In vitro demineralization/remineralization cycles at human tooth enamel surfaces investigated by AFM and nanoindentation

Correlative Atomic Force Microscopy and Raman Spectroscopy in Acid Erosion of Dentin

Physical properties and chemical composition are fundamentally defining and interconnected surface characteristics. However, few techniques are able to capture both in a correlative fashion at the same sample location and orientation. This is especially important for complex materials such as dentin, which is an inner tooth structure and is a heterogeneous, composite inorganic-organic material with open channels (tubules) that extend toward the tooth pulp. Here, a combined microscope system consisting of an atomic force microscope and a confocal Raman spectrometer was used to study the correlative physical and chemical properties of human dentin. The local hardness of dentin was highly correlated with the Raman signal ratio of inorganic to organic material, and this was enhanced in the peritubular regions of dentin. When the samples were etched with citric acid, Young's modulus, hardness, and inorganic-to-organic material ratio decreased significantly, collagen fibrils on the surface were exposed, the peritubular regions were removed, and the tubule diameters increased. Thus, the combined atomic force microscopy (AFM)-Raman approach allows for comprehensive and correlative physical-chemical analysis of material surfaces and will be invaluable for evaluating oral therapeutic strategies.

Ex-vivo analysis of demineralisation on irradiated teeth using optical coherence tomography

Head and neck cancer patients are prone to dental caries after radiotherapy. An ex-vivo study was conducted to assess the feasibility of optical coherence tomography (OCT) to detect tooth demineralization due to caries in irradiated teeth. Thirty-nine human molar teeth were subjected to caries lesion induction through irradiation (Group 1), pH cycling (Group 2-1), and both (Group 2-2). The OCT signal attenuation coefficient, µR was assessed and validated against microhardness test and scanning electron microscope (SEM). The µR for Group 1 increased from 10 Gy to 40 Gy, and subsequently decreased after irradiated to 50 Gy and 60 Gy due to damaged enamel microstructure. In Group 2-1, the µR decreased with duration of pH cycling from day 1 to day 14 due to the increase of porosity in enamel layer. However, the µR showed decreasing trend from day 14 to day 28 of pH cycling, resulted from mineral deposition in the enamel layer. Although no significant difference was found in the µR between Group 2-1 and 2-2, SEM of Group 2-2 demonstrated visually higher porosity and larger gaps between microstructures. Irradiation may accelerate caries damage to tooth microstructure by increasing its porosity and brittleness, but larger sample size may be needed to further prove the effect. OCT could potentially be used for early detection of tooth demineralization in vivo based on the measurable µR changes for all groups which are shown negatively correlated with microhardness value (p < 0.05).

Fatigue and wear of human tooth enamel: A review

Human tooth enamel must withstand the cyclic contact forces, wear, and corrosion processes involved with typical oral functions. Furthermore, unlike other human tissues, dental enamel does not have a significant capacity for healing or self-repair and thus the longevity of natural teeth in the oral environment depends to a large degree on the fatigue and wear properties of enamel. The purpose of this review is to provide an overview of our understanding of the fatigue and wear mechanisms of human enamel and how they relate to in vivo observations of tooth damage in the complex oral environment. A key finding of this review is that fatigue and wear processes are closely related. For example, the presence of abrasive wear particles significantly lowers the forces needed to initiate contact fatigue cracking while subsurface fatigue crack propagation drives key delamination wear mechanisms during attrition or attrition-corrosion of enamel. Furthermore, this review seeks to bring a materials science and mechanical engineering perspective to fatigue and wear phenomena. In this regard, we see developing a mechanistic description of fatigue and wear, and understanding the interconnectivity of the processes, as essential for successfully modelling enamel fatigue and wear damage and developing strategies and treatments to improve the longevity of our natural teeth. Furthermore, we anticipate that this review will stimulate ideas for extending the lifetime of the natural tooth structure and will help highlight where our understanding is too limited and where additional research into fatigue and wear of human tooth enamel is warranted.

Xylitol Fluoride Varnish: In Vitro Effect Analysis on Enamel by Atomic Force Microscopy

(1) Background: Numerous studies have shown the beneficial role of fluoride in the primary prevention of dental caries. The aim of the present study was to put into evidence the change in the enamel structure immediately after the application of a fluoride varnish. (2) Methods: A xylitol−fluoride varnish was evaluated. The enamel specimens (n = 10) were analyzed by atomic force microscopy on enamel surface and treatment with fluoride varnish applied. The dimensional topographic analysis was performed by 2D and 3D analysis software. Statistical analysis was performed using SPSS Version 26.00 (IBM, Armonk, NY, USA). A one-sample statistics test was used to identify significant differences (p < 0.05). (3) Results: Surface roughness (Ra) measurements ranged from Ra = 0.039 μm (±0.048), to Ra = 0.049 μm (±0.031), respectively (p < 0.05), with an increase in the surface roughness passing from the intact enamel to the enamel exposed to fluoride varnish. When comparing Ra values of the nonfluorinated enamel and fluorinated enamel, significant differences (p < 0.05) were found, suggesting that the varnish had a protective effect on the enamel surface. (4) Conclusions: Xylitol−fluoride varnish, even in one single short-time application, is effective in reducing the surface roughness of enamel structure exposed to abrasion, thus increasing resistance to dental caries.

Effectiveness of Self-Assembling Peptide (P11-4) in Dental Hard Tissue Conditions: A Comprehensive Review

The limitations on the use of fluoride therapy in dental caries prevention has necessitated the development of newer preventive agents. This review focusses on the recent and significant studies on P11-4 peptide with an emphasis on different applications in dental hard tissue conditions. The self-assembling peptide P11-4 diffuses into the subsurface lesion assembles into aggregates throughout the lesion, supporting the nucleation of de novo hydroxyapatite nanocrystals, resulting in increased mineral density. P11-4 treated teeth shows more remarkable changes in the lesion area between the first and second weeks. The biomimetic remineralisation facilitated in conjunction with fluoride application is an effective and non-invasive treatment for early carious lesions. Despite, some studies have reported that the P11-4 group had the least amount of remineralised enamel microhardness and a significantly lower mean calcium/phosphate weight percentage ratio than the others. In addition, when compared to a low-viscosity resin, self-assembling peptides could neither inhibit nor mask the lesions significantly. Moreover, when it is combined with other agents, better results can be achieved, allowing more effective biomimetic remineralisation. Other applications discussed include treatment of dental erosion, tooth whitening and dentinal caries. However, the evidence on its true clinical potential in varied dental diseases still remains under-explored, which calls for future cohort studies on its in vivo efficacy.

Effect of Bioactive Glass-Containing Light-Curing Varnish on Enamel Remineralization

This study aimed to evaluate the effect of novel experimental light-curing bioactive glass (BAG)-containing varnish on enamel remineralization. An experimental light-curing, BAG-containing varnish and two commercial varnishes (Nupro White Varnish; Dentsply International, York, PA, USA and Tooth Mousse; GC Corporation, Tokyo, Japan) were used. Microhardness tests (n = 3), field emission scanning electron microscopy (FE-SEM) coupled with energy dispersive X-ray spectroscopy (EDS) (n = 5), and X-ray diffraction (XRD) analysis (n = 5) were performed to compare the remineralization effect of three varnishes with and without ultrasonication. The data of microhardness test were analyzed using one-way ANOVA and Tukey's post hoc comparison (P < 0.05). Microhardness of demineralized enamel increased after the application of three varnishes (P < 0.05). The experimental BAG-containing varnish showed the highest microhardness among the three varnishes (P < 0.05). Ultrasonication decreased microhardness of Tooth Mousse and BAG-containing varnish groups (P < 0.05). FE-SEM and XRD revealed precipitates of hydroxyapatite (HAP) or fluorapatite (FAP) crystals of three varnishes. The novel experimental BAG-containing varnish may be a promising clinical strategy for the remineralization of early carious lesions or demineralized enamel surfaces.

Comparison of dynamic mechanical properties of dentin between deciduous and permanent teeth

Purpose: Even though differences between deciduous and permanent dentin have been widely studied, their dynamic mechanical behavior has never been compared. The objective of the present study was to quantify the differences between deciduous and permanent dentin under cyclic mechanical loading, which is similar to masticatory stress.Materials and Methods: Deciduous and permanent teeth, respectively from children (9 ~ 12 years old) and young people (18 ~ 25 years old), were wet-sectioned perpendicular to the longitudinal axis and the central specimens of coronal dentin were evaluated by nanoscopic dynamic mechanical analysis (nanoDMA).Results: The average storage, loss, and complex moduli, as well as the hardness of deciduous dentin were significantly (p < 0.05) lower than those of permanent dentin. Moreover, the tan δ value of permanent dentin was significantly (p < 0.05) lower than that of deciduous dentin across the loading frequency range, indicating that viscoelastic behavior and loss of elastic energy were significantly reduced in the stiffer permanent dentin. All the nanoDMA responses showed a significant influence of the dynamic loading frequency (p < 0.05): Both deciduous and permanent dentin showed reduced viscoelasticty with increased loading frequencies.Conclusions: Compared with deciduous dentin, permanent dentin exhibits higher stiffness with reduced energy loss during deformation, and therefore superior mechanical characteristics for the mastication process.

Baseline Specimens of Erosion and Abrasion Studies

The difficulty in obtaining human teeth that are caries-free that have similar environmental exposure, e.g., diet intake and water fluoridation has lead researchers to opt for bovine teeth as a substitute for erosion studies. Bovine mandibular incisors are readily available at abattoirs and often originate from the same region and are likely to consume similar dietary intake. The bovine teeth for erosion or abrasion studies usually undergo specimen preparation to produce a "flat surface" baseline specimen. Among other terms used to define baseline specimens for erosion and abrasion studies include phrases like "optically flat" and "flat and smooth surface." However, these terms might have no quantitative value as it does not justify the actual surface characteristics of the prepared flattened surface. In dentistry, roughness average (Ra) is the most commonly used parameter when reporting the roughness of specimens Reporting Ra alone might not be sufficient as it does not provide information regarding the surface texture as there is no distinction between valleys and peaks, nor does it provide information about the core structure of a material unlike the bearing area curve. The incorporation of Ra and BAP values in baseline specimens has the potential in predicting the wear or lubricating potential of these specimens. Furthermore, standardization of baseline specimens by acknowledging its surface roughness values ensures comparability of erosion and abrasion studies as different specimen preparation technique might influence the outcome or results of research.

Surface degradation effects of carbonated soft drink on a resin based dental compound

Dental compounds and restorative materials undergo surface degradation and erosion from exposure to a variety of dietary substances. In this study we investigated changes in the surface properties of Rebaron, a hard denture reline material (HDRM), following timed immersion in carbonated soft drinks to determine its durability in a common acidic environment. Samples were prepared and immersed in a carbonated soft drink (or its components) for 6, 12, or 24 h. Surface structure and mechanical properties were characterized using Atomic Force Microscopy (AFM). Raman spectroscopy was used to identify changes in the HDRM surface chemistry following exposure to the test solutions. AFM revealed that prolonged exposure led to pit formation and a subsequent increase in surface roughness, from 302.02 ± 30.20 to 430.59 ± 15.07 nm Ra, following a 24 h exposure. Young's modulus values decreased from 9.3 ± 7.0 to 0.53 ± 0.26 GPa under the same conditions, demonstrating a softening and embrittlement of the HDRM sample. Raman results revealed that immersion in the carbonated soft drink or acidic solution changed the nature of the HDRM structure, converting the HDRM surface chemistry from primarily hydrophobic to hydrophilic. Our study indicates that sustainability and durability of Rebaron HDRM are significantly reduced by prolonged exposure to carbonated (acidic) soft drink, resulting in deformation and degradation of the material surface.

Characterization of Enamel and Dentine about a White Spot Lesion: Mechanical Properties, Mineral Density, Microstructure and Molecular Composition

The study focuses on in vitro tracing of some fundamental changes that emerge in teeth at the initial stage of caries development using multiple approaches. The research was conducted on a mostly sound maxillary molar tooth but with a clearly visible natural proximal white spot lesion (WSL). Values of mineral density, reduced Young's modulus, indentation hardness and creep as well as the molecular composition and surface microstructure of the WSL and bordering dentine area were studied. The results obtained were compared to those of sound enamel and dentine on the same tooth. A decrease of mechanical properties and mineral density both for the WSL and bordering dentine was detected in comparison to the sound counterparts, as well as increase of creep for the enamel WSL. Differences in molecular composition and surface microstructure (including the indenter impressions) were found and described. WSL induces a serious change in the state of not only the visually affected enamel but also surrounding visually intact enamel and dentine in its vicinity. The results provide the basis for future studies of efficacy of minimal invasive treatments of caries.

Comprehensive analysis of laserscanner validity used for measurement of wear

OBJECTIVES

The aims of this study were to test the hypotheses that (a) a laserscanner used for measuring maximum depth and volume loss will yield the same results as a surface profilometer; (b) the surface roughness will affect the maximum depth and volume loss measured with the laserscanner; (c) analytical results using the laserscanner from multiple operators have no more than 10% inter-rater difference and; (d) replicating samples using either stone or impression material is an accurate method for measuring wear using the laserscanner.

MATERIALS AND METHODS

The volume and maximum depth of indentations from fine, medium and rough burs on glass-ceramic disks were measured using two devices, a surface profilometer (Dektak II, Veeco) and a 3D Laserscanner (LAS-20, SD Mechatronik). Replicates of the indentations made from polyvinysiloxane impression material and gypsum were also measured.

RESULTS

Comparison of profilometer and laserscanner readings using ceramic disks demonstrated a mean error of 13.61% for depth and 25.32% for volume. Replication errors were minimal (2.6% for impression, 2.5% for stone). Surface profilometer data for volume measurements revealed a difference of 6.1% for impression and 6.5% for stone compared with ceramics. However, when measurements for replicates were compared between laserscanner and surface profilometer, depth had a mean error of 74% for impression and 51% for stone. Volume differences of 78% for impression and 44% for stone were recorded.

CONCLUSION

This work demonstrated that the laserscanner was a convenient device for measuring wear but there is a need to validate the accuracy of the measurements.

Enamel sample preparation for AFM: Influence on roughness and morphology

Human dental enamel is organized by prisms that are structured between 3 and 6 µm in diameter. Determining the relationships between different treatments on the surface of enamel using ultrastructural analysis is the purpose of many in vitro experiments. Different sample pretreatments have been reported in the literature. Grinding and polishing are common procedures for enamel preparation. They provide a flat and standardized surface, which is imperative for the use of some techniques such as ATR-FTIR. However, for morphological analysis, SEM and AFM represent easier methods to measure and reduce the biological sample variation. Therefore, the objective of this study was to establish how different forms of enamel preparation can influence the advent of artifacts during ultrastructural observation, especially by AFM analysis. Four groups (n = 10) were tested: (a) without preparation; (b) polishing with a diamond paste; (c) grinding with decreasing granulations of silicon carbide papers; (d) grinding with polishing. Images were obtained using the Peak-Force Tapping mode. After the first images were obtained, all fragments were acid etched with 37% phosphoric acid for 30 seconds, rinsed for 60 seconds, and dried intensively. Upon grinding and polishing, the exposure of the inner enamel surfaces provided a less mineralized layer that was marked by scratches and a higher susceptibility to treatments. Moreover, using native enamel provided more valuable information on the surface and the roughness changes for clinical applications. In addition, phosphoric acid is an option for observing the prismatic arrangement after grinding and/or polishing changes the morphology. RESEARCH HIGHLIGHTS: The use of native enamel samples to investigate the effects of different treatments on surface should be preferred in research, when the technique allows it.

Hierarchical Biomineralization: from Nature's Designs to Synthetic Materials for Regenerative Medicine and Dentistry

Biomineralization is a highly dynamic, yet controlled, process that many living creatures employ to develop functional tissues such as tooth enamel, bone, and others. A major goal in materials science is to create bioinspired functional structures based on the precise organization of building blocks across multiple length scales. Therefore, learning how nature has evolved to use biomineralization could inspire new ways to design and develop synthetic hierarchical materials with enhanced functionality. Toward this goal, this review dissects the current understanding of structure-function relationships of dental enamel and bone using a materials science perspective and discusses a wide range of synthetic technologies that aim to recreate their hierarchical organization and functionality. Insights into how these strategies could be applied for regenerative medicine and dentistry are also provided.

Review of potential health risks associated with nanoscopic calcium phosphate

Calcium phosphate is applied in many products in biomedicine, but also in toothpastes and cosmetics. In some cases, it is present in nanoparticulate form, either on purpose or after degradation or mechanical abrasion. Possible concerns are related to the biological effect of such nanoparticles. A thorough literature review shows that calcium phosphate nanoparticles as such have no inherent toxicity but can lead to an increase of the intracellular calcium concentration after endosomal uptake and lysosomal degradation. However, cells are able to clear the calcium from the cytoplasm within a few hours, unless very high doses of calcium phosphate are applied. The observed cytotoxicity in some cell culture studies, mainly for unfunctionalized particles, is probably due to particle agglomeration and subsequent sedimentation onto the cell layer, leading to a very high local particle concentration, a high particle uptake, and subsequent cell death. There is no risk from an oral uptake of calcium phosphate nanoparticles due to their rapid dissolution in the stomach. The risk from dermal or mucosal uptake is very low. Calcium phosphate nanoparticles can enter the bloodstream by inhalation, but no adverse effects have been observed, except for a prolonged exposition to high particle doses. Calcium phosphate nanoparticles inside the body (e.g. after implantation or due to abrasion) do not pose a risk as they are typically resorbed and dissolved by osteoclasts and macrophages. There is no indication for a significant influence of the calcium phosphate phase or the particle shape (e.g. spherical or rod-like) on the biological response. In summary, the risk associated with an exposition to nanoparticulate calcium phosphate in doses that are usually applied in biomedicine, health care products, and cosmetics is very low and most likely not present at all.

STATEMENT OF SIGNIFICANCE

Calcium phosphate is a well-established biomaterial. However, there are occasions when it occurs in a nanoparticulate form (e.g. as nanoparticle or as nanoparticulate bone substitution material) or after abrasion from a calcium phosphate-coated metal implant. In the light of the current discussion on the safety of nanoparticles, there have been concerns about potential adverse effects of nano-calcium phosphate, e.g. in a statement of a EU study group from 2016 about possible dangers associated with non-spherical nano-hydroxyapatite in cosmetics. In the US, there was a discussion in 2016 about the dangers of nano-calcium phosphate in babyfood. In this review, the potential exposition routes for nano-calcium phosphate are reviewed, with special emphasis on its application as biomaterial.

Preventive effects of different protective agents on dentin erosion: An in vitro investigation

Background

The purpose of this in vitro study was to evaluate the preventive effects of different protective agents on dentine erosion, measuring mean percentage weight loss. Dissolution of dentine under erosive challenges caused by soft drinks was analyzed: specimens were weighed following each immersion period, with mean percent weight losses calculated.

Material and Methods

Extracted teeth were sectioned into uniform slabs. Seventy permanent enamel specimens were randomly distributed to seven groups. Initial weights of all dentin specimens were performed. The fluoride pastes Remin Pro, MI Paste Plus, Tooth Mousse, Biorepair, Biorepair Plus and Regenerate were used in this study. A control group was treated just with tap water. The specimens then were immersed in Coca-Cola for a total of 32 min at room temperature. Finally each specimen was dry and weighed. The mass loss was calculated as a percentage of that observed prior the fluoride pastes application. Weight loss data were subjected to Analysis of Variance (One-way ANOVA) followed by Bonferroni’s post hoc tests.

Results

Percent weight loss of specimens exposed to early stages in Coca-Cola showed linear progression with time. Specimen’s application of fluoridated varnishes such as Biorepair or Regenerate, prior immersion in Coca-Cola, significantly protect dentin from demineralization. Otherwise, application of Tooth Mousse or Biorepair Plus increased dentin demineralization starting from 24 min of immersion in Coca-Cola.

Conclusions

Despite the limitations of this study, the protective pastes that showed the less weight loss due to the acidic challenge are Biorepair and Regenerate.

Key words:Dentine, erosion, protective agents, soft drinks, toothpastes.

Effect of different salivary exposure times on the rehardening of acid-softened enamel

This in situ study assessed the effect of different times of salivary exposure on the rehardening of acid-softened enamel. Bovine enamel blocks were subjected in vitro to a short-term acidic exposure by immersion in 0.05 M (pH 2.5) citric acid for 30 s, resulting in surface softening. Then, 40 selected eroded enamel blocks were randomly assigned to 10 volunteers. Intraoral palatal appliances containing 4 enamel blocks were constructed for each volunteer, who wore the appliance for 12 nonconsecutive hours: initial 30 min, followed by an additional 30, and then by an additional 1 hour. For the last additional 10 hours the appliances were used at night, during the volunteers' sleep. Surface hardness was analyzed in the same blocks at baseline, after erosion and after each period of salivary exposure, enabling percentage of surface hardness recovery calculation (%SHR). The data were tested using repeated measures ANOVA and Tukey's test (α = 0.05). Increasing periods of salivary action promoted a progressive increase in the surface hardness (p < 0.001). However a similar degree of enamel rehardening (p = 0.641) was observed between 2 hours (49.9%) and 12 hours (53.3%) of salivary exposure. Two hours of salivary exposure seems to be appropriate for partial rehardening of the softened enamel surface. The use of the intraoral appliance during sleep did not improve the enamel rehardening after erosion.

Composites of fluoroapatite and methylmethacrylate-based polymers (PMMA) for biomimetic tooth replacement

Synthetic composite materials that mimic the structure and composition of mammalian tooth enamel were prepared by mixing fluoroapatite rods (diameter 2-3 μm, thickness about 0.5 μm) and methylmethacrylate (MMA), followed by polymerization either during or immediately after ultracentrifugation, using either a tertiary amine/radical initiator for polymerization at room temperature or a radical initiator for thermal polymerization. This led to mineral-rich composites (mineral content between 50 and 75 wt%). To enhance the mechanical stability and the interaction between fluoroapatite and polymer matrix, small amounts of differently functionalized MMA monomers were added to the co-monomer mixture. Another approach was the coating of the fluoroapatite rods with silica and the polymerization in the presence of a siloxane-functionalized MMA monomer. The hardness of the composites was about 0.2-0.4 GPa as determined by Vickers indentation tests, about 2 times higher than the polymer matrix alone. The composites had a good resistance against acids (60 min at pH 3, 37 °C).

Effect of Fluoride-Releasing Adhesive Systems on the Mechanical Properties of Eroded Dentin

Abstract The aim of the study was to evaluate the effect of erosive pH cycling with solutions that simulate dental erosion on Martens hardness (HMV) and elastic modulus (Eit) of dentin restored with fluoride-releasing adhesive systems. Twenty-seven bovine dentin slabs were restored with three adhesive systems: Adper Single Bond 2 total-etch adhesive system, One Up Bond F and Clearfil SE Protect fluoride-containing self-etching adhesive systems. The restorations were made with Filtek Z250. The HMV and Eit values at distances of 10, 30, 50 and 70 µm from the interface were evaluated using a dynamic ultra microhardness tester before and after immersion in deionized water, citric acid and hydrochloric acid (n=9). Data were submitted to repeated-measures ANOVA and Fisher's PLSD tests (=0.05). After erosive cycling, HMV values of dentin decreased in all groups. For dentin restored with Adper Single Bond 2, the lowest values were found closer to the hybrid layer, while for One Up Bond F and Clearfil SE Protect, the values remained unaltered at all distances. For dentin restored with fluoride-releasing adhesive systems, a decrease in Eit was found, but after 30 µm this difference was not significant. The acid substances were able to alter HMV and Eit of the underlying dentin. For fluoride-releasing adhesives, the greater the distance from bonded interface, the lower the Eit values. The fluoride in One Up Bond F and Clearfil SE Protect was able to protect the underlying dentin closer to the materials. In this way, the fluoride from adhesive systems could have some positive effect in the early stages of erosive lesions.

Artificial Saliva Formulations versus Human Saliva Pretreatment in Dental Erosion Experiments

The aim of this study was to evaluate the erosion-preventive effect of different artificial saliva formulations and human saliva in vitro compared to human saliva in situ. In the in vitro experiment, bovine enamel and dentin specimens were stored in artificial saliva (4 different formulations, each n = 20), deionized water (n = 20) or human saliva (n = 6 enamel and dentin specimens/volunteer) for 120 min. In the in situ experiment, each of the 6 enamel and dentin specimens was worn intraorally by 10 volunteers for 120 min. The specimens were then eroded (HCl, pH 2.6, 60 s). Half of the specimens were subjected to microhardness analysis (enamel) and the determination of calcium release into the acid (enamel and dentin), while the other half were again placed in the respective medium or worn intraorally, respectively, for 120 min before a second erosion was performed. Knoop microhardness of enamel and the calcium release of enamel and dentin into the acid were again determined. Statistical analysis was conducted by two-way repeated-measures ANOVA or two-way ANOVA (α = 0.05). Enamel microhardness was not significantly different between all test groups after the first and the second erosive challenge, respectively. Enamel calcium loss was significantly lower in situ compared to the in vitro experiment, where there was no significant difference between all test groups. Dentin calcium loss was significantly lower than deionized water only after the first and than all except one artificial saliva after the second erosion. Under the conditions of this experiment, the use of artificial saliva formulations and human saliva in vitro does not reflect the intraoral situation in dental erosion experiments adequately.

Calcium orthophosphates (CaPO4): occurrence and properties

The present overview is intended to point the readers' attention to the important subject of calcium orthophosphates (CaPO4). This type of materials is of the special significance for the human beings because they represent the inorganic part of major normal (bones, teeth and antlers) and pathological (i.e., those appearing due to various diseases) calcified tissues of mammals. For example, atherosclerosis results in blood vessel blockage caused by a solid composite of cholesterol with CaPO4, while dental caries and osteoporosis mean a partial decalcification of teeth and bones, respectively, that results in replacement of a less soluble and harder biological apatite by more soluble and softer calcium hydrogenorthophosphates. Therefore, the processes of both normal and pathological calcifications are just an in vivo crystallization of CaPO4. Similarly, dental caries and osteoporosis might be considered as in vivo dissolution of CaPO4. In addition, natural CaPO4 are the major source of phosphorus, which is used to produce agricultural fertilizers, detergents and various phosphorus-containing chemicals. Thus, there is a great significance of CaPO4 for the humankind and, in this paper, an overview on the current knowledge on this subject is provided.

Monitoring Demineralization and Subsequent Remineralization of Human Teeth at the Dentin-Enamel Junction with Atomic Force Microscopy

Using atomic force microscopy, we monitored the nanoscale surface morphology of human teeth at the dentin-enamel junction after performing successive demineralization steps with an acidic soft drink. Subsequently, we studied the remineralization process with a paste containing calcium and phosphate ions. Repeated atomic force microscopy imaging of the same sample areas on the sample allowed us to draw detailed conclusions regarding the specific mechanism of the demineralization process and the subsequent remineralization process. The about 1-μm-deep grooves that are caused by the demineralization process were preferentially filled with deposited nanoparticles, leading to smoother enamel and dentine surfaces after 90 min exposure to the remineralizing agent. The deposited material is found to homogeneously cover the enamel and dentine surfaces in the same manner. The temporal evolution of the surface roughness indicates that the remineralization caused by the repair paste proceeds in two distinct successive phases.

Dental lessons from past to present: ultrastructure and composition of teeth from plesiosaurs, dinosaurs, extinct and recent sharks

Sharks and dinosaurs used fluoroapatite in their teeth, unlike their contemporary relatives, as shown by a comprehensive analysis of the composition and structure of their fossilized teeth.

Preventive effect of different toothpastes on enamel erosion: AFM and SEM studies

The aim of the present in vitro study was the evaluation of new formulation toothpastes on preventing enamel erosion produced by a soft drink (Coca Cola), using atomic force microscopy (AFM) and scanning electron microscopy (SEM). Fifty enamel specimens were assigned to 10 groups of 5 specimens each. 1: intact enamel, 2: enamel + soft drink, 3: intact enamel + BioRepair Plus-Sensitive Teeth, 4: enamel + soft drink + BioRepair Plus-Sensitive Teeth, 5: intact enamel + BioRepair Plus-Total Protection, 6: enamel + soft drink + BioRepair Plus-Total Protection, group 7: intact enamel + Sensodyne Repair & Protect, 8: dentin + soft drink + Sensodyne Repair & Protect, 9: intact dentin + Colgate Sensitive Pro Relief, 10: dentin + soft drink + Colgate Sensitive Pro Relief. The surface of each specimen was imaged by AFM and SEM. The root mean-square roughness (Rrms ) was obtained from the AFM images and the differences in the averaged values among the groups were analyzed by ANOVA test. Comparing groups 4, 6, 8, 10 (soft drink + toothpastes) Colgate Sensitive Pro Relief promoted enamel remineralization, while BioRepair Plus-Sensitive Teeth, Biorepair Plus-Total Protection and Sensodyne Repair & Protect provided lower effectiveness in protecting enamel against erosion.

SIGNIFICANCE

the use of new formulation toothpastes can prevent enamel demineralization.

Exploring the retention properties of CaF2 nanoparticles as possible additives for dental care application with tapping-mode atomic force microscope in liquid

Amplitude-modulation atomic force microscopy (AM-AFM) is used to determine the retention properties of CaF2 nanoparticles adsorbed on mica and on tooth enamel in liquid. From the phase-lag of the forced cantilever oscillation the local energy dissipation at the detachment point of the nanoparticle was determined. This enabled us to compare different as-synthesized CaF2 nanoparticles that vary in shape, size and surface structure. CaF2 nanoparticles are candidates for additives in dental care products as they could serve as fluorine-releasing containers preventing caries during a cariogenic acid attack on the teeth. We show that the adherence of the nanoparticles is increased on the enamel substrate compared to mica, independently of the substrate roughness, morphology and size of the particles.

Analysis of dentin/enamel remineralization by a CPP-ACP paste: AFM and SEM study

The aim of the present in vitro study was the evaluation of a CPP-ACP paste on preventing dentin/enamel erosion produced by a soft drink; Atomic Force Microscopy and Scanning Electron Microscopy were used. Eighty extracted human incisors free of caries were selected and divided into four groups (each divided in two subgroups); group 1a: intact dentin; group 1b: dentin + soft drink; group 2a: intact dentin + CCP-ACP paste; group 2b: dentin + soft drink + CCP-ACP paste; group 3a: intact enamel; group 3b: enamel + soft drink; group 4a: intact enamel + CCP-ACP paste; group 4b: enamel + soft drink + CCP-ACP paste. The CPP-ACP paste was applied for 3 min at 0, 8, 24, and 36 h. The surface of each dentin/enamel specimen was imaged by AFM (Rrms values were registered) and SEM. A statistical significant difference was recorded between groups 1b (dentin + soft drink) and 2b (dentin + soft drink + CCP-ACP paste) and between groups 3b (enamel + soft drink) and 4b (enamel + soft drink + CCP-ACP paste), suggesting that treatment of the specimens with the CPP-ACP paste had a protective effect on enamel demineralization, which was more evident for enamel specimens. Under the limitations of the present in vitro study, it can be concluded that the application of a CPP-ACP paste is effective on preventing dentin/enamel erosion produced by a soft drink.

Calcium orthophosphates in dentistry

Dental caries, also known as tooth decay or a cavity, remains a major public health problem in the most communities even though the prevalence of disease has decreased since the introduction of fluorides for dental care. Therefore, biomaterials to fill dental defects appear to be necessary to fulfill customers' needs regarding the properties and the processing of the products. Bioceramics and glass-ceramics are widely used for these purposes, as dental inlays, onlays, veneers, crowns or bridges. Calcium orthophosphates belong to bioceramics but they have some specific advantages over other types of bioceramics due to a chemical similarity to the inorganic part of both human and mammalian bones and teeth. Therefore, calcium orthophosphates (both alone and as components of various formulations) are used in dentistry as both dental fillers and implantable scaffolds. This review provides brief information on calcium orthophosphates and describes in details current state-of-the-art on their applications in dentistry and dentistry-related fields. Among the recognized dental specialties, calcium orthophosphates are most frequently used in periodontics; however, the majority of the publications on calcium orthophosphates in dentistry are devoted to unspecified "dental" fields.

Saliva and dental erosion

Dental erosion is a multifactorial condition. The consideration of chemical, biological and behavioral factors is fundamental for its prevention and therapy. Among the biological factors, saliva is one of the most important parameters in the protection against erosive wear.

OBJECTIVE

This review discusses the role of salivary factors on the development of dental erosion.

MATERIAL AND METHODS

A search was undertaken on MeDLINe website for papers from 1969 to 2010. The keywords used in the research were "saliva", "acquired pellicle", "salivary flow", "salivary buffering capacity" and "dental erosion". Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were solved by discussion and consensus or by a third party.

RESULTS

Several characteristics and properties of saliva play an important role in dental erosion. Salivary clearance gradually eliminates the acids through swallowing and saliva presents buffering capacity causing neutralization and buffering of dietary acids. Salivary flow allows dilution of the acids. In addition, saliva is supersaturated with respect to tooth mineral, providing calcium, phosphate and fluoride necessary for remineralization after an erosive challenge. Furthermore, many proteins present in saliva and acquired pellicle play an important role in dental erosion.

CONCLUSIONS

Saliva is the most important biological factor affecting the progression of dental erosion. Knowledge of its components and properties involved in this protective role can drive the development of preventive measures targeting to enhance its known beneficial effects.

Mechano-morphological studies of aligned nanofibrous scaffolds of polycaprolactone fabricated by electrospinning

Mechanical and morphological studies of aligned nanofibrous meshes of poly(epsilon-caprolactone) (PCL) fabricated by electrospinning at different collector rotation speeds (0, 3000 and 6000 rpm) for application as bone tissue scaffolds are reported. SEM, XRD and DSC analyses were used for the morphological characterization of the nanofibers. Scaffolds have a nanofibrous morphology with fibers (majority) having a diameter in the range of 550-350 nm (depending on fiber uptake rates) and an interconnected pore structure. With the increase of collector rotation speed, the nanofibers become more aligned and oriented perpendicular to the axis of rotation. Deposition of fibers at higher fiber collection speeds has a profound effect on the morphology and mechanical properties of individual fibers and also the bulk fibrous meshes. Nanoindentation was used for the measurement of nanoscopic mechanical properties of individual fibers of the scaffolds. The hardness and Young's modulus of aligned fibers measured by nanoindentation decreased with collector rotation speeds. This reveals the difference in the local microscopic structure of the fibers deposited at higher speeds. The sequence of nanoscopic mechanical properties (hardness and modulus) of three fibers is PCL at 0 rpm > PCL at 3000 rpm > PCL at 6000 rpm. This may be explained due to the decrease in crystallinity of fibers at higher uptake rates. However, uni-axial tensile properties of (bulk) scaffolds (tensile strength and modulus) increased with increasing collector rotation speed. The average ultimate tensile strength of scaffolds (along the fiber alignment) increased from 2.21 +/- 0.23 MPa for PCL at uptake rate of zero rpm, to a value of 4.21 +/- 0.35 MPa for PCL at uptake rate of 3000 rpm and finally to 9.58 +/- 0.71 MPa for PCL at 6000 rpm. Similarly, the tensile modulus increased gradually from 6.12 +/- 0.8 MPa for PCL at uptake rate of zero rpm, to 11.93 +/- 1.22 MPa for PCL at uptake rate of 3000 rpm and to 33.20 +/- 1.98 MPa for PCL at 6000 rpm. The sequence of macroscopic mechanical properties (tensile strength and modulus) of three fibers, from highest to lowest, is PCL at 0 rpm < PCL at 3000 rpm < PCL at 6000 rpm. This is attributed to the increased fiber alignment and packing and decrease in inter-fiber pore size at higher uptake rates.

Calcium orthophosphates: occurrence, properties, biomineralization, pathological calcification and biomimetic applications

The present overview is intended to point the readers' attention to the important subject of calcium orthophosphates. This type of materials is of special significance for human beings, because they represent the inorganic part of major normal (bones, teeth and antlers) and pathological (i.e., those appearing due to various diseases) calcified tissues of mammals. For example, atherosclerosis results in blood vessel blockage caused by a solid composite of cholesterol with calcium orthophosphates, while dental caries and osteoporosis mean a partial decalcification of teeth and bones, respectively, that results in replacement of a less soluble and harder biological apatite by more soluble and softer calcium hydrogenphosphates. Therefore, the processes of both normal and pathological calcifications are just an in vivo crystallization of calcium orthophosphates. Similarly, dental caries and osteoporosis might be considered an in vivo dissolution of calcium orthophosphates. Thus, calcium orthophosphates hold a great significance for humankind, and in this paper, an overview on the current knowledge on this subject is provided.

The addition of nano-sized hydroxyapatite to a sports drink to inhibit dental erosion: in vitro study using bovine enamel

OBJECTIVES

This study examined the dental erosion and demineralization potential of a sports drink containing nano-sized hydroxyapatite (nano-HA) as an additive.

METHODS

The experimental solutions were Powerade (PA) alone and PA with 0.05%, 0.10%, and 0.25% nano-HA. The pH, titratable acidity, and calcium and phosphate content of each solution were analysed, and the degree of saturation with respect to the dental enamel (DS(En)) was obtained. Twelve sound bovine enamel specimens for each group were treated in accordance with the pH-cycling schedule which had 60min treatment with experimental solution per day for 7 days. The erosion potential was determined from the changes in surface micro hardness (SMH), the depths of erosion and demineralized layer using confocal laser scanning microscopy (CLSM), and the morphological changes to the tooth surface were examined with scanning electron microscopy (SEM) after pH-cycling.

RESULTS

pH and DS(En) increased with increasing nano-HA concentration in the drinks, whereas the titratable acidity decreased. There were significant differences in the SMH between the PA alone and >0.10% nano-HA groups (p<0.001). Although the PA alone group showed a pronounced erosion depth, CLSM showed no erosion depth in 0.25% nano-HA group. SEM showed an intact surface with increasing nano-HA concentration in the drinks. In conclusion, dental erosion was effectively prevented with increase of adding concentration of nano-HA, and a sports drink containing 0.25% nano-HA might prevent dental erosion.

Laser ultrasonic evaluation of human dental enamel during remineralization treatment

In this work a non-destructive laser ultrasonic technique is used to quantitatively evaluate the progressive change in the elastic response of human dental enamel during a remineralization treatment. The condition of the enamel was measured during two weeks treatment using laser generated and detected surface acoustic waves in sound and demineralized enamel. Analysis of the acoustic velocity dispersion confirms the efficacy, as well as illuminating the progress, of the treatment.

Impact of two toothpastes on repairing enamel erosion produced by a soft drink: an AFM in vitro study

OBJECTIVES

The aim of the present in vitro study was the evaluation of two toothpastes (Sensodyne Pronamel and Biorepair Plus on repairing enamel erosion produced by a soft drink (Coca Cola), using Atomic Force Microscopy (AFM).

METHODS

Fifty extracted human central incisors free of caries were selected and divided in a treatment and a control half; they were kept in artificial saliva during whole experimentation. The treatment halves were divided into five groups; group 1: demineralization with soft drink; group 2: demineralization with soft drink + Pronamel; group 3: demineralization with soft drink + Biorepair Plus; group 4: intact enamel + Pronamel; group 5: intact enamel + Biorepair Plus. Specimen demineralization was carried on in 4 intervals of 2 min. In groups 2, 3, 4, and 5 the toothpastes were applied for 3 min at 0, 8, 24 and 36 h. The surface of each specimen was imaged by AFM and R(rms), root-mean-square roughness, and Maximum Depth of the cavities were registered.

RESULTS

Amongst treatment specimens of groups 1, 2, and 3 a statistically significant difference (P<0.01) in R(rms) and Maximum Depth values was registered: the toothpastes reduced enamel demineralization. No statistical differences in R(rms) values were registered between the two toothpastes.

CONCLUSIONS

The toothpastes tested (Pronamel and BioRepair Plus) offer a degree of protection from erosive drinks.

Resveratrol promotes osteogenic differentiation and protects against dexamethasone damage in murine induced pluripotent stem cells

Resveratrol is a natural polyphenol antioxidant that has been shown to facilitate osteogenic differentiation. A recent breakthrough has demonstrated that ectopic expression of four genes is sufficient to reprogram murine and human fibroblasts into induced pluripotent stem (iPS) cells. However, the roles of resveratrol in the differentiation and cytoprotection of iPS cells have never been studied. In this study, we showed that, in addition to cardiac cells, neuron-like cells, and adipocytes, mouse iPS cells could differentiate into osteocyte-like cells. Using atomic force microscopy that provided nanoscale resolution, we monitored mechanical properties of living iPS cells during osteogenic differentiation. The intensity of mineralization and stiffness in differentiating iPS significantly increased after 14 days of osteogenic induction. Furthermore, resveratrol was found to facilitate osteogenic differentiation in both iPS and embryonic stem cells, as shown by increased mineralization, up-regulation of osteogenic markers, and decreased elastic modulus. Dexamethasone-induced apoptosis in iPS cell-derived osteocyte-like cells was effectively prevented by pretreatment with resveratrol. Furthermore, resveratrol significantly increased manganese superoxide dismutase expression and intracellular glutathione level, thereby efficiently decreasing dexamethasone-induced reactive oxygen species (ROS) production and cytotoxicity. Transplantation experiments using iPS cell-derived osteocyte-like cells further demonstrated that oral intake of resveratrol could up-regulate osteopontin expression and inhibit teratoma formation in vivo. In sum, resveratrol can facilitate differentiation of iPS cells into osteocyte-like cells, protect these iPS cell-derived osteocyte-like cells from glucocorticoid-induced oxidative damage, and decrease tumorigenicity of iPS cells. These findings implicate roles of resveratrol and iPS cells in the stem cell therapy of orthopedic diseases.

Slanted orientations of dentine tubules on remineralized dentine surfaces

Dentine carious lesions can be remineralized under optimal conditions, while the surface characteristics of the caries-attacked area may play an important role in the remineralization process. To understand such a surface mechanism, we examined the microstructures of the remineralized area pretreated with different methods. It was found that dentinal tubules on the remineralized surface orientated differently from intrinsic dentine tubules, with the specific alignment angle determined by different surface treatments. Various surface treatments included in this study were 37% phosphoric acid treatment (the etched group), 37% phosphoric acid etching followed by the application of 10% sodium hypochlorite treatment (the deproteinized group), and untreatment (the control group). These findings are helpful for understanding the non-restorative repair of dentine lesions and the remineralization process of the caries-affected dentin surface.