The stoic tooth root: how the mineral and extracellular matrix counterbalance to keep aged dentin stable

Advanced statistical analyses to reduce inconsistencies in bond strength data focused on donor factors: A six-factor analysis using linear mixed and nonlinear regression models

PURPOSE

This study aimed to investigate the effects of the age and sex of tooth donors on dentin bond strength.

METHODS

A total of 38 extracted teeth (12 male and 26 female donors; age range: 17-82 years) were used in this study. In addition to donor age and sex, four other microtensile bond strength (μTBS) test specimen factors were evaluated: dentin position, bonding area, presence of voids at the interface, and computed tomography (CT) values of dentin. The μTBS was measured immediately (24 h) and 6 months after storage in water. After the μTBS testing, linear mixed and nonlinear regression models were used to analyze the effects of these factors on the μTBS data.

RESULTS

The results from the linear mixed model revealed that the bonding area (P = 0.02), presence of voids at the interface (P = 0.04), and storage time (P < 0.001) significantly affected bond strength. In contrast, no correlation was observed between the μ TBS and dentin position (P = 0.08) or sex (P = 0.07). The results of the nonlinear regression model with robust variance-covariance estimators revealed that age significantly affected bond strength (P < 0.001). In addition, a significant positive correlation was found between μTBS and age (P < 0.001), with nonlinearity (P = 0.002). However, no correlation was observed between the μTBS and CT values (P = 0.69) without nonlinearity (P = 0.39).

CONCLUSIONS

These findings suggest that bond strength increases with age until 60 years but not afterward.

Synchrotron X-ray Studies of the Structural and Functional Hierarchies in Mineralised Human Dental Enamel: A State-of-the-Art Review

Hard dental tissues possess a complex hierarchical structure that is particularly evident in enamel, the most mineralised substance in the human body. Its complex and interlinked organisation at the Ångstrom (crystal lattice), nano-, micro-, and macro-scales is the result of evolutionary optimisation for mechanical and functional performance: hardness and stiffness, fracture toughness, thermal, and chemical resistance. Understanding the physical-chemical-structural relationships at each scale requires the application of appropriately sensitive and resolving probes. Synchrotron X-ray techniques offer the possibility to progress significantly beyond the capabilities of conventional laboratory instruments, i.e., X-ray diffractometers, and electron and atomic force microscopes. The last few decades have witnessed the accumulation of results obtained from X-ray scattering (diffraction), spectroscopy (including polarisation analysis), and imaging (including ptychography and tomography). The current article presents a multi-disciplinary review of nearly 40 years of discoveries and advancements, primarily pertaining to the study of enamel and its demineralisation (caries), but also linked to the investigations of other mineralised tissues such as dentine, bone, etc. The modelling approaches informed by these observations are also overviewed. The strategic aim of the present review was to identify and evaluate prospective avenues for analysing dental tissues and developing treatments and prophylaxis for improved dental health.

The multi-scale meso-mechanics model of viscoelastic dentin

Human dentin is a hierarchical material with multi-level micro-/nano-structures, consisting of tubule, perti-tubular dentin (PTD) and intertubular dentin (ITD) as the major constituents at microscale; and the PTD and ITD are further composed of collagen and hydroxyapatite (HAp) crystals with different volume fractions at nanoscale. In most cases, the HAp is considered as elastic while the collagen as viscoelastic material. It is of great significance to study the hierarchical structure and viscoelasticity of human dentin to understand the mechanical properties of dentin for further development of restorative materials. Based on this, this paper focuses on multiscale modeling of the elastic properties and dynamic viscoelastic response of dentin and establishes a bottom-up micromechanics model from nano-to macro-scale. In order to study the nanostructural effect on the viscoelastic behavior of hierarchical structures, the homogenization theories of random platelets composites (HTRPC) and the locally-exact homogenization theory (LEHT) are introduced for the homogenization of heterogeneous materials of microstructures at different levels. The HTRPC, based on Eshelby Inclusion theory, is used to predict the effective modulus of PTD and ITD. The LEHT is a method for homogenizing multiphase dentin characterized by repeated unit cells (RUCs). The resulting predictions are in very good agreement with several experimental data from the literature. In addition, the results of nanostructrual effect on dentin show that the viscoelasticity of dentin is majorly contributed by collagen and the HAp greatly provide the strength and hardness of dentin. Furthermore, the ageing effect on dentin's viscoelasticity is considered from the proposed multiscale micromechanics model. It is demonstrated that the ageing effect is much more influential in affecting the loss moduli of dentin than the storage.

Comparison of collagen features of distinct types of caries-affected dentin

OBJECTIVES

To compare the biodegradability, mechanical behavior, and physicochemical features of the collagen-rich extracellular matrix (ECM) of artificial caries-affected dentin (ACAD), natural caries-affected dentin (NCAD) and sound dentin (SD).

METHODS

Dentin specimens from human molars were prepared and assigned into groups according to the type of dentin: ACAD, NCAD, or SD. ACAD was produced by incubation of demineralized SD with Streptococcus mutans in a chemically defined medium (CDM) with 1% sucrose for 7 days at 37 °C under anaerobic conditions. Specimens were assessed to determine collagen birefringence, biodegradability, mechanical behavior, and chemical composition. Data were individually processed and analyzed by ANOVA and post-hoc tests (α = 0.05).

RESULTS

CDM-based biofilm challenge reduced loss, storage, and complex moduli in ACAD (p < 0.001), while the damping capacity remained unaffected (p = 0.066). Higher red and lower green birefringence were found in ACAD and NCAD when compared with SD (p < 0.001). Differently to ACAD, SD and NCAD presented higher biodegradability to exogenous proteases (p = 0.02). Chemical analysis of the integrated areas of characteristic bands that assess mineral quality (carbonate/phosphate and crystallinity index), mineral to matrix (phosphate/amide I) and post-translational modifications (amide III/CH₂, pentosidine/CH₂, and pentosidine/amide III) (p<0.05) showed that NCAD was significantly different from SD while ACAD exhibited intermediate values.

CONCLUSIONS

CDM-based biofilm challenge produced a dentin ECM with decreased mechanical properties and increased collagen maturity. The compositional and structural conformation of the ACAD suggested that CDM-based biofilm challenge showed potential to produce artificial lesions by revealing a transitional condition towards mimicking critical features of NCAD.

CLINICAL SIGNIFICANCE

This study highlights the importance of developing a tissue that mimics the features of natural caries-affected dentin ECM for in vitro studies. Our findings suggested the potential of a modified biofilm challenge protocol to produce and simulate a relevant substrate, such as caries-affected dentin.