The Early Stages of Native Enamel Dissolution Studied with Atomic Force Microscopy

The Contribution of Scanning Force Microscopy on Dental Research: A Narrative Review

Scanning force microscopy (SFM) is one of the most widely used techniques in biomaterials research. In addition to imaging the materials of interest, SFM enables the mapping of mechanical properties and biological responses with sub-nanometer resolution and piconewton sensitivity. This review aims to give an overview of using the scanning force microscope (SFM) for investigations on dental materials. In particular, SFM-derived methods such as force-distance curves (scanning force spectroscopy), lateral force spectroscopy, and applications of the FluidFM® will be presented. In addition to the properties of dental materials, this paper reports the development of the pellicle by the interaction of biopolymers such as proteins and polysaccharides, as well as the interaction of bacteria with dental materials.

The effect of location/site on polished human enamel after mechanical and chemical wear

OBJECTIVE

To compare profilometry and microhardness of polished occlusal and buccal human enamel following a mechanical and chemical wear regime.

METHODS

Enamel from polished human molars were sectioned into buccal and occlusal surfaces and randomly allocated into two groups (n = 10) and then exposed to 0.3 % citric acid at pH 2.7 for 10, 20, 40 and 60 mins each followed by abrasion with non-fluoridated toothpaste for 240 strokes in a reciprocating brushing machine. A white light profilometer with a spot size of 12 um measured mean step-height following each cycle. Microhardness indentations were conducted following the final cycled 60 mins erosion/abrasion using 0.01, 0.02, 0.1, 0.5 and 2.5 kgf indentation load. Statistical disparity were evaluated using a two-way ANOVA and post-hoc Sidak's multiple comparisons tests at α = 0.05.

RESULTS

After erosion/abrasion, the mean (SD) step-heights on occlusal and buccal surfaces were not significantly different until 60 mins, when occlusal surfaces exhibited greater step-heights, 32.9 µm (2.8) and 31.1 µm (1.8) and p = 0.02, respectively. Buccal and occlusal microhardness was statistically lower following erosion/abrasion at loads of 0.01 kgf (p = 0.0005) and 0.02 kgf (p = 0.0006) but no significant differences were observed in the microhardness between the surfaces at any loads.

CONCLUSION

The occlusal and buccal surfaces were not statistically different for microhardness or step height suggesting the susceptibility to wear is not related to the anatomy and structure of the tooth and is more likely related to other factors such as the environment.

CLINICAL SIGNIFICANCE

The study emphasizes that a notable difference in wear between occlusal and buccal enamel surfaces emerges only after prolonged exposure to simultaneous chemical and mechanical stress. This finding necessitates a preventive dental approach that accounts for both the duration of exposure and environmental factors.

Erosion-Driven Enamel Crystallite Growth Phenomenon at the Tooth Surface In Vitro

The erosion of tooth enamel is a common oral disease. The erosion pattern and location and the effects of nanoscale chemical composition on the erosion susceptibility of enamel have been well documented. However, the enamel remineralization accompanied by erosion and its underlying physicochemical mechanisms still remain poorly understood. Here, using rat molars selected for its good relevancy to human teeth, we investigated the remineralization behavior of the outermost enamel surface at the nanoscale level during erosion in diluted hydrochloric acid solutions. While particles on the outermost enamel surface that represent the termination of crystallites protruding to the surface from the near-surface core eroded by acid-attack, the lateral-growth of the particles (i.e., the main remineralization picture of the surface enamel) occurred concurrently. Ionic analyses indicate that the particle growth is driven by the local increase in pH near the eroding enamel surface as a result of the combination of the PO₄^3- and CO₃^2- released from the enamel surface with H⁺. As the pH increases eventually to the equilibrium pH level (∼5.5), a local supersaturation of solute ions is induced, resulting in particle growth. A simple growth model based on the experimental results together with an assumption that the particle growth is a diffusional process suggests that the particle growth rate is controlled by the degree of supersaturation and accommodation site for solute ions, which are affected by the pH of solution eroding the enamel surface. The remineralization mechanism presented by our study can explain how the enamel on being acid-exposed or tooth decay progress by beverage or food can naturally remineralize in the oral cavity and how remineralization can foster different surface topology at the nanoscale, depending on the pH value of etchant before the dental filling material is applied.

Nanoscopic wear behavior of dentinogenesis imperfecta type II tooth dentin

OBJECTIVES

The aim of this study was to investigate the wear behavior of Dentinogenesis imperfecta type II (DGI-II) dentin and elucidate the correlation between its tribological properties and components.

METHODS

The mid-coronal dentin of normal and DGI-II teeth were divided into two groups: perpendicular and parallel to the dentin tubules. The microstructure of dentin was detected using atomic force microscopy (AFM). The wear behavior of dentin was evaluated by nanoscratch tests and scanning electron microscopy (SEM). Meanwhile, changes in molecular groups and chemical composition were analyzed by Raman and Energy-Dispersive X-ray (EDX) tests, respectively. Nanohardness was also evaluated.

RESULTS

AFM images of DGI-II dentin illustrated a decrease in the number of tubules and the tubule diameter. Nanoscratch test showed a higher friction coefficient and a greater depth-of-scratch in DGI-II dentin. The wear resistance of DGI-II dentin was reduced independent of tubule orientation. EDX results indicated that DGI-II dentin mineral content decreased and Raman spectra results showed DGI-II dentin had a decreased collagen matrix structure stability coupled with hypomineralization. Furthermore, a significant reduction in nanohardness and elastic modulus of DGI-II dentin was observed. Regression analysis revealed a close correlation between dentin components and inferior wear resistance.

CONCLUSIONS

All results indicated the wear behavior of DGI-II dentin was significantly deteriorated, presumably caused by the disorder in microstructures and the reduction of chemical composition.

Nanoscale effects of beverages on enamel surface of human teeth: An atomic force microscopy study

Dental erosion has become a prevalence disease and attracted increasing attention worldwide. In this research, we quantitatively evaluate the mechanical and morphological changes in the very early stages of softening and weakening of human enamel surfaces induced by soft drinks using atomic force microscopy (AFM). With an increase of the immersion time in soft drinks, we found a significant increase of surface roughness (R_q) of the enamel surface. The prismatic structure of enamel was clearly observed after a 1-h immersion in Coca-Cola®, which shows its strong erosion effect. According to the elastic modulus mapping images obtained by AFM, a considerable decrease of elastic modulus (E) of enamel surface has been found as the enamel surface structures are etched away by soft drinks. A high surface roughness of enamel will result in a high chance of cavities due to easier bacterial adhesion on rougher surface, while a drastic deterioration of the mechanical properties of the enamel will weaken its protection property. Our findings show the serious influence of acidic drinks on enamel surface at the very beginning stage of etching process, which is quite meaningful for people to prevent dental erosion and keep dental health.

Near-Surface Studies of the Changes to the Structure and Mechanical Properties of Human Enamel under the Action of Fluoride Varnish Containing CPP-ACP Compound

Changes to the features of the enamel surface submitted to induced demineralisation and subsequent remineralisation were studied. The in vitro examination was conducted on polished slices of human molar teeth, divided in four groups: the untreated control (n = 20), challenged by a demineralisation with orthophosphoric acid (H₃PO₄) (n = 20), and challenged by a demineralisation following remineralisation with fluoride (F) varnish containing casein phosphopeptides (CPP) and amorphous calcium phosphate (ACP) compounds (n = 20). The specimens’ enamel surfaces were subjected to analysis of structure, molecular arrangement, mechanical features, chemical composition, and crystalline organization of apatite crystals. Specimens treated with acid showed a significant decrease in crystallinity, calcium, and phosphorus levels as well as mechanical parameters, with an increase in enamel surface roughness and degree of carbonates when compared to the control group. Treatment with fluoride CPP–ACP varnish provided great improvements in enamel arrangement, as the destroyed hydroxyapatite structure was largely rebuilt and the resulting enamel surface was characterised by greater regularity, higher molecular and structural organisation, and a smoother surface compared to the demineralised one. In conclusion, this in vitro study showed that fluoride CPP–ACP varnish, by improving enamel hardness and initiating the deposition of a new crystal layer, can be an effective remineralising agent for the treatment of damaged enamel.

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.

The Influence of Suspension Containing Nanodiamonds on the Morphology of the Tooth Tissue Surface in Atomic Force Microscope Observations

Reduced friction and wear of materials after the use of the carbon nanomaterials including nanodiamonds (NDs) have been confirmed by several studies in material engineering. Mechanical cleaning of the tooth surface by brush bristles should leave as little tissue roughened as possible. Higher surface roughness increases the tissue's wear and encourages the redeposition of the bacteria and the colouring agents present in the diet. Therefore, we evaluated the tooth tissues' surface's morphological changes after brushing them with the NDs suspension. Ten human teeth were brushed with the NDs aqueous suspension. The surfaces were observed using an Atomic Force Microscope (AFM). We found that the nature of the tissue surface became milder and smoother. A number of selected profilometric parameters were compared before and after brushing. We observed that brushing with the suspension of NDs resulted in a significant reduction in the enamel and dentine's surface roughness both in the range of the average parameters (Ra; p-0,0019) and in the detailed parameters (Rsk; p-0,048 and Rku; p-0,036). We concluded that the NDs used in the oral hygiene applications have a potentially protective effect on the enamel and the dentine's surfaces.

Enamel sample preparation for AFM: Influence on roughness and morphology

Human dental enamel is organized by prisms that are structured between 3 and 6 µm in diameter. Determining the relationships between different treatments on the surface of enamel using ultrastructural analysis is the purpose of many in vitro experiments. Different sample pretreatments have been reported in the literature. Grinding and polishing are common procedures for enamel preparation. They provide a flat and standardized surface, which is imperative for the use of some techniques such as ATR-FTIR. However, for morphological analysis, SEM and AFM represent easier methods to measure and reduce the biological sample variation. Therefore, the objective of this study was to establish how different forms of enamel preparation can influence the advent of artifacts during ultrastructural observation, especially by AFM analysis. Four groups (n = 10) were tested: (a) without preparation; (b) polishing with a diamond paste; (c) grinding with decreasing granulations of silicon carbide papers; (d) grinding with polishing. Images were obtained using the Peak-Force Tapping mode. After the first images were obtained, all fragments were acid etched with 37% phosphoric acid for 30 seconds, rinsed for 60 seconds, and dried intensively. Upon grinding and polishing, the exposure of the inner enamel surfaces provided a less mineralized layer that was marked by scratches and a higher susceptibility to treatments. Moreover, using native enamel provided more valuable information on the surface and the roughness changes for clinical applications. In addition, phosphoric acid is an option for observing the prismatic arrangement after grinding and/or polishing changes the morphology. RESEARCH HIGHLIGHTS: The use of native enamel samples to investigate the effects of different treatments on surface should be preferred in research, when the technique allows it.

Preventive effects of different protective agents on dentin erosion: An in vitro investigation

Background

The purpose of this in vitro study was to evaluate the preventive effects of different protective agents on dentine erosion, measuring mean percentage weight loss. Dissolution of dentine under erosive challenges caused by soft drinks was analyzed: specimens were weighed following each immersion period, with mean percent weight losses calculated.

Material and Methods

Extracted teeth were sectioned into uniform slabs. Seventy permanent enamel specimens were randomly distributed to seven groups. Initial weights of all dentin specimens were performed. The fluoride pastes Remin Pro, MI Paste Plus, Tooth Mousse, Biorepair, Biorepair Plus and Regenerate were used in this study. A control group was treated just with tap water. The specimens then were immersed in Coca-Cola for a total of 32 min at room temperature. Finally each specimen was dry and weighed. The mass loss was calculated as a percentage of that observed prior the fluoride pastes application. Weight loss data were subjected to Analysis of Variance (One-way ANOVA) followed by Bonferroni’s post hoc tests.

Results

Percent weight loss of specimens exposed to early stages in Coca-Cola showed linear progression with time. Specimen’s application of fluoridated varnishes such as Biorepair or Regenerate, prior immersion in Coca-Cola, significantly protect dentin from demineralization. Otherwise, application of Tooth Mousse or Biorepair Plus increased dentin demineralization starting from 24 min of immersion in Coca-Cola.

Conclusions

Despite the limitations of this study, the protective pastes that showed the less weight loss due to the acidic challenge are Biorepair and Regenerate.

Key words:Dentine, erosion, protective agents, soft drinks, toothpastes.

Protective effect of zinc-hydroxyapatite toothpastes on enamel erosion: An in vitro study

BACKGROUND

The aim of the present study was to test the impact of different toothpastes with Zinc-Hydroxyapatite (Zn-HAP) on preventing and repairing enamel erosion compared to toothpastes with and without fluoride.

MATERIAL AND METHODS

The following four toothpastes were tested: two toothpastes with Zn-HAP, one toothpaste with fluoride and one toothpaste without fluoride. An additional control group was used in which enamel specimens were not treated with toothpaste. Repeated erosive challenges were provided by immersing bovine enamel specimens (10 per group) in a soft drink for 2 min (6mL, room temperature) at 0, 8, 24 and 32 h. After each erosive challenge, the toothpastes were applied neat onto the surface of specimens for 3 min without brushing and removed with distilled water. Between treatments the specimens were kept in artificial saliva. Enamel hardness, after the erosive challenge and toothpaste treatment was monitored using surface micro-hardness measurements.

RESULTS

As expected, repeated erosive challenge by a soft drink for total of 8 min significantly reduced enamel surface hardness (ANOVA, p < 0.05). No re-hardening of the surface softened enamel was observed in the group treated with fluoride-free toothpaste. Surface hardness of the softened enamel increased when the specimens were treated with the fluoride toothpaste and the two toothpastes with Zn-HAP (p < 0.05).

CONCLUSIONS

Toothpaste with Zn-HAP resulted in significant enamel remineralisation of erosively challenged enamel, indicating that these toothpastes could provide enamel health benefits relevant to enamel erosion. Key words:Enamel, erosion, remineralization, surface hardness, toothpastes.

Prenatally administered HMB modifies the enamel surface roughness in spiny mice offspring: An atomic force microscopy study

OBJECTIVE

The aim of this research was to check the effect of the prenatally administered β-hydroxy β-methylbutyrate (HMB) on the development of enamel surface of the spiny mice offspring.

DESIGN

The spiny mice dams were randomly assigned into three groups: control group (not supplemented with HMB) and two experimental groups in which powdered HMB was given at the daily dosage of 0.2g/kg of body weight (group I) and 0.02g/kg of body weight (group II) during the last period of gestation. Newborn pups were euthanized by CO₂ inhalation. The morphology of incisor teeth was analysed using atomic force microscopy (AFM) in semi-contact mode in the height, magnitude and phase domains. Height images became a basis for determination of surface roughness parameters.

RESULTS

Conducted study indicated that maternal HMB administration markedly influences enamel development. Enamel of offspring's teeth in both experimental groups was characterized by significantly smaller values of indices describing surface roughness and profile. HMB supplementation influenced the calculated parameters regardless of the diet type and offspring sex, however higher dose of HMB caused stronger changes in enamel surface's physical properties and could be observed in higher intensity in the male group.

CONCLUSIONS

HMB administration caused reduction in the irregularities of enamel surface, thereby possibly reducing the probability of bacteria adhesion and caries development. These observations may serve to improve nutrition and supplementation of animals and could be a lead for further research.

Combinatorial localized dissolution analysis: Application to acid-induced dissolution of dental enamel and the effect of surface treatments

A combination of scanning electrochemical cell microscopy (SECCM) and atomic force microscopy (AFM) is used to quantitatively study the acid-induced dissolution of dental enamel. A micron-scale liquid meniscus formed at the end of a dual barrelled pipette, which constitutes the SECCM probe, is brought into contact with the enamel surface for a defined period. Dissolution occurs at the interface of the meniscus and the enamel surface, under conditions of well-defined mass transport, creating etch pits that are then analysed via AFM. This technique is applied to bovine dental enamel, and the effect of various treatments of the enamel surface on acid dissolution (1mM HNO3) is studied. The treatments investigated are zinc ions, fluoride ions and the two combined. A finite element method (FEM) simulation of SECCM mass transport and interfacial reactivity, allows the intrinsic rate constant for acid-induced dissolution to be quantitatively determined. The dissolution of enamel, in terms of Ca(2+) flux ( [Formula: see text] ), is first order with respect to the interfacial proton concentration and given by the following rate law: [Formula: see text] , with k0=0.099±0.008cms(-1). Treating the enamel with either fluoride or zinc ions slows the dissolution rate, although in this model system the partly protective barrier only extends around 10-20nm into the enamel surface, so that after a period of a few seconds dissolution of modified surfaces tends towards that of native enamel. A combination of both treatments exhibits the greatest protection to the enamel surface, but the effect is again transient.

Effect of three nanobiomaterials on the surface roughness of bleached enamel

Background:

The ever-increasing demand for enhanced esthetic appearance has resulted in significant developments in bleaching products. However, the enamel surface roughness (SR) might be negatively affected by bleaching agents. This in vitro study was undertaken to compare the effects of three nanobiomaterials on the enamel SR subsequent to bleaching.

Materials and Methods:

The crowns of six extracted intact nonerupted human third molars were sectioned. Five dental blocks measuring 2 mm × 3 mm × 4 mm were prepared from each tooth and placed in colorless translucent acrylic resin. The enamel areas from all the specimens were divided into five groups (n = 6): Group 1 did not undergo any bleaching procedures; Group 2 was bleached with a 40% hydrogen peroxide (HP) gel; Groups 3, 4, and 5 were bleached with a 40% HP gel modified by bioactive glass (BAG), amorphous calcium phosphate, and hydroxyapatite, respectively. The enamel SR was evaluated before and after treatment by atomic force microscopy. The data were analyzed by Kruskal–Wallis and Mann–Whitney tests.

Results:

SR increased significantly in the HP group. SR decreased significantly in the HP gel modified by BAG group as compared to other groups.

Conclusions:

Within the limitations of this study, incorporation of each one of the three test biomaterials proved effective in decreasing enamel SR subsequent to in-office bleaching technique.

Preventive effect of different toothpastes on enamel erosion: AFM and SEM studies

The aim of the present in vitro study was the evaluation of new formulation toothpastes on preventing enamel erosion produced by a soft drink (Coca Cola), using atomic force microscopy (AFM) and scanning electron microscopy (SEM). Fifty enamel specimens were assigned to 10 groups of 5 specimens each. 1: intact enamel, 2: enamel + soft drink, 3: intact enamel + BioRepair Plus-Sensitive Teeth, 4: enamel + soft drink + BioRepair Plus-Sensitive Teeth, 5: intact enamel + BioRepair Plus-Total Protection, 6: enamel + soft drink + BioRepair Plus-Total Protection, group 7: intact enamel + Sensodyne Repair & Protect, 8: dentin + soft drink + Sensodyne Repair & Protect, 9: intact dentin + Colgate Sensitive Pro Relief, 10: dentin + soft drink + Colgate Sensitive Pro Relief. The surface of each specimen was imaged by AFM and SEM. The root mean-square roughness (Rrms ) was obtained from the AFM images and the differences in the averaged values among the groups were analyzed by ANOVA test. Comparing groups 4, 6, 8, 10 (soft drink + toothpastes) Colgate Sensitive Pro Relief promoted enamel remineralization, while BioRepair Plus-Sensitive Teeth, Biorepair Plus-Total Protection and Sensodyne Repair & Protect provided lower effectiveness in protecting enamel against erosion.

SIGNIFICANCE

the use of new formulation toothpastes can prevent enamel demineralization.

The role of different toothpastes on preventing dentin erosion: an SEM and AFM study®

The aim of the present in vitro study was the evaluation of new formulation toothpastes on preventing dentin erosion produced by a soft drink (Coca Cola®), using atomic force microscopy (AFM) and scanning electron microscopy (SEM). Fifty dentin specimens were divided in treatment and control halves and were than assigned to 5 groups of 10 specimens each: group 1a: intact dentin, group 1b: dentin + soft drink, group 2a: intact dentin + Biorepair Plus-Sensitive Teeth®, group 2b: dentin + soft drink + Biorepair Plus-Sensitive Teeth®, group 3a: intact dentin + Biorepair Plus-Total Protection®, group 3b: dentin + soft drink + Biorepair Plus-Total Protection®, group 4a: intact dentin + Sensodyne Repair & Protect®, group 4b: dentin + soft drink + Sensodyne Repair & Protect®, group 5a: intact dentin + Colgate Sensitive Pro Relief®, group 5b: dentin + soft drink + Colgate Sensitive Pro Relief®. The surface of each specimen was imaged by AFM and SEM. Comparing specimens of group a and b (no demineralization and demineralization), a statistically significant difference (p < 0.01) in Rrms values was registered. Comparing b groups, all the analyzed toothpastes tended to remineralize the dentine surface in different extent. Biorepair Plus-Total Protection® and Sensodyne Repair & Protect® provided higher protective effect against dentin demineralization.

Analysis of dentin/enamel remineralization by a CPP-ACP paste: AFM and SEM study

The aim of the present in vitro study was the evaluation of a CPP-ACP paste on preventing dentin/enamel erosion produced by a soft drink; Atomic Force Microscopy and Scanning Electron Microscopy were used. Eighty extracted human incisors free of caries were selected and divided into four groups (each divided in two subgroups); group 1a: intact dentin; group 1b: dentin + soft drink; group 2a: intact dentin + CCP-ACP paste; group 2b: dentin + soft drink + CCP-ACP paste; group 3a: intact enamel; group 3b: enamel + soft drink; group 4a: intact enamel + CCP-ACP paste; group 4b: enamel + soft drink + CCP-ACP paste. The CPP-ACP paste was applied for 3 min at 0, 8, 24, and 36 h. The surface of each dentin/enamel specimen was imaged by AFM (Rrms values were registered) and SEM. A statistical significant difference was recorded between groups 1b (dentin + soft drink) and 2b (dentin + soft drink + CCP-ACP paste) and between groups 3b (enamel + soft drink) and 4b (enamel + soft drink + CCP-ACP paste), suggesting that treatment of the specimens with the CPP-ACP paste had a protective effect on enamel demineralization, which was more evident for enamel specimens. Under the limitations of the present in vitro study, it can be concluded that the application of a CPP-ACP paste is effective on preventing dentin/enamel erosion produced by a soft drink.

Application of the specular and diffuse reflection analysis for in vitro diagnostics of dental erosion: correlation with enamel softening, roughness, and calcium release

We present assembly and application of an optical reflectometer for the analysis of dental erosion. The erosive procedure involved acid-induced softening and initial substance loss phases, which are considered to be difficult for visual diagnosis in a clinic. Change of the specular reflection signal showed the highest sensitivity for the detection of the early softening phase of erosion among tested methods. The exponential decrease of the specular reflection intensity with erosive duration was compared to the increase of enamel roughness. Surface roughness was measured by optical analysis, and the observed tendency was correlated with scanning electron microscopy images of eroded enamel. A high correlation between specular reflection intensity and measurement of enamel softening (r(2) ≥ -0.86) as well as calcium release (r(2) ≥ -0.86) was found during erosion progression. Measurement of diffuse reflection revealed higher tooth-to-tooth deviation in contrast to the analysis of specular reflection intensity and lower correlation with other applied methods (r(2) = 0.42-0.48). The proposed optical method allows simple and fast surface analysis and could be used for further optimization and construction of the first noncontact and cost-effective diagnostic tool for early erosion assessment in vivo.

The addition of nano-sized hydroxyapatite to a sports drink to inhibit dental erosion: in vitro study using bovine enamel

OBJECTIVES

This study examined the dental erosion and demineralization potential of a sports drink containing nano-sized hydroxyapatite (nano-HA) as an additive.

METHODS

The experimental solutions were Powerade (PA) alone and PA with 0.05%, 0.10%, and 0.25% nano-HA. The pH, titratable acidity, and calcium and phosphate content of each solution were analysed, and the degree of saturation with respect to the dental enamel (DS(En)) was obtained. Twelve sound bovine enamel specimens for each group were treated in accordance with the pH-cycling schedule which had 60min treatment with experimental solution per day for 7 days. The erosion potential was determined from the changes in surface micro hardness (SMH), the depths of erosion and demineralized layer using confocal laser scanning microscopy (CLSM), and the morphological changes to the tooth surface were examined with scanning electron microscopy (SEM) after pH-cycling.

RESULTS

pH and DS(En) increased with increasing nano-HA concentration in the drinks, whereas the titratable acidity decreased. There were significant differences in the SMH between the PA alone and >0.10% nano-HA groups (p<0.001). Although the PA alone group showed a pronounced erosion depth, CLSM showed no erosion depth in 0.25% nano-HA group. SEM showed an intact surface with increasing nano-HA concentration in the drinks. In conclusion, dental erosion was effectively prevented with increase of adding concentration of nano-HA, and a sports drink containing 0.25% nano-HA might prevent dental erosion.

Microscopic study of hydroxyapatite dissolution as affected by fluoride ions

Fluoride ions play a critical role in preventing tooth decay. We investigated the microscopic effects of fluoride ions on hydroxyapatite (100) surface dissolution using in situ atomic force microscopy. In the presence of 10 mM NaF, individual surface step retraction velocities decreased by about a factor of 5 as compared to NaF-free conditions. Importantly, elongated hexagonal etch pits, which are characteristic of (100) surface dissolution, were no longer observed when NaF was present. The alteration of pit shape is more distinct at a higher NaF concentration (50 mM) where triangular etch pits evolved during dissolution. Furthermore, in a fluoride concentration typical for tap water (10 μM), we observed roughening of individual step lines, resulting in the formation of scalloped morphologies. Morphological changes to individual steps across a wide range of fluoride concentrations suggest that the cariostatic capabilities of fluoride ions originate from their strong interactions with molecular steps.

In vitro alterations in dental enamel exposed to acidic medicines

OBJECTIVE

To evaluate the effect of acidic medicines (Klaricid(®), Claritin(®), and Dimetapp(®)) on surface enamel in vitro.

METHODS

Enamel blocks (n=104) were randomly distributed into two groups: G1 (pH-cycling simulating physiological oral conditions) and G2 (erosive conditions). Each group was divided into four subgroups, three to be immersed in the medicines and the control in deionized water. Specimen surfaces were evaluated for roughness and hardness at baseline and again after the in vitro experimental phase, which included 30 min immersions in the medicines twice daily for 12 days. Scanning electron microscopy (SEM) was also performed after the in vitro experimental phase.

RESULTS

All medicines produced a significant reduction in hardness in G1 after 12 days (P<0.05). The three medicines promoted greater roughness after both pH-regimens - G1 and G2 (P<0.01), except for Claritin in G1. Scanning electron microscopy analysis showed erosive patterns in all subgroups. Dimetapp(®) showed the most erosion and Klaricid(®) the least, in both groups.

CONCLUSION

Dimetapp(®) (lowest pH and viscosity) and deionized water (control) showed the most pronounced erosive patterns. Klaricid(®) (highest pH and viscosity) presented an in vitro protective effect against acid attacks perhaps due to its mineral content and viscosity.

In vitro demineralisation of the cervical region of human teeth

OBJECTIVE

The aim of this study was to investigate a possible role for demineralisation of the cervical region of human teeth in the development of non-carious cervical lesions (NCCLs).

MATERIALS AND METHODS

Freshly extracted human premolars were demineralised and prepared for nanoindentation and scanning electron microscope (SEM) observation. After 1 day or 2 days demineralisation in a solution of pH 4.5, specimens were embedded, cut and polished to 1 μm diamond paste. Nanoindentation was done at the cementum-enamel junction (CEJ) region with an interval of 30 μm, to develop mechanical properties maps. After the indentation, SEM with back-scatter detector was employed to observe the degree of demineralisation at the CEJ.

RESULTS

After 1 day and 2 days demineralisation, the mechanical properties of enamel and dentine at the CEJ decreased by ∼50% and ∼90%, respectively. SEM images illustrate that artificial demineralisation generated typical demineralised zones in enamel near the CEJ. Moreover, 2 days demineralisation penetrated the sound enamel at the CEJ, and the dentine beneath was undermined.

CONCLUSION AND SIGNIFICANCE

One day and 2 days demineralisation reduced the mechanical properties of teeth at the CEJ significantly. Demineralised enamel and dentine with low mechanical properties are prone to wear and abrasion. The findings of the investigation indicate that acid typical of that produced by dental plaque may compromise the mechanical properties of enamel and dentine at the CEJ to the extent that they would be susceptible to tooth brush abrasion, producing NCCLs.

Impact of two toothpastes on repairing enamel erosion produced by a soft drink: an AFM in vitro study

OBJECTIVES

The aim of the present in vitro study was the evaluation of two toothpastes (Sensodyne Pronamel and Biorepair Plus on repairing enamel erosion produced by a soft drink (Coca Cola), using Atomic Force Microscopy (AFM).

METHODS

Fifty extracted human central incisors free of caries were selected and divided in a treatment and a control half; they were kept in artificial saliva during whole experimentation. The treatment halves were divided into five groups; group 1: demineralization with soft drink; group 2: demineralization with soft drink + Pronamel; group 3: demineralization with soft drink + Biorepair Plus; group 4: intact enamel + Pronamel; group 5: intact enamel + Biorepair Plus. Specimen demineralization was carried on in 4 intervals of 2 min. In groups 2, 3, 4, and 5 the toothpastes were applied for 3 min at 0, 8, 24 and 36 h. The surface of each specimen was imaged by AFM and R(rms), root-mean-square roughness, and Maximum Depth of the cavities were registered.

RESULTS

Amongst treatment specimens of groups 1, 2, and 3 a statistically significant difference (P<0.01) in R(rms) and Maximum Depth values was registered: the toothpastes reduced enamel demineralization. No statistical differences in R(rms) values were registered between the two toothpastes.

CONCLUSIONS

The toothpastes tested (Pronamel and BioRepair Plus) offer a degree of protection from erosive drinks.

Protective effect on enamel demineralization of a CPP-ACP paste: an AFM in vitro study

OBJECTIVES

The aim of the present in vitro study was the evaluation of a CPP-ACP paste (Tooth Mousse) on preventing dental erosion produced by a soft drink (Coca Cola), using Atomic Force Microscopy (AFM).

METHODS

Thirty extracted human central incisors free of caries were selected and divided in a treatment and a control half. The treatment halves were divided in three groups-group 1: demineralization with soft drink (4 intervals of 2 min); group 2: demineralization with soft drink (4 intervals of 2 min) plus Tooth Mousse; group 3: intact enamel plus Tooth Mousse. In groups 2 and 3 Tooth Mousse was applied for 3 min at 0, 8, 24 and 36 h. The surface of each specimen was imaged by AFM and R(rms) values were registered.

RESULTS

Among treatment specimens of groups 1 and 2, a statistically significant difference (P<0.01) in R(rms) values was registered: treatment of the specimens with CPP-ACP paste had a protective effect on enamel demineralization. In group 3 no statistically significant difference was registered between exposed and not exposed halves of the specimens.

CONCLUSIONS

The use of a CPP-ACP paste had a protective effect on enamel demineralization in an in vitro model.

Principles of demineralization: modern strategies for the isolation of organic frameworks. Part II. Decalcification

This is the second paper on principles of demineralization. The initial paper is dedicated to the common definitions and the history of demineralization. In present work we review the principles and mechanisms of decalcification, i.e., removing the mineral Ca-containing compounds (phosphates and carbonates) from the organic matrix in its two main aspects: natural and artificial. Natural chemical erosion of biominerals (cavitation of biogenic calcareous substrata by bacteria, fungi, algae, foraminifera, sponges, polychaetes, and mollusks) is driven by production of mineral and organic acids, acidic polysaccharides, and enzymes (cabonic anhydrase, alkaline and phosphoprotein phosphataes, and H(+)-ATPase). Examples of artifical decalcification includes demineralization of bone, dentin and enamel, and skeletal formations of corals and crustacean. The mechanism and kinetics of Ca-containing biomineral dissolution is analyzed within the framework of (i) diffusion-reaction theory; (ii) surface-reaction controlled, morphology-based theories, and (iii) phenomenological surface coordination models. The application of surface complexation model for describing and predicting the effect of organic ligands on calcium and magnesium dissolution kinetics is also described. Use of the electron microscopy-based methods for observation and visualization of the decalcification phenomenon is discussed.

Influence of beverage composition on the results of erosive potential measurement by different measurement techniques

The influence of beverage composition on the measurement of erosive potential is unclear. The aim of this study was to evaluate whether beverage composition influences the measurement of erosive potential and to evaluate the influence of exposure in small and large volumes. Eleven beverages were included: water (control), 3 alcopops, 2 beers and 5 soft drinks. For each beverage 15 bovine enamel samples were used: 5 for chemical and 10 for profilometric analysis. After exposure to the beverages (63 min) the resulting solutions were analyzed for Ca and inorganic phosphorus (P(i)) content. The samples for optical profilometry were submersed sequentially in 500 ml or in 1 ml of the drinks for 3, 6, 9, 15 and 30 min (total 63 min). For some of the beverages high baseline concentrations of Ca (energy drink) or P(i) (cola drink, cola lemon drink, beer, beer lemon) were found. Some of the beverages showed a good correlation between the chemical methods. Profilometry (both for 1 and 500 ml) showed generally lower enamel losses than the chemical methods. Lower enamel losses were found for the profilometry 1 ml compared to the profilometry 500 ml only for the cola drinks. It can be concluded that the composition of the beverages had a significant effect on the determination of the erosive potential with chemical analyses. Drink composition also influenced the effect of small versus large exposure volumes, indicating the need for standardization of exposure parameters.

Nanomechanical Properties of Tooth and Bone Revealed by Nanoindentation and AFM

In this paper, an overview on nanoindentation and its combination with AFM is presented with regard to current instrument technology and applications on dental and bony tissues. Nanoindentation has been a widely used technique to determine the mechanical properties such as nanohardness and Young’s modulus for nanostructured materials. Especially, atomic force microscopy (AFM) combined with nanoindentation, with the pit positions controlled accurately, become a powerful technique used to measure mechanical properties of materials on the nanoscale, and has been applied to the study of biological hard tissues, such as bone and tooth. Examples will be shown that significantly different nanohardness and modulus in the isolated domains within single enamel, the prisms, interprisms, the surrounding sheaths and the different parts of skeletal bone, could been distinguished, while such information was unable to be obtained by traditional methods of mechanical measurements.

A new model for nanoscale enamel dissolution

The dissolution kinetics of human tooth enamel surfaces was investigated using nanomolar-sensitive constant composition (CC) and in situ atomic force microscopy (AFM) under simulated caries formation conditions (relative undersaturation with respect to hydroxyapatite = 0.902, pH = 4.5). Scanning electron microscopic (SEM) examination of the resulting etched enamel surfaces showed that deminerzalization, initiated at core/wall interfaces of rods, developed anisotropically along the c-axes. After an initial rapid removal of surface polishing artifacts, the dissolution rate decreased as the reaction proceeded in accordance with our recently proposed crystal dissolution model, resulting in hollow enamel cores and nanosized remaining crystallites, resistant to further dissolution. Generally, dissolution of minerals is regarded as a spontaneous reaction in which all the solid phase can be dissolved in undersaturated solutions. However, the dissolution of some biominerals may be suppressed when the crystallites approach nanometer size. This study shows that CC demineralization of enamel in acidic medium follows this new model that can be used to mimic carious lesion formation. In dissolution studies, nanosized enamel crystallites exhibit a remarkable degree of self-preservation in the fluctuating physiological milieu.

In situ tracing the process of human enamel demineralization by electrochemical impedance spectroscopy (EIS)

OBJECTIVE

The purpose of this study was to in situ characterize the demineralization (namely dissolution of hydroxyapatite) on the surface of the human enamel using electrochemical impedance spectroscopy (EIS) technology.

METHODS

Fresh human third molars extracted without visible evidence of caries, were used in this study. After they were immersed in a demineralizing solution prepared from lactic acid and carboxy methyl cellulose sodium (Na-CMC) buffering at pH 4, demineralization happened on their surfaces. EIS of the specimens were measured at a series of immersed interval. X-ray diffractometer (XRD) were used to distinguish the microstructure of the surface layer of the specimens. The depositions that appeared in the demineralizing solution after 46 h immersion were analyzed by fourier transform infrared spectrometer (FTIR).

RESULTS

XRD analysis revealed that the percentage of intensity (I%) of HAP gradually decreased with the elapsed immersing time, which indicated the dissolution of HAP columns of enamel. Nyquist spectra were fitted with an equivalent circuit characterized by some parameters, such as Q and R(p) (error<0.1%). Changes of the parameters' values revealed that the rate of demineralization accelerated at the forepart of the demineralization, but slowed down beyond 70 h immersion.

CONCLUSIONS

The results suggested that EIS was proved to be a useful method for in situ investigating and in vivo detecting the demineralization of the enamel.

Thirty-five percent carbamide peroxide application causes in vitro demineralization of enamel

OBJECTIVES

The objective of this in vitro study was to investigate whether a high concentration 'in-office' bleaching agent affected the mineral content of enamel and dentin.

METHODS

A commercially available 35% carbamide peroxide bleaching agent was applied for 2h to sectioned teeth (n=11). Specimens were then immersed in artificial saliva at 37 degrees C for a further 24h to simulate the oral environment. Tomographic images of these sections were obtained (micro-CT 80, Scanco, Switzerland) prior to and post-bleach application. Eight three-dimensional regions of interest (ROI), starting from the enamel surface extending to the dentinoenamel junction, were selected for each section. The hydroxyapatite equivalent mineral concentrations (g/cm(3)) of the ROIs were calculated. Any changes in mineral content as a consequence of the bleaching procedure were calculated in relation to each ROI.

RESULTS

There was a significant reduction in the mineral content of enamel specimens post-bleach application extending to a depth of 250microm (paired t-test, p<0.05); this reduction in mineral content was greatest in the ROI's closest to the tooth surface. There was, however, no significant difference in the mineral content of dentin as a consequence of bleaching.

SIGNIFICANCE

This in vitro study has shown that significant demineralization of enamel occurred following bleaching with 35% carbamide peroxide. The concept that 'in-office' bleaching is a non-destructive cosmetic procedure should be reconsidered.

Microcomputerised tomography evaluation of 10% carbamide peroxide applied to enamel

OBJECTIVES

There is still some controversy in the dental literature whether carbamide peroxide bleaching causes demineralization of teeth. One of the reasons for this controversy is that there is as yet no reliable, non-destructive in vitro method for assessing mineral loss in bleached teeth. The objective of this study was to investigate the possible demineralization effect of 10% carbamide peroxide bleaching agent on enamel and dentine non-destructively.

METHODS

microCT images were obtained of 12 human molar tooth sections. These sections had 10% carbamide peroxide applied for eight hours a day over a period of 15 days. Further tomographic images were obtained and the mineral content prior to and post bleaching assessed.

RESULTS

A total of 144 regions were evaluated using the image processing language available in the work station. The application of 10% carbamide peroxide was found to cause demineralization of the enamel extended to a depth of 50 microm below the enamel surface (Paired t-test, p<0.05).

CONCLUSIONS

This study confirmed that microCT was indeed a highly suitable method for assessing mineral content of dental enamel after bleach application. It is recommended that application of bleaching agents should be carefully considered in patients susceptible to caries and tooth wear.

Relationship between enamel erosion and liquid flow rate

The association of severe erosion with certain habits of consuming soft drinks prompted a study of erosion in relation to fluid flow. In the main experiments, citric acid solution (pH 3.2) was directed at polished enamel surfaces at flow rates of 26, 67 or 126 ml min(-1) through outlets of diameters 1.0, 2.6 or 5.0 mm for up to 20 min. Erosion depth increased with time of exposure and total volume of solution, with increasing flow rate and with decreasing outlet diameter. Scanning electron microscopy of acid-treated surfaces and of the subsurface enamel indicated that the clearance of dissolution products, rather than the mechanical dislodgement of partly dissolved crystal bundles, was the main process involved. For an exposure time of 20 min, erosion increased with (liquid velocity)(1/4). In a secondary experiment, it was found that the erosive potential of a low-erosive drink did not increase with increasing liquid velocity. The rapid increase in the rate of erosion caused by citric acid at low liquid velocities shows that reproducible stirring is essential for precision and intercomparison of in vitro studies. It also accounts for the rapid erosion seen when erosive drinks are consumed from a straw placed labial to the anterior teeth, or are "swished" between the teeth.

Human enamel erosion in constant composition citric acid solutions as a function of degree of saturation with respect to hydroxyapatite

The objective of this study was to investigate human enamel erosion under constant composition conditions, as a function of solution degree of saturation (DS) with respect to hydroxyapatite. The experimental conditions were relevant to the initial stages of enamel erosion by soft drinks. Nanoindentation was used to compare enamel surface softening caused by a control mineral water and two citric acid solutions with DS = 0.000 and DS = 0.032, both having pH 3.30. Enamel hardness and reduced elastic modulus were measured after 0, 30, 60, 120, 300 and 600 s exposure. A statistically significant change in enamel hardness was detected after 30 s exposure to both citric acid solutions, indicating that nanoindentation is extremely sensitive to the initial stages of erosion. There was a statistically significant difference between the mechanical properties of enamel exposed to the two citric acid solutions after 30, 60 and 120 s. At these times, the solution with DS = 0.000 caused twice as much enamel softening as that with DS = 0.032. This demonstrates that it may be possible to design a soft drink with a low erosive potential and a good taste by a small change in DS, at a typical drink pH.

In vitro demineralization/remineralization cycles at human tooth enamel surfaces investigated by AFM and nanoindentation

The early stages of enamel surface dissolution (erosion) are of high scientific relevance; however, little is known about if and to what extent these early stages, which result in the softening of the enamel surface, are reversible. The present study investigated the possible rehardening of surface softened enamel in two separate experiments in vitro, employing physiologically relevant demineralization and remineralization times and remineralizing solutions possessing chemical properties close to those of human saliva. Atomic force microscopy (AFM) based nanoindentation has been used to study the nanomechanical properties and the ultrastructure of polished enamel samples as affected by demineralization/remineralization cycles. In contradiction to previous studies employing microhardness techniques, no enamel rehardening has been observed after remineralization; however, the demineralization schemes used in the present study (short treatments with a citric acid buffer) are not comparable to the ones used in previous studies, making a comparison difficult. A mineral deposition after remineralization on softened enamel samples has been observed by AFM; however, a protective effect of this deposited layer could not be revealed. The exposure of softened enamel samples to either a remineralizing solution or a mineral water led to an improved acid resistance of these samples as shown in a demineralization/remineralization cycle. The present study has demonstrated that AFM based nanoindentation is a useful tool to investigate the demineralization and remineralization of surface softened enamel with high accuracy.

The laboratory assessment of enamel erosion: a review

OBJECTIVES

To review the various methods and techniques available to assess enamel erosion in vitro.

DATA

Peer reviewed scientific articles.

SOURCES

Medline and Web of Science searches and manual searching.

STUDY SELECTION

Laboratory based assessments only included.

CONCLUSIONS

A number of macroscopic and microscopic techniques have been used to assess enamel erosion in vitro and in situ. This review examines techniques which are either well established or comparatively novel techniques that are being explored for their potential.