Comparison of methods for quantifying dental wear caused by erosion and abrasion

The potential of galactomannan from Caesalpinia ferrea on erosive dentin wear reduction in vitro

Gels containing juca seed galactomannan (JSG) were evaluated for their potential to prevent the progression of dentin erosive wear in an in vitro study with four experimental groups (n = 9). The treatments included distilled water (DW), 0.05% stannous fluoride (121 ppm F), and 0.5% or 1% JSG. The specimens underwent a cycle (3 times/day) consisting of immersion in 1% citric acid (5 minutes), treatment (5 minutes), and artificial saliva exposure (2 hours/overnight) for 5 days. Surface changes were assessed using mechanical profilometry (wear), scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDS). The data were analyzed using ANOVA followed by Tukey's post-test (p < 0.05). The negative control group exhibited the highest wear (6.0 µm ± 3.5), significantly differing from the group treated with 0.05% stannous fluoride gel (p = 0.007), which showed less dentin loss. The groups treated with 0.5% and 1% JSG showed results similar to the negative control (p = 0.661; p = 0.212, respectively) and the stannous fluoride group (p = 0.103; p = 0.379, respectively). In the SEM images, the specimen treated with stannous fluoride showed obliterated tubules, while the JSG gels formed crystals on the dentin surface, as confirmed by the presence of oxygen and calcium in the EDS analysis. Although the JSG gels showed similar results to the stannous fluoride, did not exhibit superior efficacy at the tested concentrations.

Evaluation of Struthio camelus eggshell as an in vitro alternative to extracted human teeth in preliminary screening studies on dental erosion

OBJECTIVES

This in vitro work investigates the potential of ostrich eggshell as a substitute for extracted human teeth in preliminary screening studies on dental erosion. Additionally, it aims to demonstrate the potential of ostrich eggshell compared to human enamel in evaluating the efficacy of a preventive agent in protecting against dental erosion, using an artificial mouth model.

METHODS

The experiment utilized 96 erosion testing specimens from each substrate, human enamel, and ostrich eggshell. The specimens were subjected to six different experimental regimens of increasing erosive challenge, simulating the consumption of an acidic drink. The acidic drink was delivered at a consistent volume and duration range. Both artificially stimulated and unstimulated saliva flowed throughout the experimental regimens. Surface hardness was measured using a Through-Indenter Viewing hardness tester with a Vickers diamond, while surface profiling was done using a surface contacting profilometer with a diamond stylus. An automated chemistry analyzer system was used to detect calcium and phosphate ions.

RESULTS

The study found that ostrich eggshell specimens demonstrated predictable surface loss, hardness drop, and ion loss due to the acidic challenge. Meanwhile, enamel appeared to fall short in terms of surface hardness predictability. The transient hardness loss phase, which manifests as an overlooked decrease in surface hardness despite significant ion and structural loss, may explain this phenomenon.

CONCLUSIONS

The experiment showed that assessing surface loss is essential in addition to hardness testing, particularly as certain experimental conditions may produce a false perception of tissue recovery despite the actual surface loss. By analyzing the response of ostrich eggshell specimens to erosive challenges, researchers were able to identify an "overlooked" reduction in hardness in enamel specimens. The differences in the structure, chemical composition, and biological response to erosion in the presence of artificial saliva between enamel and ostrich eggshell could explain their distinct behaviors.

Comparative analysis of the effect of Bioactive Glass 45S5 on enamel erosion progression in human dentitions (in vitro study)

OBJECTIVES

The aim of the present study was to compare the surface morphology alterations, mineral content, and surface roughness of eroded enamel surface versus eroded enamel surface which was preceded by Bioactive Glass 45S5 (BAG45S5) application in both primary and permanent human dentitions.

MATERIALS AND METHODS

Fifty-two primary teeth and fifty-two permanent teeth were selected. Teeth were randomly divided into 4 groups of twenty-six teeth each. Groups A1 and B1 underwent erosion with 1% citric acid, while groups A2 and B2 were subjected to application of BAG45S5 powder followed by the same erosive conditions as A1 and B1. Measurements were performed by scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), and surface profilometry. They were used to examine the surface morphology alterations, mineral content, and surface roughness, respectively.

RESULTS

SEM of enamel which received BAG45S5 showed smoother surface in primary teeth post erosion. EDX analysis showed that enamel exhibited crucial resistance to mineral loss in the group which received BAG45S5 prior to inducing erosion as compared to the induced erosion-only group. This was significant (p < 0.005) in both human dentitions. Erosion-only groups showed significantly less surface roughness in permanent teeth (p < 0.045). A marked decrease in surface roughness was observed in surfaces receiving BAG45S5, primary teeth (p < 0.001), and permanent teeth (p < 0.001).

CONCLUSIONS

Bioactive Glass 45S5 proved successful against erosive conditions in both primary and permanent teeth with better performance in the permanent teeth so it can be regarded as a means of prevention.

CLINICAL RELEVANCE

Bioactive Glass 45S5 powder could be used not only to remove stains but also as a prophylactic preventive measure against the multiple episodes of acidic food and beverage consumption in children.

Wear Behavior and Surface Quality of Dental Bioactive Ions-Releasing Resins Under Simulated Chewing Conditions

Bioactive materials can reduce caries lesions on the marginal sealed teeth by providing the release of ions, such as calcium, phosphate, fluoride, zinc, magnesium, and strontium. The presence of such ions affects the dissolution balance of hydroxyapatite, nucleation, and epitaxial growth of its crystals. Previous studies mostly focused on the ion-releasing behavior of bioactive materials. Little is known about their wear behavior sealed tooth under mastication. This study aimed to evaluate the wear behavior and surface quality of dental bioactive resins under a simulated chewing model and compare them with a resin without bioactive agents. Three bioactive resins (Activa, BioCoat, and Beautifil Flow-Plus) were investigated. A resin composite without bioactive agents was used as a control group. Each resin was applied to the occlusal surface of extracted molars and subjected to in vitro chewing simulation model. We have assessed the average surface roughness (Ra), maximum high of the profile (Rt), and maximum valley depth (Rv) before and after the chewing simulation model. Vickers hardness and scanning electron microscopy (SEM) also analyzed the final material surface quality). Overall, all groups had increased surface roughness after chewing simulation. SEM analysis revealed a similar pattern among the materials. However, the resin with polymeric microcapsules doped with bioactive agents (BioCoat) showed increased surface roughness parameters. The material with Surface Pre-reacted Glass Ionomer (Beautifil Flow-Plus) showed no differences compared to the control group and improved microhardness. The addition of bioactive agents may influence surface properties, impairing resin composites' functional and biological properties. Future studies are encouraged to analyze bioactive resin composites under high chemical and biological challenges in vitro with pH cycles or in situ models.

Protective effect of green tea catechins on eroded human dentin: an in vitro/in situ study

The present study sought to evaluate the protective effect of Epigallocatechin-3-gallate (EGCG) and commercial green tea (GT) on eroded dentin using in vitro and in situ experimental models. For the in vitro experiment, matrix metalloproteinases (MMPs) were extracted from demineralized human coronary dentin powder (citric acid, pH 2.3) and assessed via a colorimetric assay and electrophoresis in gelatin. The gels were exposed to buffers with: control (no treatment), 0.05% sodium fluoride (NaF), 0.12% chlorhexidine digluconate (CHX), GT infusion, and 0.1% EGCG, and their respective activity was analyzed by zymography. For the in situ experiment, 20 healthy volunteers (aged 20-32 years) participated in this single-center, blind, crossover study. The subjects wore upper removable devices containing four human dentin blocks. Erosive challenge (coke-1 min) was performed four times/day/5 days. Blocks were treated for 1 min with: control (No treatment), 0.05% NaF, 0.1% EGCG, and GT. Thereafter, the specimens were subjected to stylus profilometry and SEM. ANOVA was used to evaluate dentin roughness and wear, with a significance level of 5%. In the zymography analysis, 0.12% CHX, GT, and 0.1% EGCG were found to inhibit the action of MMPs; however, in the colorimetric assay, only green tea inhibited the activity of MMPs. There were no significant differences observed in dentin roughness or wear (p > 0.05). Herein, EGCG and GT inhibited the activity of endogenous proteases, resulting in protection against erosion-induced dentin damage; however, they could not prevent tooth tissue loss in situ.

Hesperidin reduces dentin wear after erosion and erosion/abrasion cycling in vitro

OBJECTIVE

To evaluate the action of hesperidin (HPN) at different concentrations to prevent dentin erosive wear, associated or not to abrasion.

METHODS

A study with 6 experimental groups (n = 10) for erosion (experiment 1) and another 6 for erosion + abrasion (experiment 2). The treatments were: distilled water (DW), DW with collagenase (DW + Col), 0.46% epigallocatechin-3-gallate (EGCG) and 0.1%, 0.5% or 1% HPN. The specimens were submitted to a cycle (3x/day) for 5 days that consisted of immersion on 1% citric acid (5 min), artificial saliva (60 min), treatment (5 min), brushing (150 movements only in experiment 2), and artificial saliva (60 min / overnight). Collagenase was added in artificial saliva for all groups except DW-group. Dentin changes were assessed with optical profilometry and scanning electron microscopy. Data were submitted to one-way analysis of variance and Tukey tests (α = 0.05).

RESULTS

For experiment 1, DW showed the lowest wear and did not significantly differ from EGCG. DW + Col showed the highest wear, being significantly different from HPN at 1%. In experiment 2, DW showed the lowest wear and DW + Col the highest. EGCG showed less wear than the three groups treated with HPN. In addition, for both cycling models, there were no significant differences among the three concentrations of HPN analyzed. In micrographs of HPN-treated groups, it could be observed the formation of a barrier on the dentin that promoted the obliteration of the tubules.

CONCLUSIONS

HPN was able to preserve the demineralized organic matrix layer but did not overcome the effect of EGCG.

Sustained Antibacterial Effect and Wear Behavior of Quaternary Ammonium Contact-Killing Dental Polymers after One-Year of Hydrolytic Degradation

This study intended to investigate the long-term antibacterial effect, mechanical performance, and surface topography of new anticaries dental composites. While most artificial aging studies of dental resins lasted for 30–90 days, this study prolonged the water-aging to one year to be more clinically relevant. The base resin was loaded with dimethylaminohexadecyl methacrylate (DMAHDM) at 3 or 5 wt.% and nano-sized amorphous calcium phosphate (NACP) at 20 wt.%. Composites were subjected to one-year water storage and wear. Following water aging, samples were evaluated for flexural strength, elastic modulus, and microbiological assays. Biofilm plate counting method, metabolic assay, colorimetric quantification of lactic acid, and Baclight bacterial viability assay were measured after one year. Topography changes (ΔRa, ΔRq, ΔRv, ΔRt) were examined after wear and observed by scanning electron microscopy. Biofilm assays and topography changes data were analyzed via one-way ANOVA and Tukey’s tests. Mechanical properties and normalized data were verified using a t-test. The flexural strength values for the formulations that contained 5% DMAHDM-20% NACP, 3% DMAHDM, and 5% DMAHDM were reduced significantly (p < 0.05) in relation to the baseline but the values were still above the ISO standards. No significant differences were observed between the groups concerning the topography changes, except for the ΔRt, where there was a significant increase in the 5% DMAHDM-20% NACP group. All the groups demonstrated robust biofilm-inhibition, with slightly reduced antibacterial properties following water aging. The aged samples reduced the total microorganisms, total streptococci, and mutans streptococci by 1.5 to 3-log, compared to the experimental control. The new formulations containing DMAHDM and NACP were able to sustain the antibacterial performance after one-year of aging. Mechanical properties and surface topography were slightly affected over time.

Erosion of CAD/CAM restorative materials and human enamel: An in vitro study

This in vitro study used the same frequency and duration of acid contact as a previous in situ/in vivo study to evaluate the effect of erosion on CAD/CAM restorative materials and human enamel and to compare the effects of in vitro and in situ/in vivo acid challenges on CAD/CAM restorative materials and human enamel. The CAD/CAM restorative materials (IPS e.max CAD, Lava Ultimate, and PMMA block) and human enamel were eroded by immersion in 150 ml of cola drink for 14 days (4 × 5 min/day). The surface microhardness and surface roughness of the specimens were measured at baseline (T1), day 7 (T2), and day 14 (T3). The substance losses were measured at T2 and T3. The data were statistically analyzed using repeated measures ANOVA and Bonferroni's test (α = 0.05). Erosion significantly decreased the surface microhardness of the CAD/CAM restorative materials and human enamel (all P < 0.001). The overall percentage of surface microhardness loss (%SMH_l) of the PMMA block and enamel due to in vitro erosion was significantly higher than that due to in situ/in vivo erosion (P = 0.02 and P < 0.001, respectively). Consistent with in situ/in vivo erosion, the surface roughness and profile of the tested restorative materials remained unchanged after in vitro erosion. A significant increase in the surface roughness and substance loss was observed for enamel after in vitro erosion (all P < 0.001). The overall substance loss of enamel due to in vitro erosion was significantly higher than that due to in situ/in vivo erosion (P < 0.001). In conclusion, erosion decreased the surface microhardness of the CAD/CAM restorative materials and human enamel. Moreover, erosion negatively influenced the substance loss and surface roughness of human enamel. For the substance loss of enamel and %SMH_l of PMMA block and enamel, the in vitro erosive effects were approximately 1-2 times greater than the in situ/in vivo effects. However, for the surface roughness and profile of the CAD/CAM restorative materials, no significant difference was found between in vitro and in situ/in vivo erosion.

Fluoride dentifrice containing calcium silicate and sodium phosphate salts on dental erosion: In vitro study

OBJECTIVE

To investigate the effect of a commercial dentifrice containing fluoride, calcium silicate, and sodium phosphate and its dual phase gel serum to prevent erosive tooth wear in enamel.

METHODS

Forty-eight enamel specimens were selected by surface hardness and randomly allocated into 4 groups (n = 12) according to the commercial toothpastes: non-fluoridated (NF); 1100 ppm Stannous fluoride (SnF₂); 1450 ppm MFP + calcium silicate + sodium phosphate (CSSP); CSSP + dual-phase gel (CSSP + Serum). Cyclic experiments were repeated 3x / day for five days, including an erosive challenge with 0.05 M citric acid (pH 3.75 for 30 s), treatment with toothpaste slurries (1 min), and remineralization with artificial saliva (pH 7.0 for 60 min). Surface alterations were determined by stylus profilometry (μm) and scanning electron microscopy (SEM). Data were analyzed by ANOVA and Tukey tests (α = 0.05).

RESULTS

SnF₂, CSSP and CSSP + Serum significantly reduce surface wear compared to NF treated group. Besides, there were no significant differences among SnF₂, CSSP and CSSP + Serum. In micrographs of both groups treated with CSSP, the surface demonstrates the presence of a protective layer as a deposition of particles.

CONCLUSIONS

Dentifrice containing calcium silicate and sodium phosphate with or without the dual-phase gel was able to prevent the erosive tooth wear.

Measurement of erosion depth using microcomputed tomography and light microscopy

Tooth-erosion is the surface loss of dental hard tissue mostly associated with an acid attack. The aim was to compare dentin and enamel erosion depth measurements using micro-computed tomography (microCT) and light microscopy (LM). Enamel/dentin blocks were prepared from caries-free human molar-teeth (N = 12). Teeth were sectioned to a rectangular shape of 4 × 4 × 6 mm. Specimens were treated with water (NC) or 1.0% citric-acid solution (PC). After treatment, specimens were scanned with micro-computed tomography. On completion, specimens were sectioned and observed under a light-microscope. Lesion depth was observed with 10× magnification and images transferred to Simpleware software. Vertical distance from lesion surface to bottom was measured. Pearson correlation test was used to evaluate correlation and Wilcoxon Signed Rank test to evaluate differences in the two-analysis methods. Mean enamel erosion depth was 0.63 and 38.38 μm (microCT) and 0.54 and 39.43 μm (LM) for NC and PC, respectively. Dentin erosion depth was 0.72 and 48.05 μm (microCT) and 0.56 and 49.92 μm (LM) for NC and PC, respectively. There was a significant correlation between the two-analysis methods (r = 0.998; p < .001). No statistically significant difference in results were obtained when microCT and LM were compared (p = .584). This results obtained from the current study suggested that erosion depth measurements made using microCT and LM yielded comparable results. The microCT method is preferred if the conservation of specimens is desired.

Assessment of surface roughness changes on orthodontic acrylic resins by all-in-one spray disinfectant solutions

Background. The disinfection of orthodontic acrylic resins might change the physical and mechanical properties of these materials. We aimed to investigate the impact of four different commercially available disinfectants on the surface roughness of acrylic resins used for orthodontic appliances.

Methods. Four disinfectant solutions (BirexSE, Opti-Cide3, COEfect MinuteSpray, and CaviCide Spray) were used to disinfect orthodontic acrylic resins using the spraying method. The resins were subjected to repeated disinfection protocols. Distilled water, also applied via spraying method, was used as a control. Surface roughness was scrutinized to examine the extent of surface topography changes by stylus profilometry. Data normality was evaluated via the Shapiro–Wilk test, followed by the Wilcoxon Signed-Rank test for non-parametric data or paired Student’s t-test for parametric data to compare intra-group differences in roughness before and after the use of the disinfectant solutions.

Results. Some of the disinfectants (BirexSE and CaviCide) resulted in significant changes in surface roughness values before and after the disinfection compared to the controls (P<0.05). The groups that were in contact with distilled water, Opti-Cide, and Coeffect did not exhibit significant differences in surface roughness before and after the intervention (P>0.05). However, from a clinical perspective, the resulting variations in surface roughness (<%0.15) induced by these solutions might not reflect clinically significant differences.

Conclusion. The use of disinfectant solutions is unlikely to harm the surface of orthodontic acrylic resins. Oral care providers need to be attentive to the interpretation and implementation of clinically significant changes in their evidence-based approach regarding potential material damages by disinfection sprays.

Raman spectroscopy-multivariate analysis related to morphological surface features on nanomaterials applied for dentin coverage

Raman spectroscopy and scanning electron microscopy (SEM) were used to investigate the effect of coating materials and acidulated phosphate fluoride gel (APF) treatment on dentin before and after erosion-abrasion cycles. A multi-walled carbon nanotube/graphene oxide hybrid carbon-based material (MWCNTO-GO), nanohydroxyapatite (nHAp), or a combined composite (nHAp/MWCNTO-GO) were used as a coating. Seventy root dentin fragments obtained from 40 bovine teeth were prepared and divided into groups (n = 10): negative control, artificial saliva - C, positive control - APF; nHAp; MWCNTO-GO; APF_nHAp; APF_MWCNTO-GO and APF_nHAp/MWCNTO-GO. All samples were subjected to cycles of demineralization (orange juice, pH ~3.7, room temperature, 1 min) followed by remineralization (saliva, 37 °C, 1 h). The remineralization procedures were followed by tooth brushing (150 strokes). The above cycle was repeated 3×/day for 5 days. The previous APF treatment of dentin allowed a better affinity of nHAp and MWCNTO-GO with the inorganic and organic portion of dentin, respectively. This interaction indicates the formation of a protective layer for the dentin surface and for the collagen giving possible protection against erosion. SEM micrographs illustrated the formation of a protective layer after application of the biomaterials and that it was partially or totally removed after the erosion and abrasion. Raman spectroscopy combined with multivariate analysis could distinguish samples with respect to treatment efficacy. The APF_nHAP/MWCNT-GO composite has shown to be a promising material since it has binding characteristics both to the inorganic and organic portion of the dentin and reduced solubility. Mineral-to-matrix ratio (MMR) parameter analysis confirmed the binding capability of MWCNTO-GO-based materials to dentin.

Adverse effects of respiratory disease medicaments and tooth brushing on teeth: A scanning electron microscopy, X-ray fluorescence and infrared spectroscopy study

The present study aims to evaluate the effect of brushing with fluoride dentifrice on teeth severely affected by erosion due to respiratory medicaments. Enamel (n = 50) and dentin (n = 50) bovine specimens were prepared and treated with artificial saliva (S-control), acebrofilin hydrochloride (AC), ambroxol hydrochloride (AM), bromhexine hydrochloride (BR), and salbutamol sulfate (SS) and subjected to cycles of demineralization (immersing in 3 mL, 1 min, three times a day at intervals of 1 hr, for 5 days) followed by remineralization (saliva, 37°C, 1 hr). Simulated brushing with fluoridated toothpaste was performed using 810 strokes in a reciprocal-action brushing simulator. Scanning electron microscopy, micro energy dispersive X-ray fluorescence (μ-EDXRF) spectroscopy and attenuated total reflection Fourier transform infrared (ATR FTIR) spectroscopy were then performed. μ-EDXRF images showed extensive erosion after treatment with all medicaments. SEM images showed enamel erosion in order SS > BR > AC = AM > S after brushing and fluoridation. FTIR results were in agreement. In case of dentin, μ-EDXRF measurements showed significant difference in mineral content (percent weight of calcium and phosphate) in SS + brushing + fluoridation treated enamel compared to control, while μ-EDXRF images showed erosive effects in the order SS > AM>BR > AC = S post brushing + fluoridation. SEM images showed erosion in the order SS > AM = BR > AC > S post brushing + fluoridation. Again, FTIR multivariate results were in agreement. Overall, our study shows that proper oral care is critical when taking certain medication. The study also demonstrates the possible use of FTIR for rapid clinical monitoring of tooth erosion in clinics.

Chemical and morphological evaluation of enamel and dentin near cavities restored with conventional and zirconia modified glass ionomer subjected to erosion-abrasion

Microenergy dispersive X-ray fluorescence (μ-EDXRF) spectroscopy and scanning electron microscopy (SEM) were used to test the hypothesis that zirconia modified glass ionomer cement (GIC) could improve resistance to erosion-abrasion to a greater extent than conventional cement. Bovine enamel (n = 40) and dentin (n = 40) samples were prepared with cavities, filled with one of the two restorative materials (GIC: glass-ionomer cement or ZrGIC: zirconia-modified GIC). Furthermore, the samples were treated with abrasion-saliva (AS) or abrasion-erosion cycles (AE). Erosive cycles (immersion in orange juice, three times/day for a duration of 1 min over a 5 day period) and/or abrasive challenges (electric toothbrush, three times/day for a duration of 1 min over a 5 day period) were performed. Positive mineral variation (MV%) on the enamel after erosion-abrasion was observed for both materials (p < 0.05), whereas a negative MV% on the dentin was observed for both materials and treatments (p < 0.05). The SEM images showed clear enamel loss after erosion-abrasion treatment and material degradation was greater in GIC_AE compared to those of the other groups. Toothbrush abrasion showed a synergistic effect with erosion on substance loss of bovine enamel, dentin, GIC, and ZrGIC restorations. Zirconia addition to the GIC powder improved the resistance to abrasive-erosive processes. The ZrGIC materials may find application as a restorative material due to improved resistance as well as in temporary restorations and fissure sealants.

Comprehensive analysis of laserscanner validity used for measurement of wear

OBJECTIVES

The aims of this study were to test the hypotheses that (a) a laserscanner used for measuring maximum depth and volume loss will yield the same results as a surface profilometer; (b) the surface roughness will affect the maximum depth and volume loss measured with the laserscanner; (c) analytical results using the laserscanner from multiple operators have no more than 10% inter-rater difference and; (d) replicating samples using either stone or impression material is an accurate method for measuring wear using the laserscanner.

MATERIALS AND METHODS

The volume and maximum depth of indentations from fine, medium and rough burs on glass-ceramic disks were measured using two devices, a surface profilometer (Dektak II, Veeco) and a 3D Laserscanner (LAS-20, SD Mechatronik). Replicates of the indentations made from polyvinysiloxane impression material and gypsum were also measured.

RESULTS

Comparison of profilometer and laserscanner readings using ceramic disks demonstrated a mean error of 13.61% for depth and 25.32% for volume. Replication errors were minimal (2.6% for impression, 2.5% for stone). Surface profilometer data for volume measurements revealed a difference of 6.1% for impression and 6.5% for stone compared with ceramics. However, when measurements for replicates were compared between laserscanner and surface profilometer, depth had a mean error of 74% for impression and 51% for stone. Volume differences of 78% for impression and 44% for stone were recorded.

CONCLUSION

This work demonstrated that the laserscanner was a convenient device for measuring wear but there is a need to validate the accuracy of the measurements.

Analysis of the bond interface between self-adhesive resin cement to eroded dentin in vitro

The purpose of this study was to evaluate the bonding interface between a self-adhesive resin cement to in vitro eroded dentin. Seventy-two third molars were used and divided into two groups: sound dentin and in vitro eroded dentin. The in vitro erosion was performed following a demineralization protocol, in which the specimens were immersed in a demineralizing solution for 2 minutes per cycle and remineralizing solution for 10 minutes per cycle for 9 days. Both groups were submitted to four dentin surface treatments: control group (without any treatment), 2% chlorhexidine, 20% polyacrylic acid, and 0.1 M EDTA (n = 9). Blocks of resin-based composite were bonded with RelyX U200 self-adhesive resin cement applied on the pretreated dentin surfaces. The teeth were sectioned into beams (1mm²) and submitted to microtensile bond strength testing to evaluate the bond strength of self-adhesive resin cement to dentin after 24 hours and 8 months of immersion in artificial saliva. Three specimens of each group were longitudinally cut and evaluated using confocal laser scanning microscopy to analyze the dentin/cement interface. Eroded dentin showed higher bond strength values when compared to sound dentin for the 2% chlorhexidine group (p = 0.03), 24 hours after adhesion. When considering eroded dentin, the 0.1M EDTA group showed higher bond strength values with a statistically significant difference only for the control group (p = 0.002). After 8 months of storage, the present results showed that there was no statistically significant difference between the two substrates for all experimental groups (p>0.05). Analysis of the microscopy confocal showed different types of treatments performed on dentin generally increased tags formation when compared to the control group. The eroded dentin showed a significant increase in density and depth of resinous tags when compared to sound dentin. The storage of samples for 8 months seems to have not caused significant degradation of the adhesive interface.

In vitro evaluation of modified surface microhardness measurement, focus variation 3D microscopy and contact stylus profilometry to assess enamel surface loss after erosive-abrasive challenges

The aim of the study was to compare surface loss values after erosion-abrasion cycles obtained with modified surface microhardness measurement (mSMH), focus variation 3D microscopy (FVM) and contact stylus profilometry (CSP). We cut human molars into buccal and lingual halves, embedded them in resin and ground 200 μm of enamel away. The resulting surfaces were polished. To maintain a reference area, we applied Block-Out resin to partly cover the enamel surface. The samples were incubated in artificial saliva (37°C; 1 h), then rinsed in deionized water (10 s) and dried with oil-free air (5 s). We immersed the specimens individually in 30 mL citric acid (1%, pH 3.6) for 2 min (25°C, 70 rpm dynamic conditions) before brushing them (50 strokes, 200 g) in an automatic brushing machine with toothpaste-slurry. We calculated the surface loss as per mSMH, by re-measuring the length of the same six indentations made before the abrasive challenge. The experiment consisted of five experimental groups that received between 2 and 10 erosion-abrasion cycles. Each group contained 15 specimens and samples in groups 1, 2, 3, 4 and 5 underwent a total of 2, 4, 6, 8 and 10 cycles, respectively. The resin was removed from the reference area in one piece under 10× magnification and the FVM and CSP were performed. Agreement between the methods was calculated with the intraclass correlation coefficient (ICC) and depicted in Bland-Altman plots. All methods presented a linear pattern of surface loss measurements throughout the experiment, leading overall to a strong, statistically significant correlation between the methods (ICC = 0.85; p<0.001). So, despite the different surface loss values, all methods presented consistent results for surface loss measurement.

Wear Distribution Detection of Knee Joint Prostheses by Means of 3D Optical Scanners

The objective of this study was to examine total knee polyethylene inserts from in vitro simulation to evaluate and display-using a 3D optical scanner-wear patterns and wear rates of inserts exposed to wear by means of simulators. Various sets of tibial inserts have been reconstructed by using optical scanners. With this in mind, the wear behavior of fixed and mobile bearing polyethylene knee configurations was investigated using a knee wear joint simulator. After the completion of the wear test, the polyethylene menisci were analyzed by an innovative 3D optical scanners in order to evaluate the 3D wear distribution on the prosthesis surface. This study implemented a new procedure for evaluating polyethylene bearings of joint prostheses obtained after in vitro wear tests and the proposed new approach allowed quantification of the contact zone on the geometry of total knee prostheses. The results of the present study showed that mobile TKPs (total knee prosthesis) have lower wear resistance with respect to fixed TKPs.

Carbohydrate-electrolyte drinks exhibit risks for human enamel surface loss

Objectives

The aim of this investigation was to give insights into the impact of carbohydrate-electrolyte drinks on the likely capacity of enamel surface dissolution and the influence of human saliva exposure as a biological protective factor.

Materials and Methods

The pH, titratable acidity (TA) to pH 7.0, and buffer capacity (β) of common beverages ingested by patients under physical activity were analyzed. Then, we randomly distributed 50 specimens of human enamel into 5 groups. Processed and natural coconut water served as controls for testing three carbohydrate-electrolyte drinks. In all specimens, we measured surface microhardness (Knoop hardness numbers) and enamel loss (profilometry, µm) for baseline and after simulated intake cycling exposure model. We also prepared areas of specimens to be exposed to human saliva overnight prior to the simulated intake cycling exposure. The cycles were performed by alternated immersions in beverages and artificial saliva. ANOVA two-way and Tukey HDS tests were used.

Results

The range of pH, TA, and β were 2.85 - 4.81, 8.33 - 46.66 mM/L and 3.48 - 10.25 mM/L × pH, respectively. The highest capacity of enamel surface dissolution was found for commercially available sports drinks for all variables. Single time human saliva exposure failed to significantly promote protective effect for the acidic attack of beverages.

Conclusions

In this study, carbohydrate-electrolyte drinks usually consumed during endurance training may have a greater capacity of dissolution of enamel surface depending on their physicochemical proprieties associated with pH and titratable acidity.

Effect of surface treatment on enamel surface roughness

Purpose:

To compare the effects of different methods of surface treatment on enamel roughness.

Materials and Methods:

Ninety human maxillary first premolars were randomly divided into three groups (n=30) according to type of enamel surface treatment: I, acid etching; II, Er:YAG laser; III, Nd:YAG laser. The surface roughness of enamel was measured with a noncontact optical profilometer. For each enamel sample, two readings were taken across the sample—before enamel surface treatment (T1) and after enamel surface treatment (T2). The roughness parameter analyzed was the average roughness (Ra). Statistical analysis was performed using a Paired sample t test and the post-hoc Mann- Whitney U test, with the significance level set at 0.05.

Results:

The highest Ra (average roughness) values were observed for Group II, with a significant difference with Groups I and III (P<0.001). Ra values for the acid etching group (Group I) were significantly lower than other groups (P<0.001).

Conclusion:

Surface treatment of enamel with Er:YAG laser and Nd:YAG laser results in significantly higher Ra than acid-etching. Both Er:YAG laser or Nd:YAG laser can be recommended as viable treatment alternatives to acid etching.

Erosive Effect of Different Soft Drinks on Enamel Surface in vitro: Application of Stylus Profilometry

OBJECTIVE

To assess the erosive potential of various soft drinks by measuring initial pH and titratable acidity (TA) and to evaluate enamel surface roughness using different exposure times.

MATERIALS AND METHODS

The initial pH of the soft drinks (group 1: Coca-Cola; group 2: orange juice; group 3: Cedevita; group 4: Guarana, and group 5: strawberry yoghurt) was measured using a pH meter, and TA was measured by titration with NaOH. Enamel samples (n = 96), cut from unerupted human third molars, were randomly assigned to 6 groups: experimental (groups 1-5) and control (filtered saliva). The samples were exposed to 50 ml of soft drinks for 15, 30 and 60 min, 3 times daily, during 10 days. Between immersions, the samples were kept in filtered saliva. Enamel surface roughness was measured by diamond stylus profilometer using the following roughness parameters: Ra, Rq, Rz, and Ry. Data were analyzed by one-way ANOVA, Tukey's post hoc and Student-Newman-Keuls post hoc tests.

RESULTS

The pH values of the soft drinks ranged from 2.52 (Guarana) to 4.21 (strawberry yoghurt). Orange juice had the highest TA, requiring 5.70 ml of NaOH to reach pH 7.0, whereas Coca-Cola required only 1.87 ml. Roughness parameters indicated that Coca-Cola had the strongest erosion potential during the 15 min of exposure, while Coca-Cola and orange juice were similar during 30- and 60-min exposures. There were no significant differences related to all exposure times between Guarana and Cedevita. Strawberry yoghurt did not erode the enamel surface regardless of the exposure time.

CONCLUSION

All of the tested soft drinks except yoghurt were erosive. Erosion of the enamel surfaces exposed to Coca-Cola, orange juice, Cedevita, and Guarana was directly proportional to the exposure time.

Three-dimensional profilometric assessment of early enamel erosion simulating gastric regurgitation

OBJECTIVES

A priority research area in minimal intervention dentistry is the characterization of the early stages of dental erosion. The aim of this in vitro study was to assess the effect of short, repetitive erosive challenges to human enamel over 2 min at pH 1.5 and 3.0 under conditions simulating gastric regurgitation.

METHODS

Enamel surfaces were subjected to erosive challenges at pH 1.5 (Group 1, n=10) and pH 3.0 (Group 2, n=9) for periods of 30s (stage 1), 60s (stage 2) and 120 s (stage 3). Quantitative changes were assessed longitudinally by measuring the 3D average surface roughness (Sa) values using 3D confocal microscopy. Qualitative micrographic assessment of surface changes was also conducted by using environmental scanning electron microscopy.

RESULTS

Linear mixed model analysis showed significant effects of the pH values (p<0.001) and the stages (p<0.001) on the observed Sa values. Post hoc tests showed significant increases in the Sa values between baseline and other stages in both groups (p<0.01). The mean Sa values also increased significantly from stage 1 to stage 2 in Group 1 (p<0.05). Micrographic analysis displayed severely etched enamel rods in Group 1, but only subtle changes in Group 2.

CONCLUSIONS

The complexity of the enamel surface is influenced by both acid concentration (pH value) and duration of acid exposure during early stages of erosion. Erosion occurring under conditions simulating GORD can be detected in its initial stages, opening up the possibilities of early diagnosis and management of this condition.

CLINICAL SIGNIFICANCE

Erosive tooth wear occurs progressively and insidiously, often creating complex treatment challenges. This emphasizes the need for early diagnosis and management in accordance with minimal intervention philosophy. Our findings provide a foundation for further research that could lead to the development of highly-sensitive clinical diagnostic tools and preventive strategies.

Effects of diode laser therapy and stannous fluoride on dentin resistance under different erosive acid attacks

OBJECTIVE

This in vitro study aimed to evaluate the effect of a low intensity diode laser (λ=808 nm; 60 J/cm2) associated with stannous fluoride on the inhibition of dentin erosion by assessing percentage of superficial hardness loss (%SHL) and calcium release into the acid solution.

MATERIALS AND METHODS

Human root dentin slabs were assigned to eight groups (n=10), according to treatments (control, stannous fluoride, diode laser therapy, and the combination of stannous fluoride and laser therapy), and acid challenge (hydrochloridric or citric acid). All slabs were subjected to a previous 2 h acquired pellicle formation; laser and fluoride treatments were performed according to the groups. Subsequently, the slabs were exposed to erosive challenge (0.01 M hydrochloridric acid or citric acid 1% for 60 sec). Additionally, calcium released into the acid solution during erosive challenge was analyzed by photometric test. Data were analyzed by ANOVA followed by Tukey's test (p<0.05).

RESULTS

Mean values (±SD) for %SHL of treated groups did not present statistically significant differences, regardless of the erosive challenge. However, in relation to released calcium concentration, groups treated with laser presented statistically significant lower calcium loss under hydrochloridric acid challenge (p<0.001). To groups under citric acid attack, only the combination of treatments (p=0.037) was able to show a protective effect on dentin.

CONCLUSIONS

Under the conditions of this study, 808 nm diode laser with or without stannous fluoride could effectively reduce dentin surface loss under both acid exposures. Only calcium concentration analysis was sensitive enough to measure the effects under the tested conditions.

Measuring enamel erosion: a comparative study of contact profilometry, non-contact profilometry and confocal laser scanning microscopy

OBJECTIVES

To compare three instruments for their ability to quantify enamel loss after acid erosion.

METHODS

6 randomized parallel groups of bovine enamel samples were subjected to citric acid (higher acidity) or orange juice (lower acidity) erosion and remineralisation in a cycling model. Two protected shoulders were created on each of the samples using tape, to serve as reference for analysis. The time of exposure to each acid was varied, along with presence or absence of agitation. After treatment, samples were measured on 3 instruments capable of measuring step height: a contact profilometer (CP); a non-contact profilometer (NCP); and a confocal laser scanning microscope (CLSM) by three different examiners. Additionally, 3D (volume) step height was also measured using the CLSM.

RESULTS

Increasing acid concentration and exposure time resulted in greater erosion, as did agitation of samples while in acid solution. All instruments/methods identified the same statistically significant (p<0.05) pair-wise differences between the treatments groups. Further, all four methods exhibited strong agreement (Intra-class correlation ≥ 0.96) in erosion level and were highly correlated, with correlations of 0.99 or higher in all cases.

SIGNIFICANCE

All instruments/methods used in this study produced very similar conclusions with regard to ranking of enamel loss, with data showing very high agreement between instruments. All instruments were found to be equally suited to the measurement of enamel erosion.