Efficacy of a self-assembling peptide to remineralize initial caries lesions - A systematic review and meta-analysis

Longevity of posterior direct versus indirect composite restorations: A systematic review and meta-analysis

OBJECTIVES

The goal of this systemic review and meta-analysis was to compare the longevity of direct and indirect composite restorations in posterior teeth.

DATA

Randomized controlled trials (RCT) investigating direct and indirect composite restorations in permanent posterior teeth.

SOURCES

Three electronic databases (PubMed, CENTRAL (Cochrane) and Embase) were screened. No language or time restrictions were applied. Study selection, data extraction and quality assessment were done in duplicate. Risk of bias and level of evidence was graded using Risk of Bias 2.0 tool and Grade Profiler 3.6.

RESULTS

A total of 3056 articles were found by electronic databases. Finally, five RCTs were selected. Overall, 627 restorations of which 323 were direct and 304 indirect composite restorations have been placed in 279 patients (age: 28-81 years). The highest annual failure rates (AFR) were found for indirect restorations ranging from 0 % to 15.5 %. Lower AFR were found for direct restorations ranging from 0 % to 5.4 %. The most frequent failures were found to be chipping and fracture of the restoration followed by caries. Meta-analysis revealed that the failure rate for direct restorations was significantly lower than for indirect restorations (Risk Ratio (RR) [95 %CI] = 0.61 [0.47; 0.79]; very low level of evidence). Furthermore, all studies showed a high risk of bias.

CONCLUSION

Direct and indirect composite restorations can be recommended for large class II cavities including cusp coverage in posterior teeth for single tooth restoration. Meta-analysis revealed significantly lower relative risk to fail for direct composite restorations than for indirect restorations but results are with high risk of basis.

Morphology and root canal configuration of maxillary lateral incisors: a systematic review and meta-analysis

The purpose of this study was to explore maxillary lateral incisors (MxLI) intern morphology by analyzing existing literature. We searched five electronical databases (Cochrane, Embase, LILACS, Scopus, MEDLINE via PubMed) using keywords and predefined search terms. Additional studies were identified by cross-referencing and reviewing bibliographies of relevant articles. From 92 initial studies, 27 duplicates were removed, and 65 records screened. After full-text review and hand searching were 19 studies included. The most reported root canal configurations (RCC) of MxLI were Vertucci (Ve) I (1-1-1/1; 78.1-100%), Ve II (2-2-1/1; 0.2-5%), Ve III (1-2-1/1; 0.1-14.6%), Ve IV (2-2-2/2; 0.5%), and Ve V (1-1-2/2; 0.5-4.9%). A meta-analysis of six studies from Europe and Asia indicated sex-differentiated patterns in RCC prevalence: higher occurrences of Ve II (2-2-1/1; OR [95%CI] = 1.19 [0.51, 2.73]), Ve III (1-2-1/1; (OR [95%CI] = 1.72 [0.61, 4.85]), and Ve V (1-1-2/2; (OR [95%CI] = 2.95 [1.02, 8.55]) configurations were noted in males, whereas females predominantly exhibited Ve I (1-1-1/1; [95%CI] = 0.99 [0.97, 1.02]), and Ve IV (2-2-2/2; (OR [95%CI] = 0.11 [0.01, 2.02]). Examination methods varied, with cone beam computed tomography (CBCT) being most commonly (n = 11), followed by staining & clearing (n = 5), and radiographic analysis (n = 1). The predominant RCC in MxLI is type Vertucci I. CBCT is the most common method for assessing the morphology of root canals. However, up to 20% of cases may present with complex and sex-specific patterns, highlighting the need for clinicians to be aware of these differences to prevent complications during endodontic treatments.

Morphology and root canal configuration of maxillary canines: a systematic review and meta-analysis

BACKGROUND

This study assessed the internal morphology of maxillary canines (MxC) through a systematic review of existing literature.

METHODS

Research articles up to June 2024 were retrieved from five electronic databases (MEDLINE via PubMed, Embase, Scopus, LILACS, and Cochrane). Predefined search terms and keywords were used, and potential studies were identified by cross-referencing and bibliographies of the selected articles reviewed.

RESULTS

Two hundred studies were identified, 73 duplicates were removed, 127 records were screened, and 113 were removed after consultation of title and abstract. After full-text consultation and hand searching, finally 22 studies were included. Using the method for describing the root canal configuration (RCC) of Briseño Marroquín et al. (2015) and Vertucci (Ve) (1984), the most frequently reported RCC of MxC were 1-1-1/1 (Ve I, 75.4-100%), 2-2-1/1 (Ve II, 0.1-20%), 1-2-1/1 (Ve III, 0.1-11.6%), 2-2-2/2 (Ve IV, 0.1-0.4%), 1-1-2/2 (Ve V, 0.1-2.4%), 2-1-2/2 (Ve VI, 0.5-1.2%), and 1-2-1/2 (Ve VII, 0.1-0.2%). The meta-analysis of six studies (Europe/Asia) showed that a significantly higher number of RCC of 2-2-1/1 (Ve II) (OR [95%CI] = 1.34 [0.53, 3.41]), 1-2-1/1 (Ve III) (OR [95%CI] = 2.07 [1.01, 4.26]), and 1-1-2/2 (Ve V) (OR [95%CI] = 2.93 [1.07, 8.07]), were observed in males, and 2-2-2/2 (Ve IV) (OR [95%CI] = 0.08 [0.00, 4.00]) in females. No sex differences in the RCC of 1-1-1/1 (Ve I) and 1-2-1/2 (Ve VII) were observed.

CONCLUSIONS

Cone beam computed tomography is the most frequently used method for research on the RCC of MxC. Despite the high prevalence of type 1-1-1/1 (Ve I) RCC in MxC, clinicians should remain vigilant for more complex and sex-differentiated patterns in up to 25% of cases to prevent endodontic treatment complications or failures.

Systematic review and meta-analysis of root morphology and canal configuration of permanent premolars using cone-beam computed tomography

INTRODUCTION

The efficacy of root canal treatment is greatly impacted by a thorough understanding of root canal anatomy. This systematic review and meta-analysis aim to thoroughly investigate the root morphology and canal configuration (RMCC) of permanent premolars (PMs).

METHODOLOGY

A comprehensive analysis was conducted following the PRISMA guidelines. Literature exploration was carried out across four electronic databases (PubMed, Embase, Cochrane, and Web of Science). The risk of bias assessment was conducted for the included studies utilizing the Anatomical Quality Assessment (AQUA) tool. Data analysis was performed utilizing SPSS and RevMAN5.3.3. The meta-analysis was applied with a 95% confidence interval to calculate odds ratios (OR).

RESULTS

Among the 82 selected studies, 59 studies exhibited potential bias in domain one (objective(s) and subject characteristics), followed by domain three (methodology characterization). The majority of maxillary PM1s had either single root (46.7%) or double roots (51.9%), while three-rooted variants were uncommon (1.4%). Conversely, most other PMs exhibited a single root. In terms of canal configuration, maxillary PM1s predominantly featured double distinct canals (87.2%), with the majority of maxillary PM2s displaying either a single canal (51.4%) or double canals (48.3%). Mandibular PMs were primarily characterized by single canals, accounting for 78.3% of mandibular PM1s and 90.3% of mandibular PM2s. Subgroup analyses revealed higher incidences of single-rooted and single-canalled PMs among Asians compared to Caucasians. Additionally, women exhibited a higher incidence of single-rooted PMs, while men showed a greater frequency of double-rooted PMs.

CONCLUSIONS

The comprehensive analysis indicated that maxillary PM1s predominantly possess double roots and double canals, whereas maxillary PM2s and mandibular PMs were primarily characterized by single-rooted with a single canal. Notably, single root and single canal were more prevalent among women and Asian samples.

Effect of three different remineralising agents on prevention against acidic erosion of primary teeth: an in vitro study

PURPOSE

This study aimed to evaluate and compare the protective effect of fluoride varnish (Enamelast™, Ultradent Inc., Cologne, Germany), casein phosphopeptide-amorphous calcium phosphate fluoride/CPP-ACPF (MI Paste Plus, GC Corp., Tokyo, Japan) and self-assembling P11-4 peptide (Curodont™ Protect, Credentis AG, Windisch, Switzerland), against acidic erosion of primary teeth.

METHODS

Forty primary anterior teeth were randomly assigned to four groups (n = 10): group 1: control, group 2: fluoride varnish, group 3: CPP-ACPF and group 4: self-assembling P11-4 peptide. After applying remineralising agents, except for the control group, all specimens underwent an erosive challenge of carbonated soft drink and artificial saliva for 15 cycles of 6 s each at 6-h intervals for a day. Groups were compared in terms of surface microhardness, roughness readings, and surface scanning with an extra-oral scanner (D800; 3Shape A/S) before and after the erosive process.

RESULTS

All experimental groups showed superior results than the control group regarding microhardness, surface roughness, and substance loss. The fluoride varnish group showed significantly favourable results in microhardness change. There was no significant difference between the experimental groups regarding surface roughness and enamel loss measurements.

CONCLUSION

5% NaF fluoride varnish, CPP-ACPF and self-assembling P11-4 peptide protect the enamel of primary teeth against erosion compared to artificial saliva alone.

Remineralizing potential of the biomimetic P11-4 self-assembling peptide on noncavitated caries lesions: A retrospective cohort study evaluating semistandardized before-and-after radiographs

BACKGROUND

Self-assembling peptide (SAP) P11-4 was introduced to treat initial caries lesions by means of guiding hydroxyapatite regeneration within the lesion. The objective of this study was to assess its effectiveness in a practical clinical setting.

METHODS

Caries lesions in permanent teeth treated with monomeric and polymeric SAP P11-4 from May 2015 through October 2020 were retrospectively analyzed at lesion and child levels by means of bite-wing radiography for changes in stage and cavitation and restoration.

RESULTS

Two hundred and nineteen children aged 10 through 19 years with a total of 405 proximal lesions in posterior teeth were followed from 0.4 through 5.5 years (median, 7 months; interquartile range, 6-19 months). Regression occurred in 37% of stage RA1 (radiolucency in the outer one-half of enamel) (95% CI, 31% to 44%), 38% of stage RA2 (radiolucency in the inner one-half of enamel plus or minus the enamel-dentin junction) (95% CI, 30% to 45%), and 40% of stage RA3 (radiolucency limited to the outer one-third of dentin) (95% CI, 16% to 68%) lesions. The proportion of lesions with no cavitation was 0.96 (95% CI, 0.94 to 0.98) after 1 year and 0.91 (95% CI, 0.88 to 0.95) after 2 years.

CONCLUSIONS

Real-world clinical data indicate that SAP P11-4 can lead to recovery and a healthier tooth stage.

PRACTICAL IMPLICATIONS

SAP P11-4 is a safe treatment for initial caries lesions in permanent teeth that remineralizes in the deepest zone of the lesion and can be introduced easily into routine dental practice.

Self-assembling peptide and nano-silver fluoride in remineralizing early enamel carious lesions: randomized controlled clinical trial

BACKGROUND

Nanoparticles and regenerative biomineralization are new caries prevention technologies. This study assessed the remineralizing effect of self-assembling peptide (P11-4), Nanosilver Fluoride (NSF) and sodium fluoride (NaF) on white spot lesions (WSLs) in permanent teeth.

METHODS

Sixty six young adults with WSLs on buccal surfaces in permanent teeth and ICDAS code 1 or 2, were randomly assigned to one of three groups; P11-4, NSF or NaF. Assessment of ICDAS scores, lesion activity (Nyvad scores) and diagnodent readings of lesions were done at baseline and after 1, 3, 6 and 12 months of agents' application. Comparisons between groups were made using chi squared test and comparison within groups were made using McNemar test. Multilevel binary logistic regression was used to assess the effect of agents on change of ICDAS scores after 3, 6 and 12 months (reduction versus no reduction).

RESULTS

There were 147 teeth in 66 patients; mean ± SD age = 13.46 ± 4.31 years. There were significant differences in the change of ICDAS scores among the three groups after 3 and 6 months (p = 0.005). The reduction in ICDAS score increased steadily in all groups across time with the greatest increase in the P11-4 group: 54.5% after 12 months. Lesion activity (Nyvad scores) showed significant differences among the three groups with the greatest percentage of inactive cases in the P11-4 group. Multilevel binary logistic regression showed non-significant reduction of ICDAS in P11-4 and NSF varnishes compared to NaF varnish (AOR = 2.56, 95% CI: 0.58, 8.77 and AOR = 2.12, 95% CI: 0.59, 7.64 respectively).

CONCLUSION

P11-4 and NSF varnish reduced the ICDAS scores, caries activity and diagnodent readings of WSLs in permanent teeth. However, the change in ICDAS scores was not significantly different from NaF.

TRIAL REGISTRATION

This trial was prospectively registered on the clinicaltrials.gov registry with ID: NCT04929509 on 18/6/2021.

Systematic review and meta-analysis on the effect of self-assembling peptide P11-4 on arrest, cavitation, and progression of initial caries lesions

BACKGROUND

Simple noninvasive evidence-based interventions for caries are needed to overcome limitations in the restorative paradigm. The self-assembling peptide P₁₁-4 is a noninvasive intervention that regenerates enamel in initial caries lesions.

STUDIES REVIEWED

The authors conducted a systematic review and meta-analysis on the effectiveness of the P₁₁-4 products Curodont Repair (Credentis; now manufactured by vVARDIS) (CR) and Curodont Repair Fluoride Plus (Credentis; now manufactured by vVARDIS) on initial caries lesions. Primary outcomes were lesion progression after 24 months, caries arrest, and cavitation. Secondary outcomes were changes in merged International Caries Detection and Assessment System score categories, quantitative light-induced fluorescence (QLF; Inspektor Research System), esthetic appearance, and lesion size.

RESULTS

Six clinical trials met the inclusion criteria. Results of this review represent 2 primary and 2 secondary outcomes. When compared with parallel groups, use of CR likely results in a large increase in caries arrest (relative risk [RR], 1.82 [95% CI, 1.32 to 2.50]; 45% attributable risk [95% CI, 24% to 60%]; number needed to treat [NNT], 2.8) and likely decreases lesion size by a mean (SD) of 32% (28%). The evidence also suggests that use of CR results in a large reduction in cavitation (RR, 0.32 [95% CI, 0.10 to 1.06]; NNT, 6.9) and is uncertain about lowering merged International Caries Detection and Assessment System score (RR, 3.68 [95% CI, 0.42 to 32.3]; NNT, 19). No studies used Curodont Repair Fluoride Plus. No studies reported adverse esthetic changes.

PRACTICAL IMPLICATIONS

CR likely has clinically important effects on caries arrest and decreased lesion size. Two trials had nonmasked assessors, and all trials had elevated risks of bias. The authors recommend conducting longer trials. CR is a promising treatment for initial caries lesions. The protocol for this systematic review was registered a priori with PROSPERO (304794).

Organic volume and permeability variations in the surface layer of artificial and natural enamel carious lesions

OBJECTIVES

Test the hypothesis the type of enamel caries (natural, artificial induced by gel, and artificial induced by acid solutions) affect the organic volume and the permeability of the surface layer in enamel caries lesions.

DESIGN

Artificial enamel caries, induced by either acidic solution (organic-poor; Group 1) or acidic gel (organic-rich; Group 2), and natural non-cavitated inactive approximal enamel caries lesions (NEC; Group 3) were obtained, from which longitudinal ground sections were prepared. Measurements of the mineral (V_min) (by microradiography), and water (α) and organic (β) volumes (by optical birefringence) were obtained at three points in the surface layer (n = 30/group).

RESULTS

The main outcomes were the ratio between experimental β by predicted β (β Ratio) and the ratio between experimental and predicted permeabilities (α_d Ratio). β Ratio in Group 1 was lower than in Groups 2 (Cohen's d: -1.81; 95% CI:-1.45,-2.32; p < 0.001) and 3 (Cohen's d: -0.71; 95% CI:-0.27,-1.18; p = 0.004), and Group 2 surpassed Group 3 (Cohen's d: 0.49; 95% CI:0.07,0.94; p = 0.03). α_d Ratio in Group 1 was higher than in Groups 2 (Cohen's d: 1.86; 95% CI:1.49,2.33; p < 0.001) and 3 (Cohen's d: 0.60; 95% CI:0.18,1.14; p = 0.01), and Group 3 surpassed Group 2 (Cohen's d: 0.61; 95% CI:0.23,1.07; p = 0.01).

CONCLUSIONS

The highest organic volume and the lowest permeability occurred at the surface layer of gel-induced artificial enamel caries lesions, which should be preferred in in vitro studies on de- and remineralization and resin infiltration.

Systematic review and meta-analysis on physical barriers to prevent root dentin demineralization

The present review systematically analyzed in vitro and in situ studies investigating physical diffusion barriers (sealants, desensitizer or adhesives) to prevent the development or the progression of root (dentin) demineralization. Three electronic databases (PubMed-Medline, CENTRAL, Ovid-EMBASE) were screened for studies from 1946 to 2022. Cross-referencing was used to identify further articles. Article selection and data abstraction were done in duplicate. Languages were not restricted. The type of outcome was not restricted, and their mean differences (MD) were calculated using fixed- or random-effects models. Risk of Bias was graded using Risk of Bias 2.0 tool. From 171 eligible studies, 34 were selected for full-text analysis evaluating 69 different materials, and 17 studies-still evaluating 36 different materials-were included (3 in situ and 14 in vitro). Ten studies evaluated desensitizers; 8 adhesives; and 1 infiltration. Meta-analyses were possible for all 17 studies. Meta-analyses revealed that lesion depth after no treatment was significantly higher than after the application of single-step adhesives (MD[_95%CI] = - 49.82[- 69.34; - 30.30]) and multi-step adhesives (MD[_95%CI]=-60.09 [-92.65, -27.54]). No significant differences in the lesion depth increase between single- and multi-step adhesives could be observed (MD[_95%CI]=30.13 [-21.14, 81.39]). Furthermore, compared to no treatment the increase of the lesion depth was significantly hampered using desensitizers (MD[_95%CI] = - 38.02[- 51.74; - 24.31]). Furthermore, the included studies presented unclear or high risk. A physical diffusion barrier can significantly hamper the increase of lesion depth under cariogenic conditions. Furthermore, multi-step adhesives seem not to be more effective than single-step adhesives. However, this conclusion is based on only few in vitro and in situ studies.

Posterior ceramic versus metal restorations: A systematic review and meta-analysis

OBJECTIVES

The goal of this systemic review and meta-analysis was to evaluate the longevity of indirect adhesively-luted ceramic compared to conventionally cemented metal single tooth restorations.

DATA

Randomized controlled trials (RCT) investigating indirect adhesively-luted ceramic restorations compared to metal or metal-based cemented restorations in permanent posterior teeth.

SOURCES

Three electronic databases (PubMed, CENTRAL (Cochrane) and Embase) were screened. No language or time restrictions were applied. Study selection, data extraction and quality assessment were done in duplicate. Risk of Bias and level of evidence was graded using Risk of Bias 2.0 tool and Grade Profiler 3.6.

RESULTS

A total of 3056 articles were found by electronic databases. Finally, four RCTs were selected. Overall, 443 restorations of which 212 were adhesively-luted ceramic restorations and 231 conventionally cemented metal restorations have been placed in 314 patients (age: 22-72 years). The highest annual failure rates were found for ceramic restorations ranging from 2.1% to 5.6%. Lower annual failure rates were found for metal (gold) restorations ranging from 0% to 2.1%. Meta-analysis could be performed for adhesively-luted ceramic vs. conventionally cemented metal restorations. Conventionally cemented metal restoration showed a significantly lower failure rate than adhesively-luted ceramic ones (visual-tactile assessment: Risk Ratio (RR)[95%CI]=0.31[0.16,0.57], low level of evidence). Furthermore, all studies showed a high risk of bias.

CONCLUSION

Conventionally cemented metal restorations revealed significantly lower failure rates compared to adhesively-luted ceramic ones, although the selected sample was small and with medium follow-up periods with high risks of bias.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.

Is Silver Diamine Fluoride Effective in Arresting Enamel Caries? A Randomized Clinical Trial

Background: There is limited information on the effectiveness of 38% silver diamine fluoride (SDF) in managing enamel caries. Objective: This study aimed to compare effectiveness of 38% SDF and 5% Sodium fluoride (NaF) varnish in arresting enamel caries in young children when applied semiannually over 18 months. Methods: A randomized controlled trial was conducted on children aged 1−3 years who had at least one active carious surface. They were allocated into two groups: Group 1 (38% SDF) and Group 2 (5% NaF varnish). Visual-tactile examination was used to assess extent of carious lesions. Enamel caries that did not progress to dentin were classified as having caries arrest. Intention-to-treat analysis was performed. Results: At baseline, 290 children with 1974 tooth surfaces with enamel caries were recruited. Caries arrest rates at the tooth surface level in Group 1 and Group 2 were 59.1% and 58.8%, respectively (p = 0.873), at 18 months. The multilevel logistic regression analysis revealed that tooth position, tooth surface, extent of enamel caries at baseline, caries experience, and brushing with fluoride toothpaste influenced caries arrest (p < 0.05). Conclusion: The semiannual application of 38% SDF and 5% NaF varnish had comparable effectiveness in arresting enamel caries in primary teeth.

Efficacy of nano-hydroxyapatite on caries prevention-a systematic review and meta-analysis

INTRODUCTION/OBJECTIVES

The review systematically explored in vivo or in situ studies investigating the efficacy of nano-hydroxyapatite (nHA) to reduce initiation of or to remineralize initial caries lesions.

DATA

Prospective controlled (non-)randomized clinical trials investigating the efficacy of a nHA compared to any other (placebo) treatment or untreated/standard control.

SOURCES

Three electronic databases (Central Cochrane, PubMed-MEDLINE, Ovid EMBASE) were screened. Outcomes were, e.g., ICDAS score, laser fluorescence, enamel remineralization rate, mineral loss, and lesion depth. No language or time restrictions were applied. Risk of bias and level of evidence were graded using the Risk of Bias 2.0 tool and GRADE profiler.

STUDY SELECTION/RESULTS

Five in vivo (and 5 in situ) studies with at least 633 teeth (1031 specimens) being assessed in more than 420 (95) patients were included. No meta-analysis could be performed for in vivo studies due to the high heterogeneity of the study designs and the variety of outcomes. In situ studies indicate that under demineralization conditions, NaF was able to hinder demineralization, whereas nHA did not; simultaneously, nHA did not differ from the fluoride-free control. In contrast, under remineralizing conditions, nHA and NaF show the same remineralizing potential. However, the level of evidence was very low. Furthermore, six studies showed a high risk of bias, and six studies were funded/published by the manufacturers of the tested products.

CONCLUSION

The low number of clinical studies, the relatively short follow-up periods, the high risks of bias, and the limiting grade of evidence do not allow for conclusive evidence on the efficacy of nHA.

CLINICAL RELEVANCE

No conclusive evidence on the efficacy of nHA could be obtained based on the low number of clinical studies, the relatively short follow-up periods, the high risks of bias, the limiting grade of evidence, and study conditions that do not reflect the everyday conditions.

Advanced non-fluoride approaches to dental enamel remineralization: The next level in enamel repair management

In modern dentistry, a minimally invasive management of early caries lesions or early-stage erosive tooth wear (ETW) with synthetic remineralization systems has become indispensable. In addition to fluoride, which is still the non-plus-ultra in these early caries/ETW treatments, a number of new developments are in the test phase or have already been commercialized. Some of these systems claim that they are comparable or even superior to fluoride in terms of their ability to remineralize enamel. Besides, their use can help avoid some of the risks associated with fluoride and support treatments of patients with a high risk of caries. Two individual non-fluoride systems can be distinguished; intrinsic and extrinsic remineralization approaches. Intrinsic (protein/peptide) systems adsorb to hydroxyapatite crystals/organics located within enamel prisms and accumulate endogenous calcium and phosphate ions from saliva, which ultimately leads to the re-growth of enamel crystals. Extrinsic remineralization systems function on the basis of the external (non-saliva) supply of calcium and phosphate to the crystals to be re-grown. This article, following an introduction into enamel (re)mineralization and fluoride-assisted remineralization, discusses the requirements for non-fluoride remineralization systems, particularly their mechanisms and challenges, and summarizes the findings that underpin the most promising advances in enamel remineralization therapy.

Self-Assembling Peptides: From Design to Biomedical Applications

Self-assembling peptides could be considered a novel class of agents able to harvest an array of micro/nanostructures that are highly attractive in the biomedical field. By modifying their amino acid composition, it is possible to mime several biological functions; when assembled in micro/nanostructures, they can be used for a variety of purposes such as tissue regeneration and engineering or drug delivery to improve drug release and/or stability and to reduce side effects. Other significant advantages of self-assembled peptides involve their biocompatibility and their ability to efficiently target molecular recognition sites. Due to their intrinsic characteristics, self-assembled peptide micro/nanostructures are capable to load both hydrophobic and hydrophilic drugs, and they are suitable to achieve a triggered drug delivery at disease sites by inserting in their structure's stimuli-responsive moieties. The focus of this review was to summarize the most recent and significant studies on self-assembled peptides with an emphasis on their application in the biomedical field.

Efficacy of the dual-action GA-KR12 peptide for remineralising initial enamel caries: an in vitro study

OBJECTIVE

To investigate the antibiofilm and remineralising effects of the dual-action peptide GA-KR12 on artificial enamel caries.

MATERIALS AND METHODS

Enamel blocks with artificial caries were treated with sterilised deionised water as control or GA-KR12. The blocks underwent biochemical cycling with Streptococcus mutans for 3 weeks. The architecture, viability, and growth kinetics of the biofilm were determined, respectively, by scanning electron microscopy (SEM), confocal laser scanning microscopy, and quantitative (culture colony-forming units, CFUs). The mineral loss, calcium-to-phosphorus ratio, surface morphology, and crystal characteristics of the enamel surface were determined, respectively, using micro-computed tomography, energy dispersive spectroscopy, SEM, and X-ray diffraction (XRD).

RESULTS

SEM showed confluent growth of S. mutans in the control group but not in the GA-KR12-treated group. The dead-to-live ratios of the control and GA-KR12-treated groups were 0.42 ± 0.05 and 0.81 ± 0.08, respectively (p < 0.001). The log CFUs of the control and GA-KR12-treated groups were 8.15 ± 0.32 and 6.70 ± 0.49, respectively (p < 0.001). The mineral losses of the control and GA-KR12-treated groups were 1.39 ± 0.09 gcm^-3 and 1.19 ± 0.05 gcm^-3, respectively (p < 0.001). The calcium-to-phosphorus molar ratios of the control and GA-KR12-treated groups were 1.47 ± 0.03 and 1.57 ± 0.02, respectively (p < 0.001). A uniformly remineralised prismatic pattern on enamel blocks was observed in the GA-KR12-treated but not in the control group. The hydroxyapatite in the GA-KR12-treated group was better crystallised than that in the control group.

CONCLUSION

The dual-action peptide GA-KR12 inhibited the growth of S. mutans biofilm and promoted the remineralisation of enamel caries.

CLINICAL RELEVANCE

GA-KR12 potentially is applicable for managing enamel caries.

Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a systematic review and meta-analysis

To analyse clinical studies investigating coating agents such as sealants and other bonding materials to prevent the initiation or inhibit the progress of white spot lesions (WSL) during orthodontic treatment with fixed appliances. Electronic databases (Pubmed, CENTRAL, EMBASE) were screened for studies. No language restrictions were applied. Study selection, data extraction and quality assessment were done in duplicate. Primary outcome included assessment of WSL with visual-tactile assessment and/or laser fluorescence measurements. Twenty-four studies with 1117 patients (age: 11–40 years) and 12,809 teeth were included. Overall, 34 different sealants or bonding materials were analysed. Fourteen studies analysed fluoride and 14 studies non-fluoride releasing materials. Meta-analysis for visual tactile assessment revealed that sealants significantly decreased the initiation of WSL compared to untreated control (RR [95%CI] = 0.70 [0.53; 0.93]; very low level of evidence). Materials releasing fluoride did not decrease initiation of WSL compared to those with no fluoride release (RR [95%CI] = 0.84 [0.70; 1.01]; very low level of evidence). For laser fluorescence measurements no meta-analysis could be performed. The use of sealants seems to be effective in preventing the initiation of post-orthodontic WSL. Furthermore, there is no evidence supporting that fluoride-releasing sealants or bonding materials are more effective than those without fluoride release. No gold standard prevention strategy to prevent WSL during treatment with fixed orthodontic appliances has been established yet. However, based on only a limited number of studies the use of sealants seems to be effective in preventing the initiation of post-orthodontic WSL.

Remineralising dentine caries using an artificial antimicrobial peptide: An in vitro study

OBJECTIVE

To investigate the antibacterial and remineralising effects of a novel dual-action antimicrobial peptide, GA-KR12, on artificial dentine caries.

METHODS

Human dentine blocks with artificial carious lesions were allocated to two groups - Group 1: dentine blocks treated with the novel antimicrobial peptide GA-KR12 twice daily; Group 2: dentine blocks received water as the negative control. Two groups underwent Streptococcus mutan biofilm-remineralisation cycles at 37 °C for 7 days. The morphology, viability and growth kinetics of the S. mutans biofilm were evaluated by scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM) and colony-forming unit (CFU) counting, respectively. The dentine blocks' lesion depths and mineral loss, changes in chemical structure, dentine surface morphology and crystal characteristics were determined using micro-computed tomography, Fourier transform infrared (FTIR), SEM and X-ray diffraction (XRD), respectively.

RESULTS

The surface of the dentine blocks in Group 1 was partially covered by S. mutans with damaged cell structure. Group 2 showed affluent growth of S. mutans covering the dentine surface when compared to Group 1. The dead-to-live ratio of Group 1 and Group 2 were 0.78 ± 0.01 and 0.47 ± 0.08, respectively (p < 0.001). The Log CFUs of Group 1 and Group 2 were 7.14 ± 0.30 and 8.24 ± 0.20, respectively (p < 0.001). The lesion depths of Group 1 and Group 2 were 109 ± 1 µm and 135 ± 3 µm, respectively (p < 0.001). The mineral loss of Group 1 and Group 2 were 0.59 ± 0.08 gHApcm^-3 and 0.81 ± 0.07 gHApcm^-3, respectively (p < 0.001). FTIR showed the amide I-to-hydrogen phosphate (HPO₄^2-) ratios of Group 1 and Group 2 were 0.25 ± 0.05 and 0.39 ± 0.05 (p < 0.001), respectively. SEM images showed Group 1 had less exposed dentine collagen fibres than Group 2. The XRD revealed that the hydroxyapatite in Group 1 was well crystalised.

CONCLUSION

This study demonstrated that the novel antimicrobial peptide GA-KR12 inhibited the growth of S. mutans biofilm and enhanced the remineralisation of artificial dentine caries.

Root canal morphology of the mandibular second premolar: a systematic review and meta-analysis

Background

The aim of this paper was to systematically review the root canal configuration (RCC) and morphology literature of the mandibular second premolar (Mn2P).

Methods

Systematic research of five electronic databases was performed to identify published literature concerning the root canal configuration (RCC) of the Mn2P up through July 2020. Studies were selected according to predefined search terms and keywords inclusion criteria: “root canal configuration”, “root canal system”, “root canal morphology”, “mandibular second premolar”, “mandibular premolars”, “morphology” and “anatomy”. Further possible studies were identified by cross-referencing and screening the bibliographies of the selected articles.

Results

From 1622 retrieved studies, 44 studies investigating the internal morphology of 17,839 Mn2Ps were included. Most examined Mn2Ps were single-rooted (89.5–100%); two-rooted (0.1–8%) and three-rooted (0.1–3.5%) Mn2Ps at lower frequency. Most frequent RCCs reported were 1–1–1/1 (55.3–99.6%) followed by 1–1–2/2 (0.5–57%) and 2–2–2/2 (0.6–18%). The meta-analysis of seven studies demonstrated that a significantly higher number of RCC type 1–2–1/1 (OR [95%CI] = 2.05 [1.27, 3.33]) and 2–2–2/2 (OR [95%CI] = 2.32 [0.65, 8.63]) were observed in male than in female patients.

Conclusions

Different RCC research methods have been reported. Whereas clearing and radiographs were commonly used in the past, CBCT has been prevalent in recent years. A globally high frequency of a 1–1–1/1 RCC in the Mn2P has been reported. Nevertheless, the probability that different, more complicated RCCs can appear in Mn2Ps should not be underestimated and, thus, should be taken into consideration when making decisions during an endodontic treatment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01668-z.