Enamel demineralization after different methods of interproximal polishing

Comparison of near-infrared imaging with cone-beam computed tomography for proximal caries detection in permanent dentition: An in vivo study

OBJECTIVES

This study aimed to evaluate the diagnostic performance of near-infrared imaging (NIRI) and unaided visual examination (UVE) in detecting proximal caries in permanent dentition in comparison with cone-beam computed tomography (CBCT).

METHODS

Patients who underwent NIRI, UVE, and CBCT imaging within 1 week were enrolled. Using CBCT as the reference test, the positive percent agreement (PPA), negative percent agreement (NPA), and overall percent agreement (OPA) of NIRI, UVE, and a combination of the two for detecting proximal caries at different depths and in different tooth locations were assessed. Additionally, the consistency of these diagnostic methods with CBCT was evaluated.

RESULTS

We evaluated 6,084 proximal surfaces and identified 177 CBCT-positive sites. NIRI had a PPA, NPA, and OPA of 68.93 %, 99.09 %, and 98.21 %, respectively, with a substantial agreement with CBCT. When combined with UVE, the PPA increased by approximately 50 % compared with that of UVE alone. Regarding caries at different depths, NIRI outperformed UVE in detecting initial caries (ICDAS 1-2) over moderate-to-advanced caries (ICDAS 3-6). However, the combined use of NIRI and UVE improved the detection of moderate-to-advanced caries. In the anterior teeth region, NIRI exhibited excellent agreement with CBCT, surpassing its performance in the posterior region.

CONCLUSIONS

Although NIRI cannot fully replace radiographic methods, the substantial agreement of NIRI with CBCT in detecting proximal caries highlights its potential as a complementary tool in routine caries screening, especially when combined with UVE.

CLINICAL SIGNIFICANCE

This study highlights the potential of NIRI as a radiation-free method for detecting proximal caries in permanent teeth. Early detection through regular NIRI scanning can lead to timely intervention, improved patient outcomes, and reduced overall disease burden.

Metal leakage from orthodontic appliances chemically alters enamel surface during experimental in vitro simulated treatment

Human enamel is composed mainly of apatite. This mineral of sorption properties is susceptible to chemical changes, which in turn affect its resistance to dissolution. This study aimed to investigate whether metal leakage from orthodontic appliances chemically alters the enamel surface during an in vitro simulated orthodontic treatment. Totally 107 human enamel samples were subjected to the simulation involving metal appliances and cyclic pH fluctuations over a period of 12 months in four complimentary experiments. The average concentrations and distribution of Fe, Cr, Ni, Ti and Cu within the enamel before and after the experiments were examined using ICP‒MS and LA‒ICP‒MS techniques. The samples exposed to the interaction with metal appliances exhibited a significant increase in average Fe, Cr and Ni (Kruskal-Wallis, p < 0.002) content in comparison to the control group. The outer layer, narrow fissures and points of contact with the metal components showed increased concentrations of Fe, Ti, Ni and Cr after simulated treatment, conversely to the enamel sealed with an adhesive system. It has been concluded that metal leakage from orthodontic appliances chemically alters enamel surface and microlesions during experimental in vitro simulated treatment.

Manual and mechanical stripping-induced enamel roughness and elemental composition in vivo

Objectives

Interproximal enamel reduction (IPR) is routinely used in orthodontics to generate small to moderate amounts of space within the dental arch. Aim of this ex vivo study was to evaluate the effect of two different IPR systems on the enamel surface’s waviness, roughness, and elemental composition after 6 months of intraoral exposure.

Materials and methods

Fifteen orthodontic extraction patients were included in the present study. The 39 healthy premolars, which were scheduled to be extracted, were subjected to IPR at least 6 months before their extraction. IPR was performed on their mesial side with two different methods: (1) instrumented method with the Ortho-Strips system (on handpiece) and (2) manually with the Intensiv ProxoStrip (strips)—each with four different grits for contouring, finishing, and polishing. The distal side of each premolar served as its own internal control. Treated and untreated tooth surfaces were evaluated by optical profilometry, Raman, and scanning electron microscope/X-ray energy-dispersive (EDX) analyses. Data were analysed with descriptive statistics and generalized linear models at alpha = 5%.

Results

Both IPR methods significantly reduced the waviness of the enamel surface (P &lt; 0.001), with manual IPR leading to smaller waviness reductions than the instrumented IPR (P ≤ 0.001). On the other side, both IPR methods led to a significant increase in enamel surface roughness (P &lt; 0.001), with no significant differences between IPR methods. EDX and Raman analyses did not demonstrate any alterations on elemental composition of enamel after at least 6 months of intraoral exposure.

Conclusions

Both stripping systems led to a flatter but rougher enamel surface. Further polishing is needed to restore the initial enamel smoothness. The elemental composition of the stripped enamel returns to the baseline level after 6 months of intraoral exposure.

Effects of interproximal enamel reduction techniques used for orthodontics: A systematic review

This systematic review aimed to determine the effects of the interproximal enamel reduction (IPR) techniques used in orthodontics. Six databases were searched: PubMed, Scopus, Web of Science, Dentistry & Oral Sciences Source, ScienceDirect and Clinical Trials. Grey literature was sourced from Google Scholar. The risk of bias was assessed by Risk of Bias 2, Newcastle-Ottawa Scale and Robins-I depending on the design of the evaluated study. Additionally, the quality of the included studies was determined using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. This systematic review included randomized clinical trials, non-randomized clinical trials and observational studies with a control group that reported the effects of IPR for orthodontic purposes on the teeth and periodontium. Case reports, and in vitro and in vivo studies were excluded. Eight clinical studies match the eligibility criteria. As a result, no demineralization of the enamel, no increase in caries incidence, no periodontal changes or dental sensitivity was found after IPR. Also, considering the duration of orthodontic treatment, IPR resulted in a quicker technique than dental extractions. At the risk-of-bias assessment, all observational studies showed low risk, the non-randomized clinical trial had a critical bias, and all randomized clinical trials exhibited some concerns. The overall quality of the studies was found to be between low and very low. After the analysis of the data from included studies, it was concluded that the IPR procedures could be useful to treat dental crowding in orthodontic clinical practice without negative effects. However, more randomized controlled clinical trials with a longer follow-up time and high-quality studies are required to generate robust statements.

Effectiveness of a toothpaste and a serum containing calcium silicate on protecting the enamel after interproximal reduction against demineralization

To evaluate the effectiveness of a calcium silicate/phosphate fluoridated tooth paste and a serum compared with a toothpaste containing hydroxyapatite on protecting the enamel after interproximal reduction against demineralization. 3 sets of eleven incisors were created. The teeth underwent interproximal enamel reduction (IER) of 0.5 mm. Each set was allocated to one of three groups: (1) Brushing without toothpaste (control group); (2) Vitis toothpaste + Remin Pro; (3) Regenerate toothpaste + Regenerate Serum. The agents were applied three times a day and specimens subjected to demineralization cycles for 30 days. The weight percentages of calcium (Ca) and phosphorous (P) were quantified by X-ray microfluorescence spectroscopy. Surface microhardness measurements and electron scanning microscopy (SEM) observations were made. Ca data and the Ca/P ratio were significantly higher in Group 3 than the other groups (p < 0.017), while P was significantly lower in Group 3 (p < 0.017). No significant differences were found between Groups 1 and 2 (p > 0.017). Group 3 showed significantly higher microhardness values (p < 0.05) than Group 1. No significant differences were found for other comparisons between groups (p < 0.05). SEM images showed less demineralization in Group 3. The application of a calcium silicate/phosphate fluoridated tooth paste (Regenerate advance) and a dual serum (Regenerate advance enamel serum) protect the enamel with interproximal reduction against demineralization. Therefore, this treatment could be used to prevent the dissolution of hydroxyapatite after IER.

Depth of acid penetration and enamel surface roughness associated with different methods of interproximal enamel reduction

Objectives

To assess and compare the enamel surface quality after interproximal enamel reduction (IPR) was performed with different systems and to study the relation between acid penetration depth and enamel surface quality as well as the importance of remineralization.

Methods

Sixty-five extracted teeth were randomly allocated to five experimental groups: untreated control, manual with New Metal Strips, mechanical with oscillating segment (OS) discs, Safe-Tipped Bur Kit, and the Ortho-Strip, followed by 30 s of polishing with the Softflex system and the Compo-system after treating the tooth with OS discs. Mesial surfaces were demineralized for 24 h and distal surfaces were subjected to interchanging demineralization and remineralization cycles of 24 h each for 18 days. The analysis was carried out by profilometry, scanning electron microscopy, and polarization microscopy.

Results

After IPR and polishing, enamel roughness was reduced for all systems tested except for the Essix Safe-Tipped Bur Kit. Subsequent demineralization increased enamel roughness in all groups except controls beyond the original level prior to IPR except for IPR with New Metal Strips or Ortho-Strips and subsequent polishing. Cyclic demineralization and remineralization for 18 days yielded a reduction in acid penetration depth and an increase in surface smoothness, which correlated with each other only for controls and treatment with New Metal Strips or Ortho-Strips.

Conclusions

Manual IPR, using New Metal Strips and, even more, the oscillating IPR system Ortho-Strips, yielded smoother interproximal enamel surfaces and less acid penetration depth than the IPR systems with OS discs and the Safe-Tipped Bur Kit after polishing and 18 days of cyclic demineralization and remineralization. Irrespective of the IPR procedure, proper remineralization of IPR-treated surfaces is advisable to reduce caries susceptibility.

Quantitative evaluation of the progressive wear of powered interproximal reduction systems after repeated use : An in vitro study

PURPOSE

To evaluate the residual surface roughness of 5 common diamond-coated interproximal reduction (IPR) systems after consecutive in vitro applications in relation to system, diamond grain size, and instrument thickness.

METHODS

IPR was performed on 80 extracted human incisors using motor-driven strips and discs under predefined conditions. The IPR auxiliaries were applied at 5 consecutive sessions of 20 s on intact interproximal surfaces, and the surface profile (R_a, R_z, R_max) was analyzed at baseline and after each session with an optical profilometer.

RESULTS

No overall significant difference in the roughness values was found between systems (P = 0.07 for R_a, P = 0.33 for R_z, and P = 0.48 for R_max). There was a significant average decrease of R_a, R_z, and R_max for all systems for every unit increase in time by -0.171 μm (P < 0.001), -3.297 (P ≤ 0.001), and -2.788 μm (P = 0.001), respectively. R_a, R_z, and R_max values increased significantly, i.e., by 0.194 μm (P = 0.003), 5.890 μm (P = 0.001), and 5.319 μm (P = 0.010) as instrument thickness increased by one unit. No significant reductions in R_a, R_z, and R_max were observed across grain sizes (-0.008 μm [P > 0.05], -0.244 μm [P > 0.05], and -0.179 μm [P > 0.05], respectively). There was no evidence of interaction between system and time as the P values for R_a, R_z, and R_max were 0.88, 0.51, and 0.70, respectively.

CONCLUSIONS

All IPR materials presented significant gradual decrease of surface roughness after repeated applications. There were no significant roughness changes among auxiliaries of different grain sizes. Thinner auxiliaries showed significantly more roughness reduction, possibly requiring more frequent replacement than thick auxiliaries in clinical practice.

In vivo enamel stripping: A macroscopic and microscopic analytical study

INTRODUCTION

Interdental stripping is often used in orthodontics to correct discrepancies of tooth shape or size. However, this procedure involves significant risks for the enamel. The roughness of the enamel surface might depend on the instruments used; it can lead to the accumulation of cariogenic plaque and periodontal problems. The main objective of our study was to evaluate the enamel surface condition after interproximal stripping in the mouth, by comparing different manual and mechanized enamel reduction protocols; on the other hand, the topography of the stripped area was observed to specify its location on the stripped proximal surfaces.

MATERIALS AND METHODS

An in vivo study was carried out: interdental stripping was performed in the mouths of patients undergoing orthodontic treatment and on healthy teeth intended for extraction for orthodontic or periodontal reasons. The sample was divided into four groups: in group 1, the distal faces were stripped with conventional single-sided diamond abrasive strips and non-stripped mesial faces (control faces); in group 2: the distal faces were stripped with the manual ContacEZ IRP Kit (single-sided abrasive files of different grain sizes) and non-stripped mesial faces (control faces); in group 3: the faces were stripped with ContacEZ IRP diamond discs attached to a handpiece and the mesial faces were not stripped (control faces); in group 4: the distal faces were stripped with the Intensiv Ortho-Strips mechanized system and the mesial faces were not stripped (control faces).

RESULTS

Our study showed that regardless of the type of stripping material used, the enamel surface showed some roughness with the presence of striations and grooves of different widths and depths. Our observations objectivised more regular and less roughened enamel surface conditions when using the Intensiv oscillating files. Manual instruments (abrasive strips and files) have shown rougher and more irregular surface conditions that may constitute a real risk of carious and periodontal disease. The macroscopic evaluation of the topography of the stripped area showed that there is great variability in the situation and extent of the stripped area in relation to several parameters.

CONCLUSION

The current mechanized instruments (oscillating files) provide enamel stripping with more comfort for the patient and the practitioner, and seem to produce a more regular and less harmful surface condition for the tooth and periodontium.

Efficacy of fluoride varnishes for preventing enamel demineralization after interproximal enamel reduction. Qualitative and quantitative evaluation

Objectives

To evaluate quantitatively and qualitatively the changes produced to enamel after interproximal reduction and subjected to demineralization cycles, after applying a fluoride varnish (Profluorid) and a fluoride varnish containing tricalcium phosphate modified by fumaric acid (Clinpro White).

Materials and methods

138 interproximal dental surfaces were divided into six groups: 1) Intact enamel; 2) Intact enamel + demineralization cycles (DC); 3) Interproximal Reduction (IR); 4) IR + DC; 5) IR + Profluorid + DC; 6) IR + Clinpro White + DC. IR was performed with a 0.5 mm cylindrical diamond bur. The weight percentage of calcium (Ca), phosphorous (P) and fluoride (F) were quantified by energy-dispersive X-ray spectrometry (EDX). Samples were examined under scanning electron microscopy (SEM).

Results

The weight percentage of Ca was significantly higher (p<0.05) in Groups 1, 2 and 5 than Groups 4 and 6. No significant differences were detected in the weight percentage of Ca between Group 3 and the other groups (p>0.05). The weight percentage of P was similar among all six groups (p>0.05). F was detected on 65% of Group 6 surfaces. SEM images of Groups 4 and 6 showed signs of demineralization, while Group 5 did not.

Conclusions

Profluorid application acts as a barrier against the demineralization of interproximally reduced enamel.