State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management

A novel biomimetic strategy for mimicking amelogenesis to repair enamel

According to the principle of minimal invasiveness in modern dentistry, biomimetic remineralization therapy constitutes a significant strategy for the prevention and treatment of early enamel caries. Based on the three "key events" of amelogenesis in vivo, silk fibroin (SF) combined with carboxymethyl chitosan (CMC) successfully formed an SF/CMC composite, and amorphous calcium phosphate (ACP) was then used to form an SF/CMC-ACP nanocomposite with remineralization properties. In our study, SF was used as a template protein for biomimetic amelogenin, ACP was stabilized with CMC and the remineralization was guided using NaClO to simulate the action of proteolytic enzymes. The SF/CMC-ACP nanocomposite demonstrated excellent biocompatibility and enamel remineralization effects in both in vitro/in vivo experiments; thus, a theoretical basis for biomimetic enamel remineralization studies was provided.

Ion-releasing resin composites prevent demineralization around restorations in an in-vitro biofilm model

OBJECTIVE

This study aimed to evaluate the effectiveness of two ion-releasing, resin-based composites (RBCs), ACTIVA BioACTIVE-Restorative (BIO1) and ACTIVA Presto (BIO2), in preventing demineralization around restorations.

METHODS

Class I and II cavities were prepared on bovine (n = 4) and human teeth (n = 8) and restored with BIO1, BIO2, a conventional composite (RBC, Filtek Supreme XTE), and a resin-modified glass ionomer cement (RMGIC, Ionolux). Following restorations (class I, n= 16/material; class II, n= 8/material), the specimens were exposed to Streptococcus mutans biofilm in a continuous-flow bioreactor over two weeks. Micro-computed tomography (micro-CT) assessed demineralization depths at restoration margins, and supernatant pH changes were measured after a 24-h acidic challenge. Statistical analyses included one and two-way ANOVA and Tukey's test (p < 0.05).

RESULTS

On enamel surfaces, RMGIC showed no demineralization, followed by BIO1 (≈50 μm), BIO2 (≈125 μm), and RBC (≈150 μm). No difference between human or bovine enamel was observed. In dentin, RMGIC showed the least demineralization (≈190 μm), followed by BIO1 (≈230 μm), BIO2 (≈280 μm), and RBC (≈400 μm). pH buffering was highest in RMGIC (+ 0.24 pH), while BIO1, BIO2, and RBC showed similar buffering capacities (∼ +0.1 pH). Gaps were found at several interfaces for BIO1 and RMGIC.

CONCLUSIONS

Ion-releasing RBCs varied in effectiveness for reducing demineralization of surrounding tissues, with limited pH buffering capacity. RMGIC exhibited better performance. Gaps between cavity walls and BIO1/RMGIC raised concerns about long-term adhesion.

CLINICAL SIGNIFICANCE

ACTIVA BioACTIVE Restorative (BIO1) and ACTIVA Presto (BIO2) resin-based composites promoted slight inhibition of demineralization in an in-vitro biofilm model, suggesting that further modifications in their chemical composition are necessary.

Expert consensus on the prevention and treatment of enamel demineralization in orthodontic treatment

Enamel demineralization, the formation of white spot lesions, is a common issue in clinical orthodontic treatment. The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment. The prevention, diagnosis, and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties. This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment, advocating for proactive prevention, early detection, timely treatment, scientific follow-up, and multidisciplinary management of white spot lesions throughout the orthodontic process, thereby maintaining the dental health of patients during orthodontic treatment.

Comparison of the effectiveness of sodium-tri-metaphosphate-treated varnish containing eggshell and membrane powder and bioactıve glass varnish with fluoride varnish in preventing erosion: in vitro

The aim of this in vitro study was to compare the efficacy of sodium-tri-metaphosphate-treated varnish containing eggshell and membrane powder and bioactive glass varnish with fluoride varnish in preventing erosion. Two windows were created on the buccal surface of 72 molars for the erosion cycle. One of the windows was treated with fluoride varnish [(FV, Metroberry, Imicryl), varnish containing STMP-treated eggshell and membrane powder (EPV, BioViera, Imicryl) and bioactive glass varnish (BAG, Polimo, Imicryl)] while the other window was used as control. Acidic syrup (Atarax) was applied 3 times a day and acidic drink (Coca Cola) 4 times a day for 5 days. The samples were analyzed by SEM (n = 1), ATR-FTIR (n = 6) and Vicker's hardness (n = 5). Data were analyzed by one-way ANOVA and post hoc Tukey test. The protective effects of the varnishes were observed in the SEM images obtained. There was a difference between the FV and EPV groups in the 875 cm-1 v2 CO3-2 peak spectrum and microhardness values (p < 0.05). There was a difference between FV and FV-C in the carbonate v2 band in the acidic beverage demineralised varnish groups (p < 0.05). Other band areas and CO3-2 /PO4-3 ratios of the varnish areas against the erosion and control areas showed similar results (p > 0.05). Microhardness analyses showed that the BAG group demineralized with acidic syrup and the FV group demineralized with acidic drink were similar to the control group (p > 0.05). The varnishes tested in our study showed a similar protective effect against erosion as fluoride varnishes.

Parental perception of the application of silver diamine fluoride (SDF) for dental caries treatment among Iraqi school children: a cross-sectional study

OBJECTIVES

The present study aimed to assess parental acceptance of silver diamine fluoride (SDF) treatment for dental caries in children in Najaf city, Iraq.

METHODS

A cross-sectional design was used, involving 670 parents of children aged 6-7 years from primary schools in Najaf city, Iraq, during the academic year 2023-2024. The participants were selected via a multistage random sampling method. A structured questionnaire was administered to gather the participants' views on tooth staining caused by SDF application to cavitated teeth. Statistical procedures included descriptive analysis, chi-square tests, and ordinal logistic regression.

RESULTS

In total, 670 parents were recruited for this study. The mean age of the participants was 34.47 ± 8.2 Approximately half of the respondents were male and aged 31-50 years, and approximately three-fourths of the parents reported having a low education level and were in the low-income category. Parental acceptance of SDF treatment was greater for posterior teeth, with 51.2% agreeing, and 24.2% strongly agree. For anterior teeth, acceptance was lower, with only 23.3% agreeing and 10.7% strongly agreeing. Parental age (p = 0.008), education level (p < 0.001), and income (p = 0.003) were significantly associated with acceptance of SDF treatment for posterior teeth. However, for anterior teeth, parental education (p < 0.001) and income (p = 0.029) were significantly associated with acceptance of SDF treatment.

CONCLUSION

Parents showed high acceptance of SDF treatment, particularly for posterior teeth, although concerns about aesthetics affected their views of anterior teeth. Improving parents' awareness and addressing their apprehensions could increase the adoption of this evidence-based caries management approach for children.

The advancement of nanosystems for drug delivery in the prevention and treatment of dental caries

The dental caries remains a globally prevalent disease. Although its incidence has decrease due to enhancements in sanitation policies and public health measures, the treatment and prevention of dental caries still pose significant challenges. Within the oral cavity, traditional drug delivery systems suffer from limitation such as inadequate tissue penetration, short duration of action at target site, and low specificity, which minimally affect the prevention and treatment of dental caries. Consequently, nanosystem for drug delivery, offering enhanced drug stability, solubility, and bio-availability while reducing side effects, garnering attention increasing attention in the fight against dental caries. Therefore, this review examines the role of nanosystems for drug delivery in combating dental caries by inhibiting bacteria survival, biofilm formation, demineralization, and promoting remineralization, and exploring their potential to become the mainstream means of prevention and treatment of dental caries in future.

Size-controllable synthesis of hydroxyapatite nanorods via fluorine modulation: applications in dental adhesives for enhanced enamel remineralization

BACKGROUND

There has been little application of fluorine-substituted hydroxyapatites (FHAs) in dental adhesives. Previous studies primarily focused on the effect of fluoride content on enamel remineralization, neglecting the role of FHA particle size. This study aimed to synthesize uniform FHA nanorods of varying sizes by adjusting the fluorine doping levels, and to investigate the synergistic effects of the fluorine content and nanorod size on enamel remineralization by incorporating the FHA nanorods into adhesives.

METHODS

FHA nanorods with varying fluorine doping levels and sizes were synthesized based on a hydrothermal method. The characterization analyses of FHA nanorods were demonstrated by X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), and transmission electron microscopy (TEM). The composite adhesives containing 10 wt% different FHA nanorods were characterized via scanning electron microscopy (SEM). The colloidal stability, light-curing poperties, and degree of conversion (DC %) were assessed. The shear bond strength (SBS) was determined and the failure mode analysis was reported. The release of Ca2+ and F- within 30 days was detected. The remineralization was evaluated via SEM, energy dispersive X-ray spectroscopy (EDS), XRD, and micro-hardness through in vitro and in vivo experiments. Statistical analyses were performed using the Shapiro-Wilk test, Levene test, one-way ANOVA, Tukey HSD method, Welch test, Tamhane test, Fisher's exact test and Kruskal-Wallis test (α = 0.05).

RESULTS

Uniform FHA nanorods of varying sizes were synthesized by adjusting the fluorine doping level (2 wt%, 6 wt%, and 10 wt%). The lengths of these FHA nanorods were 505.31 ± 104.43 nm, 111.27 ± 22.89 nm, and 66.21 ± 12.68 nm, respectively. The composite adhesives containing FHA nanorods showed good colloidal stability and appropriate light-curing properties. The SBS of composite adhesives decreased due to the incorporation of FHA nanorods, but the values still remained within the clinically required range. Three groups of the composite adhesives could release Ca2+ and F- continuously. The group of 10 wt% F-doped HA nanorods with shorter lengths exhibited more mineral deposition and absorption of Ca²⁺ onto the adhesive and enamel surfaces.

CONCLUSIONS

The strategy of adding the synthesized FHA nanorods into dental adhesives can be an effective approach to promote enamel remineralization, while maintaining adequate bond strength. The 10 wt% F-doped HA nanorods with shorter lengths exhibited superior remineralization.

Nanomaterial-based synergistic strategies for combating dental caries: progress and perspectives

Dental caries, as the predominant global oral disease, remains a critical public health issue worldwide, particularly in socioeconomically disadvantaged communities. However, common caries prevention approaches (e.g., oral health education, mechanical plaque removal, and delivery of fluoride agents) are still insufficient for optimal caries management, and therefore, alternative regimens that can supplement existing strategies are highly warranted. Nanomaterials exhibit considerable potential in combating cariogenic pathogens and biofilms owing to their promising antimicrobial capacity, improved penetration into biofilms, targeted precision delivery, and versatile physicochemical properties. As unifunctional materials are limited in caries management, this review underscores the latest advancement in multifunctional anti-caries nanomaterials/nanomedicines. It highlights the cutting-edge materials developed or engineered to (i) incorporate diagnostic capabilities to prevent caries at an early stage, thus enhancing treatment efficiency, (ii) integrate mechanical "brushing" with anti-caries approaches to mechanochemically eradicate biofilms, (iii) exert antimicrobial/antibiofilm effects while preserving dental hard tissue. The current work also outlines future directions for optimizing nanosystems in the management of dental caries while emphasizing the need for innovative solutions to improve preventive and therapeutic efficacies.

Antimicrobial and Remineralization of Carboxymethyl Chitosan and Xylitol Functionalized Carbon Dots Coating on Orthodontic Brackets

Purpose

During fixed orthodontic treatment, oral hygiene is difficult to ensure and can easily lead to an imbalance in the oral micro-ecological balance. In this study, based on the adhesive properties of polydopamine (PDA) and the good antimicrobial and remineralization properties of carboxymethyl chitosan (CMC) and xylitol (Xy), new nanocomposites with both antimicrobial and remineralization capabilities were prepared to coat on orthodontic brackets.

Methods

Composite carbon dots (CDs) were synthesized using carboxymethyl chitosan and xylitol, we characterized them and the antimicrobial properties of the CMC-Xy-CDs were investigated by co-cultivation with S. mutans in vitro and in vivo. The composite coating was then adhered to the brackets. After the characterization measurements, antibacterial properties against S. mutans and the ability to promote remineralization of isolated teeth were investigated.

Results

Biological studies demonstrated that L929 cells co-cultured with CMC-Xy-CDs did not observe significant cytotoxicity and CMC-Xy-CDs have good biocompatibility. In the adhesive action of PDA, various characterizations have proved that CDs are modified on the brackets surface. In the antibacterial experiment, CMC-Xy-CDs and the adhesive coating on the brackets were found to have better antibacterial performance than the control group, with an antibacterial rate of up to 80%. In the animal experiment, the results of CMC-Xy-CDs promoting the healing of S. mutans infection wound models showed that there was a significant difference at 7d (P < 0.001), indicating that the experimental group had good antibacterial effects. The SEM of teeth after CMC-Xy-CDs promoted remineralization showed that the structure of the tooth surface became dense and some precipitation appeared, and the surface hardness measurement was significantly increased (p<0.0001).

Conclusion

Our study revealed that new nanocomposites with both antimicrobial and remineralization capabilities coated on orthodontic brackets provide a good basis for future clinical applications.

Biomimetic and protective effects of bioactive toothpastes on eroded enamel surfaces

This study aimed to evaluate the effectiveness of bioactive toothpastes in remineralizing eroded enamel surfaces in vitro. Bovine enamel blocks (n = 48) were obtained and classified into untreated, demineralized, and treated areas. Specimens were randomly classified into six groups (n = 8 each): fluoride-free toothpaste (NCT), Colgate Total 12 (PCT), Sensodyne Repair and Protect (SRP), Sensodyne Pronamel (SPE), Regenerador + Sensitive (RGS), and RGS/calcium booster (RCB). The specimens were subjected to erosive pH cycling for 5 days for 4 times/day (90 s) and treated with toothpaste slurries (1:3) for 1 min. The Vickers hardness (50 g/10 s) and percentage surface hardness recovery (%SMHR) were calculated. Furthermore, the topography and roughness (Ra) of the enamel surface were evaluated using a 3D non-contact optical profilometer, along with the tooth surface loss (TSL). Data were statistically analyzed using analysis of variance or Tukey's test (significance: 5%). The %SMHR of the SRP and NCT groups were significantly lower than those of the other groups (p < 0.05). Ra was higher when the eroded area was treated with SRP and SPE (p < 0.05). Treatment with RGS, PCT, and SPE favored the recovery of the enamel surface compared with the NCT group (p < 0.05). The best TSL results were obtained with treatment with RGS, followed by PCT and SPE (p < 0.05). The RCB group showed statistically equivalent results for surface hardness recovery and TSL (p > 0.05). Conclusively, PCT and RGS toothpastes were more effective in remineralizing the enamel surface.

Effects of Adding Tricalcium Silicate Nanoparticles to the Universal G2 Bond Adhesive as Self-Etch Mode on the Shear Bond Strength to the Orthodontic Bracket

OBJECTIVE

This study investigated the effects of adding tricalcium silicate nanoparticles (TCSNp) to the universal G2 bond adhesive (G2BU) in self-etch (SE) mode on shear bond strength (SBS) to orthodontic brackets, cytotoxicity, and degree of conversion (DC).

MATERIAL AND METHODS

A total of 176 human teeth were divided into four groups based on TCSNp concentration in G2BU adhesive: 0% (control), 1%, 3%, and 5%. The G2BU adhesive consists of a hydrophilic primer (P) and a hydrophobic bonding agent (2B). TCSNp were added to the 2B component by mixing 0.1, 0.3, and 0.5 g of TCSNp with 9.9, 9.7, and 9.5 g of 2B, respectively. SBS was assessed after 24 h of water storage and 5000 thermocycles using a universal testing machine. Cytotoxicity was evaluated using the MTT assay on rat embryo fibroblast cells, and DC was measured using fourier-transform infrared spectroscopy. Statistical analysis included one-way ANOVA and Tukey's post-hoc test, with significance set at p < 0.05.

RESULTS

After 24 h, mean SBS values were 15.58 MPa (control), 13.66 MPa (1% TCSNp), 15.99 MPa (3% TCSNp), and 12.04 MPa (5% TCSNp). After 5000 thermocycles, SBS values decreased to 12.91 MPa (control), 12.42 MPa (1% TCSNp), 11.11 MPa (3% TCSNp), and 10.21 MPa (5% TCSNp). ANOVA showed significant differences between groups (p < 0.05), except between the control and 3% TCSNp groups. Cell viability increased with higher TCSNp concentrations, with significant differences at 72 h between control and 5% TCSNp groups (p = 0.014). Mean DC values were 51.66% (control), 49.33% (1% TCSNp), 49.66% (3% TCSNp), and 48% (5% TCSNp). ANOVA indicated no significant differences between groups.

CONCLUSIONS

Adding TCSNp to G2BU in SE mode maintains clinically acceptable SBS levels and enhances cytocompatibility. Higher TCSNp concentrations may reduce SBS and DC slightly. Further studies are needed to evaluate long-term effects.

Updates on the clinical application of glass ionomer cement in restorative and preventive dentistry

The World Health Organization (WHO) has added glass ionomer cement (GIC) to the WHO Model List of Essential Medicines since 2021, which represents the most efficacious, safe and cost-effective medicines for priority conditions. With the potential increase in the use of GIC, this review aims to provide an overview of the clinical application of GIC with updated evidence in restorative and preventive dentistry. GIC is a versatile dental material that has a wide range of clinical applications, particularly in restorative and preventive dentistry. It has unique properties, such as direct adhesion to tooth structures, minimal shrinkage or expansion, a similar coefficient of thermal expansion to natural tooth structure, biocompatibility, and long-lasting fluoride release. According to the chemical composition, GIC can be classified as conventional glass ionomer cement (CGIC) and resin-modified glass ionomer cement (RMGIC). It has been used as restorative materials, luting cement for indirect restorations, liner and base of restorations, and dental sealants. While its use as a base material and liner is debatable, the clinical application of GIC as restorative cement, luting cement, and dental sealant is supported by current research.

Effect of Fluoride-incorporated Bioactive Glass Toothpaste on Remineralization of Primary Enamel Lesions: An In-Vitro Study

Aims

This study aimed to evaluate the enamel remineralization effect of fluoride-incorporated bioactive glass (F-BG) toothpaste on artificial subsurface caries in primary teeth.

Materials and Methods

Forty sound primary maxillary incisors were subjected to a demineralizing solution for four days to induce artificial enamel caries. The teeth were randomly divided into four experimental groups (n = 10 per group): Group I, F-BG toothpaste (530 ppm fluoride) (BiominF®); Group II, 0.22% sodium fluoride toothpaste (1000 ppm fluoride) (Colgate®); Group III, 0.32% sodium fluoride toothpaste (1450 ppm fluoride) (Colgate®); and Group IV, deionized water as a control. Over the course of seven days, each specimen was treated with a slurry of the respective toothpaste twice daily, followed by pH cycling to simulate oral conditions. Mineral density (MD) values were measured at depths of 0, 40, 80, and 120 μm using micro-computed tomography (micro-CT) before and after the pH cycling. The percentage of remineralization was calculated based on changes in MD. Statistical comparisons among the groups were made using one-way analysis of variance (ANOVA), followed by post-hoc Bonferroni tests, with a significance level set at P < 0.05.

Results

At depths of 0, 40, and 80 μm, both F-BG toothpaste (Group I) and the 1450 ppm fluoride toothpaste (Group III) demonstrated significantly higher remineralization than the 1000 ppm fluoride toothpaste (Group II) and the control group (Group IV) (P < 0.05). No significant difference in remineralization was observed between Group I and Group III (P > 0.05). At a depth of 120 μm, none of the test groups showed significant remineralization compared to the control group.

Conclusions

The fluoride-incorporated bioactive glass toothpaste (530 ppm fluoride) demonstrated remineralization effects on enamel comparable to those of the 1450 ppm fluoride toothpaste in terms of both surface and subsurface enamel restoration in primary teeth. Clinically, this suggests that F-BG toothpaste may be a viable alternative for remineralization therapy in pediatric populations, especially in situations where lower fluoride concentrations are preferred for young children. Further long-term studies are needed to assess the clinical durability and efficacy of F-BG toothpaste in caries prevention and management.

Nano-Hydroxyapatite toothpaste of rice field snail shell combined with basil leaf extract as a remineralizing and antibacterial agent to prevent dental caries

Background

This study aimed to compare rice snail shell nano-hydroxyapatite (nano-HAp) toothpaste combined with basil leaf extract and 1450 ppm fluoridated herbal toothpaste as remineralizing and antibacterial agents.

Material and Methods

Experimental toothpastes were prepared with different concentrations of nano-HAp (5% nano-HAp, 10% nano-HAp) and a fixed concentration of basil leaf extract (5% extract). 24 bovine tooth enamel samples were divided into 4 treatment groups. After 6 days of pH cycling, surface microhardness was tested using Vickers Microhardness Test and microporosity was observed using Scanning Electron Microscopy (SEM). The pitting diffusion method was used to test the antibacterial activity of toothpaste against Streptococcus mutans and Lactobacillus acidophilus.

Results

Enamel surface microhardness showed an increase with increasing nano-HAp concentration, while fluoride toothpaste showed the highest level of surface microhardness. Microporosity observation showed the disappearance of microporosity as nano-HAp concentration increased, while fluoride toothpaste still left microporosity. Antibacterial activity of the toothpaste showed that the mean inhibition zone of each group was not significantly different with a very strong inhibition zone.

Conclusions

Rice snail shell nano-HAp toothpaste combined with 5% basil leaf extract is effective as a remineralizing agent by reducing the level of tooth enamel microporosity but cannot match 1450 ppm fluoride toothpaste in increasing surface hardness. In addition, nano-hydroxyapatite toothpaste of paddy field snail shell combined with 5% basil leaf extract is effective as an antibacterial agent for preventing dental caries because it has antibacterial activity equivalent to 1450 ppm fluoride herbal toothpaste. Key words:Nano-hydroxyapatite, basil leaf extract, toothpaste, remineralization, antibacterial.

Applications of smart materials in minimally invasive dentistry - some research and clinical perspectives

OBJECTIVES

Dental caries is one of the most prevalent bacteria-induced non-communicable diseases globally. It is known to be the top oral health burden in both developing and developed nations. There is substantial literature on the disease process and there is still debate on the extent of caries removal needed and the adequacy of the materials available to restore the lost tooth structure. The current review discusses the disease process together with the contemporary management of the carious lesion and also presents substantial evidence on novel materials and techniques that make minimally invasive dentistry predictable.

METHODS

The written work presented shows the most relevant literature for the management of dental caries focusing on novel materials used in minimally invasive dentistry.

RESULTS

There is still much to learn about specific antimicrobial and caries prevention mechanisms of novel materials. Materials that respond to a single or a few stimuli remain "weakly intelligent" in the face of the complex microenvironment in the oral cavity. Engineered systems that combine artificial intelligence and chemical engineering, are expected to possess higher intelligence, self-healing capabilities as well as environmental adaptability, and may be future promising research directions.

SIGNIFICANCE

The targeted approach in managing dental caries will hopefully have a better clinical outcome. The strategies discussed are alternatives to the contemporary approach and will improve the clinical management.

The Remineralization of Enamel from Saliva: A Chemical Perspective

The natural remineralization of enamel is of major importance for oral health. In principle, early erosions (demineralization) induced by acidic beverages and foods as well as initial caries lesions can be covered and remineralized by the deposition of calcium phosphate, i.e., tooth mineral. This remineralization effect is characterized by the presence of calcium and phosphate ions in saliva that form hydroxyapatite on the enamel surface. Although it is apparently a simple crystallization, it turns out that remineralization under in vivo conditions is actually a very complex process. Calcium phosphate can form a number of solid phases of which hydroxyapatite is only one. Precipitation involves the formation of metastable phases like amorphous calcium phosphate that convert into biological apatite in a number of steps. Nanoscopic clusters of calcium phosphate that can attach on the enamel surface are also present in saliva. Thus, remineralization under strictly controlled in vitro conditions (e.g., pH, ion concentrations, no additives) is already complex, but it becomes even more complicated under the actual conditions in the oral cavity. Here, biomolecules are present in saliva, which interact with the forming calcium phosphate mineral. For instance, there are salivary proteins which have the function of inhibiting crystallization to avoid overshooting remineralization. Finally, the presence of bacteria and an extracellular matrix in plaque and the presence of proteins in the pellicle have strong influences on the precipitation on the enamel surface. The current knowledge on the remineralization of the enamel is reviewed from a chemical perspective with a special focus on the underlying crystallization phenomena and the effects of biological compounds that are present in saliva, pellicle, and plaque. Basically, the remineralization of enamel follows the same principles as calculus formation. Notably, both processes are far too complex to be understood on a microscopic basis under in vivo conditions, given the complicated process of mineral formation in the presence of a plethora of foreign ions and biomolecules.

Could the Arginine-Fluoride Association Have a Real Impact on Caries Prevention?

In the context of preventive therapy, fluoride has allowed the reduction of the incidence and prevalence of caries. The establishment of the protective role of arginine in the neutralization of plaque acids has led to the development of new arginine-fluorine associations to potentiate this preventive aspect. Studies have reported that this association could provide superior efficacy compared to fluoride alone. A synergistic effect that could be potential and thus represent a promising ecological approach for caries prevention. However, confirmation of the effective efficacy of the arginine-fluoride association requires additional clinical studies to be carried out before establishing recommendations.

Surface porosity of enamel white spot lesions and penetration of fluorapatite nanocrystals into their subsurface: proof-of-concept study

OBJECTIVES

In this study, we used atomic force microscopy (AFM) to quantify the size of surface pore apertures of enamel white spot lesions and then demonstrated the penetration of fluorapatite nanocrystals (nFA) into the subsurface of these lesions.

METHODS

For the porosity study, enamel lesions were created on three sound human teeth using a demineralizing gel for 8 days. The interface between sound enamel and the artificial lesion was analyzed by AFM. To visualize the penetration of nFA tagged with a calcium-binding fluorophore (Fluo-4) into the subsurface of white spot lesions, we used two-photon microscopy. Sixteen extracted human teeth with either active, natural, or in vitro-created carious lesions in enamel were randomly divided into three groups. The teeth were treated for 2 min with either a suspension of tagged nFA crystals, Fluo-4 alone, or deionized water, and left for 30 min before being washed with distilled water and examined microscopically.

RESULTS

A greater concentration of surface pores with larger areas was observed on the in vitro demineralized enamel (29 % of pores greater than 1.0 µm2) when compared with the adjacent sound enamel (8 % of pores greater than 1.0 µm2) (p=0.012, Fisher exact test). In vitro and natural lesions treated with tagged nFA showed fluorescence at depths ranging from 50 to 170 µm, demonstrating penetration of the nFA into the lesion subsurface. The lesions treated with Fluo-4 alone with no crystals showed mostly surface fluorescence (restricted to the outer 25 µm), while those treated with deionized water showed minimal (restricted to the outer 20 µm) to no fluorescence.

CONCLUSION

We have demonstrated the use of AFM to quantify the surface pore apertures and two-photon microscopy to visualize nFA crystals in the subsurface of non-cavitated enamel lesions.

CLINICAL SIGNIFICANCE

The restoration of the subsurface of non-cavitated caries lesions is a clinical challenge. This study demonstrated that a 2 min application of nFA could penetrate through the surface apertures of non-cavitated enamel lesions into their subsurface.

Evaluation of Mechanical and Elemental Properties of Bioceramic-Coated Orthodontic Brackets and Enamel Surface

OBJECTIVE

 The aim is to coat orthodontic brackets with two different bioactive materials and to compare the mechanical and morphological properties of coated brackets and tooth surfaces.

MATERIALS AND METHODS

 A total of 120 stainless steel brackets were divided equally into three groups, that is, the uncoated brackets and nanohydroxyapatite (nHA)-coated, and nanobioactive glass (nBG)-coated brackets using a spin coater machine. The brackets were bonded on the enamel surface and underwent remineralization/demineralization cycles for days 1, 7, 14, and 30. At each time interval, the bond strength of the brackets was assessed using mechanical loading. An optical and scanning electron microscope (SEM) were used for surface evaluation, and the adhesive remanent index (ARI) values were obtained and quantified.

STATISTICAL ANALYSIS

 One-way analysis of variance using Tukey's test was used to compare the differences among the groups.

RESULTS

 A uniform distribution of nanoparticles occurred on the surfaces of brackets. The shear bond strength (SBS) showed no significant differences in any tested groups on days 1, 7, and 14. However, control and nBG showed a significant difference from nHA at day 30. On days 7, 14, and 30, the nHA group showed the highest SBS values among the groups. For ARI, most samples showed an adhesive nature of failure at the enamel-brackets interface. The images confirmed the presence of coated particles on brackets and remnants of adhesives after SBS.

CONCLUSION

 This study confirmed that the nHA- and nBG-coated brackets have a high potential for application in orthodontics regarding structural and mechanical properties.

Morphological study of remineralization of the eroded enamel lesions by tyrosine-rich amelogenin peptide

BACKGROUND

Tyrosine-rich amelogenin peptide (TRAP) is the main amelogenin digestion product in the developmental enamel matrix. It has been shown to promote remineralization of demineralized enamel in our previous study. However, direct evidence of the effect of TRAP on the morphology and nanostructure of crystal growth on an enamel surface has not been reported. This study aimed to examine the effect of TRAP on the morphology of calcium phosphate crystals grown on early enamel erosion using a pH-cycling model.

METHODS

Eroded lesions were produced in human premolars by 30-second immersion in 37% phosphoric acid. Forty-five samples of eroded human premolar enamel blocks were selected and randomly divided into 3 groups: deionized water (DDW, negative control); 100 µg/mL TRAP, and 2 ppm sodium fluoride (NaF, positive control group). For 14 days, the specimens were exposed to a pH-cycling model. Using scanning electron microscopy (SEM) and atomic force microscopy (AFM) methods, the surface morphology, calcium-phosphorus ratio, and enamel surface roughness were examined. X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FT-IR) were used to assess crystal characteristics.

RESULTS

After pH-cycling, compared to the two control groups, the surface of the eroded enamel of the peptide TRAP group shows a large number of new, densely arranged rod-like crystals, parallel to each other, regularly arranged, forming an ordered structure, with crystal morphology similar to that of natural enamel. The crystals are mostly hydroxyapatite (HA).

CONCLUSION

This study demonstrates that the peptide TRAP modulates the formation of hydroxyapatite in eroded enamel and that the newly formed crystals resemble natural enamel crystals and promote the remineralization of enamel, providing a promising biomaterial for remineralization treatment of enamel lesions.

A comparative evaluation of human enamel remineralization ability of biomimetic nacre against casein phosphopeptide-amorphous calcium phosphate: An in vitro study

Introduction

This study aimed to assess and compare the efficacy of Nacre and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on the remineralization of enamel using surface microhardness analysis, scanning electron microscopy (SEM), and energy dispersive X-ray (EDX) spectroscopy.

Materials and Methods

Twenty human maxillary premolars extracted for orthodontic reasons were collected. Under cool water spray, the crowns were sectioned mesiodistally into buccal and palatal halves using a diamond disc. The samples were subsequently mounted in self-cure acrylic resin. The samples were then subjected to Vickers hardness testing and SEM-EDX for baseline. To simulate carious lesions, all of the samples were acid-etched with 37% phosphoric acid for 30 s in a specific area on the enamel samples and subjected to surface microhardness testing and SEM-EDX. The enamel samples were randomly assigned to Group 1: Nacre water-soluble matrix (WSM), Group 2: Nacre varnish, and Group 3: CPP-ACP for remineralization. After 21 days, remineralization assessment of the test samples was done using SMH analysis and SEM-EDX analysis. Data obtained were statistically analyzed using the one-way analysis of variance to reveal the significant differences between the groups. Tukey's test was used for post hoc comparisons.

Results

All three groups showed a significant increase in surface microhardness. All three groups showed a significant calcium and phosphorous ratio increase after remineralization. Among the three groups, the highest Ca:P ratio was seen in the Nacre WSM group (0.58) followed by the Nacre Varnish (0.57) and CPP-ACP group (0.57). SEM images of the Nacre surface revealed the presence of extensive interlocking. A layer of packed hydroxyapatite particles was formed on the surface of the nacre through surface reactions.

Conclusion

All the groups in the present study showed some extent of remineralizing ability irrespective of the different materials and mechanisms of action. Nacre WSM showed a remarkable hardness spike close to natural enamel after demineralization.

Surface and Mineral Changes of Primary Enamel after Laser Diode Irradiation and Application of Remineralization Agents: A Comparative In Vitro Study

OBJECTIVES

The purpose of this study is to evaluate the remineralization potential of primary teeth enamel after being exposed to different laser diode therapies.

METHODS

Ninety-six vestibular primary teeth enamel samples were divided into eight groups (n = 12) with varying treatments: control (G1), CPP-ACP-fluoride varnish (G2), diode lasers at 980 nm (G3), 808 nm (G4), 450 nm (G5), 980 nm + CPP-ACP-fluoride varnish (G6), 808 nm + CPP-ACP-fluoride varnish (G7), and 450 nm + CPP-ACP-fluoride varnish (G8). Each sample was assessed using a DIAGNOdent® (KaVo Dental, Biberach, Germany), at baseline, post-treatment, and post-pH cycle remineralization. SEM imaging was performed before and after treatment and following the pH cycle.

RESULTS

The results indicated that the 980 nm and 808 nm diode lasers, both alone and in combination with CPP-ACP-fluoride varnish, either maintained or increased the calcium (Ca) weight percentage (Wt%) in the enamel. The 980 nm diode laser combined with CPP-ACP-fluoride varnish (G6) showed a significant increase in Ca Wt%, suggesting a strong remineralization effect. Similarly, the 808 nm diode laser alone (G4) also promoted a substantial increase in Ca Wt%. In contrast, the 450 nm diode laser, whether applied alone or in combination with CPP-ACP-fluoride varnish, resulted in a lower Ca Wt% and an increase in phosphorus (P) Wt%. Most groups, except for the CPP-ACP-fluoride varnish alone (G2), demonstrated an increase in P Wt%, indicating a complex interaction between laser therapy and enamel remineralization.

CONCLUSIONS

The combined use of laser therapy with CPP-ACP-fluoride varnish significantly enhanced the remineralization of temporary teeth enamel. The 980 nm diode laser + CPP-ACP-fluoride varnish showed the most pronounced improvement in remineralization, while the 808 nm diode laser alone also effectively increased calcium solubility. These findings suggest that higher-wavelength diode lasers, particularly when combined with remineralizing agents, can effectively enhance the mineral content of primary teeth and promote enamel remineralization.

The Effect of Formulated Dentin Remineralizing Gel Containing Hydroxyapatite, Fluoride, and Bioactive Glass on Dentin Microhardness: An In Vitro Study

Objectives

This study aimed to develop a gel with dentin-remineralizing properties, integrating nano-hydroxyapatite (nHA), sodium fluoride (NaF), and bioactive glass (BG).

Materials and Methods

The enamel layer of 40 bovine incisors was removed. The samples were allocated into four groups of 10 each, based on varying concentrations of nHA, BG, and NaF in the gel compositions (wt%): (1) 2.5%-7.5%-0.05%, (2) 5%-5%-0.05%, (3) 7.5%-2.5%-0.05%, and (4) a control group with a base gel lacking remineralizing agents. After 8 hr of demineralization, the dentin surface microhardness was measured at depths of 30, 60, and 140 µm. After a 20-day pH cycling, the percentage of surface microhardness recovery (SMHR%) was measured and compared among the groups using the ANOVA and Tukey HSD post hoc tests (α = 0.05). Scanning electron microscopy analysis evaluated each specimen's superficial morphology.

Results

At all depths, the SMHR% of the Group 2 and Group 3 was significantly higher than the control group (p  < 0.05). The SMHR% Group 1 (67.39% ± 29.34%) was significantly higher than the control group (-21.24% ± 51.72%) only at the depth of 30 μm (p = 0.047). Group 3 had higher SMHR% than Group 2 at all depths; however, the difference was not statistically significant. Moreover, the SMHR% of Group 3 was significantly higher than that of Group 1 at depths of 30 μm (187. 94% ± 68.95% vs. 67.39% ± 29.34%; p = 0.005) and 60 μm (179.55% ± 75.96% vs. 64.34% ± 41.96%; p = 0.043). Surface deposition and tubule occlusion were observed in the Groups 2 and 3 samples, which was more prominent in the latter.

Conclusions

Combining 7.5% nHA, 2.5% BG, and 0.05% NaF could potentially remineralize primary carious lesions.

The damage and remineralization strategies of dental hard tissues following radiotherapy

OBJECTIVES

This study pursued two main purposes. The first aim was to expound on the microscopic factors of radiation-related caries (RRC). Further, it aimed to compare the remineralization effect of different remineralizing agents on demineralized teeth after radiotherapy.

METHODS

The enamel and dentin samples of bovine teeth were irradiated with different doses of radiation. After analysis of scanning electron microscope (SEM), X-Ray diffraction (XRD), and energy dispersive spectrometer (EDS), the samples irradiated with 50 Gy radiation were selected and divided into the demineralization group, the double distilled water (DDW) group, the Sodium fluoride (NaF) group, the Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) group, the NaF + CPP-ACP group, and the Titanium tetrafluoride (TiF4) group. After demineralization, remineralizing agents treatment, and remineralization, the samples were evaluated using SEM, atomic force microscope (AFM), EDS, and transverse microradiography (TMR).

RESULTS

A radiation dose of 30 Gy was sufficient to cause damage to the dentinal tubules, but 70 Gy radiation had little effect on the microstructure of enamel. Additionally, the NaF + CPP-ACP group and the TiF4 group significantly promoted deposit formation, decreased surface roughness, and reduced mineral loss and lesion depth of demineralized enamel and dentin samples after radiation.

CONCLUSIONS

Radiation causes more significant damage to dentin compared to enamel. NaF + CPP-ACP and TiF4 had a promising ability to promote remineralization of irradiated dental hard tissues.

ADVANCES IN KNOWLEDGE

This in vitro study contributes to determining a safer radiation dose range for teeth and identifying the most effective remineralization approach for RRC.

Tooth whitening: current status and prospects

As a safe, effective, economical, and convenient technique, tooth whitening is one of the most popular treatments for improving tooth discoloration. This review summarizes the theoretical and recent research developments in the classification and mechanisms of tooth discoloration, as well as the principles, agents, effects, and side effects of tooth whitening techniques. The aim is to provide a basis for the clinical treatment of tooth whitening techniques and to suggest possible new ideas for further research. The accepted mechanism of whitening is the redox reaction of oxides in the whitening reagent, and the whitening effect is remarkable. However, side effects such as tooth sensitivity and irritation of gum and other oral soft tissues can still occur. It is recommended that more monitoring be carried out in the clinic to monitor these side effects, and care should be taken to protect the soft tissues in the mouth during office whitening procedures. Furthermore, there is a need to develop new additives or natural whitening products to reduce the occurrence of side effects.

Remineralizing effect of the association of nano-hydroxyapatite and fluoride in the treatment of initial lesions of the enamel: A systematic review

OBJECTIVE

Assessed the effect of dental products containing nano-hydroxyapatite (nano-HA) + fluoride on the remineralization of white spot lesions (WSL) in vivo or in situ.

METHODS

Seven databases were explored using a two-pronged approach (intervention/treatment). After screening, full-text assessment, and further exclusion, the qualitative synthesis of five studies (four clinical and one in situ) was performed. Based on the Cochrane collaboration guidelines relevant data of the studies were collected and summarized. The Cochrane risk of bias tool for randomized trials (RoB 2.0) was used to appraise the studies' methodological quality and the GRADE guidelines to assess their level of evidence. The RoB 2.0 domains were rated on their risk of bias (RoB) as low, high, or with some concerns, and an adaptation of the tool was used to the in situ study.

RESULTS

The included studies assessed 151 WSL in anterior permanent teeth, on patients with varying ages. The protocol application, treatment length (7d-12 w), and control groups varied greatly between the studies making the performance of a quantitative analysis unfeasible. The general RoB of the clinical studies was classified as being of low risk (n = 2) or some concerns (n = 2). The in situ study was considered as being of low risk. The level of the evidence was moderate. Most of the studies found moderate evidence regarding the superiority of this association in clinical settings.

CONCLUSION

Even with the nano-HA + fluoride promising results for the remineralization treatment of WSL, due to the restricted number of studies and types of products, its extended use cannot be recommended based on the current systematic review, especially when considering the moderate level of the evidence found.

CLINICAL SIGNIFICANCE

Due to the biocompatibility and higher surface coverage of nano-HA and the remineralization capacity of fluoride formulations, the association of these elements to remineralize WSL has been positively reported. After the collection and qualitative appraise of the data, the clinical evidence of the use of these dental products is promising but limited.

Fluoride-amorphous calcium phosphate and biomimetic nano-hydroxyapatite for enamel remineralization: An in-vitro study of surface microhardness and composition

AIM

Fluoride-Amorphous Calcium Phosphate and Biomimetic Nano-Hydroxyapatite for Enamel Remineralization; An In-Vitro Study of Surface Microhardness and Composition.

MATERIAL AND METHODS

Ninety-six extracted human premolars with sound buccal surface were divided using a randomization computer-generating software into four groups; Group I (control) sound untreated enamel, Group II (demineralized) demineralized to create white spot lesions, Group III (biom-n-HA) demineralized and then treated with biomimetic nanohydroxyapatite cream, and Group IV (F-ACP) demineralized and then treated using Fluoride-Amorphous Calcium Phosphate varnish. Each group was divided into two subgroups; subgroup "A" evaluated for mineral content using energy dispersive x-ray spectroscopy (EDX) and for surface microhardness using the Vickers microhardness test and Subgroup "B" evaluated for white spot lesion depth using a polarized light microscope (PLM).

RESULTS

The highest microhardness (VHN) was found in the (F-ACP) group (mean=428.61±54.43) and then in the (Biom-n-HA) group (mean=408.11±70.16) followed by the (Control) group (mean=402.13±53.40) with no significant difference between them and finally in the significantly different (Demineralized) group (mean=256.99±45.83). The weight percentage of Ca (30.29±1.04 and 33.44±1.07) and Ca/P ratio (1.87±0.06 and 2.03±0.05) were significantly different between Group III and Group IV respectively. PLM measurements in Group II (198.83μm), Group III (60.17μm), and Group IV (26.33μm) were significantly different.

CONCLUSIONS

Both the (Biom-n-HA) cream and the (F-ACP) varnish showed promising results for enamel remineralization. The increased enamel surface microhardness was consistent with the mineral content and the changes in the birefringence.

Biomimetic Remineralization of Artificial Caries Lesions with a Calcium Coacervate, Its Components and Self-Assembling Peptide P11-4 In Vitro

The application of calcium coacervates (CCs) may hold promise for dental hard tissue remineralization. The aim of this study was to evaluate the effect of the infiltration of artificial enamel lesions with a CC and its single components including polyacrylic acid (PAA) compared to that of the self-assembling peptide P11-4 in a pH-cycling (pHC) model. Enamel specimens were prepared from bovine incisors, partly varnished, and stored in demineralizing solution (DS; pH 4.95; 17 d) to create two enamel lesions per sample. The specimens were randomly allocated to six groups (n = 15). While one lesion per specimen served as the no-treatment control (NTC), another lesion (treatment, T) was etched (H3PO4, 5 s), air-dried and subsequently infiltrated for 10 min with either a CC (10 mg/mL PAA, 50 mM CaCl2 (Ca) and 1 M K2HPO4 (PO4)) (groups CC and CC + DS) or its components PAA, Ca or PO4. As a commercial control, the self-assembling peptide P11-4 (CurodontTM Repair, Credentis, Switzerland) was tested. The specimens were cut perpendicularly to the lesions, with half serving as the baseline (BL) while the other half was exposed to either a demineralization solution for 20 d (pH 4.95; group CC + DS) or pHC for 28 d (pH 4.95, 3 h; pH 7, 21 h; all five of the other groups). The difference in integrated mineral loss between the lesions at BL and after the DS or pHC, respectively, was analyzed using transversal microradiography (ΔΔZ = ΔZpHC - ΔZbaseline). Compared to the NTC, the mineral gain in the T group was significantly higher in the CC + DS, CC and PAA (p < 0.05, Wilcoxon). In all of the other groups, no significant differences between treated and untreated lesions were detected (p > 0.05). Infiltration with the CC and PAA resulted in a consistent mineral gain throughout the lesion body. The CC as well as its component PAA alone promoted the remineralization of artificial caries lesions in the tested pHC model. Infiltration with PAA further resulted in mineral gain in deeper areas of the lesion body.

Efficacy of Self-assembling Peptide P11-4 in Remineralizing In Vitro Caries-like Lesions in Primary Enamel Samples in Combination with Calcium Phosphate-based Remineralization Agents

Aims and background

The efficacy of self-assembling peptide P11-4 in combination with calcium-phosphate-based remineralization agents in remineralizing caries-like lesions in primary enamel was evaluated using a 21-day pH cycling experiment by Vickers microhardness [Vickers hardness number (VHN)] and scanning electron microscopy (SEM).

Materials and methods

A total of 120 primary enamel samples were made to undergo a demineralization cycle to produce caries-like lesions. They were divided into six groups, namely negative control (NC), positive control (P11-4), and four interventional groups in which each of the following calcium-phosphate-based agents were used in combination with P11-4-calcium sucrose phosphate (CSP), bioactive glass (BG), casein phosphopeptides, and casein phosphopeptides with fluoride. A 21-day pH cycling experiment was carried out with alternating demineralization and remineralization phases. The enamel samples were analyzed at baseline, post production of caries-like lesions, and post 21-day pH cycling using Vickers microhardness and SEM. Results were statistically analyzed using repeated measures of analysis of variance (ANOVA), keeping the level of significance at 0.05.

Results

Supplementing P11-4 with calcium-phosphate-based agents improved the surface hardness of the demineralized primary enamel samples, among which the fluoridated milk protein-based remineralization agent yielded a statistically significant improvement.

Conclusion

P11-4 promoted the regeneration of incipient caries-like lesions. However, there is added benefit when this peptide is used in combination with a fluoridated calcium-phosphate-based agent.

Clinical significance

This study would help the clinician compose an effective regimen for the patient to follow at home posttreatment with P11-4, in-office treatment.

How to cite this article

Krishnamoorthi A, Shanbhog RS, Godhi BS, et al. Efficacy of Self-assembling Peptide P11-4 in Remineralizing In Vitro Caries-like Lesions in Primary Enamel Samples in Combination with Calcium Phosphate-based Remineralization Agents. Int J Clin Pediatr Dent 2024;17(5):552-557.

Enamel Matrix Derivative, 58S5 Bioactive Glass, and Fluoride Varnish for Enamel Remineralization: A Multi-analysis Approach

PURPOSE

This study aimed to evaluate the enamel remineralization efficacy of enamel matrix derivative (EMD), experimental bioactive glass (BAG), and fluoride varnish in vitro.

METHODS AND MATERIALS

Artificial initial caries lesions were developed on fifty human enamel specimens using demineralization solution (pH 4.5, 37°C, 96 hours). Specimens were randomly assigned to five groups (n=10): I-5% NaF varnish (Enamelast), II-experimental 58S5 BAG+37% phosphoric acid (PA), III-EMD (Emdogain) + Ethylenediaminetetraacetic Acid (EDTA), IV-EMD+37% PA, V-Control (untreated). All remineralization agents were applied with pH cycling for seven days. The specimens were scanned by spectral domain optical coherence tomography (SD-OCT) at baseline, at demineralization, and after pH cycling. Lesion depths were measured using image analysis software (ImageJ). Lesions were evaluated using surface microhardness (SMH) and two fluorescence methods (FluoreCam and DIAGNOdent Pen [DDPen]). The data were statistically analyzed by Kruskal Wallis, Friedman, and Wilcoxon tests (α=0.05).

RESULTS

According to SD-OCT results, fluoride varnish was found to be the most effective agent in reducing lesion depth (p=0.005). All agents increased the SMH values after pH cycling. No significant difference was found among fluoride varnish, BAG, and EMD+PA groups. These SMH values were significantly higher than EMD+EDTA and control groups (p<0.001). All groups showed lower DDPen scores compared with the control group (p<0.001), however, no significant difference was found among the remineralization agents. In FluoreCam assessment, size and intensity values of all treated groups showed improvement. However, there was no significant difference between the treatment groups in terms of FluoreCam size measurements (p=0.186).

CONCLUSION

58S5 BAG and EMD+PA have remineralization capacity as effective as fluoride varnish. EMD+PA showed better SMH and lesion intensity results than EMD+EDTA.

The Assessment of Resin-Based Composite Sealants' Effectiveness in Arresting Non-Cavitated Dentin Carious Lesions (ICDAS 3)-A 12 Month Follow-Up Preliminary Study

Background and Objectives: The therapeutic management of carious lesions remains a significant focus for researchers, given their persistently high prevalence despite being largely preventable. This study aimed to compare the effectiveness of a composite resin-based sealant material in halting extended non-cavitated dentin carious lesions when used therapeutically versus preventively on caries-free teeth over a period of twelve months. Materials and Methods: out of the 236 children examined, 45 were excluded from the study due to non-compliance with the inclusion criteria. Thus, the study included 191 children aged 10-12 years, and 764 molars in total. Results: among these molars, 171 were caries-free (ICDAS II code 0), forming the Control group, while 180 molars were classified with an ICDAS II score of 3, forming the Study group. All molars were sealed and evaluated at 6- and 12-month follow-up intervals. Both intervals revealed statistically significant differences (p < 0.05) in sealant retention and carious lesion development between sound (ICDAS code 0) and decayed (ICDAS code 3) teeth. Conclusions: the findings did not support the effectiveness of sealants in halting non-cavitated dentin carious lesions classified as ICDAS II with code 3 compared to their preventive application in sound teeth classified as ICDAS II with code 0.

Parental concerns about oral health of children: Is ChatGPT helpful in finding appropriate answers?

INTRODUCTION

Artificial intelligence (AI) is becoming an important part of our lives owing to increased data availability and improved power of computing. One of the recently launched modalities of AI, ChatGPT, is being enormously used worldwide for different types of tasks. In medical context, its use is being explored for clinical queries, academia, research help, etc. Further, literature suggests that parents seek information about health of their children using different Internet resources and would surely turn toward ChatGPT for the same, as this chatbot model is easy to use, generates "one" response, and is available without any subscription. ChatGPT generates a response using text cues and applying different algorithms on prepublished literature but is still in its naïve state; hence, it is imperative to validate the generated responses. Accordingly, we planned this study to determine the clarity, correctness, and completeness of some Frequently asked questions (FAQs) about child's oral health, from a mother's perspective.

METHODS

The study design was a vignette-based survey and included a set of 23 questions, for which ChatGPT was interviewed from the perspective of an imaginary parent. The answers responded by ChatGPT were copied "verbatim," and a Google survey form was designed. The survey form was validated and then sent to 15 pediatric dentists, and the responses were mainly collected on the Likert's scale with a provision of one open-ended question aiming to determine "what they would have added" to this generated response as an expert in the field.

RESULTS

The responses on Likert's scale were condensed and values ≥4 were considered 'adequate and acceptable' while scores ≤3, were considered 'inadequate'. The generated responses and comments mentioned by different respondents in the open-ended question were critiqued in reference to the existing literature.

CONCLUSION

Overall, the responses were found to be complete and logical and in clear language, with only some inadequacies being reported in few of the answers.

Comparative Evaluation of Remineralizing Potential of Topical Cream Containing Casein Phosphopeptide-Amorphous Calcium Phosphate and Casein Phosphopeptide-Amorphous Calcium Phosphate with Fluoride: An In Vitro Study

The requirement for clinically effective treatments to remineralize early enamel caries lesions is dictated by the principles of minimally invasive dentistry. Numerous studies outlined the significance of treating early carious lesions with different remineralizing agents. This study aimed to evaluate and compare the remineralization potential of topical cream containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and CPP-ACP with fluoride in remineralizing artificial carious lesions on enamel. Forty-five freshly extracted human premolar teeth were selected as samples. These samples were divided into three groups: Group I-regular toothpaste without specific remineralizing agent; Group II-topical cream containing CPP-ACP and Group III topical cream containing CPP-ACP with fluoride. All the samples were viewed under scanning electron microscope (SEM) to assess the topographical pictures of the enamel surface and also subjected to energy dispersing X-ray analysis (EDX) for quantitative estimation of minerals, calcium (Ca), and phosphorous (P). In the result of the study, Group I does not show any increase in the Ca and P after applying toothpaste without any remineralizing agent but Group II and Group III showed a net increase in Ca and P- values after applying concerned remineralizing agents. Intergroup comparison showed Group III yielded higher net Ca and P- values than Group II. Two remineralizing agents showed remineralization potential on samples. Descriptive statistics were used to calculate the mean and standard deviation. Mann-Whitney test was used. The level of significance was set at 0.05. CPP-ACP containing fluoride showed better remineralizing potential than CPP-ACP. Hence, CPP-ACP containing fluoride can be considered the material of choice in remineralizing early enamel carious lesions.

New generation of orthodontic devices and materials with bioactive capacities to improve enamel demineralization

OBJECTIVE

The article reviewed novel orthodontic devices and materials with bioactive capacities in recent years and elaborated on their properties, aiming to provide guidance and reference for future scientific research and clinical applications.

DATA, SOURCES AND STUDY SELECTION

Researches on remineralization, protein repellent, antimicrobial activity and multifunctional novel bioactive orthodontic devices and materials were included. The search of articles was carried out in Web of Science, PubMed, Medline and Scopus.

CONCLUSIONS

The new generation of orthodontic devices and materials with bioactive capacities has broad application prospects. However, most of the current studies are limited to in vitro studies and cannot explore the true effects of various bioactive devices and materials applied in oral environments. More research, especially in vivo researches, is needed to assist in clinical application.

CLINICAL SIGNIFICANCE

Enamel demineralization (ED) is a common complication in orthodontic treatments. Prolonged ED can lead to dental caries, impacting both the aesthetics and health of teeth. It is of great significance to develop antibacterial orthodontic devices and materials that can inhibit bacterial accumulation and prevent ED. However, materials with only preventive effect may fall short of addressing actual needs. Hence, the development of novel bioactive orthodontic materials with remineralizing abilities is imperative. The article reviewed the recent advancements in bioactive orthodontic devices and materials, offering guidance and serving as a reference for future scientific research and clinical applications.

Remineralizing effects of hydroxypropyl methylcellulose film-loaded amorphous calcium phosphate nanoprecursors on enamel artificial caries lesions

OBJECTIVES

This study was to investigate hydroxypropyl methylcellulose (HPMC) film as a carrier for amorphous fluorinated calcium phosphate (AFCP) nanoprecursors to continuously deliver biomimetic remineralization of enamel artificial caries lesions (ACL).

MATERIALS AND METHODS

The AFCP/HPMC films were comprised of 25 wt% AFCP nanoparticles and 75 wt% HPMC. They were characterized by transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and biocompatibility tests. Forty enamel ACL were prepared and randomly divided into four groups (n = 10): The enamel surfaces were covered with a pure HPMC film, Tooth Mousse Plus (contains 10% CPP-ACP and 0.2% NaF), and AFCP/HPMC film, or without any things (serving as negative control). Subsequently, all samples were alternatively kept in artificial saliva and a modified pH-cycling before they were characterized by Micro-CT, scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), attenuated total reflectance (ATR)-FTIR, XRD, and nanoindentation.

RESULTS

After the enamel ACL was challenged by pH cycling, Tooth Mousse Plus and AFCP/HPMC film groups exhibited less lesion depth and mineral loss than the negative control and pure HPMC film groups. Additionally, the AFCP/HPMC film group revealed a highest remineralization rate of 55.34 ± 3.10 % among the all groups (p < 0.001). The SEM findings showed that the enamel ACL were densely deposited with minerals in the AFCP/HPMC film group, and the EDX results suggested a higher content of fluorine in the remineralized tissues. In particular, the AFCP/HPMC film group exhibited the best nanomechanical performance after 2 weeks of pH cycling (p < 0.05), with the hardness (H) restored from 0.29 ± 0.19 to 2.69 ± 0.70 GPa, and elastic modulus (Er) restored from 10.77 ± 5.30 to 68.83 ± 12.72 GPa.

CONCLUSION

The AFCP/HPMC film might be used as a promising strategy for arresting or reversing incipient enamel caries lesions.

Amelogenin-inspired peptide, calcium phosphate solution, fluoride and their synergistic effect on enamel biomimetic remineralization: an in vitro pH-cycling model

BACKGROUND

Several methods were introduced for enamel biomimetic remineralization that utilize a biomimetic analogue to interact and absorb bioavailable calcium and phosphate ions and induce crystal nucleation on demineralized enamel. Amelogenin is the most predominant enamel matrix protein that is involved in enamel biomineralization. It plays a major role in developing the enamel's hierarchical microstructure. Therefore, this study was conducted to evaluate the ability of an amelogenin-inspired peptide to promote the remineralization potential of fluoride and a supersaturated calcium phosphate solution in treating artificially induced enamel carious lesions under pH-cycling regimen.

METHODS

Fifty enamel slices were prepared with a window (4*4 mm2 ) on the surface. Five samples were set as control healthy enamel and 45 samples were subjected to demineralization for 3 days. Another 5 samples were set as control demineralized enamel and 40 enamel samples were assigned into 8 experimental groups (n=5) (P/I, P/II, P/III, P/AS, NP/I, NP/II, NP/III and NP/AS) according to peptide treatment (peptide P or non-peptide NP) and remineralizing solution used (I; calcium phosphate solution, II; calcium phosphate fluoride solution, III; fluoride solution and AS; artificial saliva). Samples were then subjected to demineralization/remineralization cycles for 9 days. Samples in all experimental groups were evaluated using Raman spectroscopy for mineral content recovery percentage, microhardness and nanoindentation as healthy, demineralized enamel and after pH-cycling. Data were statistically analysed using two-way repeated measures Anova followed by Bonferroni-corrected post hoc test for pairwise multiple comparisons between groups. Statistical significance was set at p= 0.05. Additionally, XRD, FESEM and EDXS were used for crystal orientation, surface morphology and elemental analysis after pH-cycling.

RESULTS

Nanocrystals clumped in a directional manner were detected in peptide-treated groups. P/II showed the highest significant mean values in mineral content recovery (63.31%), microhardness (268.81±6.52 VHN), elastic modulus (88.74±2.71 GPa), nanohardness (3.08±0.59 GPa) and the best crystal orientation with I002/I300 (1.87±0.08).

CONCLUSION

Despite pH changes, the tested peptide was capable of remineralizing enamel with ordered crystals. Moreover, the supplementary use of calcium phosphate fluoride solution with peptide granted an enhancement in enamel mechanical properties after remineralization.

Pomegranate extract in polyphosphate-fluoride mouthwash reduces enamel demineralization

OBJECTIVES

To evaluate the anti-demineralizing effect of a mouthwash comprising pomegranate peel extract (PPE 3%), sodium trimetaphosphate (TMP 0.3%), and fluoride (F 225 ppm) in an in situ study, and to assess its irritation potential in an ex vivo study.

METHODS

This double-blind crossover study was conducted in four phases with 7 days each. Twelve volunteers used palatal appliances containing enamel blocks, which were subjected to cariogenic challenges. The ETF formulation (PPE + TMP + F, pH 7.0), TF formulation (TMP + F, pH 7.0), deionized water (W, pH 7.0), and essential oil commercial mouthwash (CM, 220 ppm F, pH 4.3) were dropped onto the enamel twice daily. The percentage of surface hardness loss, integrated loss of subsurface hardness, calcium, phosphorus, and fluoride in enamel and biofilms were determined. In addition, alkali-soluble extracellular polysaccharide concentrations were analyzed in the biofilms. The irritation potential was evaluated using the hen's egg chorioallantoic membrane test through the vascular effect produced during 300-s of exposure.

RESULTS

ETF was the most efficacious in preventing demineralization. It also showed the highest concentrations of calcium and phosphorus in the enamel and in the biofilm, as well as the lowest amount of extracellular polysaccharides in the biofilm. In the eggs, ETF produced light reddening, whereas CM led to hyperemia and hemorrhage.

CONCLUSIONS

The addition of PPE to formulations containing TMP and F increased its anti-demineralizing property, and this formulation presented a lower irritation potential than the CM.

CLINICAL RELEVANCE

ETF can be a promising alternative alcohol-free mouthwash in patients at high risk of caries.

The Influence of Fluoride Gels on the Physicochemical Properties of Tooth Tissues and Dental Materials-A Systematic Review

The aim of the presented systematic review is to update the state of knowledge and relate the properties and composition of fluoride gels to their potential application. This article aims to explore the effect of fluoride gel application on changes in the properties of dental biomaterials and tooth tissues. The review includes articles assessing studies on the effects of fluoride gel on dental tissues and materials. Employing the PRISMA protocol, a meticulous search was conducted across the PubMed, Scopus, and Web of Science databases, utilizing keywords such as fluoride, gel, and properties. The publications were selected without limitation by the year of publication, and then Cohen's κ test was used to assess the agreement of the respondents. Exclusion criteria included non-English studies, opinion pieces, editorial papers, letters to the editor, review articles and meta-analyses, clinical reports, studies lacking full-text accessibility, and duplicates. The quality of the chosen papers was assessed by two independent reviewers. A total of 2385 were located in databases, of which only 17 met the inclusion criteria. All publications showed increased surface mineralization, and seven studies showed the effect of fluoride gel on the surface of dental tissues. Three articles stated a negative effect of fluoride gels on titanium and stainless steel alloys and glass ionomer fillings. The effects on shear bond strength and plaque deposition require further investigation because the study results are contradictory.

Antibiofilm Properties and Demineralization Suppression in Early Enamel Lesions Using Dental Coating Materials

This study aimed to investigate the effects of dental coating materials on Streptococcus mutans biofilm formation. The test materials were PRG Barrier Coat (PRG), BioCoat Ca (BioC), and FluorDental Jelly (FluorJ). Bovine enamel specimens were demineralized to mimic early enamel lesions. The biofilm was developed on a specimen treated with one of the materials by using a modified Robbins device flow-cell system. Scanning electron and fluorescence confocal laser scanning microscopy, viable and total cell counts, and gene expression assessments of the antibiofilm were performed. Ion incorporation was analyzed using a wavelength-dispersive X-ray spectroscopy electron probe microanalyzer. All materials allowed biofilm formation but reduced its volume. FluorJ was the only material that inhibited biofilm accumulation and had a bactericidal effect, revealing 0.66 log CFU in viable cells and 1.23 log copy reduction in total cells compared with the untreated group after 24 h of incubation. The ions released from PRG varied depending on the element. BioC contributed to enamel remineralization by supplying calcium ions while blocking the acid produced from the biofilm. In summary, the dental coating materials physically prevented acid attacks from the biofilm while providing ions to the enamel to improve its mechanical properties.

Encapsulation of a novel peptide derived from histatin-1 in liposomes against initial enamel caries in vitro and in vivo

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.

Effectiveness of plant-mediated synthesis of hydroxyapatite nano-particles impregnated in Pistachio oleogum resin on mineral contents of human teeth. An in-situ single-blind controlled study

OBJECTIVES

This study aimed to synthesize and characterize an environmentally friendly nanohydroxyapatite (n-HA) and evaluate its impact on enamel mineral content when incorporated into a Pistachio oleo gum resin (Saqqez) bio-chewing gum for in-situ models. We compared the effects of this green nano-hydroxyapatite (G n-HA) with those of a commercially available synthetic nano-hydroxyapatite (S n-HA).

METHODS

Various analytical techniques were employed including XRD, FESEM, FT-IR, EDX/SEM and TGA/DTA to characterize the crystallinity, size and composition of the G n-HA powder. Three chewing gum groups were formulated: (1) Saqqez gum containing 10% wt G n-HA, (2) Saqqez gum containing 10% wt S n-HA, and (3) pure Saqqez gum. In order to evaluate the impact of these chewing gums on enamel, intraoral appliances were fabricated, each containing six enamel specimens. Participants were instructed to chew the gums while wearing these appliances. The calcium (Ca+2) and phosphorus (P) levels in enamel specimens, both with and without exposure to an acid challenge, were quantified using EDX/SEM. FE-SEM was employed to capture the microstructure of the enamel surface. In terms of the statistical analysis, one-way ANOVA and Tukey's post hoc tests were utilized to compare the data, where the significance level (α) was set at 0.05.

RESULTS

The characterization tests confirmed the successful synthesis of G n-HA. Furthermore, EDX/SEM analysis of the enamel specimens from the intraoral appliance revealed significant variations in calcium (Ca+2) content among the enamel specimens (P = 0.000). The S n-HA group, in particular, exhibited the highest Ca+2 content, while the pure Saqqez group displayed the lowest. Nonetheless, there was no statistically significant differences in phosphorus (P) content observed among the three groups (P = 0.27).

CONCLUSIONS

Saqqez gum can be considered a wholesome natural chewing gum that serves, as a carrier for delivering remineralization agents to the tooth surfaces. This was evident in the groups containing n-HA, exhibiting elevated Ca+2 levels. It's noteworthy that G n-HA demonstrated less efficacy in enamel remineralization compared to S n-HA.

Advances in Preventive and Therapeutic Approaches for Dental Erosion: A Systematic Review

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.

Effect of the association of microparticles and nano-sized β-calcium glycerophosphate in conventional toothpaste on enamel remineralization: In situ study

OBJECTIVES

This in situ study aimed to assess the remineralizing effect of a fluoride toothpaste supplemented with β-calcium glycerophosphate in both micro (β-CaGPm) and nano-sized forms (β-CaGPn).

METHODS

This blind and cross-over study was performed in 4 phases, each spanning 3 days. Twelve volunteers utilized palatal appliances containing four bovine enamel blocks with artificial caries lesions. Volunteers were randomly assigned to the following treatment groups: Placebo (no F-β-CaGPm-β-CaGPn); 1100 ppm F alone (1100F); 1100F plus 0.5% micrometric β-CaGP (1100F-0.5%β-CaGPm); and 1100F plus 0.25%nano-sized β-CaGP (1100F-0.25%β-CaGPn). Participants were instructed to brush their natural teeth with the palatal appliances in the mouth for 1 min (3 times/day), ensuring that the enamel blocks were exposed to the natural toothpaste slurries. Following each phase, evaluations were conducted to determine the percentage of surface hardness recovery (%SHR), integrated recovery of subsurface hardness (ΔIHR), profile subsurface lesion through polarized light microscopy (PLM), as well as fluoride (F), calcium (Ca), and phosphorus (P) concentrations within the enamel. Data were analyzed by ANOVA and Student-Newman-Keuls test (p < 0.001).

RESULTS

Treatment with 1100F-0.25%β-CaGPn resulted in %SHR ∼69 % and ∼40 % higher when compared to 1100F and 1100F-0.5%β-CaGPm (p < 0.001). The reduction in lesion body (ΔIHR; PLM) was ∼40 % higher with 1100F-0.25%β-CaGPn (p < 0.001) compared to 1100F. The addition of β-CaGPm and β-CaGPn did not influence enamel F concentration (p > 0.001). Treatment with 1100F-0.25%β-CaGPn led to an increase in the concentration of Ca and P in the enamel (p < 0.001).

CONCLUSION

The addition of 0.25%β-CaGPn into 1100F formulation increased the bioavailability of calcium and phosphate, promoting a higher remineralizing effect.

CLINICAL SIGNIFICANCE

Toothpaste containing 1100F-0.25%β-CaGPn showed a potential of higher remineralization to 1100 ppm F and 1100 ppm F micrometric β-CaGP could be a strategy for patients at caries activity.

A Remineralizing and Antibacterial Coating for Arresting Caries

Dental caries is a dynamic disease induced by the unbalance between demineralization of dental hard tissues caused by biofilm and remineralization of them; however, although various effective remineralization methods have been well documented, it is a challenge to reestablish the balance by enhancing remineralization alone while ignoring the antibacterial therapy. Therefore, the integration of remineralizing and antibacterial technologies offers a promising strategy to halt natural caries progression in clinical practice. Here, the conception of interrupting dental caries (IDC) was proposed based on the development of dual-functional coating with remineralizing and antibacterial properties. In this study, bovine serum albumin (BSA) loaded octenidine (OCT) successfully to form a BSA-OCT composite. Subsequently, through fast amyloid-like aggregation, the phase-transited BSA-OCT (PTB-OCT) coating can be covered on teeth, resin composite, or sealant surfaces in 30 min by a simple smearing process. The PTB-OCT coating showed satisfactory effects in promoting the remineralization of demineralized enamel and dentin in vitro. Moreover, this coating also exerted significant acid-resistance stability and anti-biofilm properties. Equally importantly, this coating exhibited promising abilities in reducing the microleakage between the tooth and resin composite in vitro and preventing primary and secondary caries in vivo. In conclusion, this novel dual-functional PTB-OCT coating could reestablish the balance between demineralization and remineralization in the process of caries, thereby potentially preventing or arresting caries.

Fluoride Release and Rechargeability of Poly(lactic acid) Composites with Glass Ionomer Cement

This study investigates the fluoride release, rechargeability and degradation behaviors of newly developed anticariogenic poly(lactic acid) (PLA) composites. The PLA composite with various concentrations (0%, 5%, 10%, 15% and 20% by weight) of glass ionomer cement (GIC) and sodium fluoride (NaF) were prepared using solvent casting method. The fluoride release, fluoride rechargeability and degradation behavior were evaluated. All experimental groups demonstrated fluoride-releasing ability. The highest level of fluoride ions released was found in PLA composite with sodium fluoride (PLA/NaF). Following the 28-day period, both groups showed a gradual reduction in fluoride ion released, ranging between 0.03 ± 0.01 and 0.53 ± 0.06 ppm, although remaining within the effective range for tooth remineralization. However, the rechargeability was only observed in PLA composite with GIC (PLA/GIC). Following an eight-week in vitro degradation test, all PLA/NaF groups displayed a significantly higher percentage of weight change and water absorption compared to the PLA/GIC and the control group. In SEM analysis, the formation of surface porosities was clearly noticed in all PLA/NaF. All specimens retained their structural integrity throughout the study. In conclusion, the newly developed PLA/GIC displays promising possibilities as an anticariogenic material. Furthermore, the rechargeability of these ions are repeatable, ensuring their long-term utility.

Remineralising potential of Ocimum basilicum varnish and fluoride varnish on initial enamel caries: An in vitro microscopic study

Background

The focus of caries research has switched to early identification and non-invasive treatment of carious lesions.

Aim

This study aimed to evaluate and compare the remineralising potential of Ocimum (O.) basilicum varnish and fluoride varnish on initial enamel caries.

Method

The authenticated O. basilicum seeds were procured from a repository, and the extract was prepared using the Soxhlet method, which was vortexed with Indian Pharmaceutical (IP)-graded chemicals to obtain varnish. Extracted premolar tooth samples were divided into three groups of 33 each after demineralisation with a pH of 4.5 for 48 hours at 37°C. Each group was subjected to remineralisation twice daily with respective agents for 4 minutes for 30 consecutive days. Each sample was ground-sectioned through an enamel window. The lesion depth was measured using a light microscope (Leica™ DM2500) and ImageJ software. The data were evaluated using analysis of variance (ANOVA) and post hoc analysis.

Results

The mean (± SD) pre-treatment lesion depth across the groups ranged from 242.11 ± 26.144 μm to 352.66 ± 34.531 μm. The highest lesion depth recovery rate of 45.938% was recorded for the fluoride varnish group, followed by 36.015% in the O. basilicum varnish group, which was statistically significant by Tukey's post hoc analysis (p < 0.001). The gingival fibroblast cells were viable by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay.

Conclusion

The O. basilicum varnish demonstrated a homogenous layer of mineral deposition. However, the remineralising efficacy was slightly lesser than that of the fluoride varnish. Hence, the novel O. basilicum-based remineralisation agent appears to have potential as a non-invasive alternative to topical fluorides in the therapy of early caries lesions.

Brief Narrative Review on Commercial Dental Sealants-Comparison with Respect to Their Composition and Potential Modifications

The scope of this paper is to compare different dental sealants and flow materials indicated for sealing pits and fissures considering their chemical formula. The narrative review aims to address the following questions: What is the essence of different dental sealants' activity, how does their chemical formula affect their mechanisms of caries prevention, and what makes a dental sealant efficient mean of caries prevention? Another vital issue is whether the sealants that contain fluoride, or any other additions, have potentially increased antimicrobial properties. An electronic search of the PubMed, Cochrane, Web of Science, and Scopus databases was performed. The following keywords were used: (dental sealants) AND (chemical composition). Additionally, information about composition and indications for clinical use provided by manufacturers were utilized. All of the considered materials are indicated for use both in permanent and primary dentition for sealing fissures, pits, and foramina caeca. The selection of suitable material should be made individually and adjusted to conditions of the sealing procedure and patient's needs. Cariostatic mechanisms increasing sealants' effectiveness such as fluoride release are desired in modern dentistry appreciating preventive approach. The review aims are to find crucial elements of sealants' composition which affect their cariostatic mechanisms.

Nanohydroxyapatite in dentistry: A comprehensive review

Enamel, being the hardest and the highest mineralized tissue of the human body, contains nearly 96% inorganic components and 4% organic compounds and water. Dentin contains 65% inorganic components and 35% organic and water content. The translucency and white appearance of enamel are attributed to Hydroxyapatite (HA), which constitutes the major part of the inorganic component of dental hard tissue. With the advent of nanotechnology, the application of Nanohydroxyapatite (nHA) has piqued interest in dentistry due to its excellent mechanical, physical, and chemical properties. Compared to HA, nHA is found to have superior properties such as increased solubility, high surface energy and better biocompatibility. This is due to the morphological and structural similarity of nanosized hydroxyapatite particles to tooth hydroxyapatite crystals. These nanoparticles have been incorporated into various dental formulations for different applications to ensure comprehensive oral healthcare. To prevent dental caries, several nHA based dentifrices, mouth rinsing solutions and remineralizing pastes have been developed. nHA-based materials, such as nanocomposites, nano impression materials, and nanoceramics, have proven to be very effective in restoring tooth deformities (decay, fracture, and tooth loss). The nHA coating on the surface of the dental implant helps it bind to the bone by forming a biomimetic coating. A recent innovative strategy involves using nHA to reduce dentinal hypersensitivity and to reconstruct periodontal bone defects. The purpose of the present review is to discuss the different applications of nHA in dentistry, especially in preventive and restorative dentistry, dental implantology, bleaching and dentine hypersensitivity management.

Carboxymethyl Chitosan-Fluoride-doped Amorphous Calcium Phosphate: A Novel Remineralizing Gel

Background

There is a need for innovative remineralizing gel formulations based on calcium and phosphates that can slowly release fluoride ions and enhance the formation of fluorapatite crystals that are more resistant to dissolution in an acidic environment.

Aim

The aim of the work was to formulate a remineralizing agent that remineralizes enamel through the release of Ca2+, PO₄³-, and F- ions for a prolonged period of time.

Materials and methods

The gel was based on carboxymethyl chitosan (CMC) as a bioinspired gelling agent and on Fluoride-doped Amorphous Calcium Phosphate (F-ACP) as a remineralizing agent. This gel was tested in vitro on the enamel of extracted premolars after demineralization with methacrylic acid gel.

Results

When compared to the control group and demineralized enamel group, the enamel slabs remineralized with CMC/F-ACP showed a higher calcium phosphate ratio in Energy-Dispersive X-ray (EDX) and better surface morphology under scanning electron microscope (SEM).

Conclusion

Remineralization tests performed on demineralized human permanent teeth proved that CMC/F-ACP gel has excellent efficacy, inducing a complete remineralization of the outermost layers of enamel as well as a full restoration of lost mineral content.

How to cite this article

Nimbeni BS, Nimbeni SB, Divakar DD, et al. Carboxymethyl Chitosan-Fluoride-doped Amorphous Calcium Phosphate: A Novel Remineralizing Gel. Int J Clin Pediatr Dent 2023;16(5):734-739.

Evaluation of Iontophoresis as a Tool in Comparison to Topical Remineralization Systems by Transverse Microradiography and Polarized Light Microscopy: An In Vitro Study

Aim

To compare the efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (GC Tooth Mousse) and tricalcium phosphate formulation (Clinpro) by topical application and iontophoresis.

Background

Noninvasive treatment of dental caries is a major advance in the clinical management of the disease.

Materials and methods

A total of 20 primary anterior and 20 primary molars were included in the study to be analyzed by transverse microradiography (TMR) and polarized light microscopy (PLM). The samples were coated with acid-resistant varnish, leaving a window on the buccal/lingual surface of enamel and immersed in demineralizing solution for 96 hours. Each sample was coated with varnish on the left half (control), and the right half served as a test. All the samples were divided into four groups. The test windows of specimens in groups I (GC Tooth Mousse) and II (Clinpro) were subjected to remineralization treatments for 10 days. Similarly, groups III and IV were subjected to iontophoresis using GC Tooth Mousse and Clinpro for 7 minutes. The samples were analyzed by TMR and PLM.

Results

There was no significant difference in the mean difference of mineral loss among the four groups. There was a significant difference in the mean difference of lesion depth among the four groups.

Conclusion

Both iontophoresis and topical application were equally efficient, but one remineralization by iontophoresis equals 10 topical applications.

How to cite this article

VC R, Muppa R, Nallanchakrava S, et al. Evaluation of Iontophoresis as a Tool in Comparison to Topical Remineralization Systems by Transverse Microradiography and Polarized Light Microscopy: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(S-1):S85-S90.