A comparison of the mineral content of enamel and dentine in human premolars and enamel pearls measured by X-ray microtomography

Physicochemical Properties and Surface Characteristics of Ground Human Teeth

Enamel, dentin and cementum apatite has a complex composition. The lack of complete reports on the chemical composition of all tooth tissues together and the need to create a modern biomaterial that reproduces the correct ratio of individual tooth mineral components prompted the authors to undertake the research. A detailed evaluation of the micro- and macro-elements of tooth powder, using various methods of chemical analysis was conducted. All four groups of human sound teeth were crushed using the grinder. A fine powder was implemented for the FTIR (Fourier Transform Infrared Spectroscopy), ICP (Inductively Coupled Plasma Optical Emission Spectometry) and for the potentiometric titration, SEM and mercury porosimetry analyses. The obtained studies indicate that there is no significant correlation in chemical composition between the different teeth types. This proves that every removed, crushed tooth free of microorganisms can be a suitable material for alveolar augmentation. It is essential to know the chemical profiles of different elements in teeth to develop a new class of biomaterials for clinical applications.

Fluoridated milk enhances the mineral density of artificial proximal carious lesions in situ

OBJECTIVE

To compare the mineral density (MD) of non-fluoridated-milk (non-F-milk), fluoridated-milk (F-milk), adjunctive to 1000-ppm-fluoride dentifrice (FD), and 1000-ppm-FD alone of proximal artificial enamel carious lesions (AECL) in high caries-risk patients.

MATERIALS AND METHODS

This double-blind, cross-over in situ study comprised seven high caries-risk volunteers. Orthodontic brackets with one slab of AECL were fixed randomly to each volunteer per phase. The study comprised three experimental periods with a 7-d wash-out period using FD between sessions; (1) A four-week tooth brushing with FD 2×/day by all subjects as a control. The participants were then randomly allocated to (2) drinking 2.5-ppm-F-milk 1×/day or (3) non-F-milk 1×/day, adjunctive to tooth-brushing with FD for 4-weeks. The subjects crossed over from each type of milk and continued the same protocol for another four weeks. After each phase, the MD of each specimen was analyzed using micro-computed tomography (Micro-CT).

RESULTS

The baseline MD was not significantly differences (p = .653). When brushing with FD and drinking F-milk, the MD gain was significantly higher (11.68 ± 2.89%) compared with brushing with FD and drinking non-F-milk (4.59 ± 1.78%) (p = .003) or brushing with FD alone (5.30 ± 2.10%) (p = .003).

CONCLUSIONS

F-milk adjunctive to FD significantly increased MD gain compared with non-F-milk + FD or FD alone.

Novel Approach to Tooth Chemistry. Quantification of the Dental-Enamel Junction

The dentin-enamel junction (DEJ) is known for its special role in teeth. Several techniques were applied for the investigation of the DEJ in human sound molar teeth. The electron (EPMA) and proton (PIXE) microprobes gave consistent indications about the variability of elemental concentrations on this boundary. The locally increased and oscillating concentrations of Mg and Na were observed in the junction, in the layer adhering to the enamel and covering roughly half of the DEJ width. The chemical results were compared with the optical profiles of the junction. Our chemical and optical results were next compared with the micromechanical results (hardness, elastic modulus, friction coefficient) available in the world literature. A strong correlation of both result sets was proven, which testifies to the self-affinity of the junction structures for different locations and even for different kinds of teeth and techniques applied for studies. Energetic changes in tooth strictly connected with crystallographic transformations were calculated, and the minimum energetic status was discovered for DEJ zone. Modeling of both walls of the DEJ from optical data was demonstrated. Comparing the DEJ in human teeth with the same structure found in dinosaur, shark, and alligator teeth evidences the universality of dentin enamel junction in animal world. The paper makes a contribution to better understanding the joining of the different hard tissues.

Micro-CT assessment of the effect of silver diammine fluoride on inhibition of root dentin demineralization

This study evaluated the ability of different types of silver diammine fluoride (SDF) to inhibit dentin demineralization using micro-focused X-ray computed-tomography (µCT). Dentin specimens were divided into five groups (n=10); no-treatment (control), 3.8% SDF (RC), 38% SDF, 38% SDF with potassium iodide (SDF/KI), and potassium fluoride (KF). The treated-dentin surfaces were subjected to demineralization for 7-days and assessed using µCT to determine mineral loss (ML) values. Specimens were also analyzed with scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). The ML values of the SDF and KF groups were significantly lower than those of the RC and SDF/KI groups. EDS detected fluoride ions in the SDF and KF groups but not in the RC and SDF/KI groups. It was concluded that 38% SDF demonstrated a high ability to inhibit dentin demineralization while additional application of KI may diminish the inhibitory effect of SDF. The amount of dentin demineralization with SDF treatments was material dependent.

Novel Approach to Tooth Chemistry: Quantification of Human Enamel Apatite in Context for New Biomaterials and Nanomaterials Development

A series of linear profiles of the elements of the enamel in human molar teeth were made with the use of an electron microprobe and a Raman microscope. It is postulated that the enamel can be treated as the superposition of variable "overbuilt" enamel on the stable "core" enamel at the macro-, micro- and nanoscale level. The excessive values characterize the "overbuilt enamel". All the profiles of excessive parameters along the enamel thickness from the enamel surface to the dentin enamel junction (DEJ) can be approximated very precisely with the use of exponential functions, where Ca, P, Cl and F spatial profiles are decaying while Mg, Na, K and CO32- ones are growing distributions. The "overbuilt" apatite formed on the boundary with DEJ, enriched in Na, Mg, OH and carbonates, reacts continuously with Ca, Cl and F, passing into an acid-resistant form of the "overbuilt" enamel. The apparent phases arriving in boundary regions of the "overbuilt enamel" were proposed. Microdiffraction measurements reveal relative variation of energy levels during enamel transformations. Our investigations are the milestones for a further new class of biomaterial and nanomaterial development for biomedical applications.

The effects of 8DSS peptide on remineralization in a rat model of enamel caries evaluated by two nondestructive techniques

Nowadays, dental caries is one of the most common oral health problems, affecting most individuals. It has been found that, by remineralizing enamel at an early stage in the formation of enamel caries, teeth can be effectively protected from dental caries. In this work, a peptide with eight repetitive sequences of aspartate-serine-serine (8DSS) is applied as the bio-mineralizer in an in-vivo rat enamel caries model. Nondestructive quantitative light-induced fluorescence-digital (QLF-D) imaging and micro-computed tomography (micro-CT) are used to evaluate the remineralization of enamel carious lesions by measuring the total fluorescence radiance loss of the molar area (Δ Q_Total), acquired using QLF-D imaging, and the mineral density and residual molar enamel volume, acquired using micro-CT. Correlations are explored between Δ Q_Total and mineral density (strong correlation, r = 0.8000, p < 0.001) and Δ Q_Total and residual molar enamel volume (moderate correlation, r = 0.6375, p < 0.001). Our results demonstrate that 8DSS is a promising in-vivo remineralization agent that exhibits comparable effects to NaF ( p < 0.05), which has been verified using the classical Keyes method. Moreover, the nondestructive QLF-D and micro-CT methods can be combined to quantify the remineralization of enamel carious lesions three-dimensionally in vivo, making them broadly applicable in quantifying hard tissues.

Testing the Clinical Applicability of Resin Infiltration of Developmental Enamel Hypomineralization Lesions Using an In Vitro Model

Aim

The aim of this study is to investigate the penetration abilities of a commercially available low-viscosity resin infiltrant into developmentally hypomineralized teeth in vitro.

Materials and methods

Four extracted third molars of a 17-year-old patient with signs of developmental enamel hypomineralization (discoloration, increased opacity, and surface roughness) were infiltrated with a low-viscosity resin mixed with a fluorescent dye, according to the manufacturer's standard protocol. Four extracted molars with sound enamel or showing only initial fissure caries were used as a control group. Specimens were embedded in polymethylmethacrylate, and grindings were prepared. High-resolution projectional radiography of the grindings was performed, and, for one specimen, quantitative micro-computed tomography was used to measure hydroxyapatite density in enamel and dentin lesions. After decalcification, the grindings were examined by reflected bright-field microscopy, wide-field fluorescence microscopy, and confocal laser scanning microscopy. Fluorescence micrographs were superimposed on the radiographs and analyzed correlatively.

Results

The pattern of hypo-/demineralization in enamel and dentin in developmentally hypomineralized teeth showed a good congruence with the pattern of resin infiltration. Cavitations and dentin tubules up to a depth of 2 mm beyond cavitations were filled by the infiltrant. In control teeth, the penetration of the infiltrant was limited to decalcified enamel areas (initial fissure caries).

Conclusions

In vitro infiltration of developmentally hypomineralized enamel was successful.

Clinical significance

Resin infiltration might be considered as a routine procedure in the treatment of developmentally hypomineralized teeth. Further investigations with higher sample sizes, different degrees of severity, different stages of lesion extension, and modified treatment protocols are necessary.

How to cite this article

Schnabl D, Dudasne-Orosz V, et al. Testing the Clinical Applicability of Resin Infiltration of Developmental Enamel Hypomineralization Lesions Using an In Vitro Model. Int J Clin Pediatr Dent 2019;12(2):126-132.

Crystallographic texture and mineral concentration quantification of developing and mature human incisal enamel

For human dental enamel, what is the precise mineralization progression spatially and the precise timing of mineralization? This is an important question in the fundamental understanding of matrix-mediated biomineralization events, but in particular because we can use our understanding of this natural tissue growth in humans to develop biomimetic approaches to repair and replace lost enamel tissue. It is important to understand human tissues in particular since different species have quite distinct spatial and temporal progression of mineralization. In this study, five human central incisors at different stages of enamel maturation/mineralization were spatially mapped using synchrotron X-ray diffraction and X-ray microtomography techniques. From the earliest developmental stage, two crystallite-orientation populations coexist with angular separations between the crystallite populations of approximately 40° varying as a function of position within the tooth crown. In general, one population had significantly lower texture magnitude and contributed a higher percentage to the overall crystalline structure, compared to the other population which contributed only 20-30% but had significantly higher texture magnitude. This quantitative analysis allows us to understand the complex and co-operative structure-function relationship between two populations of crystallites within human enamel. There was an increase in the mineral concentration from the enamel-dentin junction peripherally and from the incisal tip cervically as a function of maturation time. Quantitative backscattered-electron analyses showed that mineralization of prism cores precedes that of prism boundaries. These results provide new insights into the precise understanding of the natural growth of human enamel.

Beam hardening correction tool improves the diagnosis of incipient caries lesions in Micro-CT images

OBJECTIVE

To evaluate the effect of Beam Hardening Correction tool (BHC) on Micro-CT images used in the diagnosis of incipient caries lesions.

METHODS

Six posterior teeth, with 6 sound proximal surfaces and 6 natural white spot lesions, were scanned using a SkyScan1174 device. Each tooth was imaged 16 times in various acquisition parameters, and reconstructed 3 times applying different levels of BHC (0, 15 and 30%). The 288 datasets were analyzed by three examiners. Gold-standard was obtained by microscopic analyses under polarized light. Area under the ROC curve was obtained for each protocol and the BHC parameter was isolated to individually observe the influence of such parameters of reconstruction.

RESULTS

Microtomographic images were accurate for the diagnosis of incipient caries lesions even when the BHC tool was not applied. Accuracy was perfect in 50 % of the protocols without BHC. When adding the artefact correction, the number of protocols that reached perfect accuracy increased to 81.25%. No difference was found between the protocols that used 15 or 30% BHC. Statistically significant differences were found only in four comparisons, and on those the images that had BHC were more accurate. Two non-BHC protocols reached accuracy scores of 0.653 and 0.881, and were improved to perfect accuracy with BHC application.

CONCLUSION

The use of the BHC tool should be encouraged when using Micro-CT to detect incipient caries lesions, especially when low-quality parameters aiming less acquisition and processing time are used.

FT-Raman spectroscopic characterization of enamel surfaces irradiated with Nd:YAG and Er:YAG lasers

Background. Despite recent advances in dental caries prevention, caries is common and remains a serious health problem. Laser irradiation is one of the most common methods in preventive measures in recent years. Raman spectroscopy technique is utilized to study the microcrystalline structure of dental enamel. In this study, FT-Raman spectroscopy was used to evaluate chemical changes in enamel structure irradiated with Nd:YAG and Er:YAG lasers.

Methods. We used 15 freshly-extracted, non-carious, human molars that were treated as follows: No treatment was carried out in group A (control group); Group B was irradiated with Er:YAG laser for 10 seconds under air and water spray; and Group C was irradiated with Nd:YAG laser for 10 seconds under air and water spray. After treatment, the samples were analyzed by FT-Raman spectroscopy.

Results. The carbonate content evaluation with regard to the integrated area under the curve (1065/960 cm^–1) exhibited a significant reduction in its ratio in groups B and C. The organic content (2935/960 cm^-1) area exhibited a significant decrease after laser irradiation in group B and C.

Conclusion. The results showed that the mineral and organic matrices of enamel structure were affected by laser irradiation; therefore, it might be a suitable method for caries prevention.

Miniature endoscopic optical coherence tomography for calculus detection

The effective treatment of periodontitis involves the detection and removal of subgingival dental calculus. However, subgingival calculus is more difficult to detect than supragingival calculus because it is firmly attached to root surfaces within periodontal pockets. To achieve a smooth root surface, clinicians often remove excessive amounts of root structure because of decreased visibility. In addition, enamel pearl, a rare type of ectopic enamel formation on the root surface, can easily be confused with dental calculus in the subgingival environment. In this study, we developed a fiber-probe swept-source optical coherence tomography (SSOCT) technique and combined it with the quantitative measurement of an optical parameter [standard deviation (SD) of the optical coherence tomography (OCT) intensity] to differentiate subgingival calculus from sound enamel, including enamel pearl. Two-dimensional circumferential images were constructed by rotating the miniprobe (0.9 mm diameter) while acquiring image lines, and the adjacent lines in each rotation were stacked to generate a three-dimensional volume. In OCT images, compared to sound enamel and enamel pearls, dental calculus showed significant differences (P<0.001) in SD values. Finally, the receiver operating characteristic curve had a high capacity (area under the curve=0.934) for discriminating between healthy regions (including enamel pearl) and dental calculus.

Effect of different desensitizers on inhibition of bovine dentin demineralization: micro-computed tomography assessment

This study evaluated the effect of two desensitizers on inhibition of dentin demineralization, after immersion in artificial saliva using micro-computed tomography (μCT). Dentin blocks cut from bovine incisors were treated with deionized water (DW, a negative control) or one of three desensitizers: a fluoride varnish (Duraphat, a positive control), a calcium phosphate desensitizer (Teethmate Desensitizer), and a fluoro-alumino-calcium silicate-based desensitizer (Nanoseal). After each treatment, the specimens in Duraphat, Nanoseal, and Teethmate Desensitizer groups were pre-immersed in artificial saliva (pH 6.5) for either 1 d or 1 wk. The mineral loss of the specimens after demineralization (pH 5.0, 3 h) was evaluated by μCT. The treated surface was investigated with scanning electron microscopy. Mineral loss in all treatment groups was significantly lower than that in DW. Duraphat was the most effective treatment against demineralization, followed by Nanoseal. Nanoseal showed significantly better reduction in mineral loss following immersion for 1 wk in artificial saliva than for 1 d. However, Teethmate Desensitizer and Duraphat did not exhibit enhanced inhibition of demineralization over a longer period of immersion in artificial saliva. Scanning electron microscopy images showed deposition of particles on the dentin in both Teethmate Desensitizer. The application of Teethmate Desensitizer and Nanoseal to the exposed dentin surface resulted in inhibition of demineralization, with Nanoseal resulting in improved inhibition after prolonged immersion in artificial saliva.

Pérola de esmalte: epidemiologia, morfopatogênese e relevância na clínica odontológica

INTRODUÇÃO: Distúrbios da odontogênese geram anomalias dentárias com relevância diagnóstica e terapêutica. OBJETIVO: O presente artigo teve como objetivos fazer uma revisão sistemática sobre a pérola de esmalte e discutir seu processo formativo, bem como a sua significância na clínica odontológica. MATERIAL E MÉTODO: Três bancos de dados eletrônicos (Pubmed, Cochrane e Biblioteca Virtual em Saúde) foram usados para recuperar artigos científicos dos últimos 30 anos, usando o descritor enamel pearls. RESULTADO: O Brasil ocupa posição de destaque nas publicações temáticas existentes (18%). A etiopatogênese desta anomalia ainda permanece obscura, sendo necessários mais estudos acerca da contribuição de fatores envolvidos com amelogênese ectópica e cementogênese deficiente in situ. Dados epidemiológicos apontam uma frequência variável na população brasileira (0,8 a 8%) e mundial (0,2 a 6,2%), sendo os molares os dentes mais acometidos. Análise morfológica das pérolas de esmalte mostra que esta anomalia de forma e volume pode ser de dois tipos: simples (pérola verdadeira externa ou interna) ou composta (esmalte-dentina ou esmalte-dentina-polpa). É importante o diagnóstico clínico-radiológico diferencial de pérolas de esmalte para permitir o tratamento odontológico adequado, que inclui a ameloplastia como conduta eficaz para minimizar o acúmulo de biofilme oral e a exarcerbação da doença periodontal. CONCLUSÃO: Faz-se necessária a publicação de pesquisas pormenorizadas sobre pérolas de esmalte, a fim de gerar evidências científicas no fazer profissional da Odontologia.

Enamel pearls in permanent dentition: case report and micro-CT evaluation

OBJECTIVES

To investigate the frequency, position, number and morphology of enamel pearls (EPs) using micro-CT (µCT) and to report a case of an EP mimicking an endodontic-periodontic lesion.

METHODS

Cone beam CT (CBCT) was performed in a patient to evaluate a radio-opaque nodule observed on the left maxillary first molar during the radiographic examination. Additionally, 23 EPs were evaluated regarding frequency, position, number and morphology by means of µCT. The results were statistically compared using the Student's t-test for independent samples.

RESULTS

1 pearl was presented in 13 specimens, while 5 specimens presented 2 pearls. The most frequent location of the EPs was the furcation between the disto-buccal and the palatal roots of the maxillary molars. Overall, the mean major diameter, volume and surface area were 1.98 ± 0.85 mm, 1.76 ± 1.36 mm³ and 11.40 ± 7.59 mm², respectively, with no statistical difference between maxillary second and third molars (p > 0.05). In the case report, CBCT revealed an EP between the disto-buccal and the palatal roots of the maxillary first left molar associated with advanced localized periodontitis. The tooth was referred for extraction.

CONCLUSIONS

EPs, located generally in the furcation area, were observed in 0.74% of the sample. The majority was an enamel-dentin pearl type and no difference was found in maxillary second and third molars regarding diameter, volume and surface area of the pearls. In this report, the EP mimicked an endodontic-periodontic lesion and was a secondary aetiological factor in the periodontal breakdown.

Effects of insertion angle and implant thread type on the fracture properties of orthodontic mini-implants during insertion

Objective:

To determine the effects of insertion angle (IA) and thread type on the fracture properties of orthodontic mini-implants (OMIs) during insertion.

Materials and Methods:

A total of 100 OMIs (self-drilling cylindrical; 11 mm in length) were allocated into 10 groups according to thread type (dual or single) and IA (0°, 8°, 13°, 18°, and 23°) (n  =  10 per group). The OMIs were placed into artificial materials simulating human tissues: two-layer bone blocks (Sawbones), root (polymethylmethacrylate stick), and periodontal ligament (Imprint-II Garant light-body). Maximum insertion torque (MIT), total insertion energy (TIE), and peak time (PT) were measured and analyzed statistically.

Results:

There were significant differences in MIT, TIE, and PT among the different IAs and threads (all P &lt; .001). When IA increased, MIT increased in both thread groups. However, TIE and PT did not show significant differences among 0°, 8°, and 13° IAs in the dual-thread group or 8°, 13°, and 18° IAs in the single-thread group. The dual-thread groups showed higher MIT at all IAs, higher TIE at 0° and 23° IAs, and longer PT at a 23° IA than the single-thread groups. In the 0°, 8°, and 13° IA groups, none of the OMIs fractured or became deformed. However, in the 18° IA group, all the OMIs were fractured or deformed. Dual-thread OMIs showed more fracturing than deformation compared to single-thread OMIs (P &lt; .01). In the 23° IA group, all OMIs penetrated the artificial root without fracturing and deformation.

Conclusions:

When OMIs contact artificial root at a critical contact angle, the deformation or fracture of OMIs can occur at lower MIT values than those of penetration.

Enamel Lesion Parameter Correlations between Polychromatic Micro-CT and TMR

Transverse microradiography (TMR) is considered as the gold standard technique for the evaluation of enamel lesions. Micro-computed tomography (µCT) has the advantage of non-destructive measurements, but the beam-hardening effect with polychromatic x-rays is a major drawback. To date, no study has validated µCT against TMR. The objective of this study was to validate µCT measurements of enamel lesions under various x-ray conditions and software beam-hardening correction (BHC) against TMR. Human molars with natural white-spot lesions were scanned for 5 min by µCT at 100 kV in different conditions: 50 µA (0.5-mm Al filter), 165 µA (0.5-mm Al/0.3-mm Cu), and 200 µA (0.5-mm Al/0.4-mm Cu), with or without BHC. Grayscale values were converted into mineral density values using phantoms. Thin sections at the same positions were then prepared for TMR. Lesion depth (LD; µm) and mineral loss (ΔZ; vol%µm) were compared between µCT and TMR by Pearson’s correlations. µCT measurements correlated well with TMR under all conditions (p < 0.001, r > 0.86 for LD and ΔZ), except for 0.5-mm Al without BHC (p > 0.05). Even without BHC, combined Al/Cu filters successfully reduced the beam-hardening effect. µCT can be used as a non-destructive alternative to TMR with comparable parameters for the study of enamel lesions.

Evaluation of enamel pearls by cone-beam computed tomography (CBCT)

OBJECTIVE

The aim of this study was to evaluate the frequency of enamel pearls according to population, sex and tooth groups on Cone-Beam Computed Tomography (CBCT) or Dental Volumetric Tomography (DVT) scans of patients, retrospectively.

STUDY DESIGN

In this study, 15185 teeth belonging to 768 patients, 430 female and 338 male, was performed cross-sectional examination by CBCT. The volumetric Computed Tomography used in the study is Newton FP based on flat-panel. The data were analyzed with Pearson chi-squared test.

RESULTS

Enamel pearls were detected in 36 subjects (4.69%). Of these enamel pearls, 19 were detected in male and 17 were in male. There was no statistically a significant association between prevalence of enamel pearls and sex. All of enamel pearls were detected in molar teeth, for prevalence 0.83%.

CONCLUSION

All of enamel pearls are found upper and lower molar teeth, especially the most commonly in maxillary second and third molars.

Effect of high phosphorus diet on tooth microstructure of rodent incisors

Enamel hypoplasia and disruption of dentinogenesis are the most common abnormalities of development and mineralization of human teeth. Several reports are available in the literature on the influence of dietary calcium on the formation of human and rodent tooth; however, the information about the influence of dietary phosphorus on the tooth formation is scarce. The aim of the present investigation was to examine the chronic effect of high phosphorus diet and improper dietary calcium to phosphorus ratio on the mandibular incisor microstructure in a hystricomorph rodent--Octodon degu--using macroscopic observation, histopathological examination, transmission and scanning electron microscopy. The present study shows that enamel and dentin development is disturbed under high phosphorus diet and improper calcium to phosphorus ratio. Disturbed mineral metabolism resulted in enamel depigmentation, enamel hypoplasia, enamel pitting and altered dentin morphology. The results suggest that more attention should be focused on dietary phosphorus content when facing altered tooth structure in young patients with deciduous or permanent dentition. Furthermore, we showed that degus can be used as an experimental animal model for the study of the developmental teeth disturbances.

Prevalence of enamel pearls in teeth from a human teeth bank

Enamel pearls are anatomical structures that can bring about clinical implications if associated with the retention of plaque, in turn resulting in periodontal disease. In an attempt to avoid periodontal disease, the removal and treatment of these enamel pearls, may be a necessity in some circumstances. A total of 45,785 extracted teeth from a human teeth bank were analyzed for the presence of enamel pearls. The most prevalent anatomical location of enamel pearls was the permanent maxillary first and second molar region. An association between the prevalence of enamel pearls and dental class (P < 0.001) was observed, most frequently in the maxillary molars. In the maxillary molars, the most prevalent anatomical location of enamel pearls in the first and second molars was the furcation between the distobuccal and palatal roots. Enamel pearls are a common observation in molars in general, but are most commonly found in maxillary molars.

Application of polychromatic µCT for mineral density determination

Accurate assessment of mineral density (MD) provides information critical to the understanding of mineralization processes of calcified tissues, including bones and teeth. High-resolution three-dimensional assessment of the MD of teeth has been demonstrated by relatively inaccessible synchrotron radiation microcomputed tomography (SRµCT). While conventional desktop µCT (CµCT) technology is widely available, polychromatic source and cone-shaped beam geometry confound MD assessment. Recently, considerable attention has been given to optimizing quantitative data from CµCT systems with polychromatic x-ray sources. In this review, we focus on the approaches that minimize inaccuracies arising from beam hardening, in particular, beam filtration during the scan, beam-hardening correction during reconstruction, and mineral density calibration. Filtration along with lowest possible source voltage results in a narrow and near-single-peak spectrum, favoring high contrast and minimal beam-hardening artifacts. More effective beam monochromatization approaches are described. We also examine the significance of beam-hardening correction in determining the accuracy of mineral density estimation. In addition, standards for the calibration of reconstructed grey-scale attenuation values against MD, including K(2)PHO(4) liquid phantom, and polymer-hydroxyapatite (HA) and solid hydroxyapatite (HA) phantoms, are discussed.

Dynamics of Biomineralization and Biodemineralization

In order to understand the fundamental processes leading to biomineralization, this chapter focuses on the earliest events of homo/heterogeneous nucleation from an initial supersaturated solution phase and subsequent growth involving various possible precursor phases (amorphous or crystalline) to the final mineral phase by specific template and other influences. We also discuss how the combination of macroscopic constant composition and microscopic atomic force microscopy provides insights into the physical mechanisms of crystal growth and phase stability and the influences of proteins, peptides or other small molecules.Biodemineralization reactions of tooth enamel and bone may be inhibited or even suppressed when particle sizes fall into certain critical nanoscale levels. This phenomenon actually involves particle-size-dependent critical conditions of energetic control at the molecular level. Clearly, this dissolution termination is a kinetic phenomenon and cannot be attributed to reaction retardation as a result of surface modification by additives. Almost all biomineralized structures are highly hierarchical at many different length scales. At the lowest level they often consist of tiny crystals, typically tens to hundreds of nanometers. This size is not arbitrary; rather, it seems to give biominerals such as bone and tooth remarkable physical characteristics.

Molar-incisor-hypomineralisation: a literature review

BACKGROUND

Molar-Incisor-Hypomineralisation (MIH) is a qualitative defect of 1-4 first permanent molars with or without the maxillary and mandibular permanent incisors. It seems to have been recognised first in the 1970s and prevalence varies between 2.8% and 25%, dependent upon the study.

METHODS

The dental literature was searched using a number of key terms entered into MEDLINE, the reference list of each paper as located was examined for further papers that had been missed in the initial search.

RESULTS

The review of the literature showed that teeth that are affected indicate a systemic cause at around the time of birth; investigators have put forward a number of possible causes; asthma, pneumonia, upper respiratory tract infections, otitis media, antibiotics, dioxins in mother's milk, tonsillitis and tonsillectomy and exanthamatous fevers of childhood. However, at the present time the aetiology remains unclear. Treatment of the affected permanent first molars can include restorations using adhesive intra-coronal restorations to extra-coronal restorations (e.g. preformed metal crowns). There is little evidence to support one option over another. In severe cases extraction at the optimum time may be the best option; allowing the permanent second molars to come forwards. There is little improvement in affected anterior teeth with microabrasion and direct or indirect composite resin restorations may be appropriate in some children. Ultrastructural and biochemical make up of MIH affected teeth seem to have been investigated less than other areas.

CONCLUSION

It is important that children with MIH are diagnosed as early as possible and managed appropriately; this will involve multidisciplinary input.

Enamel mineral concentration in diabetic rodents

AIM

This was to use x-ray microtomography (XMT), to assess the mineral composition and 3-D structure of enamel and bone in the teeth and skulls of diabetic rodents.

METHODS

Three-dimensional images of the skull were reconstructed using computer generated false colour to highlight different levels of mineralization in bone and enamel.

RESULTS

These showed that diabetic rodents exhibited more wear in their teeth. Deformities were observed in the alveolar process of the mandible and maxilla. Regions of extensive hypomineralization were found in the calvarial bone of skulls. The maximum mineral concentrations and the time constants for diabetic rodents were similar to the controls. The diabetic mice appeared to have random regions of hypomineralization and one diabetic rat had areas of hypoplasia in the mandibular incisors.

CONCLUSIONS

Diabetes may have a detrimental influence on the function of ameloblasts in laying down enamel.

Characterisation of enamel white spot lesions using X-ray micro-tomography

OBJECTIVES

The aim of this study was to characterise the mineral density (MD) of natural enamel white spot lesions (WSLs) using X-ray micro-tomography calibrated with different density hydroxyapatite phantoms.

METHODS

Seven natural WSLs from four extracted non-carious premolar teeth were scanned at a voxel size of 7.6 microm using a desktop X-ray micro-tomography system. Five hydroxyapatite phantoms (sintered pellets of hydroxyapatite powder) with densities ranging from 1.52 to 3.14 g/cm(3) were used as calibration standards for each scan. Three-dimensional image reconstruction enabled MD gradients throughout the lesion to be quantified using an MD calibration equation derived from hydroxyapatite phantoms. Background noise generated during the measurement of MD was reduced using a Gaussian filter.

RESULTS

Gaussian filter reduced the signal-to-noise ratio (standard deviation) significantly while the basic MD information (average value) remained intact. The mineral gradients through the WSLs examined were compared and are discussed in terms of existing literature. The MD of sound enamel, apparent intact surface layer of WSL, and lowest level of WSL was found to be 2.65-2.89 g/cm(3), 2.23-2.58 g/cm(3) and 1.48-2.03 g/cm(3), respectively. Our MD results are comparable with other studies.

CONCLUSIONS

X-ray micro-tomography is a sensitive in vitro technique capable of characterising and quantifying MD of small non-cavitated WSLs. This method has a promising potential for future carious and quantitative remineralisation studies.

Mineral concentration of natural human teeth by a commercial micro-CT

This study aimed to evaluate a commercial micro-CT system (microCT 20) for quantitative analysis of mineral concentration in human enamel and dentin using different methodologies, and thereby compare the obtained results with established data from published literature. A micro-CT device set at 50 kVp (160 microA) was used to scan five whole molars (G1) and five molars ground to 6-mm thickness (G2), as well as evaluate the mineral concentration of the samples. Mean mineral contents for enamel and dentin were 2.57 (+/- 0.12) and 1.53 (+/- 0.12) g/cm3 for G1, and 2.76 (+/- 0.03) and 1.45 (+/- 0.02) g/cm3 for G2. Difference between the groups was significant for enamel. For dentin, there was a clear although not significant tendency towards higher values with G1. The equipment could identify and differentiate a higher mineral content of the tooth enamel and dentin from the external to the inner tissue. Further, the absolute mean values of mineral concentration were lower in whole tooth samples than in sectioned samples due to beam hardening. In conclusion, the equipment is well suited for quantifying the mineral content of teeth. However, it is necessary to consider the limited acceleration voltage of the microCT 20 system and to limit sample evaluation to 6-mm thickness.

Microcomputed tomography used in the analysis of the morphology of root canals in extracted wisdom teeth

Microcomputed tomography is a new technique for the non-destructive study of porous biological materials. We examined 11 wisdom teeth that had been removed prophylactically by microcomputed tomography operating in the cone beam mode. The two-dimensional sections of the teeth were reconstructed with surface rendering software to provide three-dimensional models that were observed and handled in virtual reality. The tooth itself, or the pulp chamber and canals, can be reconstructed and observed separately or simultaneously. Many teeth looked dystrophic with abnormal distributions of roots and canals. Microcomputed tomography seems to be a promising way of studying dental anatomy.

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.

Synchrotron X-Ray Microtomographic Investigation of Mineral Concentrations at Micrometre Scale in Sound and Carious Enamel

Synchrotron X-ray microtomography (XMT) was used to measure the linear attenuation coefficient (LAC) for 1.9-microm sidelength voxels within approximal brown spot lesions and sound human enamel. XMT demonstrated three-dimensional features, notably sheets with approximately 30 microm periodicity having low LAC, identified as regions of demineralization corresponding to Retzius lines. Quantitative three-dimensional measurements of mineral concentration, derived from LAC with assumption of a single model composition, were consistent with previous measurements of sound and carious enamel from microradiographic projections. The uncertainty in measurements of mineral concentration and mineral fraction volume was investigated by modelling enamel with a range of composition and component densities. This analysis showed that, although mineral concentration can be determined from LAC with an error of <0.2 g cm(-3), the variation in pore fraction volume within caries lesions cannot be reliably determined from X-ray attenuation measurements alone.

The challenges of validating diagnostic methods and selecting appropriate gold standards

Caries diagnostic methods are usually methods for caries lesion detection and measurement. Caries lesions occur on a continuous scale of tissue damage, from subclinical surface changes to macroscopic cavities reaching the pulp. Any change of a lesion on this continuous scale offers the opportunity for the diagnosis of disease activity or remission. Research aimed at remineralizing agents may focus on lesions that are amenable to remineralization, and select a method that will measure small changes in early lesions. General caries management strategies depend on detecting all stages of lesion development, and methods covering early to late stages are preferred. This paper addresses some methodological issues in validating caries diagnostic methods. The available gold standards for caries lesions are discussed, with their suitability in different applications, and their "validity" as far as it is known or can be inferred. The gold standards are compared as far as their measurement of lesion parameters and reproducibility is concerned. Tentative conclusions are formulated, and recommendations for future research are given.

3D X-ray microscopic study of the extent of variations in enamel density in first permanent molars with idiopathic enamel hypomineralisation

OBJECTIVE

To measure mineral concentration distributions within teeth with idiopathic enamel hypomineralisation, a condition in which developmental defects are seen in first permanent molars, and/or incisors.

DESIGN

X-ray microtomographic and 3D x-ray microscopy.

SETTING

UK University, 2001.

MATERIALS AND METHODS

X-ray microtomographic measurements of the extent of hypomineralisation in two affected molars and two contralateral controls extracted from the same patient.

RESULTS

The control molars were visibly normal. The affected molars showed hypomineralised yellow opaque enamel with regions of breakdown. X-ray microtomographic images showed; a 20% reduction in mineral concentration of affected enamel (most cases involved full enamel thickness); hypomineralised enamel had a mineral concentration gradient opposite to that of normal enamel; regions of hypomineralisation distributed randomly throughout affected teeth, (apart from cervical region which was less severely affected).

CONCLUSIONS

The pattern of mineral concentration suggests a disturbance during the maturation process. Differences in susceptibility of the ameloblasts during different stages of dental development may explain the asymmetric distribution of the defects. Topical fluoride applications may help promote post eruption maturation of the surface layer in these teeth. The use of fissure sealants and adhesive materials appears to prevent further breakdown.

Using diagnostic radiology in human evolutionary studies

This paper reviews the application of medical imaging and associated computer graphics techniques to the study of human evolutionary history, with an emphasis on basic concepts and on the advantages and limitations of each method. Following a short discussion of plain film radiography and pluridirectional tomography, the principles of computed tomography (CT) and magnetic resonance imaging (MRI) and their role in the investigation of extant and fossil morphology are considered in more detail. The second half of the paper deals with techniques of 3-dimensional visualisation based on CT and MRI and with quantitative analysis of digital images.

Enamel pearls and cervical enamel projections on 2 maxillary molars with localized periodontal disease: case report and histologic study

Presented here is an unusual case of teeth with aberrant enamel. One small and 3 large enamel pearls were identified in 2 maxillary third molars of a patient. One long enamel projection was connected to one of the large enamel pearls, along with 2 short cervical enamel projections. The ectopic enamel was associated with advanced localized periodontal destruction. After extraction, the molars were investigated radiographically and under the scanning electron microscope. The 3 large pearls contained distinct dentinal cones. The enamel of the pearls and the long cervical projection exhibited most of the structural attributes of crown enamel but were somewhat irregular, with variable shape and course of the prisms. Morphologic considerations suggest that these enamel pearls were aberrations and should not be regarded as attempts at new cusp or new tooth formation.

Radiographic evidence of enamel pearls in jordanian dental patients

OBJECTIVE

An "enamel pearl" is an ectopic globule of enamel that is adherent to the tooth root surface. Such an anomaly may facilitate the progression of periodontal breakdown. Information on the prevalence of enamel pearls is sparse, and ethnic variations are thought to occur. Our objective was to assess the prevalence of enamel pearls in a group of Jordanian dental patients.

STUDY DESIGN

A random sample of 819 dental records were selected, and a total of 1032 periapical radiographs were interpreted for the presence of enamel pearls.

RESULTS

Enamel pearls were detected in 4.76% of the subjects and on 1.6% of the molars. No significant difference between sexes was observed. First molar teeth were the most commonly affected, whereas the third molars were the least affected with the condition.

CONCLUSIONS

Enamel pearls are not uncommon among Jordanian dental patients, and their early detection could be important in prevention of periodontal disease.

Strain-structure relations in human teeth using Moiré fringes

Teeth are subjected to stress during normal function. The manner in which the resulting strain is distributed within the tooth is related to its structure. The Moiré fringe technique was used to map the in-plane strain distribution in slices from human tooth crowns under compression. The strain inside enamel is much less than in dentin, and there is a roughly 200 microm thick zone in dentin beneath the dentin enamel junction which undergoes larger strain than the central coronal dentin. This zone is softer and less mineralized than the bulk of the dentin. The strain distribution in this zone along the dentin-enamel junction shows localized maxima on both the lingual and the labial sides. This study is consistent with the hypothesis that within the dentin there are structural adaptations for transferring and minimizing stress.