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Xu Y, Mou J, Dai J. VMT/ACP/Dextran composite nanosheets against dental caries through promoting mineralization of dentin tubules, pH buffering, and antibacterial. J Nanobiotechnology 2024; 22:490. [PMID: 39153990 PMCID: PMC11330022 DOI: 10.1186/s12951-024-02709-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 07/05/2024] [Indexed: 08/19/2024] Open
Abstract
Dental caries is a worldwide public healthcare concern, and is closely related to the acidic environment that caused by bacterial decomposition of food. In this study, a two-step ion exchange liquid-phase stripping method was applied to strip out vermiculite (VMT) nanosheets, then amorphous calcium phosphate (ACP) and dextran were inserted between the VMT nanosheets interlayer to obtain a composite two-dimension nanosheets (VMT/ACP/Dextran). VMT/ACP/Dextran composite nanosheets exhibited excellent biocompatibility and could provide exogenous Ca2+and PO43- from ACP, provide SiO44-, Mg2+, Fe2+ and obtain buffering pH and antibacterial properties from VMT, as well as improve suspension stability and targeting Streptococcus mutans through glucan. The in vitro study showed that the composite materials could promote the mineralization and sealing of dentin tubules by releasing active ions, buffer pH 4.5 (a value close to the pH in the dental plaque environment) to pH 6.6-7.1 (values close to the pH in human saliva) through ion exchange, and exert antibacterial effects by targeting Streptococcus mutans and exerting oxidase like and peroxidase like activities to produce reactive oxygen species (ROS). The in vivo animal study showed that daily cleaning teeth using VMT/ACP/Dextran composite nanosheets could effectively reduce the incidence rate and severity of dental caries in rats. Taking together, the developed VMT/ACP/Dextran composite nanosheets, which integrated the excellent properties of VMT, ACP and dextran, can effectively prevent dental caries through a combination of factors such as buffering acids, antibacterial properties, and promoting calcification, and may be used as an active ingredient for daily oral hygiene or filling materials to prevent and treat dental caries.
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Affiliation(s)
- Yanting Xu
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, No.639 Zhizaoju Road, Shanghai, 200011, China
| | - Juan Mou
- The Key Laboratory of Resource Chemistry of Ministry of Education, Shanghai Key College of Chemistry and Materials Science, Shanghai Normal University, Shanghai, 200234, China.
| | - Jiewen Dai
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, No.639 Zhizaoju Road, Shanghai, 200011, China.
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Yaşar M, Bal C, Aksoy M, Güngörmüş M, Orhan K. In vitro caries-preventive effect of a mineralization-promoting peptide combined with fluoride gel on sound primary teeth. Int J Paediatr Dent 2024; 34:256-266. [PMID: 37837213 DOI: 10.1111/ipd.13126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/12/2023] [Accepted: 09/13/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Mineralization-promoting peptide-3 (MPP3) is a new biomimetic remineralization agent. AIM To assess the remineralization efficiency of MPP3, either alone or in combination with fluoride gel. DESIGN The samples were divided into four groups: control, 1.23% fluoride gel, 10% MPP3 gel, and 1.23% fluoride gel + 10% MPP3. Following the application of remineralization agents (4 min), the samples remained in a pH-cycling model (37°C, 4 weeks). Microhardness, microcomputed tomography (micro-CT), polarized light microscopy (PLM), and field emission scanning electron microscopy (FE-SEM) analysis were conducted. RM-ANOVA, one-way ANOVA, and intraclass correlation coefficient (ICC) were used for statistical analysis, and a significance level of p < .05 was employed. RESULTS Mineralization-promoting peptide 3 and fluoride gel + MPP3 increased the microhardness of the enamel compared with initial values in each group (p < .05). Mineralization-promoting peptide 3 successfully maintained the mineral density of enamel, although the cariogenic pH-cycling and PLM results indicated that the lesion depth (μm) was significantly lower in the fluoride gel + MPP3 group (27.0336 ± 12.53650) than in the control group (37.3907 ± 12.76002, p < .05). CONCLUSION The combined use of MPP3 with fluoride gel enhanced the caries-protective and mineralization-promoting effects of fluoride. Mineralization-promoting peptide 3 may be a potential agent that can be employed to improve the physical properties of enamel.
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Affiliation(s)
- Merve Yaşar
- Department of Pediatric Dentistry, Faculty of Gulhane Dental Medicine, University of Health Sciences, Ankara, Turkey
| | - Cenkhan Bal
- Department of Pediatric Dentistry, Faculty of Gulhane Dental Medicine, University of Health Sciences, Ankara, Turkey
| | - Merve Aksoy
- Department of Pediatric Dentistry, Faculty of Gulhane Dental Medicine, University of Health Sciences, Ankara, Turkey
| | - Mustafa Güngörmüş
- School of Engineering and Natural Sciences, Biomedical Engineering, Ankara Yildirim Beyazit University, Ankara, Turkey
- MERLAB Application and Research Center, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Ankara University Faculty of Dentistry, Ankara, Turkey
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Mapar M, Gholizadeh S, Moalemnia M. Effects of Two Remineralizing Agents in Combination with Er:YAG and CO 2 Laser Irradiation on Microhardness of Demineralized Enamel: A Preliminary In Vitro Study. Front Dent 2024; 21:11. [PMID: 38742220 PMCID: PMC11089429 DOI: 10.18502/fid.v21i11.15223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/20/2023] [Indexed: 05/16/2024] Open
Abstract
Objectives: This study assessed the effects of two remineralizing agents namely MI Paste Plus containing casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACFP) and Remin Pro containing hydroxyapatite, fluoride and xylitol (HFX) with/without erbium-doped yttrium aluminium garnet (Er:YAG) and CO2 laser irradiation on demineralized enamel microhardness. Materials and Methods: In this in vitro study, 70 sound human premolars were mesiodistally sectioned, demineralized at a pH of 4.6 for 8 hours, and randomly divided into 7 remineralization groups (n=10): of (I) MI Paste Plus (CPP-ACFP), (II) Remin Pro (HFX), (III) MI Paste Plus+CO2 laser (0.7 W power, 50 Hz), (IV) Remin Pro+CO2 laser, (V) MI Paste Plus+Er:YAG laser (1 W power, 10 Hz), (VI) Remin Pro+Er:YAG laser, and (VII) negative control. The Vickers hardness number of specimens was then measured. The groups were compared by one-way ANOVA and Tukey's test (α=0.05). Results: The mean microhardness was 319.8±49.9, 325.3±44.6, 359.4±35.7, 296.4±33.7, 319.9±58.1, 358.9±28.4, and 240.0±41.6 kg/mm2 in groups 1 to 7, respectively. The difference in microhardness was significant among the groups (P<0.0001). Pairwise comparisons revealed significant differences in microhardness between all groups (P≤0.03) except between groups 1 and 2, 1 and 5, 2 and 5, and 3 and 6 (P>0.05). Conclusion: Both Remin Pro (containing HFX) and MI Paste Plus (containing CPP-ACFP) can cause enamel remineralization. MI Paste Plus+CO2 laser irradiation and Remin Pro+Er:YAG laser irradiation were significantly more effective than the application of each remineralizing agent alone.
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Affiliation(s)
- Mehran Mapar
- Department of Restorative Dentistry, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sara Gholizadeh
- Department of Restorative Dentistry, Khorasgan Islamic Azad Dental School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mina Moalemnia
- Department of Restorative Dentistry, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Lopes PC, Carvalho T, Gomes ATPC, Veiga N, Blanco L, Correia MJ, Mello-Moura ACV. White spot lesions: diagnosis and treatment - a systematic review. BMC Oral Health 2024; 24:58. [PMID: 38195439 PMCID: PMC10775501 DOI: 10.1186/s12903-023-03720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND White spot lesions represent the first stage of caries and their prevalence has been increasing in recent years, particularly in patients undergoing orthodontic treatment. DIferential diagnosis and lesion activity are essential to decide on the clinical approaches to treatment. The aim of this study is to understand if the new diagnostic tools such as fluorescence, microradiography and computed microtomography have the potential to change the conventional treatment of white spots". METHODS A systematic search of available studies in the literature was carried out, using PRISMA guidelines, in Pubmed and Scopus electronic databases and manually to identify relevant articles to answer the PICO question: "Do the new diagnostic tools have the potential to change the conventional treatment of white spots?". This systematic review included randomized controlled trials (RCT), cross-sectional and longitudinal studies complying with the following inclusion criteria: (i) studies in humans, (ii) studies about white spot lesions, (iii) studies published between 2012 and 2023, (iv) studies having both diagnosis and treatment and (v) studies with full text available. In this review we excluded other systematic reviews of clinical trials and in vitro studies. The RoB tool was used to assess the risk of bias. RESULTS The systematic literature search identified 143 potentially relevant references, which after applying the exclusion criteria, resulted in 20 articles. Regarding diagnostic methods, most articles found were based on conventional methods of visual examination (n:10) or fluorescence (n:7). The least referenced diagnostic techniques were based on the use of clinical photographs (n:2), cross-sectional microradiography (n:1) and computed microtomography (n:1). The use of DIAGNOdent was reported by 3 in vitro studies. With regard to therapies, most studies reported the use of infiltrating resin (n:7) and fluoride-based products (n:5). Other studies have reported the use of self-assembling peptide P11-4 (n:1), home care (n:1), casein phosphopeptide-amorphous calcium phosphate (n:2) and hydrochloric acid (n:1). Combination therapies were also considered. CONCLUSION Diagnostic tool does not have the potential to change the form of treatment, whether it is a conventional method or a more differentiated one.
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Affiliation(s)
- Pedro C Lopes
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Portugal PT, Centre for Interdisciplinary Research in Health (CIIS) - Universidade Católica Portuguesa, Viseu, PT, Portugal.
| | - Teresa Carvalho
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Lisbon, PT, Portugal
| | - Ana T P C Gomes
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Portugal PT, Centre for Interdisciplinary Research in Health (CIIS) - Universidade Católica Portuguesa, Viseu, PT, Portugal
| | - Nelio Veiga
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Portugal PT, Centre for Interdisciplinary Research in Health (CIIS) - Universidade Católica Portuguesa, Viseu, PT, Portugal
| | - Letícia Blanco
- Department of Surgery, Universidad de Salamanca, Salamanca, Spain
| | - Maria José Correia
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Portugal PT, Centre for Interdisciplinary Research in Health (CIIS) - Universidade Católica Portuguesa, Viseu, PT, Portugal
| | - Anna Carolina Volpi Mello-Moura
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Portugal PT, Centre for Interdisciplinary Research in Health (CIIS) - Universidade Católica Portuguesa, Viseu, PT, Portugal
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Rathore K, Patnana AK, Chugh VK, Chugh A, Kumar P. Self-assembling peptides for managing white spot lesions: a systematic review and meta-analysis. Eur Arch Paediatr Dent 2023; 24:519-531. [PMID: 37702901 DOI: 10.1007/s40368-023-00821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/03/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE The primary objective of the review was to assess the effectiveness of self-assembling P11-4 peptide (SAP) with or without any fluoride agents (FA) in remineralization of the White spot lesions (WSLs)/incipient carious lesions (ICLs) compared to other enamel remineralizing agents/non-intervention/placebo. METHODS Human RCTs published during the period from 1st January 2000-30th June 2021 were searched in the electronic bibliographic databases and scanning reference lists of articles from PubMed, Google Scholar, and The Cochrane Central Register of Controlled Trials. The Risk-of-Bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) tool for all included studies. The statistical heterogeneity between studies was assessed by the Cochrane Q test and I2 test. A random-effects model was used considering the variations in true effects size between the included studies. The quality of the evidence for remineralizing effectiveness of SAP/SAP + FA was done using the GRADEpro GDT software which employs GRADE. RESULTS Four out of eight included trials were assessed to have "high risk" of bias. Mean difference for Laser fluorescence outcome assessment method (SAP v/s FA) was - 4.89 (95% CI: - 17.35 to 7.57; p = 0. 44; I2 = 89%). The combined risk ratio observed through Nyvad criteria (SAP v/s FA) was 0.12 (95% CI: 0.01-1.59; p = 0.11; I2 = 71%). Mean difference for Laser fluorescence outcome assessment method (SAP + FA v/s FA) was - 11.52 (95% CI: - 14.43 to - 8.61; p = < 0.001;I2 = 0%). The combined risk ratio for ICDAS outcome assessment method (SAP + FA v/s FA) was 0.27 (95% CI: 0.03-2.84; p = 0.15; I2 = 53%). CONCLUSION Considering the results observed from the included trials we are uncertain whether SAP/SAP + FA increases/decreases the remineralizing/regeneration of WSLs/ICLs.
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Affiliation(s)
- K Rathore
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
| | - A K Patnana
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
- Department of Dentistry, All India Institute of Medical Sciences, Rajkot, Gujarat, 360006, India
| | - V K Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - A Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - P Kumar
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
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Helal N, Azzahrani GS, Azzouz LZ, Sabbagh HJ. Effectiveness of MI Varnish™ and PreviDent ® Varnish in Noncavitated Interproximal Lesions: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2023; 16:751-757. [PMID: 38162230 PMCID: PMC10753103 DOI: 10.5005/jp-journals-10005-2689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Aim Evaluating the remineralization efficacy of noncavitated proximal incipient lesions with Colgate® PreviDent® and MI™ varnishes in comparison to the industry standard (1.23%) acidulated phosphate fluoride (APF) gel. Study design Parallel randomized controlled, multicenter, single-blinded trial. Materials and methods By flipping a coin, 18 patients with 91 lesions were divided into three groups. The Colgate® PreviDent (n = 33), MI varnish (n = 30), and control (APF gel) groups (n = 28) were identified as the three arms. We conducted an initial assessment and therapy as well as follow-ups at 3 and 6 months to evaluate the course of the caries lesion. Results and statistics Caries progression was significantly reduced on treated surfaces across both groups. Nine surfaces in the Colgate® PreviDent® group with white spots and dryness did not change, one surface turned into a white patch without dryness, and another surface changed to a sound surface; only two surfaces were discontinued from treatment (restored) due to a misdiagnosis by the operator (n = 2). Nine of the surfaces in the MI™ group maintained their white patches with dryness, whereas one developed a new white patch that was not dry. Only MI varnish™-treated teeth exhibited dramatic radiographic improvement. Caries on the outside enamel were either unchanged or restored to healthy levels. Caries on the inner surface of the enamel also did not change. Conclusion Remineralizing noncavitated early-stage lesions may be done with both MI™ and Colgate® PreviDent® varnishes. Despite this, radiographic results did not vary significantly across the three groups. In situations of rather advanced incipient caries seen on radiographs, the MI varnish™ might be recommended. How to cite this article Helal N, Azzahrani GS, Azzouz LZ. Effectiveness of MI VarnishTM and PreviDent® Varnish in Noncavitated Interproximal Lesions: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(5):751-757.
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Affiliation(s)
- Narmin Helal
- Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghadi S Azzahrani
- Department of Pediatric Dentistry, Ministry of Health, Yanbu, Saudi Arabia
| | - Lujain Z Azzouz
- Department of Pediatric Dentistry, King Abdulaziz University, Saudi Arabia
| | - Heba J Sabbagh
- Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Alsafi AM, Taher NM. Microhardness and surface roughness of resin infiltrated bleached enamel surface using atomic force microscopy: An in vitro study. Saudi Dent J 2023; 35:692-698. [PMID: 37817796 PMCID: PMC10562102 DOI: 10.1016/j.sdentj.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/23/2023] [Accepted: 07/02/2023] [Indexed: 10/12/2023] Open
Abstract
to evaluate the microhardness (VHN) and surface roughness (Ra) of human enamel surface treated with resin infiltration followed by in office bleaching and to study the effect of artificial saliva (AS) storage time on the VHN and Ra of resin infiltrated enamel. Materials and methods: Eighty enamel specimens were prepared from extracted human premolar teeth. Specimens were divided into two main groups (I and II) then, they were demineralized to create white spot lesions (WSLs). Group I was divided into A and B sub groups. Group A was treated with in office bleaching material while for group B, resin infiltration (Icon) was applied after 24 h storage in AS followed by bleaching. Group II was divided into (C and D). Group C was treated like group B. Specimens in group D were stored in AS for 14 d after treatment with Icon and before application of bleaching. Atomic force microscopy (AFM) Ra analysis and VHN calculation were done. Independent T Test was used to compare between groups at P < 0.05. Results: Group B demonstrated a significant increase in VHN compared with group A. Storage time in AS showed no significant difference on VHN or Ra between groups. Conclusion: Application of resin infiltration before bleaching significantly increased VHN and slightly improved Ra of WSLs compared with bleaching alone. Application of bleaching material after 24 h or 14 days of the application of resin infiltration did not have a significant effect or surface hardness or roughness of WSLs.
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Affiliation(s)
- Alaa M. Alsafi
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Nadia M. Taher
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Carey CM. Remineralization of Early Enamel Lesions with Apatite-Forming Salt. Dent J (Basel) 2023; 11:182. [PMID: 37623278 PMCID: PMC10453125 DOI: 10.3390/dj11080182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/04/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVES This study sought to evaluate the remineralization of ex vivo human teeth using commercially available artificial saliva, SalivaMAX®, a supersaturated calcium phosphate rinse (SSCPR). METHODS early enamel lesions were artificially induced on ex vivo human teeth by chemical means. The teeth were exposed to the SSCPR for two minutes (experimental) or dH2O (control) four times per day for a total of 35 days. At time points of 0, 2.5, 21, and 35 days, micro-CT was utilized to determine the mineral density profile across the lesion and evaluate lesion depth. The relative percent remineralization was calculated from the initial lesion depth (Time 0) at each evaluation time. Student's t-test was used to compare the extent of remineralization between the SSCPR and control groups for statistical significance at each time. To evaluate the changes in percent remineralization over time, a two-way ANOVA was used. RESULTS At Time 0 and 2.5 days, there was no difference in the percent remineralization between the SSCPR and control groups (p > 0.05). After 21 days, the teeth exposed to the SSCPR remineralized 56.7 ± 3.7%, while the control only remineralized 10.7 ± 11.0% (p < 0.0001). At day 35, the remineralization was 73.7 ± 5.4% and 18.2 ± 10.8% (p < 0.0001) for the SSCPR and control groups, respectively. CONCLUSIONS A marked increase in remineralization occurred with the use of the SSCPR. Notably, the remineralization of the SSCPR occurred deep within the tooth and progressed toward the surface over time.
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Affiliation(s)
- Clifton M Carey
- School of Dental Medicine, University of Colorado, Aurora, CO 80045, USA
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Ravi Kiran KR, Sabrish S, Mathew S, Shivamurthy PG, Sagarkar R. Effectiveness of amine fluoride mouthwash in preventing white spot lesions during fixed orthodontic therapy - A randomized control trial. Indian J Dent Res 2023; 34:261-265. [PMID: 38197343 DOI: 10.4103/ijdr.ijdr_984_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Background and Aim One of the main reasons that patients seek orthodontic treatment is aesthetics. Unfortunately, treatment with fixed orthodontic appliances can at times increase the chances of developing white spot lesions on the surfaces of teeth, thus creating a new aesthetic issue for the patient. The prevalence of white spot lesions (WSL) reported after treatment varies from 2% to 97%, and these lesions can occur despite increased attention to hygiene. Hence the aim of this study was to assess the effect of Amine fluoride mouthwash in preventing white spot lesions during fixed orthodontic therapy. Materials and Methods Study participants were randomly divided into two groups (Group A - experimental 25 patients and Group B - control 25 patients). The pre-intervention and post-intervention intra-oral digital photographs were analysed by using ImageJ software to assess the percentage of the facial surface affected on the teeth (10 maxillary teeth), which had white spot lesions. Results The mean value of WSLs showed significant difference between the experimental and control groups. Mean values of WSL in the experimental group decreased from 2 to 1.54 with a mean difference of 0.46 after 6 months of follow-up which indicated that amine fluoride mouthwash was effective in preventing WSLs during fixed orthodontic treatment. Conclusion WSLs scores were significantly reduced in patients who received the mouthwash when compared to patients who followed standard oral hygiene regimen with fluoridated toothpaste only. In clinical practice, amine fluoride mouthwash is an effective method for the prevention of WSLs during fixed orthodontic treatment.
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Affiliation(s)
- K R Ravi Kiran
- Department of Orthodontics, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Sharanya Sabrish
- Department of Dentofacial Orthopedics, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Silju Mathew
- Department of Dentofacial Orthopedics, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Prashantha G Shivamurthy
- Department of Dentofacial Orthopedics, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Roshan Sagarkar
- Department of Dentofacial Orthopedics, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
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Evaluation of the remineralizing effect of biomimetic self-assembling peptides in post-orthodontic white spot lesions compared to fluoride-based delivery systems: randomized controlled trial. Clin Oral Investig 2023; 27:613-624. [PMID: 36287272 PMCID: PMC9889428 DOI: 10.1007/s00784-022-04757-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/13/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate the clinical performance of self-assembling peptides versus fluoride-based delivery systems in post-orthodontic white spot lesions. MATERIALS AND METHODS The participants were randomly assigned into two groups (n = 58) according to the remineralizing agent used, where (A) group represented participants receiving a varnish containing 22.600 fluoride ppm and tricalcium phosphate, while the second group (B) represented participants receiving self-assembling peptide. The remineralizing process of the white spot lesion was assessed using the DIAGNOdent pen and ICDAS scoring system according to the time when the remineralizing agent was used (T), where T0 represented the score taken at baseline. T1 represented the score taken after 3 months of follow-ups and T2 score represented the score taken after 6 months of follow-up. Data were collected and statistically analyzed. The parametric data: two-way ANOVA was used to test the effect of interaction among different variables. The non-parametric data: Mann-Whitney test was used. The significance level was set at p ≤ 0.05. RESULTS There was a quantitative statistically significant difference via DIAGNOpen readings between Group A (fluoride material) and Group B (self-assembling peptides). The highest mean value of 10.51 was found in Group A, while the least mean value of 6.45 was found in Group B. Besides, there was a significant difference in each group concerning the time factors T0, T1, and T2 groups where (p < 0.001. As for the qualitative results concerning the ICDAS score, there was no significant difference between the two groups along with the follow-up periods T0, T1, and T2 where the p value is equal to 0.064, 0.087, and 0.277 respectively. CONCLUSIONS The visual assessment using ICDAS reveals that the biomimetic remineralization using self-assembling peptides and the fluoride-based varnish material showed a similar effect in masking post-orthodontic white spot lesions. However, the laser fluorescence using DIAGNOpen showed that the self-assembling peptides reveal higher performance in subsurface remineralization than the fluoride-based varnish material. Therefore, self-assembling peptides are considered a promising material for lesion regression in post-orthodontics white spot lesions. CLINICAL RELEVANCE Self-assembling peptide SAP-14 is a new approach to reverse and mask off post-orthodontics white spot lesions.
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Rangarajan S, Vikram NR, Dhayananth XL, Rajakumar P, Venkatachalapathy S, Karikalan N. Efficacy of Fluoride Varnish with Casein Phosphopeptide and Amorphous Calcium Phosphate vs Fluoride Varnish in Prevention of White Spots Lesion in fixed Orthodontic Patients: In Vivo Study. J Contemp Dent Pract 2022; 23:1100-1105. [PMID: 37073932 DOI: 10.5005/jp-journals-10024-3404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
AIM The aim of the study is to compare the in vivo efficiency of Michigan (MI) varnish containing casein phosphopeptide (CPP) and amorphous calcium phosphate (ACP) and Fluoritop containing sodium fluoride (5% NaF) in the prevention and remineralization of white spot lesions (WSLs) around orthodontic brackets at days 28 and 56 after bonding. MATERIALS AND METHODS A total of 30 patients were selected and divided into two groups I (MI varnish) II (Fluoritop varnish) of 15 patients in each group. All the patients were bonded and then varnish was applied around the brackets. Right-side upper and lower first premolar teeth were taken as the control group and left-side upper and lower first premolar teeth as the experimental group. Also, 14, 24 teeth were extracted on day 28 after bonding and 34, 44 teeth after day 56 of bonding. Samples were collected and sent to laboratory for evaluation of surface microhardness (SMH). RESULTS Based on the statistics results, there was a significant decrease in demineralization and an increase in remineralization of WSLs after the application of varnish. No statistical significance was found between the effectiveness of MI varnish and Fluoritop except in the cervical region. CONCLUSION Through our study, we concluded that no statistical significance was found between the effectiveness of MI varnish and Fluoritop except in the cervical region where MI varnish was found to be more effective than Fluoritop in preventing WSLs. CLINICAL SIGNIFICANCE The results from the above study concluded that CPP-ACP varnish can be an effective method in preventing WSLs in patients undergoing fixed orthodontic treatment.
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Affiliation(s)
- Sumanth Rangarajan
- Dr. M.G.R. Educational and Research Institute (Deemed to be University), Maduravoyal, Chennai, Tamil Nadu, India, Phone: +91 9952034634, e-mail:
| | - N Raj Vikram
- Department of Orthodontics and Dentofacial Orthopedics, Thai Moogambigai Dental College and Hospital, Constituent Unit of Dr. M.G.R. Educational and Research Institute (Deemed to be University), Maduravoyal, Chennai, Tamil Nadu, India
| | - Xavier L Dhayananth
- Department of Orthodontics and Dentofacial Orthopedics, Sathyabama Dental College and Hospital, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India
| | - P Rajakumar
- Department of Orthodontics and Dentofacial Orthopedics, Thai Moogambigai Dental College and Hospital, Constituent Unit of Dr. M.G.R. Educational and Research Institute (Deemed to be University), Maduravoyal, Chennai, Tamil Nadu, India
| | - Sudhakar Venkatachalapathy
- Department of Orthodontics and Dentofacial Orthopedics, Adhiparasakthi Dental College & Hospital, Melmaruvathur, Tamil Nadu, India
| | - N Karikalan
- Department of Orthodontics and Dentofacial Orthopedics, Adhiparasakthi Dental College & Hospital, Melmaruvathur, Tamil Nadu, India
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Cardoso AA, de Sousa ET, Steiner-Oliveira C, Nobre-Dos-Santos M. Debonding of orthodontic appliance changes salivary physicochemical properties and favors regression of active caries lesions: A 13-week follow-up study. Int J Paediatr Dent 2022; 32:607-616. [PMID: 34779541 DOI: 10.1111/ipd.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/08/2021] [Accepted: 11/12/2021] [Indexed: 11/26/2022]
Abstract
AIM This prospective cohort study aimed to investigate whether orthodontic appliance removal (OAR) combined with caries-preventive strategies and fluoride varnish treatments alters salivary physicochemical properties, changes the activity of carbonic anhydrase VI (CA VIACT ) and α-amylase (α-AMLACT ), and favors the regression of active caries lesions (ACL). DESIGN Twenty-two individuals aged between 13 and 24 years were assessed for the presence of visible biofilm, daily sugar exposure, caries activity, salivary flow rate (SFR), pH, buffering capacity (BC), and CA VIACT and α-AMLACT activity at baseline, and 1, 5, and 13 weeks after OAR. Variables were assessed using repeated-measures analysis of variance, Cochran's Q and McNemar's test, and Pearson's correlation. RESULTS We observed a significant decrease in the number of ACL at the 5-week (29% reduction) and 13-week follow-ups (58% reduction). At the 5- and 13-week follow-ups, the percentage of visible biofilm and sugar exposure decreased, whereas the salivary pH and α-AMLACT activity significantly increased. BC and CA VIACT remained unchanged throughout the follow-up. CONCLUSION OAR combined with caries-preventive strategies and fluoride varnish treatments favored the regression of ACL and increased salivary pH and α-AMLACT activity, whereas BC and CA VIACT remained stable.
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Affiliation(s)
- Andreia Alves Cardoso
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba, Brazil
| | - Emerson Tavares de Sousa
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba, Brazil
| | - Carolina Steiner-Oliveira
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba, Brazil
| | - Marinês Nobre-Dos-Santos
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba, Brazil
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Cumerlato CBDF, Santos CSD, Rotta RN, Cademartori MG, Corrêa MB. Is professionally applied topical fluoride effective in treating incipient caries? A systematic review. Braz Oral Res 2022; 36:e083. [PMID: 35703708 DOI: 10.1590/1807-3107bor-2022.vol36.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/24/2022] [Indexed: 11/21/2022] Open
Abstract
The present systematic review aimed to investigate the effectiveness of professionally applied topical fluoride as therapeutic agent for incipient carious lesions in permanent teeth. Randomised clinical trials (RCTs) comparing the effectiveness of professionally applied topical fluoride (varnish or gel) with that of placebo, no intervention, and toothbrushing (control group) in the treatment of incipient carious lesions in permanent dentition were included. An electronic search was performed in the PubMed, Web of Science, Scopus, Virtual Health Library, Embase, and Cochrane databases, in the grey literature, and in clinical trials registered until January 2021. Two reviewers independently screened titles and abstracts and assessed the risk of bias using the Cochrane tool. The certainty of evidence was classified using GRADE. A total of 2,223 articles were screened using titles/abstracts. After full-text reading of the 22 selected studies, nine RCTs were included. Five RCTs found that topical fluoride may be effective in reversing incipient carious lesions in permanent teeth. Overall, five studies were classified as having a low risk of bias and four as having some concerns. Only descriptive analysis was performed because of the heterogeneity of the data. Studies comparing fluoride varnish with usual home care oral hygiene have demonstrated topical fluoride does not appear to be more effective in improving the appearance of incipient carious lesions. Therefore, usual home care oral hygiene with fluoride toothpaste may be sufficient to treat incipient carious lesions in permanent dentition. Further studies with greater methodological rigor are, however, required to reduce bias, to allow a meta-analysis, and to draw well-founded conclusions (CRD42019120406).
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Affiliation(s)
| | - Cinthia Studzinski Dos Santos
- Universidade Federal de Pelotas - UFPel, School of Dentistry , Department of Restorative Dentistry , Pelotas , RS , Brazil
| | - Rodrigo Nunes Rotta
- Universidade Católica de Pelotas , School of Dentistry , Department of Restorative Dentistry , Pelotas , RS , Brazil
| | - Mariana Gonzalez Cademartori
- Universidade Federal de Pelotas - UFPel, School of Dentistry , Department of Social and Preventive Dentistry , Pelotas , Rio Grande do Sul , Brazil
| | - Marcos Britto Corrêa
- Universidade Federal de Pelotas - UFPel, School of Dentistry , Department of Restorative Dentistry , Pelotas , RS , Brazil
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Nadar BG, Yavagal PC, Velangi CS, Yavagal CM, Basavaraj SP. Efficacy of casein phosphopeptide-amorphous calcium phosphate varnish in remineralizing white spot lesions: A systematic review and meta-analysis. Dent Res J (Isfahan) 2022; 19:48. [PMID: 35915716 PMCID: PMC9338355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/30/2021] [Accepted: 01/19/2022] [Indexed: 11/03/2022] Open
Abstract
Background This systematic review aimed to evaluate the efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACPF) varnish for remineralization of white spot lesions (WSLs) "in vitro" in human teeth. Materials and Methods Literature search included three databases, namely Medline (via PubMed), The Cochrane Controlled Clinical Trials Register, and Google Scholar from 2010 to January 2021. The studies assessing WSL depth, calcium, phosphate ion release, and microhardness due to artificial demineralization or remineralization were considered for review. Reference articles were retrieved, and a customized risk assessment tool was used. The Cochrane risk of bias assessment tool was used to generate the risk of bias summary graph. Meta-analysis was performed using RevMan 5.4. Heterogeneity was evaluated by Cochrane's test, and random effects model was used to pool estimate of effect and its 95% confidence intervals (CIs) for surface microhardness. Results Eighteen studies were selected for review based on the eligibility criteria. Four studies showed superior remineralizing effect of CPP-ACPF compared to fluoride varnishes. Four studies involving 120 human permanent teeth samples were included in the meta-analysis. Efficacy of CPP-ACPF varnish was equivalent to other fluoride varnishes in improving surface microhardness after remineralization during 7-day period (mean surface microhardness: 3.94, 95% CI [-9.08-1.21], I2: 75%, P = 0.13). Major risks of bias associated with the studies included in the review were inadequate sample size, improper sample preparation, and unexplained blinding. Conclusion CPP-ACPF varnish appears to be equally effective as other fluoride varnishes in remineralizing artificially induced WSLs, but quality of evidence is low.
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Affiliation(s)
| | - Puja C. Yavagal
- Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Chandrabhaga S. Velangi
- Chief Dental Surgeon, Border Security Force, Ministry of Home Affairs, Guwahati, Assam, India
| | - Chandrashekar Murugesh Yavagal
- Department of Pediatric Dentistry, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental, Sciences and Research Centre, Belgaum, Karnataka, India
| | - Srinidhi P. Basavaraj
- Department of Public Health Dentistry, College of Dental Sciences, Davangere, Karnataka, India
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Gudkina J, Amaechi BT, Abrams SH, Brinkmane A, Petrosina E. The Effect of MI Varnish™ on Caries Increment and Dietary Habits among 6- and 12-Year-Old Children in Riga, Latvia: A 3-Year Randomized Controlled Trial. Dent J (Basel) 2022; 10:dj10060096. [PMID: 35735638 PMCID: PMC9221846 DOI: 10.3390/dj10060096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/05/2022] [Accepted: 05/20/2022] [Indexed: 12/04/2022] Open
Abstract
Aims: This randomized controlled trial investigated the effect of MI Varnish™ (5% NaF/CPP-ACP) on caries increment in 6- and 12-year-old children in Riga, Latvia within 36 months. Methods: Forty-eight 6-year-old children (Group 1) and forty-seven 12-year-old children (Group 3) received quarterly varnish application, while forty-eight 6-year-old children (Group 2) and thirty-seven 12-year-old children (Group 4) did not have varnish applied. All children/parents received the same preventive advice. All children were visually examined using ICDAS-II criteria. Questionnaires on dietary habits were completed by the children/parents at baseline and after 36 months. DMFS and dfs were calculated from ICDAS data. The statistical analysis was performed (α = 0.05) using a Chi-squared test, paired t-test (Welch test) and the Pearson correlation coefficient. The trial registration number is ISRCTN10584414. Results: In Group 1 versus Group 2, the DMFS(SD) (Baseline/36 months) values were 5.02(5.85)/13.21(6.67) (p < 0.001) versus 2.65(4.54)/10.81(6.14) (p < 0.001), respectively; the dfs(SD) (Baseline/36 months) values were 36.75(12.96)/24.04(12.9) (p < 0.001) versus 33.67(12.74)/23.88(11.91) (p < 0.001), respectively. In Group 3 versus Group 4, the DMFS(SD) (Baseline/36 months) values were 48.62(23.18)/70.96(23.28) (p < 0.001) versus 34.73(17.99)/54.95(16.09) (p < 0.001), respectively; the dfs(SD) (Baseline/36 months) values were 1.7(4.4)/0 (p < 0.05) versus 2(6.39)/0 (p = 0.06), respectively. The prevalence of caries (dfs + DMFS) decreased by 4.52 (p < 0.001) and 1.63 (p < 0.001) in Groups 1 and 2, respectively, but increased by 20.64 (p < 0.001) and 18.22 (p < 0.001) in Groups 3 and 4, respectively. An analysis of the questionnaires indicated the habitual, frequent consumption of a sugary diet by all the children. A significant correlation (r = 0.321; p < 0.05) was observed between caries increment and the frequency of daily intake of sugary snacks, soft drinks and tea with sugar at baseline only in Group 1. Conclusions: A quarterly application of MI varnish (CPP-ACP/fluoride) reduced caries increment in 6- and 12-year-old children in Riga, Latvia.
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Affiliation(s)
- Jekaterina Gudkina
- Conservative Dentistry and Oral Health Department, Riga Stradins University, LV-1007 Riga, Latvia;
- Correspondence:
| | - Bennett T. Amaechi
- Department of Comprehensive Dentistry, University of Texas Health Science Center, San Antonio, TX 78229, USA;
| | - Stephen H. Abrams
- Quantum Dental Technologies and Cliffcrest Dental Office, 2995 Kingston Road Scarborough, Scarborough, ON M1M 1P1, Canada;
| | - Anda Brinkmane
- Conservative Dentistry and Oral Health Department, Riga Stradins University, LV-1007 Riga, Latvia;
| | - Eva Petrosina
- Statistical Laboratory, Riga Stradins University, LV-1007 Riga, Latvia;
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Yan J, Yang H, Luo T, Hua F, He H. Application of Amorphous Calcium Phosphate Agents in the Prevention and Treatment of Enamel Demineralization. Front Bioeng Biotechnol 2022; 10:853436. [PMID: 35646855 PMCID: PMC9136455 DOI: 10.3389/fbioe.2022.853436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/15/2022] [Indexed: 11/25/2022] Open
Abstract
Enamel demineralization, as a type of frequently-occurring dental problem that affects both the health and aesthetics of patients, is a concern for both dental professionals and patients. The main chemical composition of the enamel, hydroxyapatite, is easy to be dissolved under acid attack, resulting in the occurrence of enamel demineralization. Among agents for the preventing or treatment of enamel demineralization, amorphous calcium phosphate (ACP) has gradually become a focus of research. Based on the nonclassical crystallization theory, ACP can induce the formation of enamel-like hydroxyapatite and thereby achieve enamel remineralization. However, ACP has poor stability and tends to turn into hydroxyapatite in an aqueous solution resulting in the loss of remineralization ability. Therefore, ACP needs to be stabilized in an amorphous state before application. Herein, ACP stabilizers, including amelogenin and its analogs, casein phosphopeptides, polymers like chitosan derivatives, carboxymethylated PAMAM and polyelectrolytes, together with their mechanisms for stabilizing ACP are briefly reviewed. Scientific evidence supporting the remineralization ability of these ACP agents are introduced. Limitations of existing research and further prospects of ACP agents for clinical translation are also discussed.
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Affiliation(s)
- Jiarong Yan
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Hongye Yang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Prosthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Ting Luo
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Center for Evidence-Based Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- *Correspondence: Fang Hua, ; Hong He,
| | - Hong He
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- *Correspondence: Fang Hua, ; Hong He,
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Tomaževič T, Drevenšek M, Kosem R. Evaluation of fluoride varnish treatment of postorthodontic white spot lesions by visual inspection and laser fluorescence-A randomized controlled study. Clin Exp Dent Res 2022; 8:931-938. [PMID: 35510617 PMCID: PMC9382033 DOI: 10.1002/cre2.579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES White spot lesions (WSLs), as a side effect of orthodontic therapy, can be treated with fluoride varnish, with the difference in efficiency reported. MATERIAL AND METHODS Patients with buccal WSLs were consecutively included in a randomized controlled double-blind study. At first inspection and at three follow-ups over 6 months, 0.1% fluoride varnish and placebo (water) were applied in the test group (N = 21) and control group (N = 21), respectively. The maximum laser fluorescence value (LFV) of WSLs was recorded using DIAGNOdent. Between the groups, differences in the mean numbers of WSLs and the mean LFV of WSLs per patient at different time points were analyzed with mixed-design analysis of variance. Orthodontic therapy duration (OTD) was included in the model as a covariate. RESULTS A decrease in the mean WSLs number and LFV was observed; however, there were no significant differences between study groups at any time point. OTD was in interaction only with LFV. Analysis showed a different pattern of mean LFV changes for patients with OTD of >48 months compared to patients with OTD of ≤24. CONCLUSION The changes in numbers of WSLs and LFV over the study period indicated regression of WSLs, but an additional effect of FV was not confirmed.
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Affiliation(s)
- Tanja Tomaževič
- Department of Paediatric and Preventive Dentistry, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Martina Drevenšek
- Department of Orthodontics, Faculty of Medicine, University of Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Rok Kosem
- Department of Paediatric and Preventive Dentistry, University Medical Centre Ljubljana, Ljubljana, Slovenia
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The Role of Process-Directing Agents on Enamel Lesion Remineralization: Fluoride Boosters. Biomimetics (Basel) 2022; 7:biomimetics7020054. [PMID: 35645181 PMCID: PMC9149830 DOI: 10.3390/biomimetics7020054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/17/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to investigate the effects of two process-directing agents (polyaspartic acid and osteopontin) used in a polymer-induced liquid-precursor (PILP) process on the remineralization of bacteria-induced enamel demineralization. Enamel demineralization lesions (depths of about 180–200 µm) were created and exposed to Streptococcus mutans, cultured with a 10% sucrose solution for 21 days, and remineralized using a PILP process (pH = 7.4, 14 days) with a calcium phosphate solution containing either polyaspartic acid or osteopontin in the presence or absence of fluoride (0.5 ppm). The specimens were examined under scanning electron microscopy. The fluoride was successfully incorporated into the PILP remineralization process for both polyaspartic acid and osteopontin. When the fluoride was added to the PILP remineralization solution, there was more uniform remineralization throughout the lesion than with either polyaspartic acid or osteopontin alone. However, in the absence of these process-directing agents, fluoride alone showed less remineralization with the formation of a predominantly surface-only layer. The PILP remineralization process relies on the ability of process-directing agents to stabilize calcium phosphate ions and holds promise for enamel lesion remineralization, and these agents, in the presence of fluoride, seem to play an important role as a booster or supplement in the continuation of remineralization by reducing the mineral gains at the surface layer.
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DIAGNOdent pen quantification of the synergy of NovaMin® in fluoride toothpaste to remineralize white spot lesions in patients with fixed orthodontic appliances: A double-blind, randomized, controlled clinical trial. Int Orthod 2022; 20:100632. [DOI: 10.1016/j.ortho.2022.100632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/13/2022] [Accepted: 02/20/2022] [Indexed: 01/17/2023]
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Roberts WE, Mangum JE, Schneider PM. Pathophysiology of Demineralization, Part II: Enamel White Spots, Cavitated Caries, and Bone Infection. Curr Osteoporos Rep 2022; 20:106-119. [PMID: 35156182 PMCID: PMC8930953 DOI: 10.1007/s11914-022-00723-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Compare noninfectious (part I) to infectious (part II) demineralization of bones and teeth. Evaluate similarities and differences in the expression of hard tissue degradation for the two most common chronic demineralization diseases: osteoporosis and dental caries. RECENT FINDINGS The physiology of demineralization is similar for the sterile skeleton compared to the septic dentition. Superimposing the pathologic variable of infection reveals a unique pathophysiology for dental caries. Mineralized tissues are compromised by microdamage, demineralization, and infection. Osseous tissues remodel (turnover) to maintain structural integrity, but the heavily loaded dentition does not turnover so it is ultimately at risk of collapse. A carious tooth is a potential vector for periapical infection that may be life-threatening. Insipient caries is initiated as a subsurface decalcification in enamel that is not detectable until a depth of ~400μm when it becomes visible as a white spot. Reliable detection and remineralization of invisible caries would advance cost-effective wellness worldwide.
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Affiliation(s)
- W. Eugene Roberts
- American Board of Orthodontics, Indiana University & Purdue University at Indianapolis, 8260 Skipjack Drive, Indianapolis, IN 46236 USA
| | - Jonathan E. Mangum
- Translational Proteomics Laboratory, Department of Biochemistry and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Corner Grattan Street and Royal Parade, Melbourne, Victoria 3010 Australia
| | - Paul M. Schneider
- American Board of Orthodontics, Melbourne Dental School, University of Melbourne, 720 Swanston St, Melbourne, Victoria 3010 Australia
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Nadar B, Yavagal P, Velangi C, Yavagal C, Basavaraj S. Efficacy of casein phosphopeptide-amorphous calcium phosphate varnish in remineralizing white spot lesions: A systematic review and meta-analysis. Dent Res J (Isfahan) 2022. [DOI: 10.4103/1735-3327.346406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rajendran R, Hussain MS, Sandhya R, Ashik M, Thomas A, Mammen R. Effect of remineralization agents on white spot lesions: A systematic review. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2022; 14:S7-S12. [PMID: 36110620 PMCID: PMC9469339 DOI: 10.4103/jpbs.jpbs_836_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 11/10/2022] Open
Abstract
Objective: The goal of this systematic review was to evaluate the therapeutic efficacy of Casein Phosphopeptide Amorphous Calcium Phosphate (CPP-ACP) remineralizing potential to that of other remineralizing treatments and placebo in both naturally occurring and postorthodontic white spot lesions (WSL) in vivo. Materials and Methods: From 2005 to 2020, the literature search used electronic databases PubMed, Embase, Science Direct, and Google Scholar to find studies published solely in English and randomized controlled trials (RCTs) employing CPP-ACP as an intervention. All eligible studies were reviewed by two independent reviewers. Results: Excluding duplications, 72 articles were identified. Abstracts of 58 articles were reviewed independently, 19 articles were excluded, 36 full text articles were retrieved; finally selecting 14 studies. Conclusion: The CPP-ACP was found to have efficacious remineralizing potential on naturally occurring and postorthodontic WSL compared to placebo or other preventive measures. Further well-performed RCTs are needed to determine the therapeutic significance of remineralizing medicines, and long-term follow-ups are required.
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Meshki R, Basir L, Rahbar N, Kazempour M. Comparison of the effect of fluoride gel and two toothpastes with different materials on remineralization of initial carious lesions in primary teeth. J Family Med Prim Care 2021; 10:3309-3313. [PMID: 34760749 PMCID: PMC8565127 DOI: 10.4103/jfmpc.jfmpc_1046_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/19/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction: Various types of toothpastes are claimed to be able to improve initial enamel caries. This study compared the effect of fluoride gel and two toothpastes on remineralization of initial caries lesions in primary teeth. Materials and Methods: A total of sixty-four sound extracted primary canine were immersed in demineralizing solution at 37°C for 96 h to produce artificial caries in vitro. Enamel pieces (3 × 3 × 5 mm) were prepared from each tooth and mounted in self cure acrylic blocks. The specimens were randomly assigned to four groups (n = 16) based on treatment agent (fluoride gel, Chitodent toothpaste, ReminPro toothpaste, no treatment as control) and underwent a pH cycling model for 10 days. Vickers microhardness (VH) was measured before and after treatment. Data was analyzed using analysis of variance and paired t-test by SPSS 18 (P < 0.05). Results: No significant difference was found in VH between groups at baseline (fluoride group: 265.9 ± 44.8, Chitodent group: 282.6 ± 34.6, ReminPro group: 266.5 ± 26.6, control: 272.7 ± 32.5; P = 0.516). Microhardness significantly increased after exposure to ReminPro toothpaste (VH change: 24.1%, P < 0.001) and fluoride gel (VH change: 10.9%, P = 0.046), but no significant changes were observed in Chitodent (VH change: 2.8%, P = 0.635) and control (VH change: - 2.2%, P = 0.181) groups. Conclusion: ReminPro toothpaste might be effective in remineralizing initial carious lesions of primary teeth.
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Affiliation(s)
- Razieh Meshki
- Department of Pedodontics, Dental School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Leila Basir
- Department of Pedodontics, Dental School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nadereh Rahbar
- Department of Nanotechnology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Kazempour
- Department of Pedodontics, Dental School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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AlShaya MS, Sabbagh HJ, El-Housseiny AA. Diagnosis and Management Approaches for Non-cavitated Carious Dental Lesions- A Narrative Review. Open Dent J 2021. [DOI: 10.2174/1874210602115010337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Dental caries is one of the most prevalent diseases. Its detection and management should start with a comprehensive treatment plan, with the goals of the elimination of cariogenic bacteria, the reduction of plaque acidogenicity, the encouragement of tooth remineralization, and the repair of damaged teeth.
Objectives:
The aim of this paper was to review the literature regarding the latest updates on the diagnosis and management approaches of non-cavitated carious dental lesions.
Methods:
Studies regarding the diagnosis and management of non-cavitated carious dental lesions were included.
Results: The subclinical non-cavitated carious lesion might progress to an early enamel lesion, develop into an established dentin lesion, or sometimes end up with a lesion reaching the pulp. The detection and management of caries should be patient-centered, risk-based, and evidence-supported, and should consider the dentists’ expertise and the patients’ needs and preferences. The visual-tactile and radiographic detection of non-cavitated carious lesions are greatly helped by the advances of non-invasive detection tools such as DIAGNOdent, fiber-optic transillumination, quantitative light-induced fluorescence, and DIAGNOcam.
Conclusion:
Accordingly, non-cavitated carious lesions can be arrested by several non-invasive techniques, which are preferred over the invasive options. The clinicians can use sealants plus fluoride varnish on occlusal surfaces, fluoride varnish or resin infiltration on proximal surfaces, and resin infiltration,fluoride gel, or varnish alone on facial or lingual surfaces to manage non-cavitated carious lesions.
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Wang Y, Qin D, Guo F, Levey C, Huang G, Ngan P, Hua F, He H. Outcomes used in trials regarding the prevention and treatment of orthodontically induced white spot lesions: A scoping review. Am J Orthod Dentofacial Orthop 2021; 160:659-670.e7. [PMID: 34366187 DOI: 10.1016/j.ajodo.2021.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The objective was to identify and summarize the outcomes and evaluation methods used in clinical trials regarding the prevention and treatment of orthodontically induced white spot lesions (WSLs). METHODS Three electronic databases were searched to identify studies that were (1) clinical trials on prevention and/or treatment of orthodontically induced WSLs, (2) reported in English, and (3) published between January 2010 and October 2019. At least 2 authors assessed the eligibility and extracted the characteristics, outcomes, and evaluation methods from included studies. All disagreements were resolved through discussion. RESULTS Among 1328 studies identified, 51 were eligible and included. A total of 48 different outcomes and 11 different evaluation methods were used in these studies. The most frequently used outcomes were WSLs clinical visual examination scores (n = 22, 43.1%), DIAGNOdent values (n = 14; 27.5%), fluorescence loss measured with quantitative light-induced fluorescence (QLF) (n = 10; 19.6%), and lesion area measured with QLF (n = 10; 19.6%). The most frequently used evaluation methods were clinical examination (n = 25; 49.0%), visual inspection by photographs (n = 15; 29.4%), DIAGNOdent (n = 14; 27.5%), and QLF (n = 10; 19.6%). None of the included studies reported data on quality of life. CONCLUSIONS Substantial outcome heterogeneity exists among studies regarding the prevention and treatment of orthodontically induced WSLs. Most of the identified outcomes are aimed to assess morphologic changes of WSLs and may not reflect patient perspectives. REGISTRATION The Core Outcome Set for trials on the prevention and treatment of enamel White Spot Lesions (COS-WSL) project was registered in the COMET Initiative database (No. 1399).
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Affiliation(s)
- Yunlei Wang
- Department of Orthodontics, School and Hospital of Stomatology, Hubei-MOST KLOS & KLOBM, Wuhan University, Wuhan, China
| | - Danchen Qin
- Department of Orthodontics, School and Hospital of Stomatology, Hubei-MOST KLOS & KLOBM, Wuhan University, Wuhan, China
| | - Feiyang Guo
- Department of Orthodontics, School and Hospital of Stomatology, Hubei-MOST KLOS & KLOBM, Wuhan University, Wuhan, China
| | - Colin Levey
- School of Dentistry, University of Dundee, Dundee, United Kingdom
| | - Greg Huang
- Department of Orthodontics, School of Dentistry, University of Washington, Seattle, Wash
| | - Peter Ngan
- Department of Orthodontics, West Virginia University, Morgantown, WVa
| | - Fang Hua
- Department of Orthodontics and Center for Evidence-Based Stomatology, School and Hospital of Stomatology, Hubei-MOST KLOS & KLOBM, Wuhan University, Wuhan, China; Division of Dentistry, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
| | - Hong He
- Department of Orthodontics, School and Hospital of Stomatology, Hubei-MOST KLOS & KLOBM, Wuhan University, Wuhan, China.
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Govindaraj A, Dinesh SS. Effect of Chlorhexidine Varnish and Fluoride Varnish on White Spot Lesions in Orthodontic Patients- a Systematic Review. Open Dent J 2021. [DOI: 10.2174/1874210602115010151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Aim:
The aim of this study is to critically review the studies that studied the effect of Chlorhexidine varnish and fluoride varnish on White Spot Lesion (WSL) in patients undergoing orthodontic treatment.
Materials and Methods:
The electronic database PubMed, The Cochrane Library, Medline, Embase, Google Scholar, Web of Knowledge along with a complimentary manual search of all orthodontic journals till the first week of December 2019 was searched. English language study performed on humans, randomized or nonrandomized clinical trials, comparing the effect of fluoride and chlorhexidine varnish on WSL was included in the review. Quality assessment of included studies was performed.
Clinical Significance:
The need for an adjunct oral hygiene aid to reduce the incidence and prevalence of white spot lesions in orthodontic patients is necessary. The use of these varnishes will aid in the same and thus make the adverse effects of fixed orthodontic treatment negligible.
Review of Literature:
Enamel demineralization is a significant risk associated with orthodontic treatment when oral hygiene is poor. Prevention of demineralization during orthodontic treatment is one of the greatest challenges faced by clinicians despite modern advances in caries prevention. The development of White Spot Lesions (WSLs) is attributed to prolonged plaque accumulation around the brackets.
Results:
The search identified a total of 3 studies that were included in this review. One study had Low risk of bias and the remaining 2 studies had moderate overall risk. Results showed that there was a reduction in the incidence of white spot lesions in orthodontic patients after application of chlorhexidine and Fluoride varnish.
Conclusion:
Low level evidence is available to conclude that the use of chlorhexidine varnishes and fluoride varnishes reduces the prevalence of white spot lesions in patients undergoing fixed orthodontic treatment. Due to its limitations, the results of this systematic review should be handled with caution and further well-planned Randomized Clinical Trial (RCT) are needed to provide a discrete conclusion.
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Subramaniam P, Raj N S, Papulwar S. Levels of Streptococcus Mutans in mother–child pairs following application of fluoride varnish containing casein phosphopeptide: Amorphous calcium phosphate. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2021. [DOI: 10.4103/jiaphd.jiaphd_146_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Do bleaching gels affect the stability of the masking and caries-arresting effects of caries infiltration-in vitro. Clin Oral Investig 2020; 25:4011-4021. [PMID: 33319337 PMCID: PMC8137601 DOI: 10.1007/s00784-020-03732-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/04/2020] [Indexed: 11/17/2022]
Abstract
Objectives The aim of this study was to evaluate the influence of different bleaching gels on the masking and caries-arresting effects of infiltrated and non-infiltrated stained artificial enamel caries lesions. Materials and methods Bovine enamel specimens (n = 240) with each two sound areas (SI and SC) and each two lesions (DI and DC) were infiltrated (DI and SI), stained (1:1 red wine-coffee mixture,70 days), and randomly distributed in six groups to be bleached with the following materials: 6%HP (HP-6), 16%CP (CP-16), 35%HP (HP-35), 40%HP (HP-40), and no bleaching (NBl,NBl-NBr). Subsequently, specimens were pH-cycled (28 days, 6 × 60 min demineralization/day) and all groups except NBl-NBr were brushed with toothpaste slurry (1.100 ppm, 2×/day, 10 s). Differences in colorimetric values (ΔL, ΔE) and integrated mineral loss (ΔΔZ) between baseline, infiltration, staining, bleaching, and pH cycling were calculated using photographic and transversal microradiographic images. Results At baseline, significant visible color differences between DI and SC were observed (ΔEbaseline = 12.2; p < 0.001; ANCOVA). After infiltration, these differences decreased significantly (ΔEinfiltration = 3.8; p < 0.001). Staining decreased and bleaching increased ΔL values significantly (p ≤ 0.001). No significant difference in ΔΔE was observed between before staining and after bleaching (ΔEbleaching = 4.3; p = 0.308) and between the bleaching agents (p = 1.000; ANCOVA). pH-cycling did not affect colorimetric values (ΔEpH-cycling = 4.0; p = 1.000). For DI, no significant change in ΔZ during in vitro period was observed (p ≥ 0.063; paired t test). Conclusions Under the conditions chosen, the tested materials could satisfactorily bleach infiltrated and non-infiltrated stained enamel. Furthermore, bleaching did not affect the caries-arresting effect of the infiltration. Clinical relevance The present study indicates that bleaching is a viable way to satisfactorily recover the appearance of discolored sound enamel and infiltrated lesions.
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Sedlakova Kondelova P, Mannaa A, Bommer C, Abdelaziz M, Daeniker L, di Bella E, Krejci I. Efficacy of P 11-4 for the treatment of initial buccal caries: a randomized clinical trial. Sci Rep 2020; 10:20211. [PMID: 33214593 PMCID: PMC7678830 DOI: 10.1038/s41598-020-77057-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/09/2020] [Indexed: 11/09/2022] Open
Abstract
To investigate the safety and efficacy of Self-Assembling Peptide P11-4 (SAP P11-4) compared to placebo or fluoride varnish (FV), a randomized, controlled, blinded, split-mouth study with sequential design was conducted. Subjects presenting two teeth with White-Spot-Lesions (WSLs) were included and teeth were randomly assigned to test or control. Control received placebo at baseline (D0) and test SAP P11-4, all received FV at Day 90 (D90). Standardized photographs were taken at each visit, and WSL size changes were morphometrically assessed. Hierarchical Linear Modelling, considering paired and sequential design, was used to test four hypotheses. SAP P11-4 lesions (test, D90–D0) showed significant WSL size reduction compared to placebo (control, D90–D0; p = 0.008) or FV (control, D180–D90; p = 0.001). Combination of SAP P11-4 and delayed FV after 90 days (test, D180–D0), showed a significant difference compared to FV alone (control D270–D90; p = 0.003). No significant difference on FV efficacy was found when SAP P11-4 was applied 3 months before FV (test D270–D90; control D270–D90, p = 0.70). SAP P11-4 treatment resulted in superior caries regression compared to either placebo or FV, and FV efficacy seems not to be affected by SAP P11-4. SAP P11-4 was found to be a safe and effective WSL treatment.
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Affiliation(s)
| | - Alaa Mannaa
- Division of Operative Dentistry, Department of Restorative Dentistry, Faculty of Dentistry, King Abdulaziz University, P.O. Box 80209, Jeddah, 21589, Kingdom of Saudi Arabia
| | | | - Marwa Abdelaziz
- University of Geneva, University Dental Clinics CUMD, rue Michel-Servet 1, 1211, Geneva 4, Switzerland
| | - Laurent Daeniker
- University of Geneva, University Dental Clinics CUMD, rue Michel-Servet 1, 1211, Geneva 4, Switzerland
| | - Enrico di Bella
- Department of Political Sciences, University of Genova, P.le E. Brignole 3a, 16126, Genova, Italy
| | - Ivo Krejci
- University of Geneva, University Dental Clinics CUMD, rue Michel-Servet 1, 1211, Geneva 4, Switzerland.
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Effectiveness of remineralizing agents in the prevention and reversal of orthodontically induced white spot lesions: a systematic review and network meta-analysis. Clin Oral Investig 2020; 24:4153-4167. [PMID: 33057826 DOI: 10.1007/s00784-020-03610-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare the effectiveness of remineralizing agents in the prevention and reversal of white spot lesions (WSLs), which occur during fixed orthodontic treatment, through a systematic review and network meta-analysis. MATERIALS AND METHODS We reviewed controlled randomized clinical trial (RCT) data querying nine databases combined with a manual search (last search date: March 10, 2020). Of 2273 identified studies, 36 RCTs were finally included. After study selection and data extraction, pair-wise and network meta-analyses were performed to analyze the effectiveness of remineralizing agents in the prevention and reversal of WSLs in the short term (≤ 3 months) and long term (> 3 months). The risk of bias was assessed based on the Cochrane guidelines. Statistical heterogeneity, inconsistencies, and cumulative ranking were also evaluated. RESULTS In terms of WSL prevention, sodium fluoride (NaF) varnish had the highest cumulative ranking for the short-term decalcification index (99.3%); acidulated phosphate fluoride (APF) foam ranked first for long-term incidence (96.9%), followed by difluorosilane (Dfs) varnish and high-concentration fluoride toothpaste (HFT) (79.4% and 77.4%, respectively). In the reversal of WSLs, no significant difference was found among different agents or their combinations for the two available outcomes (short-term integrated fluorescence loss and short-term percentage of fluorescence loss). CONCLUSIONS In the prevention of WSLs, APF foam showed the best remineralizing effectiveness in the long term (after debonding), followed by Dfs varnish and HFT. It is unclear whether remineralizing agents can effectively reverse WSLs based on the existing evidence. CLINICAL RELEVANCE APF foam may be recommended as a remineralizing agent for preventing orthodontically induced WSLs. PROSPERO REGISTRATION NUMBER CRD42019116852.
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Brusnitsyna EV, Zakirov TV, Saipeeva MM, Ioshchenko ES, Sheshenina SA. Hypersensitivity of teeth after orthodontic treatment in adolescence. Pediatr Dent 2020. [DOI: 10.33925/1683-3031-2020-20-3-217-222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Relevance. In adolescence, focal demineralization after orthodontic treatment is highly prevalent. This, in turn, leads to symptomatic hypersensitivity in the absence of other predisposing factors (recessions, exposure of cervical dentin, increased abrasion, etc.). Reviewed the mechanism for reducing hypersensitivity and remineralizing of calcium-sodium phosphosilicate, also the effectiveness of using a prophylactic toothpaste with this component in adolescents.Materials and methods. A single-center, non-comparative open study was conducted to evaluate the effectiveness of the Sensodyne Restoration and Protection toothpaste at the Department of Pediatric Dentistry and Orthodontics, USMU for 4 weeks. 22 adolescents aged 14-16 years with focal demineralization of enamel in the stain stage after completion of orthodontic treatment participated in the study.Results. The use of toothpaste with calcium-sodium phosphosilicate after a month of use leads to a decrease in the hygiene index by 23.38%, a decrease in hypersensitivity according to the results of the Schiff air index by 56.94% (p ≤ 0.05), and a tendency to an increase in the level of mineralization and a decrease in areas of white spot lesions.Conclusions. Toothpaste with calcium-sodium phosphosilicate has a cleansing effect and reduces sensitivity and can be recommended for adolescents with focal demineralization against the background of orthodontic treatment.
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Affiliation(s)
- E. V. Brusnitsyna
- Federal State Budgetary Educational Institution of Higher Education «Ural State Medical University» of the Ministry of Health of the Russian Federation
| | - T. V. Zakirov
- Federal State Budgetary Educational Institution of Higher Education «Ural State Medical University» of the Ministry of Health of the Russian Federation
| | - M. M. Saipeeva
- Federal State Budgetary Educational Institution of Higher Education «Ural State Medical University» of the Ministry of Health of the Russian Federation
| | - E. S. Ioshchenko
- Federal State Budgetary Educational Institution of Higher Education «Ural State Medical University» of the Ministry of Health of the Russian Federation
| | - S. A. Sheshenina
- Federal State Budgetary Educational Institution of Higher Education «Ural State Medical University» of the Ministry of Health of the Russian Federation
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Tulumbaci F, Gungormus M. In vitro remineralization of primary teeth with a mineralization-promoting peptide containing dental varnish. J Appl Oral Sci 2020; 28:e20200259. [PMID: 32901695 PMCID: PMC7480669 DOI: 10.1590/1678-7757-2020-0259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/30/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022] Open
Abstract
Mineralization-promoting peptides are attractive candidates for new remineralization systems. In previous studies, peptides have been applied as aqueous solutions, which is not a clinically relevant form. OBJECTIVE This study aims to investigate the efficiency of a mineralization-promoting peptide, applied in varnish, on remineralizing artificial caries on primary teeth. METHODOLOGY 55 primary molars were collected. Specimens were immersed in a demineralizing solution for 7 days and then, divided into 7 groups: Baseline: No-remineralization, Placebo: Blank colophony, F: Colophony 5% fluoride, P: Colophony 10% peptide, P+F: Colophony 5% fluoride and 10% peptide, Embrace: Embrace™ varnish, Durashield: Durashield™ varnish. A mixture of 35% w/v colophony varnishes were prepared in ethanol and applied accordingly. Specimens were immersed in a remineralization solution for 4 weeks and it was evaluated using PLM and SEM. Lesion depth reduction was examined by one-way ANOVA. RESULTS There was no significant difference in mean lesion depths between baseline (147.04 ± 10.18 μm) and placebo groups (139.73 ± 14.92 μm), between F (120.95 ± 12.23 μm) and Durashield (113.47 ± 14.36 μm) groups and between P (81.79 ± 23.15 μm) and Embrace (90.26 ± 17.72 μm) groups. Lesion depth for the P+F group (66.95±10.59 μm) was significantly higher compared to all other groups. All groups contained samples with subsurface demineralized regions. Number of subsurface demineralized regions were higher in fluoride-containing groups. CONCLUSIONS We conclude that the mineralization-promoting peptide (MPP3) is effective in this in vitro study and the peptide shows benefits over fluoride as it yields less subsurface demineralized regions.
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Affiliation(s)
- Fatih Tulumbaci
- Ankara Yildirim Beyazit University, School of Dentistry, Department of Pediatric Dentistry, Ankara, Turkey
| | - Mustafa Gungormus
- Ankara Yildirim Beyazit University, School of Dentistry, Department of Basic Sciences, Ankara, Turkey
- Ankara Yildirim Beyazit University, School of Engineering and Natural Sciences, Biomedical Engineering, Ankara, Turkey
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Baafif HA, Alibrahim IF, Alotaibi SH, Alharbi HG, Shubaily MN, Elkwatehy WMA. The Efficacy of Resin Infiltrant and Casein Phosphopeptide-amorphous Calcium Fluoride Phosphate in Treatment of White Spot Lesions (Comparative Study). J Int Soc Prev Community Dent 2020; 10:438-444. [PMID: 33042885 PMCID: PMC7523932 DOI: 10.4103/jispcd.jispcd_483_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background: White spot lesions (WSLs) are considered as the first sign of the progression of dental caries that can be reversed. Casein phosphopeptide–amorphous calcium fluoride phosphate (CPP-ACFP) varnish can promote remineralization process of the demineralized tooth structure. Also, WSLs can be managed by using caries infiltrant (ICON), which infiltrates etched enamel surface of the WSLs. Objectives: The main aim was to evaluate and compare the efficacy of ICON versus CPP-ACFP varnish to treat WSLs in the same oral environments. Materials and Methods: A total of 30 participants aged 20–40 years with at least two WSLs have participated in this trial. Split-mouth technique has been used in this trial where WSLs on the left side have been treated with ICON, whereas WSLs on the right side have been treated with CPP-ACFP varnish. Clinical evaluation using DIAGNOdent was carried out at baseline, 1 week, 1, 3, 6, and 12 months after application to determine the effectiveness of these materials in treating WSLs. Results: Significant differences were observed between all follow-up DIAGNOdent scores compared to baseline readings of both ICON and CPP-ACFP (P = 0.000 for all comparisons). Statistically significant differences were observed between DIAGNOdent scores of ICON compared to CPP-ACFP at all follow-up intervals (P = 0.006, 0.008, 0.045, 0.036, and 0.000). Conclusion: Both ICON and CPP-ACFP were effective in the treatment of WSLs of smooth surfaces but the efficacy of CPP-ACFP was better than ICON.
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Affiliation(s)
| | | | - Sami H Alotaibi
- Faculty of Dentistry, Umm AlQura University, Mansoura, Egypt
| | - Hatem G Alharbi
- Faculty of Dentistry, Umm AlQura University, Mansoura, Egypt
| | | | - Wahdan M A Elkwatehy
- Dental Public Health and Preventive Dentistry, Faculty of Dentistry, Umm Al-Qura University, KSA and Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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An in vitro evaluation of the effects of nanoparticles on shear bond strength and antimicrobial properties of orthodontic adhesives: A systematic review and meta-analysis study. Int Orthod 2020; 18:203-213. [DOI: 10.1016/j.ortho.2020.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 01/23/2023]
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In Vitro Comparison of Fluoride, Magnesium, and Calcium Phosphate Materials on Prevention of White Spot Lesions around Orthodontic Brackets. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1989817. [PMID: 32337230 PMCID: PMC7152941 DOI: 10.1155/2020/1989817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/20/2020] [Indexed: 11/24/2022]
Abstract
One common negative side effect of orthodontic treatment with fixed appliances is the development of white spot lesions (WSLs) around brackets. This study is aimed at comparing the efficacy of various oral hygiene practices in preventing enamel demineralization around orthodontic brackets under similar in vitro conditions. The study included 90 extracted bovine incisors, which were randomized into six groups: fluoride toothpaste (FT), nonfluoride toothpaste (NFT), fluoride varnish plus fluoride toothpaste (FV+FT), CPP-ACP varnish plus fluoride toothpaste (CPP-ACP+FT), medical minerals gel plus nonfluoride toothpaste (MMG+NFT), and no intervention (control). All groups were subjected to demineralization and remineralization cycles. Visual appraisals were used to evaluate the changes in the enamel surface appearance at the beginning and end of the experiment. The changes in the demineralization degree were evaluated by measuring the Ca+2 concentration in the demineralization solution at different time points. The majority of teeth in the CPP-ACP+FT group exhibited no shift in appearance, whereas in the other groups, a slight change in enamel translucency was observed. At all the time points, the Ca+2 concentration in the demineralization solution in the CPP-ACP+FT group was the least among all other groups. At day 5, MMG+NFT's preventive efficacy was significantly higher than FV+FT's, but at days 10, 15, and 19, their efficacy was similar. However, at all the time points, MMG+NFT's efficacy was significantly higher than that of control, whereas FV+FT's efficacy was decreased at days 10, 15, and 19 and was close to the efficacy of control. To fight WSLs, early diagnosis was of great importance and examination of the tooth surface after air-drying for 5 s was recommended.
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Behrouzi P, Heshmat H, Hoorizad Ganjkar M, Tabatabaei SF, Kharazifard MJ. Effect of Two Methods of Remineralization and Resin Infiltration on Surface Hardness of Artificially Induced Enamel Lesions. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2020; 21:12-17. [PMID: 32158780 PMCID: PMC7036357 DOI: 10.30476/dentjods.2019.77864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Statement of the Problem: The progression of incipient carious lesions may be simply prevented by non-invasive remineralization of lesions, eliminating the need for invasive and high-cost restorative procedures. Purpose: This study aimed to assess the effect of two commonly used remineralizing agents and resin infiltration on surface micro hardness of incipient enamel lesions at different time points. Materials and Method:
In this in vitro study, 45 intact human maxillary central incisors were selected. After disinfection, enamel samples measuring 5x5x2.5 mm were cut out of the labial surface of the teeth.
The surface of samples was polished and they were mounted in auto-polymerizing acrylic resin. According to Amaechi’s method, samples were immersed in acidified hydroxyethylcellulose system (pH= 4.5)
for 96 hours to induce white spot lesions (WSLs). The baseline value of surface micro hardness of samples was measured using a Vickers hardness tester,
then the samples were randomly divided into three groups (n=15) based on different remineralization methods: MI-Paste Plus, Remin Pro and ICON-Infiltrant according to the manufacturer’s instructions.
All samples were stored in anti-dry mouth treatment agent during the experiment and their surface hardness was measured at 15 days (T1) and 20 weeks (T2).
Results: The hardness of samples in MI-Paste Plus and Remin Pro groups significantly increased at both T1 and T2 (p< 0.001) but this increase was not significant in ICON group (p> 0.05). Conclusion: MI-Paste Plus and Remin Pro can efficiently increase the hardness of incipient enamel lesions.
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Affiliation(s)
| | - Haleh Heshmat
- Dental Material Research Center of Tehran University of Medical Sciences, Dept. of Restorative and Cosmetic Dentistry, Islamic Azad University, Tehran, Iran
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Is there evidence for Novamin application in remineralization?: A Systematic review. J Oral Biol Craniofac Res 2020; 10:87-92. [PMID: 32190542 DOI: 10.1016/j.jobcr.2020.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background Calcium sodium phosphor-silicate material, a type of bio-glass was originally developed as an implant material to regenerate bone and recently adapted for use in oral care products (NovaMin Technology Inc.). Novamin is used for many dental problems like hypersensitivity, gingivitis, bleeding, non-carious lesions, carious lesions, whitening and is currently emerging as one of the treatment modality for the remineralization of the tooth. Since the prescription of these novel materials to the patients are based on cost effectiveness, efficacy and effectiveness, a clinician should make decision based on best available evidence. Hence, the objective of this review is to find out the current evidence available on the use of Novamin as an agent for remineralization. Materials and methods Relevant articles were searched and screened from several databases including PubMed, Cochrane review, Science Direct and trip which were published till 1988 to July 2017; The articles relevant to the objective of this review were included (RCT's) and articles out of interest of this review were excluded. The primary outcome for the chosen studies is the remineralization capacity of Novamin. Data extraction is done independently and jointly by 3 authors using data collection forms. Studies obtained were evaluated using the Cochrane Collaboration tools for accessing risk bias. The assessment of the quality of the evidence and the bias risk was obtained using the Grading of Recommendations Assessment Development and evaluation System. Results The articles from the database obtained for further review was N = 1. According to the study reviewed, the baseline comparisons using decalcification index obtained between Novamin study group (ReNew) and the control group (Crest) yield a P-value of 0.97 whereas after a 3 months interval follow up the value is 0.0403 suggesting there was a trend towards improvement in white spot lesions in the control group and at 6 months' time point the p-value is 0.81 concluding that there are no significant difference of remineralization process obtained by using traditional toothpaste and Novamin. Conclusion Review shows that Novamin has significantly less clinical evidence to prove its effectiveness as a remineralization agent in treating both carious and non-carious lesion. Hence, better designed clinical trials should be carried out in the future before definitive recommendations can be made.
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Hu H, Feng C, Jiang Z, Wang L, Shrestha S, Su X, Shu Y, Ge L, Lai W, Hua F, Long H. Effectiveness of remineralising agents in prevention and treatment of orthodontically induced white spot lesions: a protocol for a systematic review incorporating network meta-analysis. Syst Rev 2019; 8:339. [PMID: 31884975 PMCID: PMC6935494 DOI: 10.1186/s13643-019-1253-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 12/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND White spot lesions (WSLs) are common adverse effects in fixed orthodontic treatment. Remineralising agents are widely used to prevent WSLs formation and are the first-line treatment for existing WSLs. Previous systematic reviews have evaluated the effectiveness of remineralisation agents in the management of WSLs. However, their conclusions were contradictory. The objective of this study will be to compare the effectiveness and safety of current remineralising agents used in the management of WSLs in patients treated with fixed orthodontic appliances in any orthodontic setting. METHODS Literature searches will be conducted in several electronic databases (from inception onwards): MEDLINE (via Ovid), Scopus, Embase, the Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL), among others. Grey literature will be identified through searching clinical trials registries. Randomised controlled trials that compared the effectiveness of different remineralisation agents in the prevention and treatment of WSLs will be included. Two researchers will independently screen all citations, full-text articles, and abstract data. The study risk bias will be appraised using an appropriate tool. The primary outcomes will be WSLs incidence and severity of WSLs. Secondary outcomes will be subjective measures of WSLs and adverse effects. The mean difference (MD) and relative risk (RR) with corresponding 95% confidence intervals (CI) will be chosen as effect measures for continuous and binary outcomes, respectively. If feasible, fixed and random-effects pairwise meta-analyses and frequentist network meta-analyses will be conducted where appropriate. DISCUSSION This network meta-analysis will compare the effectiveness of remineralising agents in the prevention and treatment of orthodontically induced WSLs. By integrating the evidence from direct and indirect comparisons and ranking all evaluated interventions, our findings have the potential to help clinicians make more accurate treatment decisions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019116852, registered on March 15, 2019.
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Affiliation(s)
- Huimin Hu
- Department of Orthodontics, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, No. 14, Section 3, Ren Min South Road, Chengdu, 610041 China
| | - Chong Feng
- School of Medicine, University of Nankai, 94 Weijin Road, Tianjin, 300071 Nankai China
| | - Zhaowei Jiang
- School of Medicine, University of Nankai, 94 Weijin Road, Tianjin, 300071 Nankai China
| | - Lufei Wang
- Department of Oral and Craniofacial Health Sciences, University of North Carolina Adams School of Dentistry, 385 South Columbia Street, Chapel Hill, NC 27599 USA
| | - Sonu Shrestha
- Department of Orthodontics, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, No. 14, Section 3, Ren Min South Road, Chengdu, 610041 China
| | - Xiaoming Su
- Department of Medical Informatics, Biometry, and Epidemiology (IBE), Ludwig-Maximilians University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Yu Shu
- Sichuan University Library, 29 Wangjian Road, Chengdu, Sichuan China
| | - Long Ge
- Evidence-based Social Science Research Center & Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, 222 Tianshui South Road, Lanzhou, Gansu China
| | - Wenli Lai
- Department of Orthodontics, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, No. 14, Section 3, Ren Min South Road, Chengdu, 610041 China
| | - Fang Hua
- Department of Orthodontics & Centre for Evidence-Based Stomatology, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072 Hubei China
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Nell Lane, Manchester, M20 2LR UK
| | - Hu Long
- Department of Orthodontics, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, No. 14, Section 3, Ren Min South Road, Chengdu, 610041 China
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Yassaei S, Aghili H, Shahraki N, Safari I. Efficacy of erbium-doped yttrium aluminum garnet laser with casein phosphopeptide amorphous calcium phosphate with and without fluoride for remineralization of white spot lesions around orthodontic brackets. Eur J Dent 2019; 12:210-216. [PMID: 29988235 PMCID: PMC6004814 DOI: 10.4103/ejd.ejd_265_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective This study aimed to assess the efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser, pastes containing casein phosphopeptide amorphous calcium phosphate (CPP-ACP) with and without fluoride and their combination for prevention of white spot lesions in the enamel. Materials and Methods This in vitro experimental study was conducted on 90 extracted sound premolars. The teeth were then randomly divided into six groups of 15: (1) Control, (2) laser, (3) CPP-ACP with fluoride (GC MI Paste, Recaldent™ 900 ppm as NaF), (4) CPP-ACP without fluoride (GC Tooth Mousse Recaldent™), (5) laser + CPP-ACP with fluoride, and (6) laser + CPP-ACP without fluoride. In each group, enamel surface was exposed to the remineralizing agent. The teeth were then subjected to pH cycling for 14 days. The teeth were then sectioned, polished, and underwent cross-sectional microhardness testing at 20-160 μ depth quantitatively. Using the Simpson's rule, the amount of mineral loss was calculated in each group. Statistical Analysis Used: ANOVA was used for the comparisons, and Tukey's test was applied for pairwise comparisons. Results The highest mean volume percentage of microhardness at 20-60 μ depth belonged to the group laser + CPP-ACP with fluoride and the lowest belonged to the control group (P = 0.001). The differences were not significant at 80-120 μ depth (P > 0.05). These finding are confirmed according to △Z (mineral loss). Conclusion Based on these results, Er: YAG laser was able to decrease demineralization and was a potential alternative to preventive dentistry and was more effective when combined with CPP-ACP products.
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Affiliation(s)
- Sogra Yassaei
- Department of Orthodontics, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Aghili
- Department of Orthodontics, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Neda Shahraki
- Department of Orthodontics, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Isa Safari
- Department of Orthodontics, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Kooshki F, Pajoohan S, Kamareh S. Effects of treatment with three types of varnish remineralizing agents on the microhardness of demineralized enamel surface. J Clin Exp Dent 2019; 11:e630-e635. [PMID: 31516661 PMCID: PMC6731000 DOI: 10.4317/jced.55611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 06/12/2019] [Indexed: 11/05/2022] Open
Abstract
Background Remineralization of incipient caries is one of the goals in dental health care ,especially in pediatric dentistry. The present study aimed at comparing the effects of MI varnish (3M (United states)) , Nano paste( FGM(Brezil) ), 5% sodium fluoride varnish) DuraphatColgate (united states) ) on remineralization of enamel lesions. Material and Methods In this in-vitrostudy, 60 intact human pre-molars, were randomly allocated to four groups of 15. Baseline surface microhardness in three points in the center of the polished area was measured. After two days of immersion in demineralizing solution, microhardness of all samples was measured. Afterward, groups 1-3 under-went treatment with MI varnish, nano paste, 5% sodium fluoride varnish and then again microhardness was measured. The results were analyzed by one-way analysis of variance (ANOVA), repeated measures ANOVA, and Bonfreni table was used. Results Duraphat varnish in comparison with control group, significantly increased surface microhardness and in comparison with Nano and MI paste varnish groups significant differences was shown between groups. (P< 0.05). MI paste varnish and Nano paste similary showed more increases in surface microhardness in comparison with Duraphat varnish and control groups (P≈1). Conclusions According to the results of this study, all three varnishes, Duraphat , MI paste and Nano paste increase the enamel surface microhardness and remineralization of incipient caries. MI paste and Nano paste compared to Duraphat Varnish, significantly showed more increases in enamel surface microhardness but Nano paste and MI paste were almost the same. Key words:CPP-ACP, Nano varnish, fluoride varnish, microhardness, demineralization, remineralization.
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Affiliation(s)
- Fahimeh Kooshki
- Assistant Professor, Department of Pediatric Dentistry, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sanaz Kamareh
- Postgraduate student of Pediatric dentistry, Department of Pediatric dentistry, School of Dentistry , Shahid Beheshti University of Medical sciences, Tehran, Iran
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Effects of Fluoride and Calcium Phosphate Materials on Remineralization of Mild and Severe White Spot Lesions. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1271523. [PMID: 31317022 PMCID: PMC6601497 DOI: 10.1155/2019/1271523] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/27/2019] [Indexed: 11/17/2022]
Abstract
Fixed orthodontic treatments often lead to enamel demineralization and cause white spot lesions (WSLs). The aim of this study was to evaluate the mineralization degree of 2 types of WSLs based on ICDAS index and compare the remineralizing efficacy of 3 oral hygiene practices after 1 month and 3 months. 80 mild demineralized and 80 severe demineralized enamel specimens were randomized into three treatments: fluoride toothpaste (FT), fluoride varnish plus fluoride toothpaste (FV+FT), and CPP-ACP plus fluoride toothpaste (CPP-ACP+FT). Microhardness tester, DIAGNODent Pen 2190, and scanning electron microscope were used to evaluate the changes of mineralization degree. Both qualitative and quantitative indicators suggested that the mild and severe white spot lesions were different in the degree of mineralization. Severe WSLs demineralized much more seriously than mild lesions even after 3 months of treatment. Despite the variation in severity, both lesions had the same variation trend after each measure was applied: FT had weak therapeutic effect, FV + FT and CPP-ACP + FT were effective for remineralization. Their remineralizing efficacy was similar after 1 month, and combined use of CPP-ACP plus F toothpaste was more effective after 3 months. In order to fight WSLs, early diagnosis was of great importance, and examination of the tooth surface after air-dry for 5 seconds was recommended. Also, when WSLs were found, added remineralizing treatments were required.
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Thierens LAM, Moerman S, Elst CV, Vercruysse C, Maes P, Temmerman L, Roo NMCD, Verbeeck RMH, Pauw GAMD. The in vitro remineralizing effect of CPP-ACP and CPP-ACPF after 6 and 12 weeks on initial caries lesion. J Appl Oral Sci 2019; 27:e20180589. [PMID: 31116280 PMCID: PMC6534368 DOI: 10.1590/1678-7757-2018-0589] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/24/2019] [Indexed: 11/29/2022] Open
Abstract
Objective: The aim of this in vitro study was to determine the effects of remineralization promoting agents containing casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP), or CPP-ACP in combination with fluoride (CPP-ACPF) on artificial white spot lesions (WSLs) after 6 and 12 weeks. Methodology: White spot lesions were created on 123 sectioned premolars (246 specimens) with a demineralization solution during a 96 hours pH-cycling regime. Two experimental groups were created: a CPP-ACP group (Tooth Mousse™), and a CPP-ACPF group (Mi Paste Plus™). Additionally, two control groups were created, one using only a conventional toothpaste (1450 ppm fluoride) and another one without any working agents. All teeth were also daily brushed with the conventional toothpaste except the second control group. Tooth Mousse™ and Mi Paste Plus™ were applied for 180 seconds every day. The volume of demineralization was measured with transverse microradiography. Six lesion characteristics regarding the lesion depth and mineral content of WSLs were also determined. Results: The application of CPP-ACP and CPP-ACPF had a significant regenerative effect on the WSLs. Compared to Control group 1 and 2 the volume of demineralization after 6 weeks decreased significantly for CPP-ACP (respectively p<0.001 and p<0.001) and CPP-ACPF (respectively p=0.001 and p=0.003). The same trend was observed after 12 weeks. For the CPP-ACPF group, WSL dimensions decreased significantly between 6 and 12 weeks follow-up (p=0.012). The lesion depth reduced significantly after application of CPP-ACP and CPP-ACPF but increased significantly in the Control groups. Mineral content increased for CPP-ACP and CPP-ACPF after an application period of 12 weeks, but this was only significant for CPP-ACP. Conclusions: Long-term use of CPP-ACP and CPP-ACPF in combination with a conventional tooth paste shows beneficial effects in the recovery of in vitro subsurface caries lesions.
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Affiliation(s)
- Laurent A M Thierens
- Ghent University, Department of Orthodontics, Oral Health Sciences, Ghent, Belgium
| | - Sophie Moerman
- Ghent University, Department of Orthodontics, Oral Health Sciences, Ghent, Belgium
| | - Charlotte van Elst
- Ghent University, Department of Orthodontics, Oral Health Sciences, Ghent, Belgium
| | - Chris Vercruysse
- Ghent University, Department of Basic Medical Sciences, Biomaterials Group, Ghent, Belgium
| | - Petra Maes
- Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Brussels, Belgium
| | - Liesbeth Temmerman
- Ghent University, Department of Orthodontics, Oral Health Sciences, Ghent, Belgium
| | - Noëmi M C de Roo
- Ghent University, Department of Orthodontics, Oral Health Sciences, Ghent, Belgium
| | - Ronald M H Verbeeck
- Ghent University, Department of Basic Medical Sciences, Biomaterials Group, Ghent, Belgium
| | - Guy A M de Pauw
- Ghent University, Department of Orthodontics, Oral Health Sciences, Ghent, Belgium
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Hua F. Increasing the Value of Orthodontic Research Through the Use of Dental Patient-Reported Outcomes. J Evid Based Dent Pract 2019; 19:99-105. [PMID: 31326063 DOI: 10.1016/j.jebdp.2019.04.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/24/2019] [Accepted: 04/16/2019] [Indexed: 11/27/2022]
Abstract
Ten years ago, Chalmers and Glasziou pointed out in the Lancet that 85% of all biomedical research was being avoidably wasted because of imbalanced research question/outcome selection, as well as poor study design, execution, and reporting. According to findings of recent "research on research" studies, a high level of such kind of avoidable waste should also exist in orthodontic research. This warrants efforts to improve each stage of the research production and reporting process. Nowadays, patients' psychosocial function is considered a core element of oral health. Also, their treatment needs and preferences have formed a main component of evidence-based dentistry. Therefore, to achieve shared decision-making, orthodontists need to have an adequate understanding of each patient's values and perceptions. In this context, orthodontic research should be patient-centered so that the knowledge and perception gaps between clinicians and patients can be reduced, and research evidence that is suitable for patients to understand can be provided. In addition, patient-centered outcomes that can reflect patients' perceptions and psychosocial status should be widely used. However, recent scoping reviews have shown that during the past decade, patient-centered outcomes including those regarding adverse effects, health service resource utilization, and quality of life have remained under-represented in orthodontic trials. Thus, the use of dental patient-reported outcomes and dental patient-reported outcome measures should be promoted to facilitate the provision of a patient-centered evidence base, reduce the avoidable waste related to research question/outcome selection, and thereby increase the value of orthodontic research.
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Affiliation(s)
- Fang Hua
- Center for Evidence-Based Stomatology & Department of Orthodontics, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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Cosma LL, Şuhani RD, Mesaroş A, Badea ME. Current treatment modalities of orthodontically induced white spot lesions and their outcome - a literature review. Med Pharm Rep 2019; 92:25-30. [PMID: 30957083 PMCID: PMC6448498 DOI: 10.15386/cjmed-1090] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/17/2018] [Accepted: 09/24/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction White spot lesion is a demineralization of the enamel that appears as a white spot on the surfaces of the tooth. The cause of this spot is determined by the activity of the bacterial plaque and it represents the initial stage of a carious lesion. This lesion is a common side effect for patients with fixed orthodontic appliances mainly because of the brackets' position that favors the accumulation of plaque that ultimately leads to the formation of the white spot. Methods We conducted a search on a single database, PubMed. "Orthodontic", "white spot lesions", "enamel demineralization treatment" and "remineralization" were the search terms used. We found 324 articles, but we took in consideration only the ones from the last 10 years, which resulted in 223 articles. Results The first step after research was article selection: first by scrutinizing the title and secondly by reviewing the abstracts or full texts. The exclusion criteria were: meta-analysis, reviews, original articles regarding prevention of white spot lesions and their prevalence or incidence. We included the articles that seemed relevant for the treatment of white spot lesions, made either on extracted teeth either on orthodontic patients. We found 75 articles to be eligible for this research and we eliminated 5 because of the lack of an abstract or full text and a further 22 were rejected because they did not fit the aforementioned criteria. Conclusion Although some traditional methods for the treatment of white spot lesions seem to have undesirable results, nowadays with new technologies and thorough investigations in nanotechnology, the eradication of the lesion appears to be short term.
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Affiliation(s)
- Lavinia Luminiţa Cosma
- Department of Pediatric Dentistry, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Raluca Diana Şuhani
- Department of Pediatric Dentistry, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anca Mesaroş
- Department of Dental Propedeutics and Esthetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mîndra Eugenia Badea
- Department of Prevention in Dentistry, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Sardana D, Zhang J, Ekambaram M, Yang Y, McGrath CP, Yiu CK. Effectiveness of professional fluorides against enamel white spot lesions during fixed orthodontic treatment: A systematic review and meta-analysis. J Dent 2019; 82:1-10. [DOI: 10.1016/j.jdent.2018.12.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/28/2018] [Accepted: 12/16/2018] [Indexed: 11/29/2022] Open
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Pithon MM, Baião FS, Sant'Anna LID, Tanaka OM, Cople-Maia L. Effectiveness of casein phosphopeptide-amorphous calcium phosphate-containing products in the prevention and treatment of white spot lesions in orthodontic patients: A systematic review. ACTA ACUST UNITED AC 2019; 10:e12391. [PMID: 30680921 DOI: 10.1111/jicd.12391] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022]
Abstract
The purpose of the present systematic review was to evaluate the effectiveness of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-containing products in the prevention and treatment of active white spot lesions (WSL) in orthodontic patients. Searched the Scopus, PubMed, Web of Science, Cochrane, Virtual Health Language, ClinicalTrials, and Open Gray databases without limitations on the year or language of publication. We included controlled clinical trials with patients with fixed orthodontic appliances under the use of CPP-ACP-containing products compared to control, placebo, or other interventions in the prevention and treatment of WSL around orthodontic braces. Case reports, editorials, in vitro studies, annals of congress, and reviews were excluded. To assess the risk of bias, the revised version of the Cochrane tool for randomized trials (RoB 2.0) and Risk Of Bias In Non-randomized Studies for non-randomized trials were used. The biases were graded low, moderate, and high according to the tools used. Of the 599 articles found, 11 met the inclusion criteria. Of these, nine were randomized, controlled clinical trials and two were non-randomized. Two studies were considered to have moderate bias risk, and the most-used CPP-ACP presented form was a cream for topical applications. Although CPP-ACP-containing products did not differ from other fluoride products, they were able to reduce WSL and neutralize the pH around the orthodontic braces. Products containing CPP-ACP are effective in preventing and treating WSL around the braces. However, further studies with the same measurement method and periods of use, and other forms of presentation of CPP-ACP are needed.
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Affiliation(s)
- Matheus M Pithon
- Department of Health, Universidade Estadual do Sudoeste da Bahia-UESB, Jequié, Bahia, Brazil.,Department of Pediatric Dentistry and Orthodontics, Universidade Federal do Rio de Janeiro-UFRJ, Rio de Janeiro, Brazil
| | - Felipe S Baião
- Department of Health, Universidade Estadual do Sudoeste da Bahia-UESB, Jequié, Bahia, Brazil
| | - Letícia I D Sant'Anna
- Department of Health, Universidade Estadual do Sudoeste da Bahia-UESB, Jequié, Bahia, Brazil
| | - Orlando M Tanaka
- Department of Orthodontics, Pontificia Universidade Católica do Paraná-PUC/PR, Curitiba, Paraná, Brazil
| | - Lucianne Cople-Maia
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal do Rio de Janeiro-UFRJ, Rio de Janeiro, Brazil
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González-Cabezas C, Fernández CE. Recent Advances in Remineralization Therapies for Caries Lesions. Adv Dent Res 2018; 29:55-59. [PMID: 29355426 DOI: 10.1177/0022034517740124] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Remineralization of caries lesions is naturally achieved by salivary ions, and it can be enhanced by external factors or elements such as fluoride. Numerous studies have demonstrated the remineralizing efficacy of fluoride therapies as well as the limitations with some groups of the population. Consequently, developing new remineralization therapies to close this gap in efficacy has been a priority for the last 2 decades. In this review, we summarize and briefly discuss some of the latest advances in remineralization therapies. Most new therapies try to enhance the effect of fluoride by adding other potentially active ingredients to the formulation, such as calcium, phosphate, stannous, xylitol, and arginine. Other remineralization strategies have focused on creating remineralizing scaffolds within the lesions (e.g., self-assembling peptides). While several of the new remineralization strategies have progressed significantly in recent years, for most of them, the evidence is still insufficient to assess their true clinical potential.
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Affiliation(s)
- C González-Cabezas
- 1 Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - C E Fernández
- 1 Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.,2 College of Dental Medicine-Illinois, Midwestern University, Downers Grove, IL, USA
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48
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Philip N. State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management. Caries Res 2018; 53:284-295. [PMID: 30296788 DOI: 10.1159/000493031] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/11/2018] [Indexed: 12/17/2022] Open
Abstract
The principles of minimally invasive dentistry clearly dictate the need for clinically effective measures to remineralize early enamel caries lesions. While fluoride-mediated remineralization is the cornerstone of current caries management philosophies, a number of new remineralization strategies have been commercialized or are under development that claim to promote deeper remineralization of lesions, reduce the potential risks associated with high-fluoride oral care products, and facilitate caries control over a lifetime. These non-fluoride remineralizing systems can be broadly categorized into biomimetic enamel regenerative technologies and the approaches that repair caries lesions by enhancing fluoride efficacy. This paper discusses the rationale for non-fluoride remineralization and the mechanism of action, challenges, and evidence behind some of the most promising advances in enamel remineralization therapies.
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Affiliation(s)
- Nebu Philip
- School of Dentistry, University of Queensland, Brisbane, Queensland, Australia,
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Fernández-Ferrer L, Vicente-Ruíz M, García-Sanz V, Montiel-Company JM, Paredes-Gallardo V, Almerich-Silla JM, Bellot-Arcís C. Enamel remineralization therapies for treating postorthodontic white-spot lesions: A systematic review. J Am Dent Assoc 2018; 149:778-786.e2. [PMID: 30007454 DOI: 10.1016/j.adaj.2018.05.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/26/2018] [Accepted: 05/13/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND One of the adverse effects of orthodontic treatment is the appearance of white-spot lesions (WSLs) resulting from enamel demineralization. The objective of this systematic review was to investigate the effectiveness of remineralization therapies on WSLs after orthodontic treatment. TYPES OF STUDIES REVIEWED In this systematic review, the authors identified relevant articles listed in 5 databases-PubMed, the Cochrane Library, Scopus, Embase, and Web of Science-by using a combination of search terms referring to orthodontics, demineralization, and treatment. Ten articles on the efficacy of WSL remineralization therapies met the inclusion criteria. RESULTS Among the studies of remineralizing therapy, neither fluoride mouthrinses nor phosphopeptide toothpastes with or without fluoride had any positive effect in addition to oral hygiene maintenance with fluoride toothpaste. A 5% sodium fluoride varnish was the only therapy to show a statistically significant improvement compared with results in the control group. The authors found large variations in results among the studies reviewed because of the different methods used. CONCLUSIONS AND PRACTICAL IMPLICATIONS None of the treatments was capable of remineralizing WSLs. A 5% sodium fluoride varnish could improve remineralization of WSLs.
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Increasing the efficiency of CPP-ACP to remineralize enamel white spot lesions. J Dent 2018; 76:52-57. [PMID: 29933004 DOI: 10.1016/j.jdent.2018.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 06/13/2018] [Accepted: 06/18/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To compare the remineralization efficacy of using the MI paste plus according to manufacturer's instructions to MI varnish and to using a modified method of MI-paste plus application. MATERIALS AND METHODS 100 enamel specimens were obtained from the buccal and lingual surfaces of 50 extracted human non-caries third molars. All specimens were challenged by a buffered demineralization solution for 4 days, and were divided in 4 groups with 25 specimens in each group. 25 demineralized specimens had MI paste plus applied for 4 min and then wiped out (MI), 25 specimens had MI paste applied followed by application of SE-bonding agent (MI + Bond), 25 specimens had MI Varnish applied according to manufacturer instructions (MI Varnish) the rest of specimens served as controls (C). All specimens were stored for 7 days in artificial saliva. All specimens had their surface hardness (SH) measured by micro-hardness tester before/after the acidic challenge and after the treatment procedures. After the SH test all specimens were crosssectioned to obtain 100-150 micron thickness specimens to observe the lesion depth before/after treatment by the TMR (Transverse Micro Radiography) technique. RESULTS TMR experiment showed that (MI + Bond) and (MI varnish) groups recorded significant decrease in lesion depth and mineral loss of the tested subsurface lesion p < 0.05. (MI + Bond) group scored the highest significant regain of surface micro hardness results p < 0.05. CONCLUSION (MI varnish) and the modified application of MI paste are methods that can increase the efficacy of CPP-ACP in remineralizing the enamel surface lesions.
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