Remineralization of advanced root dentin lesions in vitro

Nanobacteria's potential involvement in enamel repair in caries

Dental caries is the accumulation of numerous episodes of demineralization and remineralization, rather than a unidirectional demineralization process. Demineralization and remineralization occur constantly either simultaneously or alternately and whether a lesion will progress or be repaired depends upon the predominant process over periods. Even if fluoride has demonstrated the anti-caries effect by shifting the demineralization/remineralization balance favorably, little is known about non-fluoride action in favor of the balance and the effect of fluoride could not fully explain enamel repair in caries. Recently, in vitro experiments demonstrated enamel repair by synthetic apatite nanocrystals which showed the strong affinity, excellent biocompatibility, mechanical improvement, and a higher resistance to acids than apatite from teeth. This reminds us of a controversial microorganism called nanobacteria (NB) which form nanocrystalline apatite around themselves. Although NB have been detected in some pathological calcifications, epidemiologic literature suggests that they are widespread present in the healthy people blood. Considering the similarity of synthetic nanocrystalline apatite to that of NB and blood circulation communicating with saliva, we put forward a hypothesis that NB may act in enamel surface just like what the synthetic nanocrystalline apatite does in vitro to repair enamel in caries.

Comparative assessment of hardening of demineralized dentin under lining materials using an ultramicroindentation system

The aim of the current in vitro study was to evaluate the influence of three lining materials with a reported mineralizing capacity on hardness and elasticity of demineralized dentin. Four standardized microcavities were prepared in exposed dentin surfaces of 16 extracted human molars each. Dentin was demineralized in 0.5M EDTA for 2 h. One microcavity was left empty. The others were filled with a resin-modified glass ionomer cement (RMGIC), a bioactive glass S53P4 suspension, and a prototype Ca-PO(4) cement. Teeth were then immersed in deionized water or simulated oral fluid. After 3 weeks, hardness and composite elastic modulus of the dentin subjacent to the microcavities were assessed under wet conditions using the ultramicroindentation system (UMIS). After immersion in deionized water, there was no significant improvement of the mechanical properties of dentin irrespective of the material applied beforehand, indicating a lack of direct material effects. Exposure to simulated oral fluid resulted in significantly (p < 0.05) higher hardness and composite elastic modulus values of the dentin subjacent to empty microcavities and counterparts lined with bioactive glass compared to corresponding dentin under the RMGIC. UMIS profiles showed little variance.

The influence of varying fluoride concentrations on in vitro remineralisation of artificial dentinal lesions with differing lesion morphologies

OBJECTIVE

The influence of low-level fluoride (F) concentrations and lesion characteristics on the remineralisation of sub-surface root caries was investigated in vitro.

DESIGN

Experimentally produced dentinal carious lesions were exposed to artificial saliva in the presence of 0.00ppm, 0.48ppm, 2.49ppm or 4.91ppm F (as NaF) for 5 days. Calcium, phosphate and fluoride ion uptake was quantified by chemical assay. Baseline changes in the mineral content and distribution of the lesions were assessed by transverse microradiography (TMR).

RESULTS

The uptake of calcium and phosphate was significantly increased (p<0.05) by fluoride, even at low concentrations. The action of fluoride was influenced by the mineral content and distribution of the lesions at baseline, however, with the location and degree of mineral deposition being strongly related to the mineral content of the lesions surface layer.

CONCLUSIONS

The process of remineralisation of root dentine is multifactorial. The morphology of lesions at baseline significantly affected the location and quantity of mineral deposition.

Micromorphological and micronanalytical characterization of stagnating and progressing root caries lesions

Root caries is the predominant disease of the tooth tissues in the elderly population and differs in progression and micromorphology from coronal dentin caries. Therefore, different clinical concepts are needed for the treatment of these progressing and arrested lesions. It was the aim of this study to investigate the three-dimensional structure and volume of stagnating and progressing root caries lesions and to determine the mineral composition of the different lesion zones to achieve a better understanding of the natural history of root caries lesion formation. Of 21 extracted human teeth of patients between 42 and 77 years of age with stagnating and progressing root caries lesions serial sections were cut and investigated with polarized light and scanning electron microscopy. From the polarized light micrographs 3D reconstructions were made to determine the volumes of the lesion zones and their relations expressed in a demineralization index (DI). With increasing size of the demineralizing zone the DI increased indicating an increase in the size of the translucent zone. The 3D reconstructions showed distinct differences between stagnating and progressing root caries lesions. In the hypermineralized translucent dentin not all dentin tubules were obliterated by intratubular dentin and within the translucent dentin scattered dead tracts were found. Electron dispersive X-ray (EDX) analysis showed that the intertubular dentin of the translucent dentin was also demineralized to a certain extent. The results indicate distinct morphological differences between progressing and stagnating root caries lesions which may have consequences for treatment strategies.

Linseed based saliva substitutes and their effect on mineral dissolution of predemineralized bovine dentin in vitro

OBJECTIVES

Polymers used in saliva substitutes might inhibit remineralization. The present study evaluated the effects of various calcium, phosphate, and fluoride concentrations of linseed based solutions on the mineral loss of predemineralized bovine dentin in vitro.

METHODS

Dentin specimens were prepared, embedded and polished. The specimens were demineralized (pH 5.6; 6 d; 37 degrees C) and half of each sample was covered with nail varnish. Subsequently, the specimens (n=10) were exposed to 14 linseed based solutions (calcium 0-1.1 mM; phosphate 0-7.7 mM, fluoride 0-0.03 mM) at pH 5.5 and 6.5 as well as to Salinum for 14 days (37 degrees C). The differences in mineral loss (DeltaDeltaZ) between the values prior to and after storage in the solutions were evaluated from microradiographs of thin sections.

RESULTS

After the exposure to the various solutions decreased mineral contents compared to those after demineralization could be observed (p<0.05; paired t-test) whereas for the specimens stored in solution with the highest calcium and phosphate concentration no significant change in mineral loss could be evaluated (p>0.05). Salinum induced a significantly greater mineral loss compared to the equivalent saturated solution (p<0.05; ANOVA, Bonferroni). The general linear model revealed a significant dependency for DeltaDeltaZ on 'phosphate' (p=0.000) and 'fluoride' (p=0.001), but not on 'calcium' (p=0.397) and 'pH' (p=0.368).

CONCLUSIONS

The addition of calcium, phosphates, and fluorides seems to have a positive effect on the remineralizing qualities of linseed based saliva substitutes.

Reduced antigenicity of type I collagen and proteoglycans in sclerotic dentin

Antigenic alterations to the dentin organic matrix may be detected by an immunohistochemical approach. We hypothesized that alterations in the antigenicity of type I collagen and proteoglycans occur in sclerotic dentin under caries lesions. Transverse sections were prepared from carious teeth in the sclerotic zone and normal hard dentin. A double-immunolabeling technique was performed on these sections, with anti-type I collagen and anti-chondroitin 4/6 sulfate monoclonal primary antibodies. We used gold-conjugated secondary antibodies to visualize the distribution of intact collagen fibrils and proteoglycans by high-resolution SEM. For sclerotic dentin, labeling densities were 19.57 +/- 3.01/microm2 for collagen and 9.84 +/- 2.62/microm2 for proteoglycans. For normal hard dentin, values were 35.20 +/- 2.73/microm2 and 17.03 +/- 1.98/microm2, respectively. Distribution of intact collagen fibrils and proteoglycans in sclerotic dentin was significantly lower than in normal hard dentin. Reductions in antigenicity from the organic matrix of sclerotic dentin under caries lesions raise concern about the potential of intrafibrillar remineralization.

Fluoride release and secondary caries inhibition by adhesive systems on root dentine

This study tested the fluoride-release rate and the root caries inhibitory effect of dental adhesives. In phase 1, the fluoride released from samples (n = 5) of the adhesives A (Optibond Solo), B (One-up Bond F), C (Prime & Bond NT), D (Tenure Quick), and also of the controls [+] (glass-ionomer cement) and [-] (non-fluoride releasing adhesive), was quantified on a daily basis during a pH-cycling, caries-simulating phenomenon. In phase 2, restorations were made in bovine root dentine slabs (n = 16) with the same adhesives associated with a non-fluoridated composite. Control [+] restorations were made entirely with glass-ionomer cement. Specimens were thermocycled and submitted to the pH-cycling regimen. Demineralization areas and the presence of the wall lesion (WL) and the inhibition zone (IZ) were determined by polarizing light microscopy in dentine adjacent to the restoration. The highest concentration of fluoride was released by the control [+]; adhesives A, B and C, also released fluoride. No detectable amount of fluoride was released by D or [-]. Smaller areas of demineralization were found with control [+], whereas the demineralization areas of adhesives A-D and [-] did not differ from each other. No WL was detected, and higher percentages of IZ were recorded to [+] and to adhesive A. Although some dental adhesives were able to release fluoride, they could not inhibit secondary caries development as well as the glass-ionomer cement.