Changes in the composition of the enamel of human premolar teeth shortly after eruption

Posteruptive Loss of Enamel Proteins Concurs with Gain in Enamel Hardness

Tooth enamel maturation requires the removal of proteins from the mineralizing enamel matrix to allow for crystallite growth until full hardness is reached to meet the mechanical needs of mastication. While this process takes up to several years in humans before the tooth erupts, it is greatly accelerated in in the faster developing pig. As a result, pig teeth erupt with softer, protein-rich enamel that is similar to hypomineralized human enamel but continues to harden quickly after eruption.Proteins, such as albumin, that bind to enamel crystals and prevent crystal growth and enamel hardening have been suggested as cause for hypomineralized human enamel that does not naturally harden after eruption. However, albumin is abundant in pig enamel. It is unclear whether fast posteruptive enamel hardening in pigs occurs despite the high protein content or requires a facilitated protein loss to allow for crystal growth. This study asked how the protein content in porcine enamel changes after eruption in relation to saliva. Based on previous data demonstrating the high albumin content in erupted porcine enamel, we hypothesize that following pre-eruptive maturation, enamel and saliva derived enzymes facilitate protein removal from porcine enamel after eruption. We analyzed enamel and the saliva proteome at three critical timepoints: at the time of tooth eruption, 2 weeks after eruption, and enamel 6 weeks after eruption. We used only fourth deciduous premolars and saliva samples from animals sacrificed at the respective time points to determine the organic content in tooth enamel, saliva, and saliva proteins within enamel. We found a decrease in the number of proteins and their abundancy in enamel with posteruptive time, including a decrease in serum albumin within enamel. The rapid decrease in the first two weeks is in line with previously reported rapid increase in mineral density of porcine enamel after eruption. In addition to the enamel proteases KLK-4 and MMP-20, we identified serine-, cysteine-, aspartic-, and metalloproteases. Some of these were only identified in enamel, while almost half of the enzymes are in common with saliva at all timepoints. Our findings suggest that the fast posteruptive enamel maturation in the porcine model coincides with saliva exchange and influx of saliva enzymes into porous enamel.

Enamel Microcracks Induced by Simulated Occlusal Wear in Mature, Immature, and Deciduous Teeth

Enamel wear, which is inevitable due to the process of mastication, is a process in which the microcracking of enamel occurs due to the surface contacting very small hard particles. When these particles slide on enamel, a combined process of microcutting and microcracking in the surface and subsurface of the enamel takes place. The aim of this study was to detect microscopic differences in the microcrack behavior by subjecting enamel specimens derived from different age groups (immature open-apex premolars, mature closed-apex premolars, and deciduous molars) to cycles of simulated impact and sliding wear testing under controlled conditions. Our findings indicated that the characteristics of the microcracks, including the length, depth, count, orientation, and relation to microstructures differed among the study groups. The differences between the surface and subsurface microcrack characteristics were most notable in the enamel of deciduous molars followed by immature premolars and mature premolars whereby deciduous enamel suffered numerous, extensive, and branched microcracks. Within the limitations of this study, it was concluded that enamel surface and subsurface microcracks characteristics are dependent on the posteruptive age with deciduous enamel being the least resistant to wear based on the microcrack behavior as compared to permanent enamel.

A SEM and non-contact surface white light profilometry in vivo study of the effect of a crème containing CPP-ACP and fluoride on young etched enamel

The aim of this in vivo study was to evaluate the short and a longer term effect on enamel of the application of a crème containing 10% CPP-ACP and 900 ppm fluoride, in orthodontically planned, high caries-risk patients. Epoxy resin replicas of upper lateral incisors were obtained from polyvinyl siloxane (PVS) impressions, before and after etching. The right incisors were left untreated in order to control saliva remineralizing potential. The upper left surfaces were coated with a pea-size amount of the crème. Replicas were obtained at 3 weeks and 6 months and analyzed by SEM and non-contact surface white light profilometry. In the treated sample the profilometric roughness parameters at 3 weeks were statistically significantly lower than the control group values (p < 0.05). At 3 weeks SEM images of the enamel surface showed fewer irregularities. After 6 months, differences between test and control groups were not present on SEM images and profilometric values. CPP-ACP and fluoride crème had positive in vivo effects on enamel surfaces. Significant differences in surface roughness existed after a 3-week period of crème use.

Impact of interocclusal contacts on infrared laser fluorescence in pits of sound first permanent molars in children

BACKGROUND

A device based on infrared laser fluorescence (IRLF) has become available as an adjunct for the diagnosis of dental caries.

AIMS

The objective of this study was to clarify the differences of IRLF readings in the mesial, central and distal occlusal pits of first permanent molars.

DESIGN

Sixty-four children (average age 8.0 years) were examined using IRLF. The mesial, central and distal pits of clinically healthy first permanent molars were measured. The instrument provides measurements in arbitrary units on an open-ended interval scale.

RESULTS

Mean (± SE) IRLF values in the mesial pits were 4.9 ± 0.4 (upper) and 6.5 ± 0.4 (lower) and were significantly lower than those in the central (8.8 ± 0.6 and 11.5 ± 0.9) and distal (9.6 ± 0.7 and 10.4 ± 0.8) pits in the maxilla and mandible. There was no significant difference between the right (7.3 ± 0.5, 9.4 ± 0.6) and left (8.2 ± 0.5, 9.5 ± 0.6) dental arches. IRLF measurements in the mesial pits of human first permanent sound molars were lower than the central and distal pits in children whose second molars had not erupted.

CONCLUSIONS

The inherently higher IRLF values of some sites should not be misinterpreted and trigger early invasive treatment.

Time-dependent decrease and seasonal variation of the porosity of recently erupted sound dental enamel in vivo

Recently erupted teeth are more sensitive to dental caries than teeth that have remained free from caries lesions for a few years after eruption. It has been hypothesized that this may be ascribed to differences in enamel porosity. The objective of the present work was to assess the time-dependence of electrical conductance, as an indication of porosity, of occlusal enamel in recently erupted permanent molar teeth. Fifty children aged 5-15 years of age, receiving regular dental care at six-month intervals, participated in the study when their first molar teeth (in 5- to 6-year-olds) or their second molar teeth (in 11- to 15-year-olds) had not been exposed to the oral environment for more than six months. On the first semi-annual check-up after eruption of a first or second molar, baseline diagnostic measurements, i.e., visual inspection and electrical conductance measurements (ECMs), were made at three or four pre-defined sites in the fissures. Subsequently, data collection was repeated every six months for three years. Sites were excluded from ECMs when a caries lesion was observed at a site by visual inspection. After 36 months, there were 257 sites in teeth considered sound upon visual examination. The ECM values of these sound sites showed a clear decrease with time after the first examination. The conductance decreased on average from 0.13 (Momega)(-1) to 0.059 (Momega)(-1). Since the conductance is assumed to be proportional to the porosity of the enamel, the latter decreased by a factor of 2.2 over the 36-month period. The results furthermore indicated a higher conductance for maxillary than for mandibular enamel. Almost all sites in that sample appeared to be in teeth that were observed for the first time during the months September to December. Electrical conductance, and therefore enamel porosity, of the sites showed a periodic variation with season of observation: In the fall, the conductance was higher than in the spring. This implies that a dentist should be more prudent in the fall than in the spring when indicating restorative treatment of an incipient caries lesion.

Alkali-soluble and insoluble fluoride in erupted and unerupted human enamel from a high fluoride area with a low fluorosis score

The amounts of fluoroapatite and 'CaF2-like' fluoride (F) were determined in enamel of unerupted and erupted teeth that had been exposed in vivo to 1.8-2.6 parts/10(6) F in the drinking water and to brushing with F dentifrice at least once a day, and occasionally to a F mouth-rinse (0.022% F). Enamel was sampled by acid-etching and the F levels were measured with an adapted F ion-selective electrode. More F was built into the deeper enamel in the high-F area than in a similar low-F area. Unerupted enamel did not etch significantly (p > 0.05) deeper than erupted enamel. No significant differences (p > 0.05) were found in the F concentrations amongst the following: alkali-washed erupted, unwashed erupted, alkali-washed unerupted and unwashed unerupted at the outer most enamel (approx. 6 microns). However the erupted enamel (alkali-washed or not) showed higher F levels than unerupted enamel (alkali-washed or not) between approx. 6 microns and greater than 100 microns. The increase of F for this high-F area was about 100% in the deeper enamel while for a low-F area it was approx. 78% in the most outer enamel with no increase after a depth of about 20 microns. In contrast to a similar low-F area (water F < 0.10 parts/10(6)), no significant 'CaF2-like' F could be detected in erupted or unerupted enamel for the high-F area.

Sequential observations followed by acid etching on the enamel surfaces of human teeth under scanning electron microscopy at low vacuum

A scanning electron microscope equipped with a low vacuum specimen chamber and a Robinson's backscattered electron detector was employed to observe the natural surfaces of human buccal enamel before and after 30 percent phosphoric acid etching sequentially up to 90 sec at the same sites with no coatings. Furthermore, successive etching patterns were compared between deciduous and permanent teeth. On the imbrication lines of young permanent teeth, prism-end pits surrounded with a "prismless" structure occasionally disappeared after acid etching and became a prismless enamel. Sequential etching caused the prismless areas and the areas of a type 1 etching pattern to decrease, and a cone-shaped prism structure and a complex type of the type 1 and type 2 etching pattern (type 1-2) to appear. The former was a transitional type between the prismless enamel and type 2 prisms. These etched surfaces show type 2 prisms after deeper etching. Small dome-shaped structures, slightly elevated on the attrited enamel surfaces, were found only in deciduous teeth. After acid etching, such areas which retained the prismless enamel rose to the underlying surfaces of cone-shaped prisms.

Histogenetic aspects of the composition and structure of human ectopic enamel, studied by scanning electron microscopy

This study was made on 12 enamel projections and 12 enamel pearls on human permanent molars to compare their structure and composition, which might elucidate possible histogenetic differences between these two forms of ectopic enamel. The enamel projections contained approx. 2 (weight)% less Ca and P than control occlusal and mid-coronal enamel. Their mineralization was less homogeneous and probably defective. Their enamel structure was markedly irregular in the prismatic as well as the aprismatic layer, but the composition and structure were very similar to those of the control enamel close to cervical border. The enamel of the pearls largely corresponded in composition and structure to the control occlusal and mid-coronal enamel. The enamel of large pearls also resembled coronal enamel in its compositional and structural variability in the occlusal-cervical direction. These findings suggest that amelogenesis in enamel projections is a continuation of amelogenesis in the cervical region. In contrast, amelogenesis in enamel pearls follows the same pattern as that in a dental crown, from the occlusal region to the cervical enamel border. Therefore, the enamel pearl may well be regarded as an attempt at new tooth formation.

Alkali-soluble and insoluble fluoride in erupted and unerupted sound enamel of human third molars in vivo

The amounts of firmly and loosely bound fluoride were determined in sound enamel of unerupted and erupted teeth which had been exposed in vivo for 1-16 yr to brushing at least once a day, and occasionally to mouth rinsing and the application of sealers. Enamel was sampled by an acid-etch procedure, and the fluoride levels were measured with an adapted fluoride ion-selective electrode. Unerupted enamel was etched significantly (p less than 0.05) deeper than erupted enamel up to a depth of at least 8 microns. Significant differences (p less than 0.05) were found between the mean enamel fluoride concentrations of unwashed and alkali-washed, erupted teeth up to a depth of at least 3 microns and also between unwashed or washed, erupted versus unwashed or washed, unerupted teeth. At a depth of 3 microns, the fluoride treatments of enamel had increased the total amount of fluoride by approx. 78% of which approx. 53% was loosely bound fluoride (like CaF2) and 47% firmly bound (like fluorapatite). No increase in sound enamel fluoride as a result of topical treatments over a period of up to 16 yr could be found at a level deeper than 20 microns.

The relative distribution of fluoride in erupted and unerupted enamel of human third molars from a low fluoride area

Acid-etch biopsies were taken from the centre of the mesio-lingual, disto-lingual, disto-buccal and mesio-buccal cusps of non-carious erupted (n = 16, aged 18-28 years) and unerupted (n = 21, aged 18-28 years) teeth. The donor subjects had lived continuously in a low fluoride area (F water less than 0.1 parts/10(6] from birth, and had had no systemic fluoride supplementation. Tooth brushing, mouth rinsing and the application of sealers were the only fluoride-containing anti-caries programmes practised singly or in combination. Six successive acid-etchings were taken from each of the four cusps, and the fluoride levels in the etching solution were measured with an adapted, fluoride ion-selective electrode. Up to a depth of about 10 microns, unerupted enamel was etched significantly (p less than 0.05) more deeply than erupted enamel, which might be explained by changes in its composition. Up to a depth of approximately 10 microns, significantly more fluoride was found in erupted than in unerupted enamel. This difference may mainly be attributed to the effect of fluoride from the oral environment on erupted enamel. Fluoride concentrations, up to a depth of approximately 3 microns, were (p = 0.07) higher in the buccal cusps than in the lingual cusps of erupted molars, but not at the other etch depths. There were no significant differences (p greater than 0.10) between the buccal and lingual cusps of the unerupted molars at any depth. No significant correlations between enamel fluoride concentrations and age could be found either for erupted or unerupted third molars.

In vivo remineralization of human enamel and dental calculus formation

The aim of this investigation was to determine the inorganic composition and the surface morphology of remineralized enamel areas and of dental calculus in heavy-calculus-formers (five subjects) and to compare these results with those of non-calculus-formers (two subjects). Electron probe micro-analysis (EPMA) was carried out on sound, acid-etched, and in vivo remineralized enamel samples from heavy- and non-calculus-formers. The mean values of Ca, P, Na, Mg, Al, Si, S, Cl, and K were compared with the SEM morphology. EPMA measurements showed no significant differences in the Ca/P ratio of the surface layers of prism-oriented and/or homogeneous enamel remineralization. The variations of remineralization pattern after acid-etching are similar in teeth from heavy dental-calculus-forming patients and in teeth from non-calculus-formers. The SEM appearances of remineralized areas and of the inner surface of mature dental calculus must be considered to be totally different. The experiments carried out suggest that the remineralization of enamel is not related to the formation of calculus.