301
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Hsiao J, Wang Y, Zheng L, Liu R, Said R, Hadjiyski L, Cha H, Botero T, Chatzistavrou X, Dong Q, Papagerakis S, Papagerakis P. In Vivo Rodent Models for Studying Dental Caries and Pulp Disease. Methods Mol Biol 2019; 1922:393-403. [PMID: 30838593 DOI: 10.1007/978-1-4939-9012-2_35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Dental caries is an infectious oral disease caused primarily by complex interactions of cariogenic oral flora (biofilm) with dietary carbohydrates on the tooth surface over time. Streptococcus mutans and Streptococcus sobrinus (S. mutans and S. sobrinus) are the most prevalent cariogenic species within the oral biofilm and considered the main etiological agents of caries. Pulp exposure and infection can be caused by trauma, carious lesion, and mechanical reasons. Pulp response to these exposures depends on the state of the pulp as well as the potential bacterial contamination of pulp tissue. Herein, we describe the process of using two in vivo rodent models to study the progression of dental caries and pulp disease: a nutritional microbial model and a pulp disease induction model. The progression of the carious lesion and pulpal infections in both models was assessed by micro-CT imaging and histomorphometric analysis. Moreover, the pulp disease induction models can be used to compare and assess the antibacterial and reparative properties of the different pulp capping materials.
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Affiliation(s)
- June Hsiao
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Yuanyuan Wang
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Li Zheng
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Ruirui Liu
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.,Dept. of Prosthodontics, School & Hospital of Stomatology, Xi'an Jiaotong University, Jiaotong, China
| | - Raed Said
- College of Dentistry, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lubomir Hadjiyski
- Department of Radiology, School of Medicine, University of Michigan, Ann Arbor, MI, USA.,Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Heekon Cha
- Department of Radiology, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tatiana Botero
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Xanthippi Chatzistavrou
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Qing Dong
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.,Department of Pediatric Dentistry, College of Stomatology, North China University of Science and Technology, Tangshan, China
| | - Silvana Papagerakis
- Department of Surgery, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Otolaryngology Head and Neck Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, USA.,Toxicology Interdisciplinary Program, University of Saskatchewan, Saskatoon, SK, Canada.,Biomedical Engineering, University of Saskatchewan, Saskatoon, SK, Canada
| | - Petros Papagerakis
- College of Dentistry, University of Saskatchewan, Saskatoon, SK, Canada. .,School of Dentistry, University of Michigan, Ann Arbor, MI, USA.
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302
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Balhaddad AA, Kansara AA, Hidan D, Weir MD, Xu HHK, Melo MAS. Toward dental caries: Exploring nanoparticle-based platforms and calcium phosphate compounds for dental restorative materials. Bioact Mater 2018; 4:43-55. [PMID: 30582079 PMCID: PMC6299130 DOI: 10.1016/j.bioactmat.2018.12.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/08/2018] [Accepted: 12/09/2018] [Indexed: 01/06/2023] Open
Abstract
Millions of people worldwide suffer from a toothache due to tooth cavity, and often permanent tooth loss. Dental caries, also known as tooth decay, is a biofilm-dependent infectious disease that damages teeth by minerals loss and presents a high incidence of clinical restorative polymeric fillings (tooth colored fillings). Until now, restorative polymeric fillings present no bioactivity. The complexity of oral biofilms contributes to the difficulty in developing effective novel dental materials. Nanotechnology has been explored in the development of bioactive dental materials to reduce or modulate the activities of caries-related bacteria. Nano-structured platforms based on calcium phosphate and metallic particles have advanced to impart an anti-caries potential to restorative materials. The bioactivity of these platforms induces prevention of mineral loss of the hard tooth structure and antibacterial activities against caries-related pathogens. It has been suggested that this bioactivity could minimize the incidence of caries around restorations (CARS) and increase the longevity of such filling materials. The last few years witnessed growing numbers of studies on the preparation evaluations of these novel materials. Herein, the caries disease process and the role of pathogenic caries-related biofilm, the increasing incidence of CARS, and the recent efforts employed for incorporation of bioactive nanoparticles in restorative polymer materials as useful strategies for prevention and management of caries-related-bacteria are discussed. We highlight the status of the most advanced and widely explored interaction of nanoparticle-based platforms and calcium phosphate compounds with an eye toward translating the potential of these approaches to the dental clinical reality. Current progress and future applications of functional nanoparticles and remineralizing compounds incorporated in dental direct restorative materials. Overview of the antibacterial and remineralizing mechanisms presenting direct and indirect implications on the tooth mineral loss. These investigations, although in the initial phase of evidence are necessary and their results are encouraging and open the doors to future clinical studies that will allow the therapeutic value of nanotechnology-based restorative materials to be established.
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Affiliation(s)
- Abdulrahman A Balhaddad
- Ph.D. Program in Biomedical Sciences, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA.,Division of Biomaterials & Tissue Engineering, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA.,Department of Restorative Dental Sciences, Imam Abdulrahman Bin Faisal University, College of Dentistry, Dammam, Saudi Arabia
| | - Anmar A Kansara
- Ph.D. Program in Biomedical Sciences, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA.,Department of Restorative Dentistry, Umm Al-Qura University, College of Dentistry, Makkah, Saudi Arabia
| | - Denise Hidan
- Division of Operative Dentistry, Dept. of General Dentistry, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA
| | - Michael D Weir
- Ph.D. Program in Biomedical Sciences, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA.,Division of Biomaterials & Tissue Engineering, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA
| | - Hockin H K Xu
- Ph.D. Program in Biomedical Sciences, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA.,Division of Biomaterials & Tissue Engineering, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA
| | - Mary Anne S Melo
- Ph.D. Program in Biomedical Sciences, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA.,Division of Biomaterials & Tissue Engineering, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA.,Division of Operative Dentistry, Dept. of General Dentistry, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA
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303
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Iafisco M, Degli Esposti L, Ramírez-Rodríguez GB, Carella F, Gómez-Morales J, Ionescu AC, Brambilla E, Tampieri A, Delgado-López JM. Fluoride-doped amorphous calcium phosphate nanoparticles as a promising biomimetic material for dental remineralization. Sci Rep 2018; 8:17016. [PMID: 30451901 PMCID: PMC6242929 DOI: 10.1038/s41598-018-35258-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/29/2018] [Indexed: 11/09/2022] Open
Abstract
Demineralization of dental hard tissue is a widespread problem and the main responsible for dental caries and dentin hypersensitivity. The most promising strategies to induce the precipitation of new mineral phase are the application of materials releasing gradually Ca2+ and PO43- ions or mimicking the mineral phase of the host tissue. However, the design of formulations covering both processes is so far a challenge in preventive dentistry. In this work, we have synthesized innovative biomimetic amorphous calcium phosphate (ACP), which has been, for the first time, doped with fluoride ions (FACP) to obtain materials with enhanced anti-caries and remineralizing properties. Significantly, the doping with fluoride (F) did not vary the physico-chemical features of ACP but resulted in a faster conversion to the crystalline apatite phase in water, as observed by in-situ time-dependent Raman experiments. The efficacy of the as synthesized ACP and FACP samples to occlude dentinal tubules and induce enamel remineralization has been tested in vitro in human molar teeth. The samples showed good ability to partially occlude the tubules of acid-etched dentin and to restore demineralized enamel into its native structure. Results demonstrate that ACP and FACP are promising biomimetic materials in preventive dentistry to hinder demineralization of dental hard tissues.
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Affiliation(s)
- Michele Iafisco
- Institute of Science and Technology for Ceramics (ISTEC), National Research Council (CNR), Via Granarolo 64, 48018, Faenza, Italy.
| | - Lorenzo Degli Esposti
- Institute of Science and Technology for Ceramics (ISTEC), National Research Council (CNR), Via Granarolo 64, 48018, Faenza, Italy
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parco Area delle Scienze 17/a, 43124, Parma, Italy
| | | | - Francesca Carella
- Institute of Science and Technology for Ceramics (ISTEC), National Research Council (CNR), Via Granarolo 64, 48018, Faenza, Italy
| | - Jaime Gómez-Morales
- Laboratorio de Estudios Cristalográficos, Instituto Andaluz de Ciencias de la Tierra, IACT (CSIC-UGR), Av. Las Palmeras 4, 18100, Armilla, Spain
| | - Andrei Cristian Ionescu
- Oral Microbiology Laboratory, Galeazzi Orthopedic Institute, Department of Biomedical, Surgical and Dental sciences, University of Milan, Via Pascal, 36, 20133, Milan, Italy
| | - Eugenio Brambilla
- Oral Microbiology Laboratory, Galeazzi Orthopedic Institute, Department of Biomedical, Surgical and Dental sciences, University of Milan, Via Pascal, 36, 20133, Milan, Italy
| | - Anna Tampieri
- Institute of Science and Technology for Ceramics (ISTEC), National Research Council (CNR), Via Granarolo 64, 48018, Faenza, Italy
| | - José Manuel Delgado-López
- Departamento de Química Inorgánica, Universidad de Granada, Av. Fuente Nueva, s/n, 18071, Granada, Spain.
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304
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Priyadarshini B, Vijayalakshmi U. Development of cerium and silicon co-doped hydroxyapatite nanopowder and its in vitro biological studies for bone regeneration applications. ADV POWDER TECHNOL 2018. [DOI: 10.1016/j.apt.2018.07.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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305
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Sui T, Salvati E, Harper RA, Zhang H, Shelton RM, Landini G, Korsunsky AM. In situ monitoring and analysis of enamel demineralisation using synchrotron X-ray scattering. Acta Biomater 2018; 77:333-341. [PMID: 30026103 DOI: 10.1016/j.actbio.2018.07.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/08/2018] [Accepted: 07/14/2018] [Indexed: 11/18/2022]
Abstract
Dental caries is one of the most common chronic diseases that affect human teeth. It often initiates in enamel, undermining its mechanical function and structural integrity. Little is known about the enamel demineralisation process caused by dental caries in terms of the microstructural changes and crystallography of the inorganic mineral phase. To improve the understanding of the carious lesion formation process and to help identify efficient treatments, the evolution of the microstructure at the nano-scale in an artificially induced enamel erosion region was probed using advanced synchrotron small-angle and wide-angle X-ray scattering (SAXS and WAXS). This is the first in vitro and time-resolved investigation of enamel demineralisation using synchrotron X-ray techniques which allows in situ quantification of the microstructure evolution over time in a simulated carious lesion. The analysis revealed that alongside the reduction of mineral volume, a heterogeneous evolution of hydroxyapatite (HAp) crystallites (in terms of size, preferred orientation and degree of alignment) could be observed. It was also found that the rate and direction of dissolution depends on the crystallographic orientation. Based on these findings, a novel conceptual view of the process is put forward that describes the key structural parameters in establishing high fidelity ultrastructure-based numerical models for the simulation of the enamel demineralisation process. STATEMENT OF SIGNIFICANCE Hydroxyapatite (HAp) crystallites in the enamel dissolve during dental caries although little is known about the structural-chemical relationships that control the dynamic demineralisation process. For the first time this work investigated the in situ evolution of nano-scale morphology and the spatial distribution of ultrastructural HAp crystallites of human enamel during demineralisation in simulated caries. Advanced synchrotron SAXS and WAXS techniques showed that the heterogeneous evolution of crystallites (size, preferred orientation and degree of alignment) could be attributed to crystallographic-orientation-dependent anisotropic dissolution. Hence we propose a novel conceptual schematic diagram to describe the demineralisation process. These findings have important implications for understanding the detailed mechanisms of enamel demineralisation and provide insight into potential enamel remineralisation that could restore structural integrity and function.
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Affiliation(s)
- Tan Sui
- Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK; Department of Mechanical Engineering Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK.
| | - Enrico Salvati
- Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
| | - Robert A Harper
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, 5 Mill Pool Way, Edgbaston, Birmingham B5 7EG, UK
| | - Hongjia Zhang
- Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK
| | - Richard M Shelton
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, 5 Mill Pool Way, Edgbaston, Birmingham B5 7EG, UK
| | - Gabriel Landini
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, 5 Mill Pool Way, Edgbaston, Birmingham B5 7EG, UK
| | - Alexander M Korsunsky
- Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK.
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306
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An S. The emerging role of extracellular Ca
2+
in osteo/odontogenic differentiation and the involvement of intracellular Ca
2+
signaling: From osteoblastic cells to dental pulp cells and odontoblasts. J Cell Physiol 2018; 234:2169-2193. [DOI: 10.1002/jcp.27068] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/25/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Shaofeng An
- Department of Operative Dentistry and EndodonticsGuanghua School of Stomatology, Hospital of Stomatology, Sun Yat‐sen UniversityGuangzhou China
- Guangdong Province Key Laboratory of StomatologySun Yat‐Sen UniversityGuangzhou China
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307
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Alkattan R, Lippert F, Tang Q, Eckert GJ, Ando M. The influence of hardness and chemical composition on enamel demineralization and subsequent remineralization. J Dent 2018; 75:34-40. [DOI: 10.1016/j.jdent.2018.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/01/2018] [Accepted: 05/04/2018] [Indexed: 11/28/2022] Open
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308
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Bono N, Tarsini P, Candiani G. BMP-2 and type I collagen preservation in human deciduous teeth after demineralization. J Appl Biomater Funct Mater 2018; 17:2280800018784230. [PMID: 30045659 DOI: 10.1177/2280800018784230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Great interest has recently been focused on tooth and tooth derivatives as suitable substrates for the treatment of alveolar bone defects. Here, we propose the use of demineralized baby teeth (BT) as potential grafting materials for bone augmentation procedures. METHODS Particles of human BT (Ø < 1 mm) were demineralized by means of a chemical/thermal treatment. Demineralized BT particles were thoroughly characterized by scanning electron microscopy/energy dispersive X-ray analyses to evaluate the effects of the demineralization on BT topography and mineral phase composition, and by enzyme-linked immunosorbent assays (ELISA) to quantify collagen and bone morphogenetic protein-2 (BMP-2) protein contents. The response of SAOS-2 cells to exogenous BMP-2 stimulation was evaluated to identify the minimum BMP-2 concentration able to induce osteodifferentiation in vitro (alkaline phosphatase (ALP) activity). RESULTS The demineralization treatment led to a dramatic decrease in relative Ca and P content (%) of ≈75% with respect to the native BT particles, while preserving native protein conformation and activity. Interestingly, the demineralization process led to a rise in the bioavailability of BMP-2 in BT particles, as compared to the untreated counterparts. The BMP-2 content found in demineralized BT was also proved to be very effective in enhancing ALP activity, thus in the osteodifferentiation of SAOS-2 cells in vitro, as confirmed by cell experiments performed upon exogenously added BMP-2. CONCLUSIONS In this study we demonstrate that the BMP-2 content found in demineralized BT is very effective in inducing cell osteodifferentiation, and strengthens the idea that BTs are very attractive bioactive materials for bone-grafting procedures.
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Affiliation(s)
- Nina Bono
- 1 Politecnico di Milano Research Unit, National Interuniversity Consortium of Materials Science and Technology - INSTM, Milan, Italy
| | - Paolo Tarsini
- 2 Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Gabriele Candiani
- 1 Politecnico di Milano Research Unit, National Interuniversity Consortium of Materials Science and Technology - INSTM, Milan, Italy.,2 Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
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309
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Meyer F, Amaechi BT, Fabritius HO, Enax J. Overview of Calcium Phosphates used in Biomimetic Oral Care. Open Dent J 2018; 12:406-423. [PMID: 29988215 PMCID: PMC5997847 DOI: 10.2174/1874210601812010406] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/23/2018] [Accepted: 05/14/2018] [Indexed: 11/24/2022] Open
Abstract
Background: The use of biomimetic agents is an emerging field in modern oral care. Promising biomimetic substances for such applications are calcium phosphates, because their chemical composition is very similar to that of the mineral phase in human teeth, especially of natural enamel. Examples for their application include the remineralization of early caries lesions and repair of small enamel defects. Objective: This review provides an interdisciplinary view on calcium phosphates and their applications in biomimetic oral care. The aim of this work is to give an overview of in vivo and in situ studies comparing several calcium phosphates in preventive dentistry that can be used as a knowledge base for the development of innovative alternative oral care concepts. Methods: Books, reviews, and original research papers with a focus on in vivo and in situ studies were included. The databases PubMed® and SciFinder® were used for literature search. Calcium phosphates that are frequently utilized in oral care products are covered in this review and were used as search terms alone and together with the following key words: in vivo, in situ, caries, clinical study, and remineralization. From 13,470 studies found, 35 studies complied with the inclusion criteria and were used for this review. Results: Published in vivo and in situ studies demonstrate calcium phosphates’ potential in enamel remineralization. However, more studies are needed to further substantiate existing results and to extend and refine the application of calcium phosphates in modern oral care. Conclusion: Calcium phosphates represent an innovative biomimetic approach for daily oral care because of their high similarity to natural enamel that will broaden the range of future treatments in preventive dentistry.
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Affiliation(s)
- Frederic Meyer
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611 Bielefeld, Germany
| | - Bennett T Amaechi
- Department of Comprehensive Dentistry, University of Texas Health Science Center, 703 Floyd Curl Drive, San Antonio, Texas 78229-3900, USA
| | - Helge-Otto Fabritius
- Max-Planck-Institut für Eisenforschung GmbH, Microstructure Physics and Alloy Design, Max-Planck-Straße 1, 40237 Duesseldorf, Germany
| | - Joachim Enax
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611 Bielefeld, Germany
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310
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El Assal DW, Saafan AM, Moustafa DH, Al-Sayed MA. The effect of combining laser and nanohydroxy-apatite on the surface properties of enamel with initial defects. J Clin Exp Dent 2018; 10:e425-e430. [PMID: 29849965 PMCID: PMC5971073 DOI: 10.4317/jced.54371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 03/21/2018] [Indexed: 11/06/2022] Open
Abstract
Background The aim of this study was to evaluate the effect of combining fractional CO2 LASER and nanohydroxy apatite on surface microhardness and color of enamel with initial defects. Material and Methods Two types of nano hydroxylapatite (nHAP) was prepared; Pure hydroxyapatite (nHA) and Fluoro hydroxyapatite (nFHA), Sixty extracted premolar teeth without visible caries or structural defects on enamel surface were used, immersed in 10 ml of a demineralizing solution for 2 weeks to create artificial white spot lesions, they were randomly allocated into two groups; Group 1: nHA, Group 2: nFHA, each group is then subdivided into 2 subgroups (A and B) where two different in vitroremineralization procedures have been performed, the first procedure utilizes a 10 wt% nHA aqueous slurries only, the second was first exposed to irradiation from a fractional CO2 laser then (nHAP) was applied. Microhardness and color were measured using a micro-Vickers hardness tester and spectrophotometer respectively. Results Laser treated teeth in both groups showed the highest mean hardness and lowest color difference where ΔE was less than 3.3 units, in both tests the pure type of nanohydroxyapatite gave better results than the nanofluroapatite type. Conclusions Nano-hydroxyapatite has remarkable remineralizing effects on initial lesions of enamel, certainly higher when combined with laser application. Key words:CO2 LASER, Enamel remineralization, Nanohydroxy apatite.
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Affiliation(s)
- Dina-Wahied El Assal
- Professor of Dental Laser Applications National Institute of Laser Enhanced Sciences,Cairo University
| | - Ali-Mohamed Saafan
- Professor of Dental Laser Applications National Institute of Laser Enhanced Sciences,Cairo University
| | | | - Marwa-Adel Al-Sayed
- Assistant Professor of Inorganic Chemistry Department, National Research Center Giza, Egypt
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311
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Carvalho FSR, Feitosa VP, Silva PGDB, Soares ECS, Ribeiro TR, Fonteles CSR, Costa FWG. Evaluation of different therapeutic Carnoy's formulations on hard human tissues: A Raman microspectroscopy, microhardness, and scanning electron microscopy study. J Craniomaxillofac Surg 2018; 46:749-758. [PMID: 29655532 DOI: 10.1016/j.jcms.2018.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/07/2018] [Accepted: 02/14/2018] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate different therapeutic Carnoy's solution formulations on hard human tissues. MATERIALS AND METHODS An in vitro study was performed with human teeth (n = 36) and bone fragments (n = 18), randomly divided into two experimental groups (Group I = Carnoy solution with chloroform; Group II = Carnoy solution without chloroform) and a control group (saline solution). The groups were subdivided into pre-conditioning, post-conditioning, and post-conditioning with saline washing. Raman microspectroscopy, Knoop microhardness test, and scanning electron microscopy with energy dispersive X-ray spectroscopy were used. RESULTS There was demineralization of dental structures regarding mineral/matrix and carbonate/phosphate ratios (GI versus GII, p < 0.05). The presence of chloroform resulted in a statistically significant reduction of the teeth surface microhardness (p = 0.036), but not exceeding 0.01 μm. Both GI and GII showed significant structural changes by using scanning electron microscopy with energy dispersive X-ray spectroscopy. CONCLUSION Carnoy's solution altered the organic and inorganic matrix of the human calcified specimens analyzed in vitro, and its effect was more pronounced when chloroform was present.
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Affiliation(s)
- Francisco Samuel Rodrigues Carvalho
- Division of Oral and Maxillofacial Surgery, Federal University of Ceará, Fortaleza, Brazil; Division of Oral and Maxillofacial Morphology and Oral and Maxillofacial Surgery, UNIFOR, Fortaleza, Brazil.
| | | | | | - Eduardo Costa Studart Soares
- Division of Oral and Maxillofacial Surgery, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Brazil
| | | | | | - Fábio Wildson Gurgel Costa
- Division of Oral Radiology, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Brazil
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312
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Offermanns V, Andersen OZ, Riede G, Sillassen M, Jeppesen CS, Almtoft KP, Talasz H, Öhman-Mägi C, Lethaus B, Tolba R, Kloss F, Foss M. Effect of strontium surface-functionalized implants on early and late osseointegration: A histological, spectrometric and tomographic evaluation. Acta Biomater 2018; 69:385-394. [PMID: 29425718 DOI: 10.1016/j.actbio.2018.01.049] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/18/2018] [Accepted: 01/30/2018] [Indexed: 12/15/2022]
Abstract
Numerous in vivo, in vitro and clinical studies report on beneficial effects of strontium with respect to increased bone growth. Based on this knowledge the aim of this study was to evaluate early and late osseointegration stages of functionalized titanium implants showing sustained release of strontium (Sr) and further investigate its potential systemic effect. Strontium functionalized (Ti-Sr-O) and Grade 4 (Control) titanium implants were inserted in the femoral condyle of New Zealand White rabbits. The Ti-Sr-O coating was characterized using Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray Spectrometry (EDX) for structure, coating thickness and chemical composition. Inductively Coupled Plasma Atomic Emission Spectrometry (ICP-AES) was used to evaluate released strontium in vitro while Atomic Absorption Spectrometry (AAS) was utilized to monitor serum levels of strontium and calcium. Additionally, histological and tomographic analysis of bone-to-implant contact (BIC%) and bone formation (BF%) was performed, following implantation periods of two or twelve weeks, respectively. Median values for BIC% for Ti-Sr-O revealed significant differences within the two- and twelve-week observation periods, while exceeding BF% was discovered especially after twelve weeks when performing the histological evaluation. The results from the micro-computed tomography (µ-CT) showed no significant differences, when comparing the experimental groups. AAS measurements did not indicate a systemic effect by the local strontium release. Within the limitations of the study, it was shown that a Ti-Sr-O coating with sustained release characteristics of strontium, accelerates bone apposition and represents a potential potent surface modification for endosseous medical implant devices. STATEMENT OF SIGNIFICANCE This study presents first data with respect to early and late in vivo response on a strontium functionalized titanium surface comprising a nanotopography manufactured by a magnetron sputtering process. We investigated different osseointegration stages of screw-shaped implants with dental implant geometries in a rabbit femur model observing beneficial effects of the functionalized surface on bone-to-implant contact and bone formation caused by tailored release of the bone anabolic strontium. Histomorphometrical data revealed that a functionalized titanium surface with controlled liberation of strontium accelerates osseointegration while spectrometry measurements did not indicate a potential systemic effect of this osteoinductive agent and could thus have impact on modifications of medical implant devices.
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AlShehab AH, AlHazoom AA, Alowa MH, AlAli HA, Abdulmohsen AA, Farooq I. Effect of bristle stiffness of manual toothbrushes on normal and demineralized human enamel-An in vitro profilometric study. Int J Dent Hyg 2018; 16:e128-e132. [DOI: 10.1111/idh.12332] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- AH AlShehab
- Dental Intern; College of Dentistry; Imam Abdulrahman Bin Faisal University; Dammam Saudi Arabia
| | - AA AlHazoom
- Dental Intern; College of Dentistry; Imam Abdulrahman Bin Faisal University; Dammam Saudi Arabia
| | - MH Alowa
- Dental Intern; College of Dentistry; Imam Abdulrahman Bin Faisal University; Dammam Saudi Arabia
| | - HA AlAli
- Dental Intern; College of Dentistry; Imam Abdulrahman Bin Faisal University; Dammam Saudi Arabia
| | - AA Abdulmohsen
- Dental Intern; College of Dentistry; Imam Abdulrahman Bin Faisal University; Dammam Saudi Arabia
| | - I Farooq
- Department of Biomedical Dental Sciences; College of Dentistry; Imam Abdulrahman Bin Faisal University; Dammam Saudi Arabia
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314
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Total and soluble fluoride concentration present in various commercial brands of children toothpastes available in Saudi Arabia - A pilot study. Saudi Dent J 2018; 30:161-165. [PMID: 29628740 PMCID: PMC5884239 DOI: 10.1016/j.sdentj.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 11/27/2017] [Accepted: 01/15/2018] [Indexed: 01/25/2023] Open
Abstract
Objective The aim of this pilot study was to perform chemical analysis and investigate the total and soluble fluoride concentrations in various brands of children toothpastes. Materials and methods Three samples of five different commercial brands of children toothpastes were collected and divided into five groups; group A – Biorepair Oral Care toothpaste containing no fluoride (control), group B – Signal Kids Strawberry toothpaste having 500 ppm fluoride, group C – Aquafresh Milk Teeth toothpaste having 500 ppm fluoride, group D – Aquafresh Little Teeth toothpaste having 500 ppm fluoride, and group E – Siwak F Junior having 400 ppm F. The total fluoride (TF) and total soluble fluoride (TSF) concentration of the toothpastes was determined using fluoride ion selective electrode. Data were analysed using Paired sample t-test. Results The measured TF values were inconsistent with that of the declared concentrations by the manufacturers. Mean TF found in the toothpastes ranged between 2.37 and 515.74 ppm whereas, the mean TSF ranged between 2.00 and 503.4 ppm. For two groups, TF was more than the declared TF whereas for the other three groups, it was less than the declared concentration. All the differences between the declared and observed TF concentration were statistically significant (p < .05) except for one group. All the toothpastes demonstrated mean TSF slightly lower than their respective observed mean TF concentrations. Conclusion The analysis of TF and TSF concentrations revealed variations from the labelled claims. Therefore, some of the toothpastes may have doubtful anti-caries effectiveness owing to deficiency of total and soluble fluoride.
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315
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Witten PE, Fjelldal PG, Huysseune A, McGurk C, Obach A, Owen MAG. Bone without minerals and its secondary mineralization in Atlantic salmon (Salmo salar): the recovery from phosphorus deficiency. J Exp Biol 2018; 222:jeb.188763. [DOI: 10.1242/jeb.188763] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022]
Abstract
Calcium and phosphorus (P) are the main bone minerals and P-deficiency causes hypomineralized bones (osteomalacia) and malformations. This study uses a P-deficient salmon model to falsify three hypotheses. First, an extended period of dietary P-deficiency does not cause pathologies other than osteomalacia. Second, secondary mineralization of non-mineralized bone is possible. Third, secondary mineralization can restore the bones' mineral composition and mechanical properties.
Post-smolt Atlantic salmon (Salmo salar) received for seven weeks diets with regular P-content (RP), or with a 50% lowered P-content (LP). For additional nine weeks RP animals continued on the regular diet (RP-RP). LP animals continued on the LP-diet (LP-LP), on a regular P diet (LP-RP), or on a high P diet (LP-HP).
After 16 weeks, animals in all groups maintained a non-deformed vertebral column. LP-LP animals continued bone formation albeit without mineralization. Nine weeks of RP diet largely restored the mineral content and mechanical properties of vertebral bodies. Mineralization resumed deep inside the bone and away from osteoblasts. The history of P-deficiency was traceable in LP-RP and LP-HP animals as a ring of low-mineralized bone in the vertebral body endplates but no tissue alterations occurred that foreshadow vertebral body compression or fusion. Large quantities of non-mineralized salmon bone have the capacity to re-mineralize. If 16 weeks of P-deficiency as a single factor is not causal for typical vertebral body malformations other factors remain to be identified. This example of functional bone without minerals may explain why some teleost species can afford to have an extremely low mineralized skeleton.
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Affiliation(s)
- P. Eckhard Witten
- Ghent University, Biology Department, Ledeganckstraat 35, 9000 Ghent, Belgium
| | - Per Gunnar Fjelldal
- Institute of Marine Research (IMR), Matre Aquaculture Research Station, Matredal, Norway
| | - Ann Huysseune
- Ghent University, Biology Department, Ledeganckstraat 35, 9000 Ghent, Belgium
| | - Charles McGurk
- Skretting Aquaculture Research Center, P. O. Box 48, N-4001, Stavanger, Norway
| | - Alex Obach
- Skretting Aquaculture Research Center, P. O. Box 48, N-4001, Stavanger, Norway
| | - Matthew A. G. Owen
- Skretting Aquaculture Research Center, P. O. Box 48, N-4001, Stavanger, Norway
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316
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Kangwankai K, Sani S, Panpisut P, Xia W, Ashley P, Petridis H, Young AM. Monomer conversion, dimensional stability, strength, modulus, surface apatite precipitation and wear of novel, reactive calcium phosphate and polylysine-containing dental composites. PLoS One 2017; 12:e0187757. [PMID: 29136013 PMCID: PMC5685583 DOI: 10.1371/journal.pone.0187757] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/25/2017] [Indexed: 12/21/2022] Open
Abstract
Purpose The aim was to assess monomer conversion, dimensional stability, flexural strength / modulus, surface apatite precipitation and wear of mono / tri calcium phosphate (CaP) and polylysine (PLS)—containing dental composites. These were formulated using a new, high molecular weight, fluid monomer phase that requires no polymerisation activator. Materials and methods Urethane and Polypropylene Glycol Dimethacrylates were combined with low levels of an adhesion promoting monomer and a light activated initiator. This liquid was mixed with a hybrid glass containing either 10 wt% CaP and 1 wt% PLS (F1) or 20 wt% CaP and 2 wt% PLS (F2). Powder to liquid mass ratio was 5:1. Commercial controls included Gradia Direct Posterior (GD) and Filtek Z250 (FZ). Monomer conversion and polymerisation shrinkage were calculated using Fourier Transform Infrared (FTIR). Subsequent volume increases in water over 7 weeks were determined using gravimetric studies. Biaxial flexural strength (BFS) / modulus (BFM) reduction and surface apatite precipitation upon 1 and 4 weeks immersion in water versus simulated body fluid (SBF) were assessed using a mechanical testing frame and scanning electron microscope (SEM). Mass / volume loss and surface roughness (Ra) following 7 weeks water immersion and subsequent accelerated tooth-brush abrasion were examined using gravimetric studies and profilometer. Results F1 and F2 exhibited much higher monomer conversion (72%) than FZ (54%) and low calculated polymerization shrinkage (2.2 vol%). Final hygroscopic expansions decreased in the order; F2 (3.5 vol%) > F1 (1.8 vol%) ~ Z250 (1.6 vol%) > Gradia (1.0 vol%). BFS and BFM were unaffected by storage medium type. Average BFS / BFM upon 4 weeks immersion reduced from 144 MPa / 8 GPa to 107 MPa / 5 GPa for F1 and 105 MPa / 6 GPa to 82 MPa / 4 GPa for F2. Much of this change was observed in the first week of immersion when water sorption rate was high. Surface apatite layers were incomplete at 1 week, but around 2 and 15 micron thick for F1 and F2 respectively following 4 weeks in SBF. Mass and volume loss following wear were equal. Average results for F1 (0.5%), F2 (0.7%), and FZ (0.5%) were comparable but lower than that of GD (1%). Ra, however, decreased in the order; F1 (15 μm) > F2 (11 μm) > GD (9 μm) > FZ (5 μm). Conclusions High monomer conversion in combination with large monomer size and lack of amine activator should improve cytocompatibility of the new composites. High monomer molecular weight and powder content enables low polymerisation shrinkage despite high conversion. Increasing active filler provides enhanced swelling to balance shrinkage, which, in combination with greater surface apatite precipitation, may help seal gaps and reduce bacterial microleakage. High monomer conversion also ensures competitive mechanical / wear characteristics despite enhanced water sorption. Furthermore, increased active filler could help reduce surface roughness upon wear.
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Affiliation(s)
- Kanokrat Kangwankai
- Department of Restorative Dentistry, Unit of Prosthodontics, UCL Eastman Dental Institute, London, United Kingdom
- Unit of Orthodontics, UCL Eastman Dental Institute, London, United Kingdom
| | - Sarah Sani
- Department of Restorative Dentistry, Unit of Prosthodontics, UCL Eastman Dental Institute, London, United Kingdom
| | - Piyaphong Panpisut
- Department of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, London, United Kingdom
- Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
| | - Wendy Xia
- Department of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, London, United Kingdom
| | - Paul Ashley
- Unit of Paediatric Dentistry, UCL Eastman Dental Institute, London, United Kingdom
| | - Haralampos Petridis
- Department of Restorative Dentistry, Unit of Prosthodontics, UCL Eastman Dental Institute, London, United Kingdom
| | - Anne Margaret Young
- Department of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, London, United Kingdom
- * E-mail:
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317
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Rilla K, Mustonen AM, Arasu UT, Härkönen K, Matilainen J, Nieminen P. Extracellular vesicles are integral and functional components of the extracellular matrix. Matrix Biol 2017; 75-76:201-219. [PMID: 29066152 DOI: 10.1016/j.matbio.2017.10.003] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/10/2017] [Accepted: 10/16/2017] [Indexed: 12/18/2022]
Abstract
Extracellular vesicles (EV) are small plasma membrane-derived particles released into the extracellular space by virtually all cell types. Recently, EV have received increased interest because of their capability to carry nucleic acids, proteins, lipids and signaling molecules and to transfer their cargo into the target cells. Less attention has been paid to their role in modifying the composition of the extracellular matrix (ECM), either directly or indirectly via regulating the ability of target cells to synthesize or degrade matrix molecules. Based on recent results, EV can be considered one of the structural and functional components of the ECM that participate in matrix organization, regulation of cells within it, and in determining the physical properties of soft connective tissues, bone, cartilage and dentin. This review addresses the relevance of EV as specific modulators of the ECM, such as during the assembly and disassembly of the molecular network, signaling through the ECM and formation of niches suitable for tissue regeneration, inflammation and tumor progression. Finally, we assess the potential of these aspects of EV biology to translational medicine.
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Affiliation(s)
- Kirsi Rilla
- Faculty of Health Sciences, School of Medicine, Institute of Biomedicine, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland.
| | - Anne-Mari Mustonen
- Faculty of Health Sciences, School of Medicine, Institute of Biomedicine, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland
| | - Uma Thanigai Arasu
- Faculty of Health Sciences, School of Medicine, Institute of Biomedicine, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland
| | - Kai Härkönen
- Faculty of Health Sciences, School of Medicine, Institute of Biomedicine, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland
| | - Johanna Matilainen
- Faculty of Health Sciences, School of Medicine, Institute of Biomedicine, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland
| | - Petteri Nieminen
- Faculty of Health Sciences, School of Medicine, Institute of Biomedicine, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland
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318
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Hassanali L, Wong FS, Lynch RJM, Anderson P. A Novel Kinetic Method to Measure Apparent Solubility Product of Bulk Human Enamel. Front Physiol 2017; 8:714. [PMID: 28983253 PMCID: PMC5613155 DOI: 10.3389/fphys.2017.00714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/04/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction: Tooth enamel mineral loss is influenced by its solubility product value, which is fundamental to the understanding of de- and remineralization resulting from a carious or erosive challenge. Published pKsp values for human enamel and hydroxyapatite range from 110 to 126 suggesting a heterogeneous nature of enamel solubility. However, this range of values may also result from the variety of methods used, e.g., some authors reporting values for suspensions of enamel powder and others for bulk enamel. The aim of this study was to develop a method to measure the solubility of bulk human enamel under controlled in vitro conditions simulating demineralization behavior of enamel within the oral environment using scanning microradiography (SMR). SMR was used to monitor real-time changes in enamel demineralization rates at increasing calcium concentrations in a caries simulating demineralization solution until the concentration at which thermodynamic equilibrium between enamel and solution was achieved. Method: 2 mm thick caries free erupted human enamel slabs with the natural buccal surfaces exposed were placed in SMR cells exposed to circulating caries-simulating 2.0 L 0.1 M pH = 4.0 acetic acid, at 25°C. SMR was used to continuously measure in real-time the decrease in mineral mass during the demineralization at 5 different points from on each slab. Demineralization rates were calculated from a linear regression curve of projected mineral mass against demineralization time. Changes in the demineralization rates were monitored following a series of successive increases in calcium (and phosphate at hydroxyapatite stoichiometric ratios of Ca:P 1.67) were added to the demineralizing solution, until demineralization ceased. The pH was maintained constant throughout. Results: Demineralization halted when the calcium concentration was ~30 mM. At higher calcium concentrations, mineral deposition (remineralization) occurred. By comparison with results from speciation software calculations for the calcium phosphate ternary system, this result suggests that the bulk solubility product of enamel (pKspBEnamel) under the conditions used is 121. Discussion: The apparent pKspBEnamel under these conditions was higher than many previous reported values, and much closer to those previously reported for HAp. However, this is a bulk value, and does not reflect that enamel is a heterogeneous material, nor the influence of ionic inclusions.
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Affiliation(s)
- Linda Hassanali
- Dental Physical Sciences Unit, Institute of Dentistry, Queen Mary University of LondonLondon, United Kingdom
| | - Ferranti S Wong
- Dental Physical Sciences Unit, Institute of Dentistry, Queen Mary University of LondonLondon, United Kingdom
| | - Richard J M Lynch
- Innovation Research and Development, Oral Healthcare, GlaxoSmithKlineWeybridge, United Kingdom
| | - Paul Anderson
- Dental Physical Sciences Unit, Institute of Dentistry, Queen Mary University of LondonLondon, United Kingdom
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319
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Delgado AJ, Olafsson VG. Acidic oral moisturizers with pH below 6.7 may be harmful to teeth depending on formulation: a short report. Clin Cosmet Investig Dent 2017; 9:81-83. [PMID: 28814900 PMCID: PMC5546593 DOI: 10.2147/ccide.s140254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Xerostomia affects 30% of the population and manifests as a side effect of medications, systemic diseases, or cancer therapy. Oral moisturizers are prescribed to overcome the ailments of dry mouth and its symptoms. It is imperative that these products help to restore hyposalivation and that they do not present any secondary effect that can harm oral health. It has been shown in the literature that some oral moisturizers may have an erosive potential due to their acidic pH, which is below the critical pH of dentin and enamel. The purpose of this paper was to make clinicians aware of the erosive potential of these products and make recommendations to manufactures for future formulations avoiding acidic pH. For this reason, care should be taken to formulate these products with safe pH values for both enamel and root dentin which, based on specific formulation should be around 6.7 or higher.
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Affiliation(s)
- Alex J Delgado
- Department of Restorative Dental Sciences, University of Florida, Gainesville, FL, USA
| | - Vilhelm G Olafsson
- Department of Operative Dentistry, Faculty of Odontology, University of Iceland and Private Practice, Reykjavic, Iceland.,Department of Operative Dentistry, School of Dentistry at the University of North Carolina, Chapel Hill, NC, USA
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320
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de Campaigno EP, Kebir I, Montastruc JL, Rueter M, Maret D, Lapeyre-Mestre M, Sallerin B, Despas F. Drug-Induced Dental Caries: A Disproportionality Analysis Using Data from VigiBase. Drug Saf 2017; 40:1249-1258. [DOI: 10.1007/s40264-017-0575-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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