Demineralization-remineralization dynamics in teeth and bone

Maintaining Good Oral Health With Fluoridated Water

Community water fluoridation (CWF) has been a public health measure against tooth decay since 1945. Strong evidence supports the use of CWF in reduction in caries risk in the pediatric population, and numerous studies also show benefit in adults. CWF remains an important contributor to oral health despite the availability and widespread use of other fluoride-containing dental products. The efficacy, safety, and optimal use of CWF will be discussed.

Cationic Coacervates: Novel Phosphate Ionic Reservoir for the Mineralization of Calcium Phosphates

Cationic complex coacervates are contemplated for various medical applications controlling carrier or release processes. Here, lower M_w poly(allylamine hydrochloride) (15 kg/mol) and (hydrogen)phosphate as cross-linking units were chosen to facilitate a sufficient coacervation and subsequently a controllable phosphate release, essential for consecutive mineralization reactions. In addition, the rheological characteristics of the obtained coacervates were assessed, exhibiting a pronounced liquid character, which enables beneficial properties toward remineralization applications such as high wettability and moldability. In light of our results, macroscopic hydrogels are considered for the first time as an ion source for the mineralization of crystalline calcium phosphate phases, representing an entirely new class of preceding mineralization species for potential applications in dentistry and osteology.

Crystallographic Characteristics of Inorganic Mineral in Mammoth Ivory and Ivory

In this paper, the chemical composition and crystalline properties of mammoth ivory and ivory were systematically analyzed. The results revealed that the microscopic crystalline hydroxyapatites are the major component of minerals in mammoth ivory and ivory. The Ca/P ratios of the samples studied are obviously lower than apatite. Refined cell parameters showed a similar value between mammoth ivory (a = 9.4148 Å and b = 6.8821 Å) and ivory (a = 9.4166 Å and c = 6.8841 Å). Individual crystal sizes in mammoth ivory and ivory are estimated to be 20.41–23.16 and 18.92–21.50 nm, respectively. The calculated crystallinity of two kinds of ivory (mammoth ivory: 1.55; ivory: 1.4) is far lower than geological mineral fluorapatite due to the impact of tissue function and organic matrix.

Impact of direct restorative dental materials on surface root caries treatment. Evidence based and current materials development: A systematic review

This systematic review provides an update on the development and efficacy of direct restorative dental materials for root caries interventions from in vitro and clinical studies. PubMed, Embase, and Web of Science were searched using specific MeSH keywords. Full articles from September 1990 to October 2021 were collected. Additional articles were identified by reference retrieval and manual searching. Studies not related to restorative materials for root caries treatment, case reports, non-original articles, and/or articles not written in English were excluded. Bias risk assessment was performed for the clinical studies. Forty-two articles (eleven clinical studies and thirty-one in vitro studies) were included for analysis. Most in vitro studies indicated an excellent cariostatic effect of glass ionomer cement. Resin-modified glass ionomer restorations also presented reduced recurrent caries activity but had a lower efficacy than glass ionomer cement restorations. For composite resin restorations, the main material development strategies are to strengthen the tooth structure and integrate antimicrobial activity. The clinical studies offered limited data, so the most appropriate material for surface root caries treatment is still inconclusive. However, atraumatic restorative treatment (ART) is an alternative treatment for patients with limiting conditions. Further clinical studies are required to confirm the efficacy of bioactive materials.

Association of salivary statherin, calcium, and proline-rich proteins: A potential predictive marker of dental caries

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Therapeutic effect of two fluoride varnishes on remineralisation of white spot lesions evaluated by laser fluorescence

Background / Aim: The presence of white spot lesion (WSL) is considered the first stage of dental caries. The early detection and diagnosis of WSL is of crucial importance, since caries can be prevented at this stage, reversed and/or controlled by elimination of etiological factors and by use of fluorides. The aim of this study was to compare the efficacy between the two fluoride varnishes on WSL remineralisation evaluated by laser fluorescence. Methods: A total of 30 children and 60 WSL cases (2 per each child) were included in this study. The selected WSL were randomly divided into two groups in each child: G1 applying Fluor Protector S®, Vivadent, Lichenstein (n = 30) and G2 applying MI varnish®, GC, Tokyo, Japan (n = 30). The fluoride varnishes were submitted to three applications: at baseline, four weeks and eight weeks following the baseline, according to the manufacturer's recommendations. Mineral density of the enamel was measured using laser fluorescence (DIAGNOdent® 2095, KaVo, Biberach, Germany) for each WSL. Laser fluorescence (LF) measurements were performed at baseline and at fourth, eighth and twelfth week after starting the treatment and LF scores were calculated. Results: By comparing LF scores at each measurement after treatment initiation, it was found that the scores were significantly lower in all groups when compared to baseline. Conclusion: The results of this study indicate that both fluoride varnishes used were capable of remineralising WSL as evaluated by LF measurements. No difference was noted in the remineralising efficacy of the varnishes despite their different compositions. The main limitations of this study are small sample size and short follow up period. Therefore, further studies with large sample size and a longer follow up are, however, necessary.

Characterization of dynamic process of carious and erosive demineralization - an overview

To review the analytical methods for carious and erosive demineralization an initial search of peer-reviewed scientific literature from the digital library database of PubMed/Medline indexed journals published up to early 2022 was carried out based on keywords relevant to the topic criteria including bibliographic citations from the papers to gather the most updated information. This current review aims to provide an updated overview of the advantages, limitations, and potential applications of direct and indirect research methods available for studying various dynamic stages of carious and erosive demineralization in enamel and dentin. This paper categorizes and describes the most suitable, frequently adopted and widely used quantitative and qualitative techniques in in vitro/in vivo research which are well-established, emerging, or comparatively novel techniques that are being explored for their potential validation.

Infrared Spectroscopic Analysis of the Inorganic Components from Teeth Exposed to Psychotherapeutic Drugs

Teeth are unique and complex anatomical organs that can provide relevant data about a person's health, and play an important role in forensic medicine. Teeth are exposed to food, drinks, and the microbiota of the oral cavity; therefore, they have developed a high resistance to localized demineralization. Nevertheless, the continuous demineralization–remineralization cycle present in the oral environment can be influenced by stress, medication, mineralization agents, and other factors such as individual habits, especially diet. In this study, based on attenuated total reflectance Fourier-transform infrared spectroscopy (ATR-FTIR) spectra from tooth samples of 36 patients, several parameters were estimated: the crystallinity index (CI), the phosphate/amide I ratio, and the carbonate/phosphate ratio. In addition, in eight representative samples (six of the root of the tooth and two of the enamel area of the crown), additional characterization by X-ray powder diffraction (XRPD), scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) was conducted. From the FTIR data, it was observed that the highest CI values were found in patients who smoked. Further, in both root and crown samples, the intensity of the absorption band corresponding to PO43- increased in patients undergoing treatment with psychotherapeutic drugs. On the other hand, the intensity of the absorption band of the amide I group decreased with medical treatment and with the patient's biological age. Moreover, it was found that the remineralization process was more active in enamel than in the root due to direct contact with saliva. Regarding the results obtained from the X-ray powder diffractograms, exposure to psychotherapeutic drugs affected the definition of the peaks corresponding to hydroxyapatite, both in the crown and root samples. Concerning SEM results, qualitative differences in the stratification process in demineralized surfaces were observed, and EDS analyses showed some differences in the Ca/P ratio between pathological samples and control ones, but without clear patterns. The above techniques, in particular ATR-FTIR, showed promise for the investigation of the effect of changes produced in the hydroxyapatite structure in teeth and, consequently, to determine possible strategies in the diagnostic protocol.

Calcium phosphate nanoparticles for potential application as enamel remineralising agent tested on hydroxyapatite discs

Calcium phosphate exhibits excellent biocompatibility, and with particle size in the nanoscale, calcium phosphate nanoparticles (CPNPs) were explored to replace the hydroxyapatite lost in the nanoporous teeth due to dental erosion. CPNPs (2% w/v) colloidally stabilised by sodium citrate were synthesised via co-precipitation. They were characterised in terms of particle size, morphology, crystallinity, Ca/P ratio and calcium ion release. To ensure uniformity of the substrate, hydroxyapatite (HA) discs were examined as an alternative substrate model to enamel. They were eroded in acetate buffer (0.5 M; pH 4.0) at various timepoints (1, 5, 10, 30 min, and 2, 4 h), and their physical differences compared to enamel were assessed in terms of surface microhardness, surface roughness and step height. The remineralisation properties of the synthesised CPNPs on eroded HA discs at different pH levels were investigated. It was established that CPNPs were heterogeneously deposited on the HA discs at pH 9.2, whereas newly precipitated minerals from CPNPs were potentially formed at pH 6.2.

A review on natural teeth whitening

BACKGROUND

Discoloration of teeth occurs for various reasons. Common ingredients like substances from tea and coffee, as well as antibiotics like tetracycline, or food dyes, can percolate into the teeth, and, as such, these stains may persist in the porous structure of the enamel. Smoking is also contributory to dental discoloration, with toxins of tobacco smoke accumulating in a similar way. With aging, teeth tend to be discolored with accumulation of various stains in addition to the enamel gradually eroding to expose the yellow dentin.

HIGHLIGHT

This review focused on the effect of several natural ingredients with teeth-whitening properties and their daily clinical application. Metabolic dental bleaching mechanisms, as well as tooth discoloration and decay, were also reviewed. The current scientific literature (mostly from 2000 to 2020) was consolidated from manuscripts retrieved from Scopus, PubMed, ResearchGate, and Google Scholar.

CONCLUSION

Natural teeth whitening effectively lightens the natural color of teeth without eroding dental surfaces. On the other hand, commercially available whiteners containing hydrogen peroxide and carbamide peroxide, in high concentrations, can lead to deproteinization and demineralization of teeth through oxidation processes. If used extensively, these compounds may cause a number of adverse effects. Alternative natural teeth-whiteners include ingredients like lemons, strawberries, oranges, papaya, and other fruits. Such natural ingredients offer a milder and safer way of whitening teeth than whiteners containing hydrogen peroxide or carbamide peroxide.

A Hydroxypropyl Methylcellulose Film Loaded with AFCP Nanoparticles for Inhibiting Formation of Enamel White Spot Lesions

Objective

This study investigated the effects of mineralizing film consisting of hydroxypropyl methylcellulose (HPMC) and amorphous fluorinated calcium phosphate (AFCP) nanoparticles on enamel white spot lesions (WSLs).

Material and Methods

The AFCP nanoparticles and mineralizing film were prepared via nanoprecipitation and solvent evaporation, respectively. They were characterized with Fourier transform infrared spectroscopy (FTIR), X-ray powder diffraction (XRD), transmission electron microscopy (TEM), selected area electron diffraction (SAED), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), inductively coupled plasma atomic emission spectrometry (ICP-AES), and fluoride ion selective electrode. Thirty-two human enamel slices (4 mm × 4 mm × 1.5 mm) were highly polished and randomly assigned to four groups: negative control (no treatment); pure HPMC film; mineralizing film; GC Tooth Mousse Plus^® (contains 10% CPP-ACP and 0.2% NaF). Subsequently, samples were challenged by a modified pH-cycling and characterized by color measurement, Micro-CT, SEM/EDX, and nanoindentation.

Results

The mineralizing film could sustain release of Ca, P and F ions over 24 h and maintain AFCP nanoparticles in metastable state over 8~12 h. During 4 weeks of pH cycling, the mineralizing film group exhibited least color change (∆E), mineral loss and lesion depth (120 ± 10 µm) among four groups (p < 0.05). SEM findings revealed that the porosities among enamel crystals increased in negative control and pure HPMC film groups after pH cycling, whereas in mineralizing film group, the original microstructure of enamel was well conserved and mineral deposits were detected between enamel prisms. Mineralizing film group demonstrated a least reduction of nanomechanical properties such as elastic modulus of 77.02 ± 6.84 GPa and hardness of 3.62 ± 0.57 GPa (p < 0.05).

Conclusion

The mineralizing film might be a promising strategy for prevention and management of WSLs via inhibiting enamel demineralization and promoting enamel remineralization.

Dentine matrix metalloproteinases as potential mediators of dentine regeneration

Matrix metalloproteinases (MMPs) have been implicated not only in the regulation of developmental processes but also in the release of biologically active molecules and in the modulation of repair during tertiary dentine formation. Although efforts to preserve dentine have focused on inhibiting the activity of these proteases, their function is much more complex and necessary for dentine repair than expected. The present review explores the role of MMPs as bioactive components of the dentine matrix involved in dentine formation, repair and regeneration. Special consideration is given to the mechanical properties of dentine, including those of reactionary and reparative dentine, and the known roles of MMPs in their formation. MMPs are critical components of the dentine matrix and should be considered as important candidates in dentine regeneration.

Antibacterial, remineralising and matrix metalloproteinase inhibiting scandium-doped phosphate glasses for treatment of dental caries

OBJECTIVES

Antibiotic resistance is increasingly a growing global threat. This study aimed to investigate the potential use of newly developed scandium-doped phosphate-based glasses (Sc-PBGs) as an antibacterial and anticariogenic agent through controlled release of Sc³⁺ ions.

METHODS

Sc-PBGs with various calcium and sodium oxide contents were produced and characterised using thermal and spectroscopic analysis. Degradation behaviour, ion release, antibacterial action against Streptococcus mutans, anti-matrix metalloproteinase-2 (MMP-2) activity, remineralisation potential and in vivo biocompatibility were also investigated.

RESULTS

The developed glass system showed linear Sc³⁺ ions release over time. The released Sc³⁺ shows statistically significant inhibition of S. mutans biofilm (1.2 log₁₀ CFU reduction at 6 h) and matrix metalloproteinase-2 (MMP-2) activity, compared with Sc-free glass and positive control. When Sc-PBGs were mounted alongside enamel sections, subjected to acidic challenges, alternating hyper- and hypomineralisation layers consistent with periods of re- and demineralisation were observed demonstrating their potential remineralising action. Furthermore, Sc-PBGs produced a non-toxic response when implanted subcutaneously for 2 weeks in Sprague Dawley rats.

SIGNIFICANCE

Since Sc³⁺ ions might act on various enzymes essential to the biological mechanisms underlying caries, Sc-PBGs could be a promising therapeutic agent against cariogenic bacteria.

Nano-Hydroxyapatite Gel and Its Effects on Remineralization of Artificial Carious Lesions

Introduction

Nano-hydroxyapatite gel (NHG) has never been investigated for enamel remineralization. This study evaluated the effects of two concentrations of NHG on remineralization of an artificial carious lesion in comparison with nano-HA toothpaste (NHT) and fluoride varnish (FV).

Materials and Methods

Carious lesions were prepared on 100 enamel samples and divided into 5 groups: FV, NHT, 20% NHG, and 30% NHG. One untreated (NT) group was left as control. The hardness of the surface was evaluated before, during, and after remineralization. Microhardness at various phases and the percent recovery of hardness (%HR) were determined and analyzed with ANOVA. Polarized-light micrographs (PLM) were evaluated for depth of the carious lesion.

Results

Significantly different remineralization capability was indicated for tested agents (p < 0.05). NHT was significantly capable of remineralization greater than NHG, FV, and NT (p < 0.05). No noticeable difference in %HR between 20% NHG and 30% NHG (p > 0.05) was found. Decreasing in the depth of caries lesion was notified by PLM as applying either NHT or NHG as greater than FV, with no reduction in the depth for NT.

Conclusions

Nano-HA both in toothpaste and gel form was capable of remineralization better than fluoride varnish. Comparable remineralization of 20% versus 30% NHG was evidenced. NHG for both concentrations was recommended as a capable remineralizing agent for caries remineralization. Clinical Significance: This study indicated that an application of nano-HA gel is an attractive route to deliver the material and can be more effective and less toxic than conventional formulations and provide its effectiveness directly at the site of action, especially for a noncooperative young child and medicinally intimidated patients who may face with inconvenience in using toothbrush and toothpaste for hygiene control.

The acid-resistance potential of arginine-fluoride varnish treated enamel

The study objective was to examine the acid-resistance potential of enamel carious lesions treated with arginine (Arg)-sodium fluoride (NaF) varnishes using nano-mechanical testing and chemical mapping. L-arginine (at 1%, 2%, & 4%) was incorporated in 5% NaF varnish. The experimental/control groups were: 1% Arg-NaF, 2% Arg-NaF, 4% Arg-NaF, NaF, and no treatment. Enamel specimen blocks were subjected to incipient carious lesion formation. After treatment, the specimens underwent chemical pH-cycling for 8-days and acid challenge for 2 h. The specimens were characterised for surface nano-hardness (SNH) and calcium/phosphate content of the treated lesions to determine enamel solubility reduction (ESR). Post-acid challenge, X-ray diffraction crystallography (XRD), and energy dispersive X-ray spectrophotometry (EDX) were performed. The SNH for 2%/4% Arg-NaF demonstrated a higher resistance to acid challenge with significantly higher SNH recovery than NaF varnish (p<0.05). The ESR potential of 2%/4% Arg-NaF varnish was significantly higher than NaF varnish (p<0.05). The XRD crystalline phases demonstrated that 2%/4% Arg-NaF had intense hydroxyapatite peaks discerning its increased potential to resist demineralization than NaF varnish. The EDX results showed that 2%/4% Arg-NaF demonstrated Ca/P ratio closer to hydroxyapatite (~1.67) post-acid challenge. Incorporating 2%/4% L-arginine in a 5% NaF varnish enhances the acid-resistance potential of NaF varnish.

New insights from Raman MicroSpectroscopy and Scanning Electron Microscopy on the microstructure and chemical composition of vestibular and lingual surfaces in permanent and deciduous human teeth

Teeth are characterized by a specific chemical composition and microstructure, which are related to their nature, permanent and deciduous, and to the sides, lingual and vestibular. Deeper knowledge in this topic could be useful in clinical practice to develop new strategies in restorative dentistry and in the choice of materials with the best performances. In this study, Raman MicroSpectroscopy (RMS), Scanning Electron Microscopy (SEM), Energy Dispersive X-ray Spectrometry (EDS), and Vickers MicroHardness (VMH) were exploited to: (1) identify the microstructure and the chemical/elemental composition of permanent and deciduous human teeth, also characterizing their lingual and vestibular sides, and (2) validate a new multidisciplinary analytical approach, for obtaining multiple information on calcified tissues. All applied techniques evidenced differences between permanent and deciduous teeth both in the lingual and vestibular sides. In particular, scanning electron micrographs identified areas with an irregular appearance in the vestibular and lingual sides, which presented also different VMH values. Moreover, RMS and EDS displayed a different chemical/elemental composition in outer and inner enamel and dentin, in terms of Mineral/Matrix, Crystallinity, Carbonates/phosphates, and concentrations by weight (%) of calcium, phosphorous, carbon, magnesium, and sodium. A good linear correlation was found between RMS spectral profiles and EDS and VMH measurements, suggesting that RMS may be considered a useful and non-destructive diagnostic tool for obtaining multiple information on calcified tissues.

Physicochemical and Morphological Characterization of Dentin from Deciduous and Permanent Teeth Processed by Different Methods for Tissue Regeneration

The composition of autogenous dentin differs from that of extracted deciduous and permanent teeth, as graft material must undergo procedures prior to implantation. The aim of this study was to characterize the physicochemical and morphological properties of dentin from deciduous (DTs) and permanent teeth (PTs) that had been demineralized (DMA), deproteinized (DPA), and decellularized (DSA). The dentin particles were DMA with ethylenediaminetetraacetic acid (EDTA), DPA with isopropanol, and DSA with sodium dodecyl sulfate (SDS). Sound dentin (SD) was used as the control group. Scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), Fourier transform infrared (FTIR) and X-ray diffraction (XRD) were used to examine the surface and physicochemical properties of the dentin. DMA and DPA dentin had lower concentrations of calcium and protein respectively than SD, showing a significant difference compared with DMA and DPA dentin from DTs and PTs (p < 0.05). In the DSA dentin, it was possible to eliminate the cellular residues of dentin from DTs and PTs, and the gene GAPDH was not expressed. The results of FTIR and XRD revealed a different physicochemical composition according to the dentin processing. EDS demonstrated that DMA dentin obtained the lowest values of calcium and phosphate, and the micrographs obtained by SEM exhibited a porous matrix structure in DMA dentin to a greater degree than in DPA or DSA dentin. The physicochemical properties and morphology of dentin as an autograft material differ depending on whether the teeth are deciduous or permanent; the processing method conditions the characteristics of the dentin substrate as a matrix for tissue regeneration.

Fluoride and Biological Mineralization II: Mechanism of Action of Fluoride to Influence the Collagen-Induced In Vitro Mineralization and Demineralization Reactions

Fluoride had been shown to inhibit collagen-induced in vitro mineralization without affecting demineralization at its lower concentrations (> 1X10^-5 and < 1X10^-4 M) and stimulate mineralization in addition to inhibiting demineralization at its concentration > 1X10^-4 M. The present studies were designed to investigate the mechanism by which fluoride acts to produce these concentration-dependent effects. The inhibition of mineralization occurring at the lower concentrations of fluoride was found to be due to the inactivation of the specific calcium binding sites of collagen involved in initiating the process of mineralization. Stimulation of mineralization obtained at the higher concentrations of fluoride was found to be due to the activation of the specific phosphate-binding sites of the collagen and the formation of a relatively less soluble and highly stable fluorapatite instead of hydroxyapatite. At its higher concentrations, fluoride was also found to inhibit demineralization by binding to the mineral phase associated with collagen. A model has been presented to explain the mechanisms whereby fluoride may act to produce the above observed effects.

Evaluation of Remineralization Seen in Dentin Related to Ceramic Restorations

BACKGROUND

Recently, the caries management had shifted from extension for prevention to early detection and remineralization of remaining tooth structure using noninvasive techniques.

AIM

The present trial was carried out to assess the effect of adding mono-n-Dodecyl phosphate as a surfactant to ceramic on remineralization of dentin.

MATERIALS AND METHODS

The 32 teeth were divided into the following four groups randomly (n = 8 each group) - Group I: cavities not restored, Group II: Restored with ceramic, Group III: restored with ceramic and 2% mono-n-Dodecyl phosphate, and Group IV: restored with ceramic and 5% mono-n-Dodecyl phosphate. Knoop indenter microhardness tests were done at 10, 20, and 40 days. The surface was evaluated under scanning electron microscope. The collected data were subjected to statistical evaluation, and the results were formulated.

RESULTS

In ceramic restored (Group II), an increase in Knoop microhardness (KHN) values was seen at 10-, 20-, and 40-day assessment with the respective values of 102.2 ± 20.3, 118.7 ± 19.4, and 127 ± 15.1. Similarly, a constant increase at different assessments was observed for Groups III and IV with 2% and 5% of mono-n-Dodecyl phosphate with ceramic with a 40-day KHN value of 128.2 ± 21.4 for Group III and 113.5 ± 17.3 for Group IV. A statistically significant difference was seen between ceramic and 5% mono-n-Dodecyl phosphate (Group IV) with hardness values of 30.31%, 29.8%, and 21.78% for Groups II, III, and IV, respectively, at 20 days.

CONCLUSION

The present study concludes that ceramic restorations are effective in promoting dentin remineralization. However, the addition of only 2% mono-n-Dodecyl phosphate was beneficial, whereas 5% mono-n-Dodecyl phosphate reduced the efficacy of ceramic on dentin remineralization.

Concentration-Dependent Multi-Potentiality of L-Arginine: Antimicrobial Effect, Hydroxyapatite Stability, and MMPs Inhibition

This study's objective was to examine L-arginine (L-arg) supplementation's effect on mono-species biofilm (Streptococcus mutans/Streptococcus sanguinis) growth and underlying enamel substrates. The experimental groups were 1%, 2%, and 4% arg, and 0.9% NaCl was used as the vehicle control. Sterilised enamel blocks were subjected to 7-day treatment with test solutions and S. mutans/S. sanguinis inoculum in BHI. Post-treatment, the treated biofilms stained for live/dead bacterial cells were analysed using confocal microscopy. The enamel specimens were analysed using X-ray diffraction crystallography (XRD), Raman spectroscopy (RS), and transmission electron microscopy (TEM). The molecular interactions between arg and MMP-2/MMP-9 were determined by computational molecular docking and MMP assays. With increasing arg concentrations, bacterial survival significantly decreased (p < 0.05). The XRD peak intensity with 1%/2% arg was significantly higher than with 4% arg and the control (p < 0.05). The bands associated with the mineral phase by RS were significantly accentuated in the 1%/2% arg specimens compared to in other groups (p < 0.05). The TEM analysis revealed that 4% arg exhibited an ill-defined shape of enamel crystals. Docking of arg molecules to MMPs appears feasible, with arg inhibiting MMP-2/MMP-9 (p < 0.05). L-arginine supplementation has an antimicrobial effect on mono-species biofilm. L-arginine treatment at lower (1%/2%) concentrations exhibits enamel hydroxyapatite stability, while the molecule has the potential to inhibit MMP-2/MMP-9.

Toxicity Assessment of Long-Term Exposure to Non-Thermal Plasma Activated Water in Mice

Non-thermal plasma activated water (PAW) has recently emerged as a powerful antimicrobial agent. Despite numerous potential bio-medical applications, studies concerning toxicity in live animals, especially after long-term exposure, are scarce. Our study aimed to assess the effects of long-term watering with PAW on the health of CD1 mice. PAW was prepared from distilled water with a GlidArc reactor according to a previously published protocol. The pH was 2.78. The mice received PAW (experimental group) or tap water (control group) daily for 90 days as the sole water source. After 90 days, the following investigations were performed on the euthanatized animals: gross necropsy, teeth mineral composition, histopathology, immunohistochemistry, hematology, blood biochemistry, methemoglobin level and cytokine profile. Mice tolerated PAW very well and no adverse effects were observed during the entire period of the experiment. Histopathological examination of the organs and tissues did not reveal any structural changes. Moreover, the expression of proliferation markers PCNA and Ki67 has not been identified in the epithelium of the upper digestive tract, indicating the absence of any pre- or neoplastic transformations. The results of our study demonstrated that long-term exposure to PAW caused no toxic effects and could be used as oral antiseptic solution in dental medicine.

Evaluation of the Effect of Long-term Use of Three Intracanal Medicaments on the Radicular Dentin Microhardness and Fracture Resistance: An in vitro study

Objectives

The aim of this research was to evaluate the effect of long-term use of three intracanal medicaments on the radicular dentin microhardness and fracture resistance.

Material and methods

A chemomechanical preparation was done using the Protaper rotary instruments up to F3. The teeth were stored in an incubator at 37°C at 100% humidity and were categorized in three groups by random allocation, namely: Triple Antibiotic Paste (TAP), Calcium hydroxide paste (Apexcal) and Ledermix. Following medicament application, the access openings of all teeth were sealed with 4 mm thickness of cavit. The samples were stored for periods of 1 week, 1 month and 3months. Two dentin cylinders measuring 5mm and 3mm were obtained from each sample. The cervical third was used for fracture resistance and the middle third was used for micro hardness evaluation. The microhardness testing was done using a Knoop microhardness tester, and the fracture resistance testing was done using the universal testing machine.

Results

Calcium hydroxide showed maximally negative effect on the physical properties of radicular dentin compared to TAP (p= 0.0100 at one month and Ledermix (p=0.0001 at one month). With an increase in the application time, there was an increased deterioration in the physical properties of radicular dentin.

Conclusion

Long-term placement of calcium hydroxide, Triple Antibiotic Paste, and Ledermix (p= 0.0001at 3 months) significantly affects the microhardness and fracture resistance of radicular dentin.

Efficacy of the dual-action GA-KR12 peptide for remineralising initial enamel caries: an in vitro study

OBJECTIVE

To investigate the antibiofilm and remineralising effects of the dual-action peptide GA-KR12 on artificial enamel caries.

MATERIALS AND METHODS

Enamel blocks with artificial caries were treated with sterilised deionised water as control or GA-KR12. The blocks underwent biochemical cycling with Streptococcus mutans for 3 weeks. The architecture, viability, and growth kinetics of the biofilm were determined, respectively, by scanning electron microscopy (SEM), confocal laser scanning microscopy, and quantitative (culture colony-forming units, CFUs). The mineral loss, calcium-to-phosphorus ratio, surface morphology, and crystal characteristics of the enamel surface were determined, respectively, using micro-computed tomography, energy dispersive spectroscopy, SEM, and X-ray diffraction (XRD).

RESULTS

SEM showed confluent growth of S. mutans in the control group but not in the GA-KR12-treated group. The dead-to-live ratios of the control and GA-KR12-treated groups were 0.42 ± 0.05 and 0.81 ± 0.08, respectively (p < 0.001). The log CFUs of the control and GA-KR12-treated groups were 8.15 ± 0.32 and 6.70 ± 0.49, respectively (p < 0.001). The mineral losses of the control and GA-KR12-treated groups were 1.39 ± 0.09 gcm^-3 and 1.19 ± 0.05 gcm^-3, respectively (p < 0.001). The calcium-to-phosphorus molar ratios of the control and GA-KR12-treated groups were 1.47 ± 0.03 and 1.57 ± 0.02, respectively (p < 0.001). A uniformly remineralised prismatic pattern on enamel blocks was observed in the GA-KR12-treated but not in the control group. The hydroxyapatite in the GA-KR12-treated group was better crystallised than that in the control group.

CONCLUSION

The dual-action peptide GA-KR12 inhibited the growth of S. mutans biofilm and promoted the remineralisation of enamel caries.

CLINICAL RELEVANCE

GA-KR12 potentially is applicable for managing enamel caries.

A machine learning approach to investigate the materials science of enamel aging

Understanding aging of tooth tissues is critical to the development of patient-centric oral healthcare. Yet, the traditional methods for analyzing the composition-structure-property relationships of hard tissues have limitations when considering aging and other factors.

OBJECTIVE

To apply unsupervised machine learning tools to pursue an understanding of relationships between the composition and mechanical behavior of aging enamel.

METHODS

Molar teeth were collected from primary (age ≤ 8), young adult (24 ≤ age ≤ 46) and old adult (55 ≤ age) donors. The hardness and elastic modulus were quantified using nanoindentation as a function of distance from the Dentin Enamel Junction (DEJ) within the cervical, cuspal and inter-cuspal regions of the enamel crown. Similarly, a co-located analysis of the chemical composition and structure was performed using Raman spectroscopy. A Self-Organizing Maps (SOMs) algorithm was implemented to identify multi-dimensional composition-property relationships.

RESULTS

The hardness and elastic modulus are positively correlated to crystallinity and negatively correlated with carbonate substitution. Furthermore, the effects from fluoridation on the age-dependent properties of enamel is non-linear and depends on its location. The contributions of fluoridation to the enamel properties are different in the cervical and non-cervical regions and appear to be unique within primary and senior adult teeth.

SIGNIFICANCE

Based on the findings, unsupervised learning methods can reveal complicated non-linear structure-property relationships in tooth tissues and help to understand the materials science of aging and its consequences.

Enamel remineralization and surface roughness after treatment with herbal-containing toothpastes

Background

Oral care products containing bioactive agents obtained from extracts of plant drugs were launched. This in vitro study investigated the effects of herbal-containing toothpastes associated or not with fluoride to remineralize the enamel after cariogenic challenge with pH cycling. The chemical and physical factors of toothpastes and the enamel surface roughness after brushing were also analyzed.

Material and Methods

Sixty bovine enamel blocks were obtained and divided into 3 thirds: intact (untreated), demineralized (artificial caries lesion), and treated (caries lesion, pH cycling, and brushing with toothpastes). Toothpastes containing herbal compounds contained no fluoride [Galla chinensis (GCH)], low-F concentration [D’Or (DOR); Herbal Bliss (HBL)], or a different fluoride type [Elmex Anticaries (EAC)]. The results were compared to NaF-containing toothpastes: 1450 and 5000 ppm. Enamel blocks were brushed with the toothpastes using a pH-cycling model (7 days). The Knoop hardness (25g/10s) of the surface and the longitudinal sections were then evaluated. The percentage of surface hardness recovery (%SHR) was calculated. The enamel surface roughness, pH, particle size, zeta potential, and polydispersity index of toothpaste slurries were also evaluated. Data were statistically analyzed (α=5%).

Results

No significance was observed when %SHR was compared (p>0.05). DOR, GCH, and HBL were more effective in remineralizing the enamel subsurface. Significantly higher surface roughness was observed when treated with EAC and GCH (p<0.05).

Conclusions

All toothpastes were able to remineralize the enamel, especially the subsurface, with results equal or better than that of standard toothpastes.

Key words:Enamel, hardness, roughness, toothpaste, tooth remineralization.

Machine Learning Approach Identified Multi-Platform Factors for Caries Prediction in Child-Mother Dyads

Untreated tooth decays affect nearly one third of the world and is the most prevalent disease burden among children. The disease progression of tooth decay is multifactorial and involves a prolonged decrease in pH, resulting in the demineralization of tooth surfaces. Bacterial species that are capable of fermenting carbohydrates contribute to the demineralization process by the production of organic acids. The combined use of machine learning and 16s rRNA sequencing offers the potential to predict tooth decay by identifying the bacterial community that is present in an individual’s oral cavity. A few recent studies have demonstrated machine learning predictive modeling using 16s rRNA sequencing of oral samples, but they lack consideration of the multifactorial nature of tooth decay, as well as the role of fungal species within their models. Here, the oral microbiome of mother–child dyads (both healthy and caries-active) was used in combination with demographic–environmental factors and relevant fungal information to create a multifactorial machine learning model based on the LASSO-penalized logistic regression. For the children, not only were several bacterial species found to be caries-associated (Prevotella histicola, Streptococcus mutans, and Rothia muciloginosa) but also Candida detection and lower toothbrushing frequency were also caries-associated. Mothers enrolled in this study had a higher detection of S. mutans and Candida and a higher plaque index. This proof-of-concept study demonstrates the significant impact machine learning could have in prevention and diagnostic advancements for tooth decay, as well as the importance of considering fungal and demographic–environmental factors.

Profuse diversity and acidogenicity of the candida-biome of deep carious lesions of Severe Early Childhood Caries (S-ECC)

Introduction: The retentive niches of deep caries lesions have a distinct biome. Methods: We evaluated the site-specific (occlusal and proximal) Candida-biome of Severe-Early Childhood Caries (S-ECC) in 66- children (132 lesions). Asymptomatic primary molars fitting the definition of the International Caries Detection and Assessment-(ICDAS)-caries-code 5/6 were analyzed. Deep-dentinal sampling and simultaneous assessment of pH were performed. Clinical isolates were speciated using multiplex-PCR and evaluated for their acidogenic and aciduric potential.Results: Surprisingly, a high prevalence of Candida species (72.7%), either singly or in combination, was noted from both the proximal and occlusal cavities. C. tropicalis was the most prevalent species (47%; 34/72), followed by C. krusei (43.1%; 31/72) and C. albicans (40.3%; 29/72), with C. glabrata being the least (9.7%; 7/72). Over 45% low-pH niches (pH <7) of both sites yielded either dual or triple species of Candida. Genotyping revealed three distinct C. albicans genotypes (A, B, and C) with (14/29; 48.3%) of strains belonging to Genotype A. All four evaluated Candida species exhibited acidogenic and aciduric potential, C. tropicalis being the most potent.Conclusion: This, the first report of the high-density, multispecies, yeast colonization of deep-dentinal lesions in S-ECC, suggests that the Candida-biome plays a significant etiologic role in the condition, possibly due to their profound acidogenicity in milieus rich in dietary carbohydrates.

Hydroxyapatite in Oral Care Products-A Review

Calcium phosphate compounds form the inorganic phases of our mineralised tissues such as bone and teeth, playing an important role in hard tissue engineering and regenerative medicine. In dentistry and oral care products, hydroxyapatite (HA) is a stable and biocompatible calcium phosphate with low solubility being used for various applications such as tooth remineralisation, reduction of tooth sensitivity, oral biofilm control, and tooth whitening. Clinical data on these products is limited with varied results; additionally, the effectiveness of these apatite compounds versus fluoride, which has conventionally been used in toothpaste, has not been established. Therefore, this review critically evaluates current research on HA oral care, and discusses the role and mechanism of HA in remineralisation of both enamel and dentine and for suppressing dentine sensitivity. Furthermore, we position HA’s role in biofilm management and highlight the role of HA in dental applications by summarising the recent achievement and providing an overview of commercialised HA dental products. The review also indicates the existing limitations and provides direction for future research and commercialisation of apatite-based oral care products.

Manifestation and Mechanisms of Abnormal Mineralization in Teeth

Tooth biomineralization is a dynamic and complicated process influenced by local and systemic factors. Abnormal mineralization in teeth occurs when factors related to physiologic mineralization are altered during tooth formation and after tooth maturation, resulting in microscopic and macroscopic manifestations. The present Review provides timely information on the mechanisms and structural alterations of different forms of pathological tooth mineralization. A comprehensive study of these alterations benefits diagnosis and biomimetic treatment of abnormal mineralization in patients.

Effect of Resin Infiltration on Enamel: A Systematic Review and Meta-Analysis

Subsurface enamel demineralization beneath an intact surface layer or white spots lesions (WSL) can and should be treated with non-invasive procedures to impede the development of a cavitated lesion. We aim to analyze if infiltrative resin improves enamel roughness, microhardness, shear bond strength, and penetration depth. MEDLINE [via Pubmed], Cochrane Central Register of Controlled Trials, Embase, Web of Science, Scholar, and LILACS were searched until May 2021. Methodological quality was assessed using the Joanna Briggs Institute Clinical Appraisal Checklist for Experimental Studies. Pairwise ratio of means (ROM) meta-analyses were carried out to compare the enamel properties after treatment with infiltrative resin on sound enamel and WSLs. From a total of 1604 articles, 48 studies were included. Enamel surface roughness decreased 35% in sound enamel (95%CI: 0.49–0.85, I² = 98.2%) and 54% in WSLs (95%CI: 0.29–0.74, I² = 98.5%). Microhardness reduced 24% in sound enamel (95%CI: 0.73–0.80, I² = 99.1%) and increased by 68% in WSLs (95%CI: 1.51; 1.86, I² = 99.8%). Shear bond strength reduced of 25% in sound enamel (95%CI: 0.60; 0.95, I² = 96.9%) and increased by 89% in WSLs (95%CI: 1.28–2.79, I² = 99.8%). Penetration depth was 65.39% of the WSLs (95%CI: 56.11–74.66, I² = 100%). Infiltrative resins effectively promote evident changes in enamel properties in sound and WSLs. Future studies with long-term follow-ups are necessary to corroborate these results from experimental studies.

Study of Dental Caries and PTH Gene

Parathyroid hormone (PTH) is essential for calcium and phosphate homeostasis in odontogenesis-related cells. Therefore, the present study aimed to investigate the association between single nucleotide polymorphisms in the gene encoding PTH, and dental caries in Brazilian children. Three hundred and fifty-three children (170 boys and 183 girls, age ranging from 8 to 11 years old) were included in this study. The International System for Detection and Assessment of Carious Lesions (ICDAS) was used for diagnosis of dental caries. Visible biofilm was also evaluated during the clinical examination. Genomic DNA was extracted from saliva for real-time PCR to evaluate the single nucleotide polymorphisms rs6256, rs307247 and rs694 in PTH gene. Dental caries was classified in ICDAS0 vs. ICDAS1−6 or ICDAS1−2 vs. ICDAS3−6. Chi-square test, binary logistic regression adjusted by biofilm and haplotype analyses were performed (p &lt; 0.05). Biofilm was associated with dental caries (p &lt; 0.05). There were no associations between dental caries and rs6256, rs307247, rs694 in none of the analyses performed (p &gt; 0.05). In conclusion, the present study supports that the single nucleotide polymorphisms rs6256, rs307247, and rs694 in the PTH-encoding gene are not associated with dental caries in Brazilian children.

In vitro osteogenic performance of two novel strontium and zinc-containing glass polyalkenoate cements

Glass polyalkenoate cements (GPCs) are under investigation as potential bone adhesives, as they may provide an alternative to polymethylmethacrylate-based cements. GPCs containing strontium (Sr) and zinc (Zn) in place of aluminium (Al) are of particular interest because these ions are known stimulators of osteoprogenitor differentiation. GPCs have been manufactured from a novel bioactive glass (SiO2 :0.48, ZnO:0.36, CaO:0.12, SrO:0.04) in the past, but, while such materials have been assessed for their influence on viability, their influence on osteogenic function has not been investigated until now. For this study, two GPCs were formulated from the same glass precursor evaluated in previous studies. These GPCs were named GPC A and GPC B, and they differed in glass particle size, polyacrylic acid molecular weight, and their powder: liquid ratios. The effect of these two GPCs on osteogenic differentiation of primary rat osteoblasts were evaluated using three culture systems: culture with dissolution extracts, indirect contact with transwell-inserts and direct contact. Additionally, the degradation characteristics of GPCs were assessed, including their interfacial pH and surrounding pH. The experimental outcomes revealed that collagen deposition, alkaline phosphatase expression, and mineralization were largely dependent on GPC composition as well as the mode of interaction with cells. These markers were found to be significantly elevated in response to GPC A's dissolution products. However, osteogenic differentiation was inhibited when osteoblasts were cultured indirectly and directly with GPCs, with, overall, GPC B significantly outperforming GPC A. These results suggest that GPC degradation products effect osteogenic differentiation in a dose-dependent manner.

Studying Effects of Calcium Oxide Nanoparticles on Dentinogenesis in Male Wistar Rats

This study aimed to evaluate potential impacts of calcium oxide nanoparticles (CaO-NPs) at different dosages on predentin thickness, number of blood vessels, periodontal ligament thickness, and blood glucose level of Wistar rats. Twelve rats were randomly gathered into four groups, untreated (control) and CaO-NP-treated groups at three concentrations (25, 50, and 100 mg/kg of the body weight) over a period of 60 days. Histological investigation was performed on twenty-four lower incisor teeth extracted from all the tested groups under a light microscope, and an automatic Fujifilm was used to measure the blood glucose level. The results showed that regular nanoparticle treatment significantly increased predentin and periodontal ligament thicknesses, a gradual decrease in vascularization in the pulp tissue, and an increase in the blood glucose level as the dosages of nanoparticles administered to the rats increased. Administration of the CaO-NPs at low dosage (25 mg/kg) could be beneficial for the growth and integrity of teeth and dentinal tissues in rats.

Manufacture and preliminary evaluation of acellular tooth roots as allografts for alveolar ridge augmentation

Alveolar ridge augmentation can be used to obtain appropriate alveolar ridge for dental implantation. A variety of bone graft materials including autogenous bone, allograft, xenograft, and alloplastic material are used in alveolar ridge augmentation. Autogenous tooth-derived bone graft material has received much attention for the past few years, because the structure and physicochemical characteristics of tooth are similar to those of bones. Compared to autogenous tooth, allogenic tooth has the advantage of extensive resources. However, the problem of cell-derived immunological rejection of allogenic tooth remains unresolved. In the present study, acellular tooth root (ATR) is obtained by an innovative combination procedure. The biocompatibility of ATR is assessed using cytotoxicity test, hemolysis test, intracutaneous reactivity test, and acute systemic toxicity test. Osseointegration is evaluated in vivo by implanting ATR into the rat tibia defect as an allograft material. The results show that the ATR has fine biocompatibility, and there is an osseointegration between ATR and bone bed at 8 weeks post operation. This study demonstrates that the ATR could be used in alveolar ridge augmentation as a kind of new tooth-derived bone graft material.

Role of bioglass in enamel remineralization: Existing strategies and future prospects-A narrative review

Enamel, once formed, loses the ability to regenerate due to the loss of the formative ameloblasts. It is subjected to constant damaging events due to exposure to external agents and oral microbiomes. An enamel remineralization process targets to replenish the lost ionic component of the enamel through a multitude of methods. Enamel remineralization is highly challenging as it has a complex organized hierarchical microstructure. Hydroxyapatite nanocrystals of the enamel vary in size and orientation along alignment planes inside the enamel rod. The inability of the enamel to remodel unlike other mineralized tissues is another substantial deterrent. One of the well-known biomaterials, bioglass (BG) induces apatite formation on the external surface of the enamel in the presence of saliva or other physiological fluids. Calcium, sodium, phosphate, and silicate ions in BG become responsive in the presence of body fluids, leading to the precipitation of calcium phosphate. Studies have also demonstrated the bactericidal potential of BG against Streptococcus mutans biofilms. The anticariogenicity and antibacterial activity were found to be enhanced when BG was doped with inorganic ions such as F, Ag, Mg, Sr, and Zn. Due to the versatility of BG, it has been combined with a variety of agents such as chitosan, triclosan, and amelogenin to biomimic remineralization process. Key strategies that can aid in the development of contemporary enamel remineralization agents are also included in this review.

Effect of Bioactive Glass-Containing Light-Curing Varnish on Enamel Remineralization

This study aimed to evaluate the effect of novel experimental light-curing bioactive glass (BAG)-containing varnish on enamel remineralization. An experimental light-curing, BAG-containing varnish and two commercial varnishes (Nupro White Varnish; Dentsply International, York, PA, USA and Tooth Mousse; GC Corporation, Tokyo, Japan) were used. Microhardness tests (n = 3), field emission scanning electron microscopy (FE-SEM) coupled with energy dispersive X-ray spectroscopy (EDS) (n = 5), and X-ray diffraction (XRD) analysis (n = 5) were performed to compare the remineralization effect of three varnishes with and without ultrasonication. The data of microhardness test were analyzed using one-way ANOVA and Tukey's post hoc comparison (P < 0.05). Microhardness of demineralized enamel increased after the application of three varnishes (P < 0.05). The experimental BAG-containing varnish showed the highest microhardness among the three varnishes (P < 0.05). Ultrasonication decreased microhardness of Tooth Mousse and BAG-containing varnish groups (P < 0.05). FE-SEM and XRD revealed precipitates of hydroxyapatite (HAP) or fluorapatite (FAP) crystals of three varnishes. The novel experimental BAG-containing varnish may be a promising clinical strategy for the remineralization of early carious lesions or demineralized enamel surfaces.

Evaluation of the protective effect on enamel demineralization of CPP-ACP paste and ROCS by vibrational spectroscopy and SAXS: An in vitro study

The aim of this study was to investigate human dental enamel surfaces using attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR), Raman spectroscopy, and small angle X-ray scattering (SAXS) techniques concerning differences between the demineralized enamel surface and remineralized enamel surface by casein phosphopeptide amorphous calcium phosphate, Tooth mousse® (CPP-ACP) and remineralizing oral care systems (ROCS®) agents within the same tooth. For this purpose, 20 freshly extracted human maxillary central incisors without caries and defects were used. Labial surfaces of each of the teeth were divided into four sections, which were marked as follows: Group 1, normal enamel; Group 2, demineralized enamel with demineralization solution; Group 3, demineralized enamel + remineralization agent (ROCS for 10 teeth, CPP-ACP for 10 teeth); and Group 4, remineralization agent (ROCS for 10 teeth, CPP-ACP for 10 teeth). To describe the changes in tooth enamel, the phosphate group concentration within enamel was used as an indicator of the degree of mineralization. The phosphate and carbonate bands in the FTIR and Raman spectra were used to investigate the structural changes in the demineralized and remineralized enamel. Spectroscopic data were statistically analyzed in terms of CPP-ACP and ROCS using one-way analysis of variance. The carbonate content of demineralized enamel was higher than the carbonate content in the other groups (p < .03). The apatite carbonate-phosphate balance in the samples with only remineralizing agent-especially ROCS applied-changed significantly (p < .05) compared to the normal group. The average FTIR spectra of the groups were subjected to multivariate hierarchical cluster analysis (HCA) conducted with the use of the OPUS 5.5 software. Nanosized surface morphologies of the samples were compared using pair distance distributions obtained through SAXS analyses. According to the SAXS analyses, applications of CCP + ACP and ROCS agents were effective on nanostructures for all groups.

Experimental Dental Composites Containing a Novel Methacrylate-Functionalized Calcium Phosphate Component: Evaluation of Bioactivity and Physical Properties

The aim of this study was to synthesize and characterize a novel methacrylate-functionalized calcium phosphate (MCP) to be used as a bioactive compound for innovative dental composites. The characterization was accomplished by attenuated total reflectance Fourier-transform infrared spectroscopy (ATR-FTIR), scanning electron microscopy (SEM), and energy dispersive spectroscopy (EDS). The incorporation of MCP as a bioactive filler in esthetic dental composite formulations and the ability of MCP containing dental composites to promote the precipitation of hydroxyapatite (HAp) on the surfaces of those dental composites was explored. The translucency parameter, depth of cure, degree of conversion, ion release profile, and other physical properties of the composites were studied with respect to the amount of MCP added to the composites. Composite with 3 wt.% MCP showed the highest flexural strength and translucency compared to the control composite and composites with 6 wt.% and 20 wt.% MCP. The progress of the surface precipitation of hydroxyapatite on the MCP containing dental composites was studied by systematically increasing the MCP content in the composite and the time of specimen storage in Dulbecco's phosphate-buffered solution with calcium and magnesium. The results suggested that good bioactivity properties are exhibited by MCP containing composites. A direct correlation between the percentage of MCP in a composite formulation, the amount of time the specimen was stored in PBS, and the deposition of hydroxyapatite on the composite's surface was observed.

Remineralising dentine caries using an artificial antimicrobial peptide: An in vitro study

OBJECTIVE

To investigate the antibacterial and remineralising effects of a novel dual-action antimicrobial peptide, GA-KR12, on artificial dentine caries.

METHODS

Human dentine blocks with artificial carious lesions were allocated to two groups - Group 1: dentine blocks treated with the novel antimicrobial peptide GA-KR12 twice daily; Group 2: dentine blocks received water as the negative control. Two groups underwent Streptococcus mutan biofilm-remineralisation cycles at 37 °C for 7 days. The morphology, viability and growth kinetics of the S. mutans biofilm were evaluated by scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM) and colony-forming unit (CFU) counting, respectively. The dentine blocks' lesion depths and mineral loss, changes in chemical structure, dentine surface morphology and crystal characteristics were determined using micro-computed tomography, Fourier transform infrared (FTIR), SEM and X-ray diffraction (XRD), respectively.

RESULTS

The surface of the dentine blocks in Group 1 was partially covered by S. mutans with damaged cell structure. Group 2 showed affluent growth of S. mutans covering the dentine surface when compared to Group 1. The dead-to-live ratio of Group 1 and Group 2 were 0.78 ± 0.01 and 0.47 ± 0.08, respectively (p < 0.001). The Log CFUs of Group 1 and Group 2 were 7.14 ± 0.30 and 8.24 ± 0.20, respectively (p < 0.001). The lesion depths of Group 1 and Group 2 were 109 ± 1 µm and 135 ± 3 µm, respectively (p < 0.001). The mineral loss of Group 1 and Group 2 were 0.59 ± 0.08 gHApcm^-3 and 0.81 ± 0.07 gHApcm^-3, respectively (p < 0.001). FTIR showed the amide I-to-hydrogen phosphate (HPO₄^2-) ratios of Group 1 and Group 2 were 0.25 ± 0.05 and 0.39 ± 0.05 (p < 0.001), respectively. SEM images showed Group 1 had less exposed dentine collagen fibres than Group 2. The XRD revealed that the hydroxyapatite in Group 1 was well crystalised.

CONCLUSION

This study demonstrated that the novel antimicrobial peptide GA-KR12 inhibited the growth of S. mutans biofilm and enhanced the remineralisation of artificial dentine caries.

Evaluation of Vitamin D (25OHD), Bone Alkaline Phosphatase (BALP), Serum Calcium, Serum Phosphorus, Ionized Calcium in Patients with Mandibular Third Molar Impaction. An Observational Study

The aim of this study was to evaluate the levels of vitamin D (25OHD) and other bone biomarkers in patients with third molar impaction (TMI). Thirty males and 30 females with unilateral or bilateral impacted mandibular third molar, and 15 males and 15 females as a control group (CG) were recruited. Rx-OPT was used to evaluate dental position and Pederson index to measure the difficulty of the intervention. Bone biomarkers were measured through blood venous sample in TMI group and CG. Mann-Whitney test, Pearson’s correlation coefficient, linear regression model were used to compare the different parameters in the two groups. 25OHD showed lower values in TMI group than in CG (p < 0.05) with values significantly lower in bilateral impaction (p < 0.05). Pearson’s coefficient for 25OHD presented a negative correlation with the Pederson index (ρ = −0.75). Bone alkaline phosphatase (BALP) showed significantly lower dosage in TMI group than CG (p = 0.02), Pearson’s coefficient for BALP presented a negative correlation with the Pederson index. Serum calcium, serum phosphorus, ionized calcium levels in TMI and CG groups were similar and Mann-Whitney test did not significantly differ between TMI and CG. TMI could be a sign of vitamin D deficiency and of low BALP levels that should be investigated.

Effectiveness of Nanohydroxyapatite on Demineralization of Enamel and Cementum Surrounding Margin of Yttria-Stabilized Zirconia Polycrystalline Ceramic Restoration

Introduction

Prosthetic dentistry has shifted toward prevention of caries occurrence surrounding restorative margin through the anti-demineralization process. This study examines the ability of nanohydroxyapatite (NHA) gel and Clinpro (CP) on enhancing resistance to demineralization of enamel and cementum at margin of restoration.

Materials and Methods

Thirty extracted mandibular third molars were segregated at 1 mm above and below cementoenamel junction (CEJ) to separate CEJ portions and substituted with zirconia disks by bonding to crown and root portions with resin adhesive. The enamel and cementum area of 4 × 4 mm² neighboring zirconia was applied with either NHA or CP, while one group was left no treatment (NT) before demineralized with carbopal. Vickers hardness (VHN) of enamel and cementum was evaluated before material application (B_M), after material application (A_M), and after demineralization (A_D). Analysis of variance (ANOVA) and post hoc multiple comparisons were used to justify for the significant difference (α = 0.05). Scanning electron microscopy (SEM) and X-ray diffraction (XRD) were determined for surface evaluations.

Results

The mean ± SD of VHN for B_M, A_M, and A_D for enamel and cementum was 393.24 ± 26.27, 392.89 ± 17.22, 155.00 ± 5.68 and 69.89 ± 4.59, 66.28 ± 3.61, 18.13 ± 0.54 for NT groups, respectively, 390.10 ± 17.69, 406.77 ± 12.86, 181.55 ± 7.99 and 56.01 ± 9.26, 62.71 ± 6.15, 19.09 ± 1.16 for NHA groups, respectively, and 387.90 ± 18.07, 405.91 ± 9.83, 188.95 ± 7.43 and 54.68 ± 7.30, 61.81 ± 4.30, 19.22 ± 1.25 for CP groups, respectively. ANOVA indicated a significant increase in anti-demineralization of enamel and cementum upon application of NHA or CP (p < 0.05). Multiple comparisons indicated the capability in inducing surface strengthening to resist demineralization for enamel and cementum of NHA which was comparable to CP (p > 0.05) as evidenced by SEM and XRD data indicating NHA and CP deposition and crystallinity accumulation.

Conclusion

NHA and CP were capable of enhancing anti-demineralization for enamel and cementum. The capability in resisting the demineralization process of NHA was comparable with CP. NHA was highly recommended for anti-demineralization for enamel and cementum surrounding restorative margin.

Xenogeneic dentin matrix as a scaffold for biomineralization and induced odontogenesis

Commonly recognized mechanisms of the xenogeneic-extracellular matrix-based regenerative medicine include timely degradation, release of bioactive molecules, induced differentiation of stem cells, and well-controlled inflammation. This process is most feasible for stromal tissue reconstruction, yet unsuitable for non-degradable scaffold and prefabricated-shaped tissue regeneration, like odontogenesis. Treated dentin matrix (TDM) has been identified as a bioactive scaffold for dentin regeneration. This study explored xenogeneic porcine TDM (pTDM) for induced odontogenesis. The biological characteristics of pTDM were compared with human TDM (hTDM). To investigate its bioinductive capacities on allogeneic dental follicle cells (DFCs) in the inflammation microenvironment, pTDM populated with human DFCs were co-cultured with human peripheral blood mononuclear cells (hPBMCs), and pTDM populated with rat DFCs were transplanted into rat subcutaneous model. The results showed pTDM possessed similar mineral phases and bioactive molecules with hTDM. hDFCs, under the induction of pTDM and hTDM, expressed similar col-I, osteopontin and alkaline phosphatase (ALP) (all expressed by odontoblasts). Whereas, the expression of col-I, dentin matrix protein-1 (DMP-1) and bone sialoprotein (BSP) were down-regulated when cocultured with hPBMCs. The xenogeneic implants inevitably initiated Th1 inflammation (up-regulated CD8, TNF-α, IL-1β, etc)in vivo. However, the biomineralization of pre-dentin and cementum were still processed, and collagen fibrils, odontoblast-like cells, fibroblasts contributed to odontogenesis. Although partially absorbed at 3 weeks, the implants were positively expressed odontogenesis-related-proteins like col-I and DMP-1. Taken together, xenogeneic TDM conserved ultrastructure and molecules for introducing allogeneic DFCs to odontogenic differentiation, and promoting odontogenesis and biomineralizationin vivo. Yet effective immunomodulation methods warrant further explorations.

The predictive power of saliva electrolytes exceeds that of saliva microbiomes in diagnosing early childhood caries

Early childhood caries (ECC) is one of the most prevalent chronic diseases affecting children worldwide, and thus its etiology, diagnosis, and prognosis are of particular clinical significance. This study aims to test the ability of salivary microbiome and electrolytes in diagnosing ECC, and their interplays within the same population. We here simultaneously profiled salivary microbiome and biochemical components of 331 children (166 caries-free (H group) and 165 caries-active children (C group)) aged 4-6 years. We identified both salivary microbial and biochemical dysbiosis associated with ECC. Remarkably, K⁺, Cl^-, NH₄⁺, Na⁺, SO₄^2-, Ca²⁺, Mg²⁺, and Br^- were enriched while pH and NO₃^- were depleted in ECC. Moreover, the dmft index (ECC severity) positively correlated with Cl^-, NH₄⁺, Ca²⁺, Mg²⁺, Br^-, while negatively with pH and NO₃^-. Furthermore, machine-learning classification models were constructed based on these biomarkers from saliva microbiota, or electrolytes (and pH). Unexpectedly, the electrolyte-based classifier (AUROC = 0.94) outperformed microbiome-based (AUROC = 0.70) one and the composite-based one (with both microbial and biochemical data; AUC = 0.89) in predicting ECC. Collectively, these findings indicate ECC-associated alterations and interplays in the oral microbiota, electrolytes and pH, underscoring the necessity of developing diagnostic models with predictors from salivary electrolytes.

Effect of green tea-loaded chitosan nanoparticles on leathery dentin microhardness

The purpose of this study was to assess the effect of a chitosan-based nanoformulation containing green tea on leathery (remaining) dentin subsurface microhardness. Size distribution, polydispersity index (PDI) and zeta potential (mV) of nanoformulations were previously determined by dynamic light scattering (DLS). Human dentin specimens were exposed to Streptococcus mutans for 14 d. Soft dentin were selectively removed by Er:YAG laser (n = 30) or bur (n = 30). Remaining dentin was biomodified with chitosan nanoparticles (Nchi, n = 10) or green tea-loaded chitosan nanoparticles (Gt + Nchi, n = 10) for 1 min. Control group (n = 10) did not receive any treatment. Subsurface microhardness (Knoop) was evaluated in hard (sound) and soft dentin, and then, in leathery dentin and after its biomodification, at depths of 30, 60 and 90 μm from the surface. Nchi reached an average size of ≤ 300 nm, PDI varied between 0.311 and 0.422, and zeta potential around + 30 mV. Gt + Nchi reached an average size of ≤ 350 nm, PDI < 0.45, and zeta potential around + 40 mV. Soft dentin showed significantly reduced microhardness at all depths (p > 0.05). The subsurface microhardness was independent of choice of excavation method (p > 0.05). At 30 µm from the surface, Gt + Nchi increased the leathery dentin microhardness compared to untreated group (p < 0.05). Nchi promoted intermediate values (p > 0.05). Both nanoformulations showed an average size less than 350 nm with nanoparticles of different sizes and stability along the 90-day period evaluated. Subsurface microhardness of bur-treated and laser-irradiated dentin was similar. At 30 µm, the biomodification with Gt + Nchi improved the microhardness of leathery dentin, independently of caries excavation method used.

Influence of Cavity Geometry on the Fracture Strength of Dental Restorations: Finite Element Study

The main purpose of this work was to analyze the stress distribution in premolars restored with indirect IPS Empress® CAD onlays or inlays. The three-dimensional geometry of a human first premolar was created using modeling software. The tooth fixation system was simulated through box geometry, comprising a cortical bone layer with 2 mm of thickness over a layer of trabecular bone with 15 mm of thickness. The tooth had the following approximated crown dimensions: 10.35 mm buccolingual length; 7.1 mm mesiodistal width; and 7.0 mm cervico-occlusal height. The mesio-occluso-distal (MOD) cavity preparations followed the suggestions available in the literature. The cement geometry was modified to include cohesive zone models (CZM) to perform the adhesive joint’s strength prediction. The loading body was created assuming contact between the food bolus and the tooth surface. Numerical solutions were obtained by performing static analysis and damage analysis using the finite element method. Von Mises stress values generated in the ceramic inlay restoration ranged from 1.39–181.47 MPa, which were on average 4.4% higher than those of the onlay ceramic restoration. The fracture strength of the onlay restoration was about 18% higher than that of the inlay restoration. The onlay design seems to contribute to higher homogenization of the adhesive resin cement strain and higher tooth structure protection.

Adhesion and whitening effects of P11-4 self-assembling peptide and HAP suspension on bovine enamel

OBJECTIVES

This study evaluated the adhesion and whitening effects of a combination of P11-4 self-assembling peptide and hydroxyapatite (peptide-HAP) on bovine enamel.

METHODS

Forty-six caries-free bovine teeth were selected, and 40 teeth were randomly allocated to one of five groups (n = 8). First, the effects of application frequency, exposure time, and storage in saliva on the whitening effects of an experimental low-concentrated peptide-HAP suspension (0.5 wt% HAP; Curodont, Credentis) were evaluated and compared with a commercial bleaching agent (VivaStyle Paint on Plus, VS, Ivoclar Vivadent). Tooth color was measured using a spectrophotometer (Gretag MacBeth), and color changes ΔE were statistically analyzed. Second, the effects of peptide-HAP concentration (low versus high: 6.25% HAP; Curodont Protect), and its interactions with saliva and postapplication restaining, were investigated. Third, enamel surfaces (n = 2) were treated with low concentration peptide-HAP and high-concentration peptide-HAP in polymeric and monomeric forms (Curodont Protect & Curodont Repair, Credentis) and analyzed by SEM.

RESULTS

The ΔE of the low-concentration peptide-HAP suspension did not differ from that of VS. Application frequency, exposure time, and storage in saliva did not have any significant impact on whitening efficacy of the peptide-HAP suspension. Increasing the concentration of the suspension did not promote overall ΔE. SEM observations confirmed the presence of the newly generated peptide and HAP on the enamel surface.

CONCLUSIONS

The peptide-HAP suspension is a mild tooth whitener, and the adhesion of peptide-HAP to enamel is concentration dependent.

CLINICAL RELEVANCE

This peptide-HAP suspension is effective in offsetting discoloration caused by restaining after treatment.

Efficacy of propolis in remineralising artificially induced demineralisation of human enamel - An in-vitro study

Objective

In this in vitro study, we aimed to analyse the enamel-remineralisation potential of propolis.

Materials and methods

Twenty enamel blocks (N = 20) were randomly divided into two groups (n = 10). In group 1 (control), enamel blocks were brushed with artificial saliva (AS). In group 2, they were brushed with propolis oil. All the blocks were demineralised by exposing them to 6 wt% citric acid (pH: 2.2) for 5 min. Brushing was performed inside a tooth brushing simulation machine with manual toothbrushes. Each sample received 5,000 linear strokes. Surface microhardness analysis was performed for each sample at three time intervals (pre-demineralisation or baseline, post-demineralisation, and post-remineralisation) to obtain the Vickers hardness numbers (VHNs).

Results

An enhancement in the microhardness of the enamel samples was observed after brushing with propolis oil when compared with brushing using AS alone. In group 1 (control group), the mean baseline VHN was 583.66. It decreased to 116.23 after demineralisation and increased to 184.02 after remineralisation. The mean baseline VHN of group 2 was 506.91. It decreased to 317.60 after demineralisation and increased to 435.19 after remineralisation. The VHN values of both the groups revealed statistically significant differences (p < 0.05) in inter-group and intra-group comparisons.

Conclusion

Brushing of enamel blocks with propolis led to a greater enhancement in their microhardness levels when compared with the control group. Future studies are essential to validate the exact mechanism of the beneficial effects of propolis on enamel.

High-throughput sequencing identifies salivary microbiota in Chinese caries-free preschool children with primary dentition

OBJECTIVES

The study aimed at identifying salivary microbiota in caries-free Chinese preschool children using high-throughput sequencing.

METHODS

Saliva samples were obtained from 35 caries-free preschool children (18 boys and 17 girls) with primary dentition, and 16S ribosomal DNA (rDNA) V3-V4 hypervariable regions of the microorganisms were analyzed using Illumina MiSeq.

RESULTS

At 97% similarity level, all of these reads were clustered into 334 operational taxonomic units (OTUs). Among these, five phyla (Firmicutes, Proteobacteria, Actinobacteria, Bacteroidetes, and Candidate division TM7) and 13 genera (Streptococcus, Rothia, Granulicatella, Prevotella, Enterobacter, Veillonella, Neisseria, Staphylococcus, Janthinobacterium, Pseudomonas, Brevundimonas, Devosia, and Gemella) were the most dominant, constituting 99.4% and 89.9% of the salivary microbiota, respectively. The core salivary microbiome comprised nine genera (Actinomyces, Capnocytophaga, Gemella, Granulicatella, Lachnoanaerobaculum, Neisseria, Porphyromonas, Rothia,and Streptococcus). Analysis of microbial diversity and community structure revealed a similar pattern between male and female subjects. The difference in microbial community composition between them was mainly attributed to Neisseria (P=0.023). Furthermore, functional prediction revealed that the most abundant genes were related to amino acid transport and metabolism.

CONCLUSIONS

Our results revealed the diversity and composition of salivary microbiota in caries-free preschool children, with little difference between male and female subjects. Identity of the core microbiome, coupled with prediction of gene function, deepens our understanding of oral microbiota in caries-free populations and provides basic information for associating salivary microecology and oral health.