near-IR wavelengths more accurately reflect variation in the depth and severity of the lesions.ConclusionThe results of the study suggest that near-IR reflectance measurements at longer wavelengths coincident with higher water absorption are better suited for imaging early caries lesions.

Radiography is the most used complementary means to diagnose dental caries. The aim of this study is to verify the expertise in radiography interpretation of a group of clinicians with different experience and training and also of a group of last year dental medicine students. Material and method. For this study, 18 extracted teeth were used on which proximal and occlusal demineralization, enamel preparations and dentin preparations were conducted. The teeth surfaces were then isolated with a nail polish except the preparations. Teeth were mounted in acrylic arcades and retro-alveolar radiographs, bite-wing radiographs and CBCT were performed. A questionnaire was developed that was sent online to the groups of dental clinicians and students. Results and discussion. Retro alveolar radiographs, proximal preparations: 49% of respondents did not diagnose demineralization, 42% caries in enamel and 16% caries in dentin. Occlusal preparations: 88% of the respondents did not diagnose demineralization, 60% of the caries in the enamel, all the respondents diagnosed the caries in the dentine. Bitewing radiographs, proximal preparations: 2% of respondents did not diagnose demineralization, 12% caries in enamel and 2% caries in dentin. Occlusal preparations: 90% of the respondents did not diagnose demineralization, 26% caries in enamel, all diagnosed caries in the dentine. At CBCT, proximal preparations: 26% of respondents did not diagnose demineralization, 26% caries in enamel and 20% caries in dentin. At the occlusal level, 22% of respondents did not diagnose demineralization, 8% caries in enamel and 8% caries in dentin. Conclusions. Following the radiological examinations conducted in this study, we can say that dental caries is diagnosed most quickly and correctly when they affect both the analysed proximal and occlusal surfaces with evolution in dentin.

Naif A Almosa,1 Beshayer S Sibai,2 Olla A Rejjal,3 Nasser Alqahtani1 1Department of Pediatric Dentistry and Orthodontics, King Saud University, Riyadh, Saudi Arabia; 2National Guard Hospital, Dammam, Saudi Arabia; 3State University of New York, Buffalo, NY, USA Aim: To evaluate the degree of enamel demineralization of teeth bonded with ceramic and metal brackets.Materials and methods: In this cross-sectional experimental in vitro study, 60 extracted human premolar teeth were selected according to the experimental criteria. They were divided into three groups; 20 premolar teeth in each group. Teeth in group 1 were bonded with “ceramic brackets”, and teeth in group 2 were bonded with “metal brackets”, while teeth in group 3 served as the “control group” without any brackets. Teeth in all groups were then immersed in demineralization media, de-bonded, sectioned into three parts (proximal 1, middle, and proximal 2), and evaluated to determine the level of enamel demineralization under a Scanning Electron Microscope.Results: On tooth level, the results show that the control group has significantly less enamel demineralization compared to the other two experimental groups, with mean values of 145.3 µm and 192.7 µm, respectively (P=0.000). The mean value of enamel demineralization in the metal group is 55.93 µm, compared to 72.55 µm in the ceramic group, which is significantly less (P≤0.05), while there is no difference between the control and metal group with regard to enamel demineralization. On section level, the control group has significantly less enamel demineralization in all three sections compared to the ceramic group, while a significant difference is found in one of the proximal sections when compared with the metal group. Moreover, the ceramic group has significantly higher enamel demineralization in the middle section compared to the metal group (73.54 µm, 46.5 µm, respectively) (P=0.000), while there is no statistical significant difference between the two experimental groups in proximal sections.Conclusion: In vitro, non-bonded teeth show least demineralization compared to the bonded teeth. Teeth bonded with ceramic brackets show significantly higher enamel demineralization compared to teeth bonded with metal brackets. Keywords: ceramic, demineralization, metal, orthodontic brackets, decalcification, white spot lesions, orthodontic material, adhesive

Objective: To evaluate anti-demineralization effects of dentin desensitizer containing sodium fluoride and methacrylate-co-p-styrene sulfonic acid (MS polymer) on root dentin using transverse microradiography (TMR). Material and methods: Twenty-four dentin specimens were divided into four groups: MSO (no fluoride), MSF (3000 ppm F), FJL (9000 ppm F), and Control. In MSO and MSF, each desensitizer was rubbed into the dentin surfaces for 10 s then left for 20 s. In FJL, paste containing 9000 ppm F was applied onto the surface for 30 s. All specimens, including the Controls, were rinsed with deionized water, dried and an area of their surface exposed to pH 5.0 acidic solution, refreshed every 24 h, for 4 days. Sections 300-µm-thick were assessed by TMR. Mineral profiles and integrated mineral loss (IML) of lesions were analyzed by dedicated software. IML was analyzed with one-way ANOVA and Tukey’s test. Results: MSF and FJL specimens showed high mineral volume % at the surface and in lesions, and significantly lower IML than the other groups (p

Background: With an increasing interest in preventive strategies, pedodontics research is now more focused on developing newer materials and techniques to coat the primary teeth to prevent onset of new carious lesions. Aim: The aim of this study is to evaluate the inhibitory effect of prereacted glass (PRG) filler-containing resin coat on enamel demineralization of the primary teeth. Subjects and Methods: Eight de-rooted primary caries-free teeth sectioned into 4 mm × 4 mm were divided into either experimental group which received the PRG barrier coat or control group which was left uncoated. These were then immersed in acid buffer at pH 4.5 for 3 days. Mineral content was evaluated by scanning electron microscopy with energy dispersive X-ray analysis. Statistical Analysis: Data were collected and analyzed statistically using paired Student's “t” test, with a P < 0.05 being considered statistically significant. Results: When the calcium/phosphorous (Ca/P) ratio (wt%) which is indicative of the mineral content of enamel was compared, the values were higher for the experimental group than that for the control group and the association was statistically significant (P < 0.01). Conclusion: The higher Ca/P ratio of experimental group was suggestive of the ability of PRG barrier coat to inhibit enamel demineralization in the primary teeth.

Demineralization is a process of loss of minerals in the dental hard tissue that affects seriously the health of the patients, as it diminishes the tooth resistance, generating chewing problems by altering the occlusal structure, hypersensitivity, and pulpal problems. Demineralization can be produced by pathological processes as erosion or caries, or by surgical processes as etching. Due to the complexity of natural demineralization processes, it is mandatory to provide quantitative and standardized tests to allow their study in controlled laboratory conditions. Ultrasonic techniques are suitable for this purpose as they are nondestructive, quick, and provide localized mechanical information about the tissue, which is related with its degree of demineralization. In the present work, we evaluate the complete process of demineralization of the human dentin under controlled laboratory conditions using a pulse-echo ultrasonic technique. Up to 15 human dentin teeth have been demineralized with phosphoric acid at 10%. The time-of-flight measurements using the pulse-echo system allows to obtain the speed of sound in healthy (3415 m/s) and demineralized dentin tissue (1710 m/s), as well as to characterize the dynamical process of the acid penetration, which generates well-defined boundaries between two media (demineralized and mineralized dentin), showing very different mechanical properties. These boundaries advance in depth at an initial rate of $2.9~\mu \text{m}$ /min, decelerating at −9.3 nm/min2 until the whole demineralization of the sample is achieved. In addition, the technique allows to measure the relevance of the demineralization produced by the acid residues inside the tooth once it has been removed from the acidic solution. Beyond the assessment of artificial demineralization lesions under laboratory conditions, as demonstrated in this article, the proposed technique opens new approaches to the assessment of demineralization caused by natural caries in vivo. [ABSTRACT FROM AUTHOR]