Morphological analysis and chemical content of natural dentin carious lesion zones

Assessment of Physicochemical Characterization and Mineralization of Nanofibrous Scaffold Incorporated With Aspartic Acid for Dental Mineralization: An In Vitro Study

Aim The aim of this study was to assess the physicochemical characterization and mineralization of nanofibrous scaffold incorporated with nanohydroxyapatite (nHA) and aspartic acid (Asp) for dental mineralization.  Methodology Three nanofibrous scaffolds were prepared, namely polycaprolactone (PCL), PCL with nHA, and PCL with nHA and Asp. Each scaffold was prepared separately by electrospinning. The physicochemical characterization of the surface of the nanofibrous scaffold was imaged using a scanning electron microscope (SEM), energy dispersive X-ray Analysis (EDX), X-ray diffraction (XRD), and Fourier-transform infrared spectroscopy (FTIR). In vitro mineralization studies were performed by immersing the sample in simulated body fluid (SBF) for 7, 14, and 21 days. The surface of the samples was observed under SEM with EDX. Results SEM analysis of PCL/nHA/Asp revealed that the nanofibers were bead-free, smooth, randomly oriented, and loaded with Asp. The EDX spectra of PCL/nHA/Asp composite nanofibrous scaffold revealed broad peaks and corresponded to the amorphous form, while the sharp peaks corresponded to the specific crystalline structure of nHA. FTIR analysis showed specific functional groups corresponding to PCL, nHA, and Asp. The scaffolds incorporated with Asp exhibited higher mineralization potential with an apatite-like crystal formation, which increased with an increase in the duration of immersion in SBF. Conclusion Physiochemical characterization demonstrated the incorporation of PCL/nHA/Asp in the electrospun nanofibrous scaffold. The mineralization analysis revealed that the presence of Asp enhanced the mineralization when compared with the PCL and PCL/nHA. PCL/nHA/Asp incorporated in scaffold can be a promising material for dental mineralization.

Mass Spectrometry-Based Proteomics of Poly(methylmethacrylate)-Embedded Bone

Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is a widely employed technique in proteomics research for studying the proteome biology of various clinical samples. Hard tissues, such as bone and teeth, are routinely preserved using synthetic poly(methyl methacrylate) (PMMA) embedding resins that enable histological, immunohistochemical, and morphological examination. However, the suitability of PMMA-embedded hard tissues for large-scale proteomic analysis remained unexplored. This study is the first to report on the feasibility of PMMA-embedded bone samples for LC-MS/MS analysis. Conventional workflows yielded merely limited coverage of the bone proteome. Using advanced strategies of prefractionation by high-pH reversed-phase liquid chromatography in combination with isobaric tandem mass tag labeling resulted in proteome coverage exceeding 1000 protein identifications. The quantitative comparison with cryopreserved samples revealed that each sample preparation workflow had a distinct impact on the proteomic profile. However, workflow replicates exhibited a high reproducibility for PMMA-embedded samples. Our findings further demonstrate that decalcification prior to protein extraction, along with the analysis of solubilization fractions, is not preferred for PMMA-embedded bone. The biological applicability of the proposed workflow was demonstrated using samples of human PMMA-embedded alveolar bone and the iliac crest, which revealed anatomical site-specific proteomic profiles. Overall, these results establish a crucial foundation for large-scale proteomics studies contributing to our knowledge of bone biology.

Visualization of carious lesions with polarized and depolarized light microscopy

Polarized light microscopy (PLM) is an established method in dental histology for investigating the ultrastructure and carious process of teeth. This study introduces a novel approach for measuring the degree of polarization (DOP) in a modified PLM setup and uses the DOP to assess the changes of the optical properties of enamel and dentin due to caries. The validation is provided by a comparison with complementary imaging methods, i.e. standard PLM and µCT. The results show that demineralization is reliably displayed by the DOP in accordance with the common imaging methods, and that this quantitative analysis of depolarization allows the characterization of the different pathohistological zones of caries.

Application of Photodynamic Therapy in Pediatric Dentistry: Literature Review

Microbiological control of dental pathologies presents a significant clinical challenge for dental surgeons, particularly considering drug-resistant microorganisms. To address this issue, Antimicrobial Photodynamic Therapy (PDT) has emerged as an effective and complementary technique for microbial reduction. This therapy involves the application of a photosensitizer dye (PS) either topically or systemically, followed by exposure to low-power lasers with appropriate visible light wavelengths. PDT has found a valuable place in dentistry across various specialties, including surgery, periodontics, endodontics, dentistry, implantology, orthodontics, and pediatrics. In the realm of pediatric dentistry, managing microorganisms during dental treatments has become a major challenge. Considering its promising results and ease of application, Photodynamic Therapy presents an interesting alternative for clinical practice. However, it is important to note that specific protocols must be followed for each application, encompassing the type of photosensitizer, concentration, pre-irradiation time, light type, wavelength, energy, power, and mode of light delivery. Researchers have been steadily refining these protocols to facilitate PDT's integration into clinical practice. The objective of this review is to describe in which procedures and oral health problems in children PDT can be applied. In this sense, we list what the literature brings about the possibilities of applying PDT in a pediatric dentistry clinic.

Promotion Effect of Carboxymethyl Chitosan on Dental Caries via Intrafibrillar Mineralization of Collagen and Dentin Remineralization

Objective: To observe ultrastructural changes during the process of carboxymethyl chitosan (CMC)-mediated intrafibrillar mineralization, we evaluated the biomimetic remineralization potential of CMC in type-I collagen fibrils and membranes, and further explored the bond strength as well as the bond interfacial integrity of the biomimetic remineralized artificial caries-affected dentin (ACAD). Methods: A mineralized solution containing 200 μg/mL CMC was used to induce type-I collagen biomimetic remineralization in ACAD, while traditional mineralization without CMC was used as a control. The process and pattern of mineralization were investigated by transmission electron microscopy (TEM), scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDS) as well as structured illumination microscopy (SIM). The Vickers hardness test was used to quantify the dentin hardness, while the microtensile bond strength (µTBS) test was used to assess the bond strength and durability. The bond interfacial integrity was evaluated by a confocal laser scanning microscope (CLSM). Results: TEM, SEM, and SIM images showed that CMC had a positive effect on stabilizing amorphous calcium phosphate (ACP) and promoting intrafibrillar mineralization, while extrafibrillar mineralization was formed without CMC. Furthermore, hardness evaluation and µTBS proved that CMC significantly increased dentin hardness and bond strength. CLSM indicated that CMC could create a significantly better bond interfacial integrity with less of a micro-gap in ACAD. Significance: CMC possessed the ability to promote intrafibrillar mineralization and remineralization in demineralized caries dentin lesions, as well as improve bond performance, which implied its potential in carious dentin demineralization or dentin hypersensitivity and possibly even as a possible material for indirect pulp-capping, to deal with deep caries. Highlights: CMC possessed the ability to induce intrafibrillar mineralization effectively; the bond strength and bond durability of demineralized caries dentin were improved via CMC-induced remineralization; the CMC-induced remineralization complex is a potential material for indirect pulp-capping, to deal with deep caries.

Attenuation of near-ultraviolet, visible and near-infrared light in sound and carious human enamel and dentin

Objectives

This in vitro study aimed to investigate the optical attenuation of light at 405, 660 and 780 nm sent through sound and carious human enamel and dentin, including respective individual caries zones, as well as microscopically sound-appearing tissue close to a carious lesion.

Materials and methods

Collimated light transmission through sections of 1000–125-µm thickness was measured and used to calculate the attenuation coefficient (AC). The data were statistically analysed with a MANOVA and Tukey’s HSD. Precise definition of measurement points enabled separate analysis within the microstructure of lesions: the outer and inner halves of enamel (D1, D2), the translucent zone (TZ) within dentin lesions and its adjacent layers, the enamel side of the translucent zone (ESTZ) and the pulpal side of the translucent zone (PSTZ).

Results

The TZ could be distinguished from its adjacent layers and from caries-free dentin at 125 µm. Sound-appearing dentin close to caries lesions significantly differed from caries-free dentin at 125 µm. While sound and carious enamel exhibited a significant difference (p < 0.05), this result was not found for D1 and D2 enamel lesions (p > 0.05). At 405 nm, no difference was found between sound and carious dentin (p > 0.05).

Conclusions

Light optical means enable the distinction between sound and carious tissue and to identify the microstructure of dentin caries partially as well as the presence of tertiary dentin formation. Information on sample thickness is indispensable when interpreting the AC.

Clinical relevance

Non-ionising light sources may be suitable to detect lesion progression and tertiary dentin.

Effectiveness of an actuator-driven pulsed water jet for removal of softened carious dentin

The aim of this study was to assess the utility of an actuator-driven pulsed water jet (ADPJ) as a hardness-dependent carious dentin removal device by using different outputs. Thirty-six plane surface dental caries samples were treated with the ADPJ at 150, 200, and 250 voltage (12 teeth each). The Knoop hardness number (KHN) and Ca/P mass ratio were measured at 70 μm from the deepest point of the removing groove. Furthermore, three other teeth samples were manually treated with the ADPJ at the three above mentioned voltages (one tooth each) for 1 min. The KHN and Ca/P mass ratio were measured at 70 μm from the surface of the residual dentin part. In both the KHN and Ca/P mass ratio, higher residual dentin depended on the applied voltage of ADPJ. The ADPJ enabled the removal of softened carious dentin in an applied voltage-dependent manner.

Conformational and constitutional analysis of dental caries following radiotherapy for head and neck cancer

Background

This study aimed to investigate the morphology and chemical composition of dental caries related to ionizing radiation (DCIR), an aggressive and progressive disease that affects dental hard tissues.

Materials and methods

Eight human teeth with DCIR were paired with sixteen control teeth (8 teeth with conventional caries and 8 without caries) and included in this study. An analysis of the morphology of the lesions was performed using the following techniques: periapical radiography, cone beam computed tomography, computed microtomography, and scanning electron microscopy. The chemical composition was assessed using X-ray dispersive spectroscopy.

Results

There was more demineralization in DCIR lesions when compared to conventional dental caries, even though there was no cavitation in the cervical region of the teeth. The superficial roughness and topography of DCIR lesions were similar to those of healthy teeth. On the other hand, lesions of conventional dental caries showed greater surface and topographic irregularity when compared to DCIR and healthy teeth (p = 0.001). Calcium (Ca) and phosphorus (P) levels were lower in DCIR lesions when compared to controls. However, higher levels of carbon (C) have been observed in DCIR lesions. There was a greater loss of the mineral matrix in DCIR followed by conventional caries. The reduction in the mineral matrix (Ca and P) was compatible with the imaging patterns observed in teeth with DCIR and conventional caries.

Conclusion

Despite their rapid evolution, DCIR presents an irregular, apparently intact surface with significant changes in the amount of Ca, P, and C.

Morphological patterns of circumpulpal dentin affected by radiation-related caries

BACKGROUND

The aim of this work was to evaluate the microscopic characteristics through polarized light microscopy, scanning electron microscopy and the mineral content of circumpulpal dentin of irradiated (IT) and non-irradiated teeth (NIT), with deep caries that reached the root canal.

MATERIAL AND METHODS

A total of 25 IT were analyzed macroscopically, and radiographed. 5 NIT were used as controls. Two 100-μm-thick sections, per specimen, were evaluated in a polarized light microscopy and a scanning electron microscope. Demographics and clinical data were collected.

RESULTS

The results did not demonstrate distinct morphology of the IT compared with NIT. Mineral content values by weight percentage of Ca and P were also similar, corresponding to 66.65% and 33.21% in the IT and 66.60% and 33.29% in the NIT. The Ca/P ratio did not show statistical differences between groups being respectively 2.74 and 2.72, in the IT and NIT (p> 0.05).

CONCLUSIONS

Radiotherapy does not change morphology and mineral content of circumpulpal dentin in IT. Key words:Root canal, radiation-related caries, polarization microscopy, scanning electron microscopy, radiotherapy, oral neoplasms, dentin.

The Effects of Ionizing Radiation on the Oral Cavity

AIM

The aim of this study is to present a literature review on the effects of the ionizing radiation from radiotherapy treatment on dental tissues.

BACKGROUND

Among the effects of increasing global life expectancy and longevity of the teeth in the oral cavity, increasing rates of neoplastic diseases have been observed. One of the important treatment modalities for head and neck neoplastic diseases is radiotherapy, which uses ionizing radiation as the main mechanism of action. Therefore, it is essential for dentists to be aware of the changes in oral and dental tissues caused by ionizing radiation, and to develop treatment and prevention strategies.

RESULTS

In general, there is still controversy about the effects of ionizing radiation on dental structures. However, qualitative and quantitative changes in saliva and oral microbiota, presence of oral mucositis and radiation-related caries are expected, as they represent the well-known side effects of treatment with ionizing radiation. Points that still remain unclear are the effects of radiotherapy on enamel and dentin, and on their mechanisms of bonding to contemporary adhesive materials.

CONCLUSION

Ionizing radiation has shown important interaction with organic tissues, since more deleterious effects have been shown on the oral mucosa, salivary glands and dentin, than on enamel.

CLINICAL SIGNIFICANCE

With the increasing number of patients with cancer seeking dental treatment before and after head and neck radiotherapy, it is important for dentists to be aware of the effects of ionizing radiation on the oral cavity.

Biomimetic remineralization of demineralized dentine using scaffold of CMC/ACP nanocomplexes in an in vitro tooth model of deep caries

Currently, it is still a tough task for dentists to remineralize dentine in deep caries. The aim of this study was to remineralize demineralized dentine in a tooth model of deep caries using nanocomplexes of carboxymethyl chitosan/amorphous calcium phosphate (CMC/ACP) based on mimicking the stabilizing effect of dentine matrix protein 1 (DMP1) on ACP in the biomineralization of dentine. The experimental results indicate that CMC can stabilize ACP to form nanocomplexes of CMC/ACP, which is able to be processed into scaffolds by lyophilization. In the single-layer collagen model, ACP nanoparticles are released from scaffolds of CMC/ACP nanocomplexes dissolved and then infiltrate into collagen fibrils via the gap zones (40 nm) to accomplish intrafibrillar mineralization of collagen. With this method, the completely demineralized dentine was partially remineralized in the tooth mode. This is a bottom-up remineralizing strategy based on non-classical crystallization theory. Since nanocomplexes of CMC/ACP show a promising effect of remineralization on demineralized dentine via biomimetic strategy, thereby preserving dentinal tissue to the maximum extent possible, it would be a potential indirect pulp capping (IPC) material for the management of deep caries during vital pulp therapy based on the concept of minimally invasive dentistry (MID).

Effects of fluoridated milk on root dentin remineralization

Background

The prevalence of root caries is increasing with greater life expectancy and number of retained teeth. Therefore, new preventive strategies should be developed to reduce the prevalence of root caries. The aim of this study was to investigate the effects of fluoridated milk on the remineralization of root dentin and to compare these effects to those of sodium fluoride (NaF) application without milk.

Methods

Thirty extracted human molars were divided into 6 groups, and the root cementum was removed from each tooth. The dentin surface was demineralized and then incubated with one of the following six solutions: Sodium chloride NaCl, artificial saliva, milk, milk+2.5 ppm fluoride, milk+10 ppm fluoride and artificial saliva+10 ppm fluoride. Serial sections were cut through the lesions and investigated with polarized light microscopy and quantitative morphometry, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). The data were statistically evaluated using a one-way ANOVA for multiple comparisons.

Results

The depth of the lesion decreased with increasing fluoride concentration and was the smallest after incubation with artificial saliva+10 ppm fluoride. SEM analysis revealed a clearly demarcated superficial remineralized zone after incubation with milk+2.5 ppm fluoride, milk+10 ppm fluoride and artificial saliva+10 ppm fluoride. Ca content in this zone increased with increasing fluoride content and was highest after artificial saliva+10 ppm fluoride incubation. In the artificial saliva+10 ppm fluoride group, an additional crystalline layer was present on top of the lesion that contained elevated levels of F and Ca.

Conclusion

Incubation of root dentin with fluoridated milk showed a clear effect on root dentin remineralization, and incubation with NaF dissolved in artificial saliva demonstrated a stronger effect.

Dentin matrix protein 1 and dentin sialophosphoprotein in human sound and carious teeth: an immunohistochemical and colorimetric assay

Dentin matrix protein 1 (DMP1) and dentin sialophosphoprotein (DSPP) are extracellular matrix proteins produced by odontoblasts involved in the dentin mineralization. The aim this study was to compare the distribution of DMP1 and DSPP in human sound dentin vs human sclerotic dentin. Sixteen sound and sixteen carious human molars were selected, fixed in paraformaldehyde and processed for immunohistochemical detection of DMP1 and DSPP by means of light microscopy, transmission electron microscopy (TEM) and high-resolution field emission in-lens scanning electron microscopy (FEI-SEM). Specimens were submitted to a pre-embedding or a post-embedding immunolabeling technique using primary antibodies anti DMP1 and anti-DSPP and gold-conjugated secondary antibodies. Other samples were processed for the detection of DMP1 and DSPP levels. Dentin from these samples was mechanically fractured to powder, then a protein extraction and a protein level detection assay were performed. DMP1 and DSPP were more abundant in carious than in sound samples. Immunohistochemical analyses in sclerotic dentin disclosed a high expression of DMP1 and DSPP inside the tubules, suggesting an active biomineralization of dentin by odontoblasts. Furthermore, the detection of small amounts of these proteins inside the tubules far from the carious lesion, as shown in the present study, is consistent with the hypothesis of a preventive defense of all dentin after a noxious stimulus has undermined the tooth.

X-ray microtomography study to validate the efficacies of caries removal in primary molars by hand excavation and chemo-mechanical technique

BACKGROUND/AIMS

Mechanical removal of carious dentine based on perceived hardness is subjective and tends to be excessively destructive; chemo-mechanical techniques have been proposed as being more objective and conservative. The aims of the present study are to use X-ray microtomography (XMT/micro-CT) to determine the three-dimensional mineral concentration distribution in sound, carious and excavated dentine using hand excavation (HE) and a chemo-mechanical, Carisolv (CS), removal technique for primary molars, and to compare the volume of sound dentine removed in order to validate the efficacies of these two techniques.

METHODS

Twenty-one primary molars with open carious cavities were hemisected. The carious tissue in one half was then removed by HE and the other by CS. XMT scans were taken before and after caries removal. After alignment, subtracted XMT images from the two scans revealing the tissues removed were generated, from which mineral distributions were determined, and volumes of sound dentine removed by each technique were calculated.

RESULTS

It was found that the sound dentine removed by HE and CS techniques accounted for 4.0 and 2.1% of total tissues removed, respectively. The mean cut-off linear attenuation coefficients at 40 keV to which HE and CS excavated to were 1.27 and 1.09 cm(-1), respectively. The corresponding Knoop hardness number for the cut-off for CS was 25 kg · mm(-2).

CONCLUSION

It is concluded that using XMT, CS is validated to be more conservative than HE and preserves a layer of partially demineralised dentine with a mineral concentration > 0.97 g · cm(-3).

Effects of silver diamine fluoride on dentine carious lesions induced by Streptococcus mutans and Actinomyces naeslundii biofilms

BACKGROUND. Silver diamine fluoride (SDF) has been shown to be a successful treatment for arresting caries. However, the mechanism of SDF is to be elucidated. AIM. To characterize the effects of SDF on dentine carious induced by Streptococcus mutans and Actinomyces naeslundii. DESIGN.  Thirty-two artificially demineralized human dentine blocks were inoculated: 16 with S. mutans and 16 with A. naeslundii. Either SDF or water was applied to eight blocks in each group. Biofilm morphology, microbial kinetics and viability were evaluated by scanning electron microscopy, colony forming units, and confocal microscopy. The crosssection of the dentine carious lesions were assessed by microhardness testing, scanning electron microscopy with energy-dispersive x-ray spectroscopy and Fourier transform infrared spectroscopy. RESULTS. Biofilm counts were reduced in SDF group than control (P < 0.01). Surfaces of carious lesions were harder after SDF application than after water application (P < 0.05), in S. mutans group, Ca and P weight percentage after SDF application than after water application (P < 0.05). Lesions showed a significantly reduced level of matrix to phosphate after SDF treatment (P < 0.05). CONCLUSION. Present study showed that SDF posses an anti-microbial activity against cariogenic biofilm of S. mutans or A. naeslundii formed on dentine surfaces. SDF slowed down demineralization of dentine. This dual activity could be the reason behind clinical success of SDF.

Light- and electronmicroscopic study of infiltration of resin into initial caries lesions--a new methodological approach

It was the purpose of this pilot study to investigate resin infiltration into various types of initial subsurface caries lesions using a combined microscopic technique with polarized light microscopy and fluorescence microscopy and subsequent scanning microscopy with EDX-element analysis. Six extracted premolars with initial caries lesions were used. Five were infiltrated with resin after imbibition of the subsurface carious pore volume of enamel with sodium fluorescein solution. After light curing the unbound dye was removed by washing out in water. Serial sections were cut through the lesions and investigated with polarized light microscopy, fluorescence microscopy and simultaneously with both microscopic techniques. The same sections were then studied with scanning electron microscopy and EDX-element analysis to prove the infiltration of the resin into the lesions. The results showed, that the combination technique adds further morphologic information to infiltration behaviour of the resin. The individual volume of early acute lesions versus chronic lesions involving dentin, and the fluorescein bound by resin was well documented in serial sections. The EDX calcium and phosphorus signals correlate negatively with the lesion extension, and the carbon signal correlates positively, thus labelling the resin infiltration. It could be demonstrated that resin infiltration is dependent from the pore volume of the lesion. It can be concluded that the combined polarized light microscopy with fluorescence microscopy is an advantageous tool for studying infiltration of resin into hard tissues.

Increased matrix metalloproteinase-2 and bone sialoprotein response to human coronal caries

BACKGROUND

It has been suggested that host matrix metalloproteinase-2 (MMP-2) present in dentin may be involved in caries progression, however, its response to caries is not known. Bone sialoprotein (BSP) has been implicated in dentin mineralization and MMP-2 modulation.

OBJECTIVE

To identify and compare the distribution of MMP-2 and BSP in healthy human coronal dentin and those with early caries.

METHODS

Freshly extracted 3rd molars and premolars with and without early caries were fixed, demineralized and subjected to immunohistochemistry using a monoclonal anti-MMP-2 antibody and monoclonal anti-BSP antibody with an avidin-biotin complex method. Immunoreactivity was visualized with 3,3'-diaminobenzidine substrate and observed under light microscopy.

RESULTS

Immunohistochemical analysis revealed that MMP-2 and BSP are not detected in the tubule lumens of healthy dentin. However, intense immunoreactivity for MMP-2 and BSP was detected in association with the full length of the caries-affected dentinal tubules. The MMP-2 and BSP at the dentino-enamel junction appeared unaltered.

CONCLUSION

The results indicate that MMP-2 and BSP may be actively secreted by odontoblasts in response to carious insult. MMP-2 and BSP accumulation in the caries-affected dentinal tubules may indicate their potential involvement in the host defense mechanism which results in calcification of regions affected by the carious process.

EDX-Element Analysis of the In Vitro Effect of Fluoride Oral Hygiene Tablets on Artificial Caries Lesion Formation and Remineralization in Human Enamel

Aim of this in-vitro-study was to assess the remineralization potential of a tooth cleaning tablet with different fluoride content quantitatively using EDX analysis.Twenty three caries free impacted third molars were examined; enamel surfaces were wax coated leaving two 3x4mm windows for exposure to demineralization/remineralization cycles. The teeth were randomly assigned to 4 groups of 5 control and 6 experimental teeth each. Demineralization by standardized HEC-gel, pH 4.7 at 37°C for 72h, was alternated by rinsing in remineralization solution, pH 7.0 at 37°C for 72h, total challenge time 432h. The negative control group N was treated during remineralization cycles with saline; positive control group P was treated with remineralization solution; experimental group D1 was exposed to remineralization solution containing Denttabs(®)-tablets with 1450 ppm F; experimental group D2 was exposed to remineralization solution and Denttabs(®)-tablets with 4350 ppm F. Each tooth was cut into serial sections and analyzed by scanning electron microscopy with EDX element analysis for assessment of the different zones of the lesions in 3 representative sections. Statistical analysis was based on the AVOVA test for repeated measurements and post hoc Bonferroni adjustment. The results showed a significantly higher Ca and P content in the body of the lesion in both fluoride treated groups compared to the controls. It can be concluded that higher concentrations of NaF may be more effective in remineralization of early advanced caries lesions.

In vitro effect of fluoride oral hygiene tablets on artificial caries lesion formation and remineralization in human enamel

Background

Aim of this in-vitro-study was to assess the remineralization potential of a tooth cleaning tablet with different fluoride content.

Methods

Twenty three caries free impacted third molars were examined, enamel surfaces were wax coated leaving two 3 × 4 mm windows for exposure to demineralization/remineralization cycles. The teeth were randomly assigned to 4 groups of 5 control and 6 experimental teeth. Demineralization by standardised HEC-gel, pH 4.7 at 37°C for 72 h, was alternated by rinsing in remineralization solution, pH 7.0 at 37°C for 72 h, total challenge time 432 h. The negative control group N was treated during remineralization cycles with saline; positive control group P was treated with remineralization solution; experimental group D1 was exposed to remineralization solution containing Denttabs^®-tablets with 1450 ppm F; experimental group D2 was exposed to remineralization solution and Denttabs^®-tablets with 4350 ppm F. Each tooth was cut into serial sections and analyzed by polarized light microscopy for assessment of the different zones of white-spot lesions in 3 representative sections. Statistical analysis was based on the Mann-Whitney-Test.

Results

Both control groups N(-) and P(+) exhibited characteristic white-spot lesions. The remineralization and the demineralization inhibition of the lesions increased considerably from N<P < D1<D2. Denttabs^®-2 administration showed partial/total remineralization including lamination and/or disappearance of the body of the lesion. The different results of all 4 groups were statistically highly significant (p < 0.01) with both tests.

Conclusion

Based on these results the novel Denttabs^® formulation represents a highly effective oral hygiene product and the remineralization is correlated to the fluoride content.

Radiation-related caries and early restoration failure in head and neck cancer patients. A polarized light microscopy and scanning electron microscopy study

INTRODUCTION

Radiation-related caries is a disease with high potential of teeth destruction in patients who have undergone radiotherapy in the head and neck region. Also, it is a challenge for dentistry due to high rates of recurrent caries and early restorations failure.

PURPOSE

This study aims to analyze the early restoration failures in order to better understand the etiology of dental restorations reduced longevity in irradiated teeth.

METHODS

Fifteen restored permanent teeth extracted from 11 patients who had finished head and neck radiotherapy were studied. Sections from each tooth were prepared and a qualitative description of the interface between restorations and dentin was performed by using polarized light microscopy and scanning electron microscopy.

RESULTS

Unfavorable anatomical shape of restorations, residual caries, and secondary caries affecting dentin adjacent to restorative materials were widely found. The morphological patterns of these carious lesions were similar to conventional dentin lesions with superficial demineralized zone and translucent zone.

CONCLUSIONS

Early dental restoration failure in teeth affected by radiation-related caries may have the same etiological factors from ordinary dental restoration failure and direct radiogenic damage to dentition would not be essential to early restorations failure in radiation-related caries.

Ultrastructural observations and growth of occluding crystals in carious dentine

The aim of the present study was to investigate the ultrastructural mechanisms involved in the formation of caries-induced intratubular dentine. Conventional, high resolution and scanning transmission electron microscopy, electron diffraction and energy-dispersive X-ray spectroscopy techniques were used to study the ultrastructure of the inorganic phase in the transparent zone of carious dentine. The results demonstrated that the bulk of the inorganic phase in caries-induced intratubular dentine had an apatite crystal structure with the presence of additional Mg-substituted beta-TCP (beta-tricalcium phosphate) phase in the carious region. Highly oriented apatite crystallites observed in intratubular dentine demonstrated a regulated biomineralization process during the formation of inorganic phase in this region, whereas Mg beta-TCP crystals were presumably formed purely via "dissolution/precipitation" mechanism. The study demonstrated the importance of "dissolution/precipitation" process and the growth kinetics of Mg-substituted beta-TCP crystals in understanding the process of formation of calcium-phosphate crystallites in carious intratubular dentine.

Ultrastructure of dentine carious lesions

OBJECTIVE

The aim of the present study is to investigate the ultrastructural changes within the different zones of carious dentine and compare those changes with sound dentine.

METHODS

Transmission electron microscopy and electron diffraction techniques were used to investigate the effect of caries on the inorganic phase of dentine. Areas of interest were identified with optical and scanning electron microscopes.

RESULTS

The results demonstrated that the intertubular mineral crystallites decrease in size as caries lesion progresses. In the transparent zone of carious lesion, both intratubular and intertubular dentine consisted of nano-size apatetic crystallites with smaller size in the former. The intratubular mineral phase in transparent zone was found to be chemically similar to the intertubular dentin.

CONCLUSIONS

The study suggests that a 'dissolution and precipitation' mechanism is important in understanding the process of formation of intratubular dentine within the transparent zone induced by caries attack. The observed partial demineralisation of intertubular dentine in transparent zone is discussed in terms of dissolution of tubule microbranches and exposure of intertubular dentin to acids.

Micromorphological and micronanalytical characterization of stagnating and progressing root caries lesions

Root caries is the predominant disease of the tooth tissues in the elderly population and differs in progression and micromorphology from coronal dentin caries. Therefore, different clinical concepts are needed for the treatment of these progressing and arrested lesions. It was the aim of this study to investigate the three-dimensional structure and volume of stagnating and progressing root caries lesions and to determine the mineral composition of the different lesion zones to achieve a better understanding of the natural history of root caries lesion formation. Of 21 extracted human teeth of patients between 42 and 77 years of age with stagnating and progressing root caries lesions serial sections were cut and investigated with polarized light and scanning electron microscopy. From the polarized light micrographs 3D reconstructions were made to determine the volumes of the lesion zones and their relations expressed in a demineralization index (DI). With increasing size of the demineralizing zone the DI increased indicating an increase in the size of the translucent zone. The 3D reconstructions showed distinct differences between stagnating and progressing root caries lesions. In the hypermineralized translucent dentin not all dentin tubules were obliterated by intratubular dentin and within the translucent dentin scattered dead tracts were found. Electron dispersive X-ray (EDX) analysis showed that the intertubular dentin of the translucent dentin was also demineralized to a certain extent. The results indicate distinct morphological differences between progressing and stagnating root caries lesions which may have consequences for treatment strategies.

Dentin micro-architecture using harmonic generation microscopy

OBJECTIVES

We present a novel way to create high-resolution three-dimensional images of tooth dentin by harmonic generation scanning laser microscopy.

METHODS

The images were taken using a pulsed infrared laser. Three-dimensional reconstruction enables the visualization of individual tubules and the collagen fibrils mesh around them with an optical resolution of approximately 1 microm.

RESULTS

The images show micro-morphological details of the dentinal tubules as well as the collagen fibrils at a depth of up to about 200 microm. The data show that while collagen fibrils are organized in planes perpendicular to the tubules, close to the dentin enamel junction they lie also along the long axis of the tubules.

CONCLUSIONS

The unique 3D information opens the opportunity to study the collagen fibril arrangement in relation to the tubule orientation within the dentin matrix, and may be applied to study the micro-morphology of normal versus altered dentin.