Silver diamine fluoride in preventing enamel erosion: An in vitro study with salivary pellicle

OBJECTIVES

To compare the prevention of enamel erosion and discolouring effect with a single and two weekly topical applications of silver diamine fluoride (SDF) solution.

METHODS

Human enamel blocks were divided into four groups. Group 1 (SDF2) received two weekly applications of SDF solution (Advantage Arrest: 260,000 ppm Ag, 44,300 ppm F, pH 9.1). Group 2 (SDF1) received a single application of SDF solution. Group 3 (SNF, Positive Control) received daily application of stannous-chloride/amine-fluoride/sodium-fluoride solution (Elmex® Enamel professional: 800 ppm Sn(II), 500 ppm F, pH 4.5). Group 4 (DW, Negative Control) received daily application of deionised water. The treated blocks were subjected to a 14-day erosive challenge. Crystal characteristics, elemental composition, surface morphology, percentage of surface microhardness loss (%SMHL), surface loss, and total colour change (ΔE) of the blocks were investigated using X-ray diffraction (XRD), energy-dispersive spectrometry (EDS) and scanning electron microscopy (SEM), Vickers' hardness testing, non-contact profilometry, and digital spectrophotometry, respectively.

RESULTS

XRD and EDS revealed precipitates of silver for SDF2 and SDF1 and tin for SNF. SEM showed prominent etched enamel pattern on DW than the other three groups. The%SMHL (%) of SDF2, SDF1, SNF, and DW were 26.6 ± 2.9, 33.6 ± 2.8, 38.9 ± 2.9, and 50.5 ± 2.8 (SDF2SDF1=SNF>DW, p < 0.05).

CONCLUSION

Two weekly applications was more effective than a single application of SDF in preventing enamel erosion, though it caused more discolouration.

CLINICAL SIGNIFICANCE

Topical application of 38 % SDF with two weekly applications protocol is effective in preventing enamel erosion.

Effect of gastric acids on the mechanical properties of conventional and CAD/CAM resin composites - An in-vitro study

OBJECTIVES

Dental erosion in patients with gastroesophageal reflux disease (GERD) is a current and frequent condition that may compromise the mechanical properties and clinical durability of resin-based composites (RBCs). This study assessed the mechanical properties of conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) RBCs subsequent to simulated gastric acid aging.

MATERIALS AND METHOD

Three conventional and three CAD/CAM composites were assessed. They were divided into an experimental group (exposed to simulated gastric acid aging) and a control group (no aging). Both groups were analyzed for Vickers microhardness (VHN), wear and flexural strength over a period of six months. The failure rate probability for each RBC was calculated through the Weibull cumulative distribution function (m). Statistical analysis was conducted using repeated measures ANOVA, 3-way ANOVA, a non-parametric Kruskal-Wallis and U Mann-Whitney tests (α = 0.05).

RESULTS

The mechanical properties of all the RBCs dropped significantly after aging (p < 0.05). Lower VHN and flexural strength values, along with greater wear values were evident in the experimental groups, though the effects of the treatment varied between RBCs. The Weibull m of all the RBCs decreased over time.

CONCLUSION

Conventional RBCs might show greater reduction in mechanical properties compared to CAD/CAM RBCs when exposed to gastric acid attack. Thus, CAD/CAM composites may represent a suitable choice for the treatment of patients presenting erosive issues.

The subsurface lesion in erosive tooth wear

OBJECTIVES

This study compared the surface change on natural and polished enamel exposed to a joint mechanical and chemical wear regimen.

METHODS

Human enamel samples were randomly assigned to natural (n = 30) or polished (n = 30) groups, subjected to erosion (n = 10, 0.3% citric acid, 5 min), abrasion (n = 10, 30 s), or a combination (n = 10). Wear in the form of step height was measured with a non-contact profilometer, and surface changes were inspected with SEM on selected sections. Data was normalised and underwent repeated measures MANOVA, accounting for substrate and erosive challenge as independent variables, with Bonferroni correction for significant post hoc interactions.

RESULTS

After four cycles, polished samples had mean step heights of 3.08 (0.40) μm after erosion and 4.08 (0.37) μm after erosion/abrasion. For natural samples, these measurements were 1.52 (0.22) μm and 3.62 (0.39) μm, respectively. Natural surfaces displayed less wear than polished surfaces under erosion-only conditions (p<0.0001), but the difference disappeared with added abrasion. SEM revealed a shallow subsurface layer for polished surfaces and natural ones undergoing only erosion. However, natural surfaces exposed to both erosion and abrasion showed deeper subsurface changes up to 50 µm.

CONCLUSION

Natural enamel, when exposed to erosion alone, showed less wear and minimal subsurface alterations. But with added abrasion, natural enamel surfaces saw increased wear and notable subsurface changes compared to polished ones.

CLINICAL SIGNIFICANCE

The pronounced subsurface lesions observed on eroded/abraded natural enamel surfaces highlight how combined wear challenges may accelerate tooth tissue loss.

Use of polyvinyl siloxane impressions to monitor sub-5-μm erosive tooth wear on unpolished enamel

STATEMENT OF PROBLEM

Whether polyvinyl siloxane impressions are capable of reproducing 5-μm changes on natural freeform enamel and potentially enabling clinical measurements of early surface changes consistent with wear of teeth or materials is unclear.

PURPOSE

The purpose of this in vitro study was to investigate and compare polyvinyl siloxane replicas with direct measurements of sub-5-μm lesions on unpolished human enamel lesions by using profilometry, superimposition, and a surface subtraction software program.

MATERIAL AND METHODS

Twenty ethically approved unpolished human enamel specimens were randomized to a previously reported cyclic erosion (n=10) and erosion and abrasion (n=10) model to create discrete sub-5-μm lesions on the surface. Low viscosity polyvinyl siloxane impressions were made of each specimen before and after each cycle and scanned by using noncontacting laser profilometry and viewed with a digital microscopy and compared with direct scanning of the enamel surface. The digital maps were then interrogated with surface- registration and subtraction workflows to extrapolate enamel loss from the unpolished surfaces by using step-height and digital surface microscopy to measure roughness.

RESULTS

Direct measurement revealed chemical loss of enamel at 3.4 ±0.43 μm, and the polyvinyl siloxane replicas were 3.20 ±0.42 μm, respectively. For chemical and mechanical loss direct measurement was 6.12 ±1.05 μm and 5.79 ±1.06 μm for the polyvinyl siloxane replica (P=.211). The overall accuracy between direct and polyvinyl siloxane replica measurements was 0.13 +0.57 and -0.31 μm for erosion and 0.12 +0.99 and -0.75 μm for erosion and abrasion. Surface roughness and visualization with digital microscopy provided confirmatory data.

CONCLUSIONS

Polyvinyl siloxane replica impressions from unpolished human enamel were accurate and precise at the sub-5-μm level.

Influence of carbonated acid beverage on fracture resistance and marginal gap formation in different restorative approaches to non-carious cervical lesions

OBJECTIVE

This study is to evaluate fracture resistance, failure mode, and gap formation at the restorative interface of unrestored or restored non-carious cervical lesions (NCCLs) submitted to a short-term erosive environment.

MATERIALS AND METHODS

Artificial NCCLs were produced in vitro in bovine incisors, and were randomly divided into four restorative resins groups (n = 22): nanohybrid-NR; bulk-fill-BR; flow with a nanohybrid layer-FNR; bulk-fill with a nanohybrid layer-BNR; and a group unrestored-UR (n = 16). Half of the specimens were submitted to an erosive challenge (per 5 min, 3 × a day for 7 days, before and after restoration), and the other half, was immersed in artificial saliva. After, all teeth undergone thermal (5 ºC, 37 ºC, and 55 ºC, 3600 cycles) and mechanical (50 N, 2 Hz, 300,000 cycles) aging. Eighty teeth were subjected to compressive loading, and resistance and failures were analyzed, while 24 teeth were evaluated for gaps by microcomputed tomography. Statistical tests were performed (p < 0.05).

RESULTS

The restorative approaches affected fracture resistance (η2p = 0.14, p = 0.023), and gap formation (η2 = 0.18, p = 0.012) and so did the immersion medium (fracture η2p = 0.09, p = 0.008; gap η2 = 0.09, p = 0.017). BNR showed the highest resistance, while UR the lowest. FNR showed the highest gaps in both immersion media. Neither the resin groups nor the immersion media were associated with failure mode.

CONCLUSIONS

The erosive immersion medium based in acid beverages has been shown to affect NCCLs with or without restoration, but when Bulk-Fill resin is covered by nanohybrid resin, the performance is good.

CLINICAL RELEVANCE

Erosion negatively affects restorations, but unrestored NCCL shows worse biomechanical performance in stress-bearing situations.

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.

The effect of toothpaste with reduced concentration of fluoride-containing sodium trimetaphosphate and polyols on initial enamel erosion

OBJECTIVES

This in vitro study evaluated the efficacy of toothpaste containing fluoride (F), sodium trimetaphosphate (TMP), and xylitol and erythritol (XE) to inhibit or repair initial enamel erosion lesions.

MATERIALS AND METHODS

Bovine enamel blocks (n = 120) were selected according to surface hardness (SH) and randomly divided into 5 experimental groups (n = 24 blocks/group): Placebo (no F, TMP, XE); 1100 ppm F; 16% xylitol + 4% erythritol (XE); 200 ppm F + 0.2% TMP (200 ppm F/TMP); and 200 ppm F + 0.2% TMP + 16% xylitol + 4% erythritol (200 ppm F/TMP/XE). The sound and softened blocks were immersed in toothpaste slurry in human saliva for 2 min. The blocks were then submitted to 4 erosive challenges in citric acid (0.75%, pH 3.5), each challenge for 1 min, with stirring. The SH of the blocks was determined after treatment (t) and after the 4 erosive challenges. In addition, the precipitates were analyzed by scanning electron microscopy (SEM). Variables were submitted to a two-way repeated-measures analysis of variance followed by a Student-Newman-Keuls test (p < 0.05).

RESULTS

Toothpaste containing 200 ppm F/TMP/XE led to the highest protective and repair effect compared to the other groups (p < 0.001). The protective and repair effect was XE > 200 ppm F/TMP > 1100 ppm F > placebo (p < 0.001). All groups produced precipitates with a thicker layer for XE and TMP groups.

CONCLUSIONS

Toothpaste containing 200 ppm F, TMP, and polyols demonstrated a superior protective and repair effect in initial enamel erosive lesions in vitro.

CLINICAL RELEVANCE

Toothpaste containing F and polyols could be an advantage in patients affected by dental erosion, due to its higher preventive potential, mainly in individuals who frequently drink acidic beverages. However, future studies are needed to confirm these results.

Effect of air-abrasion pretreatment with three bioactive materials on enamel susceptibility to erosion by artificial gastric juice

OBJECTIVE

The purpose of the study was to investigate the protective effect of three in-office preventive treatments with bioactive materials against enamel erosion induced by artificial gastric juice similar to that found in gastroesophageal reflux disease (GERD) patients. The treatments included air-abrasion of enamel with a fluoride-containing bioactive glass (BioMinF®), Bioglass 45S5 (ProSylc) and nano-hydroxyapatite (MI Pearls) to test enamel susceptibility following an erosive challenge.

METHODS

Enamel surface loss was evaluated using confocal microscopy, while changes in enamel surface roughness and morphology were also investigated after the treatments. SEM and EDS were used to observe formation of apatite crystals on enamel and to detect alterations in mineral composition. In Group 1 (negative control) the specimens did not receive any treatment; Group 2 specimens (positive control) treated with 0.4 % SnF₂, while in Groups 3-5 enamel was air-abraded with BioMinF®, ProSylc and MI Pearls, respectively.

RESULTS

All the experimental groups reduced significantly enamel surface loss compared to the negative control group (p < 0.05), except for the MI Pearls treatment (p > 0.05). The most protective behavior against erosion presented the treatment with SnF₂. BioMinF induced the larger amount of apatite crystals on the enamel surface, followed by ProSylc.

SIGNIFICANCE

BioMinF and ProSylc treatments may be beneficial against dental erosion induced by gastric juice in GERD patients, while MI Pearls treatment may not suitable for this indication. Both materials promote formation of apatite crystals on enamel in acidic conditions protecting the surface from the erosion. The tested treatments may be useful in GERD patients who cannot comply with at-home therapies with SnF₂.

Effect of three different remineralizing agents on artificial erosive lesions of primary teeth

BACKGROUND

This study aimed to investigate the efficacy of three remineralizing agents on dental erosion in primary teeth.

METHODS

Forty primary molars were randomly divided into four groups (n = 10 each): self-assembling peptide (P_11-4 ), casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP), sodium fluoride (NaF) and artificial saliva (AS; control). The erosion-like formation was created by immersing the samples in citric acid (4 × 2 min, pH 2.3) and AS (4 × 2 h, pH 7). The eroded samples were then treated with remineralizing agents and subjected to further erosion consisting of 15 cycles (3x/8-h interval) of immersion in citric acid and AS for 6 s each. Alterations in the mineral content and morphology of the samples were quantified using a microhardness tester and atomic force microscope.

RESULTS

All agents had a significant remineralization effect on eroded primary tooth enamel. After further erosive challenge, enamel loss in the CPP-ACFP group was found to be significantly lower than in all other groups, and no significant difference was found between the P_11-4 and NaF groups.

CONCLUSIONS

This study showed that all tested materials had remineralization ability, and CPP-ACFP had a superior effect in inhibiting enamel loss due to dental erosion in primary teeth. © 2022 Australian Dental Association.

Comparison of metrology created by profilometry and digital microscopy on polished dentine in an erosion/abrasion model

OBJECTIVE

Digital microscopy offers the ability to scan surfaces to produce 3D reconstructions, allowing step height measurements with high accuracy. The aims of this study were to compare the step heights from the gold standard, non-contact profilometry, to digital microscopy in an erosion/abrasion model.

METHODS

Dentine specimens (n = 60) were immersed in deionised water, 1450 ppm and 5000 ppm fluoride as sodium fluoride for 3 min, eroded for a total of 25 min in a cycled protocol in 0.3% citric acid (pH 2.7) and abraded with 120 and 240 brushing strokes. Samples were scanned by a non-contacting profilometer with a 0.1 μm vertical resolution and then the same samples imaged with a digital microscope and the step heights compared. Data were analysed in GraphPad Prism 7.00. Data were normally distributed and a 3 way ANOVA with post hoc analysis used to assess for differences between groups. Agreement between the measurement method was assessed using IntraClass Correlations and Bland Altmans plots.

RESULTS

The mean step heights from the profilometry and the digital microscope on the same samples were not statistically significant different. The magnitude of the differences was less than 0.5 μm. The results of the ANOVA demonstrated that the individual factors fluoride concentration and number of strokes were significant (P<0.05), however, the method of analysis was not (p = 0.74). ICC's between the two methods of analysis were excellent (0.996, p<0.001) with no proportional bias.

CONCLUSIONS

This study reports that step height on dentine from a digital microscopy and non-contact profilometry were not significantly different. The digital microscope, although slower, allows visual inspection of the samples as well as measurement.

SIGNIFICANCE

Digital microscope's offer the ability to scan, 2D or 3D images and perform meteorological analysis of samples. In this investigation both showed that 5000 ppm fluoride prevents erosive tooth wear in vitro.

Comparative Evaluation of Resin Dentin Interface using Universal and Total- Etch Adhesive Systems on Sound and Eroded Dentin: In Vitro Study

Objective This study aimed to compare the resin-dentin interface of sound and eroded dentin using universal and total-etch adhesive systems.

Materials and Methods Forty caries-free extracted human premolars were collected, and the occlusal surfaces were ground by using slow speed diamond disc with copious water supply until a flat superficial dentin was exposed. The test group underwent erosive cycle (n = 20), and another group (n = 20) was reserved for control group. Erosive protocol consisted of immersion in 1.23% citric acid for 1 minute every 12 hours and stored in artificial saliva. Both the control and eroded teeth were further subdivided (n = 10) for composite restoration by using either self-etch or total-etch systems. Then the tooth samples were sectioned longitudinally and observed under confocal laser scanning microscope at ×10 magnification to evaluate resin tag length and hybrid layer thickness.

Statistical Analysis The data obtained were analyzed by using independent t-test.

Results The highest mean value of the resin tag length and thickness of hybrid layer was observed with total-etch system in sound dentin group compared with other groups (p < 0.001).

Conclusion The resin-dentin interface of sound dentin was found to be better than eroded dentin by using total-etch system. The resin-dentin interface of eroded dentin was superior to sound dentin by using self-etch adhesive system.

Role of bioglass in enamel remineralization: Existing strategies and future prospects-A narrative review

Enamel, once formed, loses the ability to regenerate due to the loss of the formative ameloblasts. It is subjected to constant damaging events due to exposure to external agents and oral microbiomes. An enamel remineralization process targets to replenish the lost ionic component of the enamel through a multitude of methods. Enamel remineralization is highly challenging as it has a complex organized hierarchical microstructure. Hydroxyapatite nanocrystals of the enamel vary in size and orientation along alignment planes inside the enamel rod. The inability of the enamel to remodel unlike other mineralized tissues is another substantial deterrent. One of the well-known biomaterials, bioglass (BG) induces apatite formation on the external surface of the enamel in the presence of saliva or other physiological fluids. Calcium, sodium, phosphate, and silicate ions in BG become responsive in the presence of body fluids, leading to the precipitation of calcium phosphate. Studies have also demonstrated the bactericidal potential of BG against Streptococcus mutans biofilms. The anticariogenicity and antibacterial activity were found to be enhanced when BG was doped with inorganic ions such as F, Ag, Mg, Sr, and Zn. Due to the versatility of BG, it has been combined with a variety of agents such as chitosan, triclosan, and amelogenin to biomimic remineralization process. Key strategies that can aid in the development of contemporary enamel remineralization agents are also included in this review.

Is the Erosion-Protective Effect Still Maintained when Tin Concentrations Are Reduced in Mouth Rinse Solutions?

OBJECTIVE

As a preventive measure, tin (Sn2+)-containing products have a great potential to prevent enamel surface loss during erosive challenges, but adverse effects of high Sn2+ concentrations, such as astringent feeling of the teeth, are reported. Therefore, the main aim of this in vitro study was to develop a solution with lower Sn2+ concentrations that can still prevent dental erosion.

METHODS

A total of 162 enamel specimens were prepared from human premolars, which were selected from a pool of extracted teeth. The specimens were randomly distributed to 9 groups (each group n = 18 enamel specimens) according to the different test treatments: a humid chamber (no treatment) as the negative control, the commercial Elmex® Erosion Protection mouth rinse as the positive control, and 7 solutions either with lower Sn2+ concentrations and/or containing flavoring. The experiment included 4 cycles, consisting of pellicle formation by incubating the specimens with 200 μL of human saliva at 37°C for 1 h, then placing the specimens in the treatment for 2 min (60 mL, 30°C, shaking at 70 rpm), and later submitting them to an erosive challenge for 1 min in citric acid (60 mL 1%, pH 3.6, 30°C). Surface hardness was measured with a Vickers diamond and surface reflection intensity was measured with a reflectometer.

RESULTS

The control group performed significantly worse than all other solutions containing Sn2+. In general, there were no significant differences among the Sn2+-containing groups, and they presented similar protective effects on the enamel even when Sn2+ concentrations were reduced and flavorings were added.

CONCLUSION

Sn2+ concentrations in mouth rinses may be lowered to 200 ppm without compromising the anti-erosive properties of the solution.

Protective Effect of Solutions Containing Polymers Associated with Fluoride and Stannous Chloride on Hydroxyapatite Dissolution

This study investigated the protective effect of experimental solutions containing 4 polymers (polyoxirane, hydroxypropylmethylcellulose [HPMC], pectin, and an amino methacrylate copolymer [AMC]) in 2 concentrations (low and high) associated or not with sodium fluoride (F; 225 ppm F-) or sodium fluoride plus stannous chloride (FS; 800 ppm Sn2+) on the dissolution of hydroxyapatite crystals (HA). Deionized water was the control. The pretreated HA was added to a 0.3% citric acid solution (pH 3.8). An automatic titrant machine added aliquots of 0.1 N HCl at a rate of 28 μL/min, in a total reaction time of 5 min. Groups were compared with 2-way ANOVA and Tukey's test, and concentrations with Student t test (5%). The zeta potential of the HA treated with the solutions was measured. Significant differences were found for both factors and interaction (p < 0.0001). The treatments with F and FS solutions resulted in a lower amount of dissolved HA than the control. Among the polymers' solutions, only AMC was able to reduce the amount of dissolved HA, changing the surface charge of HA to positive. AMC improved the protective effect of F, but it did not affect FS. Polyoxirane and HPMC reduced the protective potential of the FS solution. No differences were found between the concentrations of the polymers. It was concluded that F and FS reduced the amount of dissolved HA. The protective effect of the experimental solutions against HA dissolution was polymer dependent. The F effect was enhanced by its combination with AMC, but the protection of FS was impaired by polyoxirane and HPMC.

The Effect of Er:YAG Laser Irradiation Combined With Fluoride Application on the Resistance of Primary and Permanent Dental Enamel to Erosion

Introduction: Erosion is an important cause of tooth mineral loss. The combined use of lasers and fluoride has been introduced as a novel modality for the prevention of enamel demineralization. This study aimed to assess the effect of Er:YAG laser combined with fluoride application on primary and permanent enamel resistance to erosion. Methods: Eighty enamel specimens of permanent (n=40) and primary (n=40) molars were prepared and randomly assigned to 4 groups: C-control (no pretreatment), F-acidulated phosphate fluoride (APF) gel, FL-APF gel application followed by Er:YAG laser irradiation, and LF-Er:YAG laser irradiation followed by the application of APF gel . The specimens were then submitted to pH cycling using Coca-Cola (pH=2.4). Enamel micro-hardness was measured using the Vickers microhardness tester before pretreatment and after the erosive process. The collected data were analyzed using the Kolmogorov-Smirnov test, two-way ANOVA and repeated measures ANOVA. Results: The micro-hardness of both permanent and primary enamel specimens significantly decreased after the erosive process (P < 0.05). In the permanent enamel specimens, the greatest reduction in micro-hardness was noted in groups C and F, while the least reduction was noted in group FL. However, these differences were not statistically significant (P > 0.05). In the primary enamel specimens, the greatest reduction in micro-hardness was noted in groups C and LF, while the least reduction was noted in group F. These differences were not statistically significant (P > 0.05). Conclusion: Within the limitations of this study, Er:YAG laser irradiation combined with fluoride application could not prevent erosion in permanent and primary enamel during the erosive process.

Eroded enamel rehardening using two intraoral appliances designs in different times of salivary exposure

BACKGROUND

The aim of this study was evaluated the eroded enamel rehardening potential using upper palatal and lower buccal removable appliances in different times of salivary exposure (30 min, 1h, 2h, 12h) after a single erosive challenge event.

MATERIAL AND METHODS

After initial surface hardness evaluation, bovine enamel blocks were eroded in vitro (0.01 M hydrochloric acid, pH 2.3, 30 seconds), selected (n = 160) and randomly assigned to the two appliance designs and twenty volunteers. Four enamel blocks were inserted in each removable appliance. On the in situ phase, the volunteers were instructed to use the upper palatal and lower buccal appliances simultaneously for 12 nonconsecutive hours. After each predetermined period of time of salivary exposure, the enamel blocks were removed from the appliances for immediate evaluation of surface hardness, enabling percentage of surface hardness recovery calculation (%SHR). The data were analyzed using two-way ANOVA and Tukey's test (α=5%).

RESULTS

The results showed no difference in the degree of enamel rehardening by the upper palatal or lower buccal appliances (p >0.0001). Regarding the time of use of the appliances, it was demonstrated that 30 minutes (upper = 21.12%, lower = 19.84%) and 1 hour (upper = 35.69%, lower = 30.50%) promoted lower hardness recovery than two hours (upper = 44.65%, lower 40.80%) of salivary exposure (p<0.0001). The use of 12 hours (upper = 49.33%, lower = 49.00%), including the sleeping time of the volunteers did not increase the %SHR.

CONCLUSIONS

The location of the appliance does not influence the re-hardening ability of saliva and the use of intraoral appliances for 2 hours seems to be appropriate for partial rehardening of the softened enamel surface. Key words:Tooth erosion, in situ, saliva, tooth remineralization.

The effects of intrinsic and extrinsic acids on nanofilled and bulk fill resin composites: Roughness, surface hardness, and scanning electron microscopy analysis

The objective of this study was to examine the effects of extrinsic or intrinsic acids on nanofilled and bulk fill resin materials in vitro. A total of 90 disks were prepared using dental restorative material (Filtek Z350XT, GrandioSO, Filtek Bulk Fill, X-tra fil). Thirty disks of each material were sub-divided into three groups (n = 10) that were immersed for 7 days in deionized water (DW), 5% citric acid (CA-pH 2.1), or 0.1% hydrochloric acid (HCl-pH = 1.2). Surface hardness and roughness (stylus profilometer by R_a parameter) analysis were performed before and after immersion. Morphological changes were evaluated by scanning electron microscopy. The data were analyzed by two-way ANOVA and Tukey's test (α = 0.05). All tested materials did not show significant differences in the effects of the DW, CA, or HCl solutions on surface roughness (p = .368). Likewise, the hardness loss was not affected by the solutions tested (p = .646), but there was a difference in the resin type (p = .002). Filtek Bulk Fill resin hardness was less affected, while Filtek Z350XT and GrandioSO presented the most hardness loss after 7 days of solution immersion. In terms of this experimental study, the results demonstrate the effectiveness of the mechanical properties (roughness and hardness surface) of nanofilled and bulk fill resin materials to resist erosion from extrinsic and intrinsic acids, therefore being potential candidates for dental applications.

100% Fruit Juice and Dental Health: A Systematic Review of the Literature

Background: The objective of this systematic review was to assess the scope and breadth of publicly available prospective cohort and randomized controlled trial (RCT) literature on 100% fruit juice and dental caries or tooth erosion in humans.

Methods: We performed a systematic search in MEDLINE/PubMed, EMBASE, and Web of Science for studies published from inception through May 2018, and the Cochrane Library databases for reports published through January 2018. Prospective cohort studies or RCTs conducted on dental health and 100% fruit juice, and published in English were selected. No restrictions were set for age, sex, geographic location, or socioeconomic status.

Results: Eight publications representing five independent prospective cohort studies and nine publications on nine RCTs were included. All prospective cohort studies were in children or adolescents, and all RCTs were in adults. Prospective cohort studies on tooth erosion found no association between juice intake and tooth erosion, while those on dental caries incidence reported either no association or an inverse association between 100% fruit juice intakes and dental caries incidence. RCTs on tooth erosion showed decreased microhardness, increased surface enamel loss, increased erosion depth, greater enamel softening, and/or increased pellicle layer with 100% fruit juice, and those on dental caries showed increased demineralization of enamel slabs with 100% fruit juice.

Conclusions: The existing evidence on 100% fruit juice intake and caries and tooth erosion are not conclusive. Overall, prospective cohort studies in children and adolescents found no association between 100% fruit juice intake and tooth erosion or dental caries, but, RCT data in adults suggests that 100% fruit juice could contribute to tooth erosion and dental caries. The RCT data, however, were from small, short-term studies that utilized intra-oral devices generally devoid of normal plaque or saliva action, and generally employed conditions that are not reflective of normal juice consumption.

Antierosive Effect of Topical Fluorides: A Systematic Review and Meta-Analysis of In Situ Studies

BACKGROUND

The effectiveness of the application of topical fluorides in prevention of erosive tooth wear has been an issue of controversy in the literature. The objective of this systematic review was to assess in situ studies investigating the effects of using topical fluorides on prevention of erosive tooth wear.

MATERIAL AND METHODS

Two electronic databases PubMed/MEDLINE and Cochrane Central Register of Controlled Trials were searched. Eligibility criteria included in situ-controlled studies that assessed the effect of the erosive process without additional tooth brushing. The search involved English-written articles only. A total of 684 potentially relevant titles and abstracts were found after removal of duplicates, of which 22 full-text articles were selected. Seventeen studies were included in the qualitative synthesis of which 6 studies included in the meta-analysis. The following data were obtained for each study: authors, year of publication, country, study design, periods of study, duration, blinding, interventions (type/concentration/form), tooth substrate, location of the intraoral appliance, number of samples attached to each appliance, type of acidic media used for erosive challenge, duration of erosive challenge, subjects (number/age/sex), reported side effects -if any-, measuring device, amounts of tissue loss.

RESULTS

The risk of bias of the included studies was assessed using the Cochrane Collaboration tool for assessing the risk of bias. A meta-analysis of the present study was performed using Comprehensive Meta-Analysis version 2.2.048 software.

CONCLUSION

The use of oral hygiene products containing AmF/NaF/SnCl2 or NaF may be effective in the prevention of erosive tooth wear.

Resin-Based Materials Protect Against Erosion/Abrasion-a Prolonged In Situ Study

While patient compliance is key to preventive measures related to dental erosion, the application of resin-based materials could serve as an additional treatment to inhibit erosion progression. This in situ study evaluated the effect of applying resin-based materials, including resin infiltrant, on previously eroded enamel subjected to prolonged erosive and abrasive challenges. The factors under study were types of treatment (infiltrant [Icon], sealant [Helioseal Clear], adhesive [Adper Scotchbond Multi-Purpose Plus], and control [no treatment]); wear conditions (erosion [ERO] and erosion + abrasion [ERO + ABR]) and challenge time (5 and 20 days) in a single-phase study. The blocks were prepared from bovine enamel, eroded (0.01 M HCl, pH 2.3 for 30 seconds) and randomized among treatments, wear conditions, and volunteers. The application of resin-based materials followed the manufacturers' recommendations. Twenty-one volunteers wore the palatal intraoral device, in which one row corresponded to ERO and the other to ERO + ABR. In each row, all treatments were represented (2 blocks per treatment). For 20 days, the erosive challenge was performed 4 times/day (immersion in 0.01 M HCl, pH 2.3, for 2 minutes) for the ERO condition. For the ERO + ABR condition, two of the erosive challenges were followed by abrasion for 15 seconds with fluoride dentifrice slurry. Enamel and/or material loss was measured using profilometry (initial, after treatment, and after the end of the fifth and 20th days of in situ erosive challenge) and analyzed by ANOVA models and Tukey's test (α=0.05). The results showed that the application of resin-based materials did not cause superficial enamel loss. The infiltrant group showed a thicker layer of material above the enamel compared with the other materials (p=0.001). After the erosive challenge, there was no difference between the conditions ERO and ERO + ABR (p=0.869). All materials protected the enamel against erosion progression compared with the control group (p=0.001). Based on these results, we conclude that the application of resin-based materials results in protection of previously eroded enamel subjected to in situ erosive and abrasive challenge for 20 days.

The effect of aspartame and pH changes on the erosive potential of cola drinks in bovine enamel: An in vitro study

BACKGROUND

The aim of this study was to clarify the mechanism behind the different erosive potential of regular and light cola drinks: pH difference and/or aspartame presence.

MATERIAL AND METHODS

Sixty bovine enamel blocks were randomly divided into 5 groups: RC - regular cola, RCpH - addition of base to increase regular cola pH, RCAS - addition of aspartame to regular cola, LC - light cola, and LCpH - addition of acid to decrease light cola pH. Two-thirds of the blocks surface was coated with nail varnish for reference. The samples were daily subjected to four erosive challenges for 2 minutes. Between the erosive challenges (2h) and overnight the samples were maintained in artificial saliva. The response variable was the percentage surface hardness change (%SHC) after 1st experimental day and enamel surface loss (µm) measured at the 5th day by profilometry. Data were analyzed by ANOVA and Tukey's test (p<0.05).

RESULTS

Independently of the cola modifications, all groups promoted similar hardness change of enamel surface. RC promoted higher enamel loss (6.69±0.71µm) than LC (4.80±0.77µm). The acid addition to light cola (LCpH: 6.60±1.78µm) significantly enhanced its erosive potential, which did not differ from RC. The base addition to regular cola (RCpH-4.00±0.64µm) resulted in similar wear to LC. The addition of aspartame to the regular cola (RCAS 5.44±0.65µm) resulted in similar wear to LC and RC.

CONCLUSIONS

The data suggest that the pH alteration has a major impact on the erosive potential of cola drinks, however, the sweetener also has some influence. Key words:Tooth erosion, dental enamel, soft drinks, ph, sweetener.

Novel methodology for determining the effect of adsorbates on human enamel acid dissolution

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Method for investigating effect of adsorbates on acid dissolution of enamel.

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Effect of repeated acid exposures on adsorbates can be measured over time.

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Specific salivary proteins significantly reduced acid demineralisation of enamel.

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Desorption of specific proteins corresponds to reduction in protection against acid.

Objective

The effect of various interventions on enamel demineralisation can be determined by chemically measuring mineral ions dissolved by the attacking acid. Results are usually expressed as mineral loss per surface area of enamel exposed. Acid resistant varnish or adhesive tape are typically used to delineate an area of enamel. However, enamel surface curvature, rugosity and porosity reduce the reliability of simple area measurements made at the macro scale. Our aim was to develop a simple method for investigating the effect of adsorbates on enamel demineralisation that does not rely on knowing the area of enamel exposed. As an exemplar we have used salivary proteins as a model adsorbate.

Design

Natural human tooth enamel surfaces were subjected to five sequential acid challenges and then incubated in adsorbate (whole clarified saliva) followed by a further 15 acid challenges. Demineralisation was determined by measuring the phosphate released into the acid during each exposure by a spectrophotometric assay. The initial five challenges established a mean baseline mineral loss for each tooth against which the effect of subsequently adsorbed proteins could be compared.

Results

Salivary proteins significantly reduced the acid demineralisation of human enamel by 43% (p < 0.01). Loss of proteins during each challenge corresponded to a gradual reduction in the degree of protection afforded.

Conclusions

The methodology provides a simple and flexible means to investigate the effect of any adsorbate on enamel acid dissolution. Knowledge of the area of exposed enamel is irrelevant as each tooth acts as its own negative control.

Susceptibility of bovine dental enamel with initial erosion lesion to new erosive challenges

This in vitro study evaluated the impact of initial erosion on the susceptibility of enamel to further erosive challenge. Thirty bovine enamel blocks were selected by surface hardness and randomized into two groups (n = 15): GC- group composed by enamel blocks without erosion lesion and GT- group composed by enamel blocks with initial erosion lesion. The baseline profile of each block was determined using the profilometer. The initial erosion was produced by immersing the blocks into HCl 0.01 M, pH 2.3 for 30 seconds, under stirring. The erosive cycling consisted of blocks immersion in hydrochloric acid (0.01 M, pH 2.3) for 2 minutes, followed by immersion in artificial saliva for 120 minutes. This procedure was repeated 4 times a day for 5 days, and the blocks were kept in artificial saliva overnight. After erosive cycling, final profile measurement was performed. Profilometry measured the enamel loss by the superposition of initial and final profiles. Data were analyzed by t-test (p<0.05). The result showed no statistically significant difference between groups (GS = 14.60±2.86 and GE = .14.69±2.21 μm). The presence of initial erosion on bovine dental enamel does not enhance its susceptibility to new erosive challenges.

Dynamic measurement of the optical properties of bovine enamel demineralization models using four-dimensional optical coherence tomography

Dental enamel mineral loss is multifactorial and is consequently explored using a variety of in vitro models. Important factors include the presence of acidic pH and its specific ionic composition, which can both influence lesion characteristics. Optical coherence tomography (OCT) has been demonstrated as a promising tool for studying dental enamel demineralization. However, OCT-based characterization and comparison of demineralization model dynamics are challenging without a consistent experimental environment. Therefore, an automated four-dimensional OCT system was integrated with a multispecimen flow cell to measure and compare the optical properties of subsurface enamel demineralization in different models. This configuration was entirely automated, thus mitigating any need to disturb the specimens and ensuring spatial registration of OCT image volumes at multiple time points. Twelve bovine enamel disks were divided equally among three model groups. The model demineralization solutions were citric acid (pH 3.8), acetic acid (pH 4.0), and acetic acid with added calcium and phosphate (pH 4.4). Bovine specimens were exposed to the solution continuously for 48 h. Three-dimensional OCT data were obtained automatically from each specimen at a minimum of 1-h intervals from the same location within each specimen. Lesion dynamics were measured in terms of the depth below the surface to which the lesion extended and the attenuation coefficient. The net loss of surface enamel was also measured for comparison. Similarities between the dynamics of each model were observed, although there were also distinct characteristic differences. Notably, the attenuation coefficients showed a systematic offset and temporal shift with respect to the different models. Furthermore, the lesion depth curves displayed a discontinuous increase several hours after the initial acid challenge. This work demonstrated the capability of OCT to distinguish between different enamel demineralization models by making dynamic quantitative measurements of lesion properties. This has important implications for future applications in clinical dentistry.

Quantitative Swept-Source Optical Coherence Tomography of Early Enamel Erosion in vivo

Swept-source optical coherence tomography (SS-OCT) shows potential for the in vivo quantitative evaluation of micro-structural enamel surface phenomena occurring during early erosive demineralization. This randomized controlled single-blind cross-over clinical study aimed to evaluate the use of SS-OCT for detecting optical changes in the enamel of 30 healthy volunteers subjected to orange juice rinsing (erosive challenge) in comparison to mineral water rinsing (control), according to wiped and non-wiped enamel surface states. Participants were randomly allocated to 60 min of orange juice rinsing (pH 3.8) followed by 60 min of water rinsing (pH 6.7) and vice versa, with a 2-week wash-out period. In addition, the labial surfaces of the right or left maxillary incisors were wiped prior to SS-OCT imaging. An automated ImageJ algorithm was designed to analyse the back-scattered OCT signal intensity (D) after orange juice rinsing compared to after water rinsing. D was quantified as the OCT signal scattering from the 33 µm sub-surface enamel, normalised by the total OCT signal intensity entering the enamel. The back-scattered OCT signal intensity increased by 3.1% (95% CI 1.1-5.1%) in the wiped incisors and by 3.5% (95% CI 1.5-5.5%) in the unwiped incisors (p < 0.0001). Wiping reduced the back-scattered OCT signal intensity by 1.7% (95% CI -3.2 to -0.3%; p = 0.02) in comparison to the unwiped enamel surfaces for both rinsing solutions (p = 0.2). SS-OCT detected OCT signal changes in the superficial sub-surface enamel of maxillary central incisor teeth of healthy volunteers after orange juice rinsing.

Effect of Fluoride Varnish Containing CPP-ACP on Preventing Enamel Erosion

This study aimed to investigate the effect of a fluoride varnish with added casein phosphopeptide-amorphous calcium phosphate treatment on the prevention of enamel erosion, and it compared the results with those of other fluoride varnishes. Fifty enamel specimens obtained from bovine incisors were randomly divided into five groups (n = 10) based on the type of surface pretreatment used: intact enamel (Group 1); intact enamel+erosive cycles (Group 2); intact enamel+MI varnish+erosive cycles (Group 3); intact enamel+Clinpro White varnish+erosive cycles (Group 4); and intact enamel+Duraphat varnish+erosive cycles (Group 5). The specimens were subjected to erosive cycles for five days. The surface roughness was evaluated using atomic force microscopy. The results were statistically analyzed using one-way ANOVA and Tukey's tests. Group 1 had the smoothest surfaces. After the erosive cycles, the greatest surface roughness values were observed in Group 2, followed by Groups 5, 4, and 3, respectively. Statistically significant differences were observed among all groups (p < 0.05). The application of fluoride varnishes had some positive effects on preventing enamel erosion; however, the most effective agent was fluoride varnish with added casein phosphopeptide-amorphous calcium phosphate.

An In Vitro Evaluation of Human Enamel Surfaces Subjected to Erosive Challenge After Bleaching

OBJECTIVES

This study aimed to evaluate whether tooth enamel bleached with hydrogen peroxide (H₂ O₂ ) is more susceptible to erosion when compared with unbleached tooth enamel; and whether the presence of calcium (Ca) in the bleaching gel influenced this process.

MATERIALS AND METHODS

Enamel blocks were prepared from human molars, and submitted to surface microhardness analysis (baseline). Blocks were prepared and randomly divided into four treatment groups (n = 20): G1 and G2-bleached with 7.5% H₂ O₂ , with and without Ca, respectively; G3 and G4-bleached with 35% H₂ O₂ , with and without Ca, respectively. After bleaching, these groups were submitted to an erosive challenge with 1% citric acid. G5 and G6 (n = 20, each) were the negative (without bleaching) and positive controls (without bleaching, but with erosion), respectively. The percentage of surface hardness loss (%SHL), the 3D non-contact profilometry and Scanning Electron Microscopy (SEM) analyses were performed.

RESULTS

G2 showed the highest %SHL after bleaching. G1 presented the lowest %SHL in comparison with G2, G3, G4, and G6 after erosion (p < 0.05), which was confirmed only by the SEM analysis.

CONCLUSION

It is suggested that low concentration of H₂ O₂ with calcium can be recommended for at-home bleaching agents, which may avoid the mineral loss of bleached enamel after an erosive challenge.

CLINICAL SIGNIFICANCE

Low concentration of H₂ 0₂ with calcium can be recommended for at-home bleaching agents, which may avoid the mineral loss of bleached enamel after an erosive challenge. (J Esthet Restor Dent 29:128-136, 2017).

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.

Short-pulse Er:YAG laser increases bond strength of composite resin to sound and eroded dentin

This study evaluated the influence of the irradiation with a short-pulse Er:YAG laser on the adhesion of composite resin to sound and eroded dentin (SD and ED). Forty-six samples of occlusal dentine, obtained from human molars, had half of their surface protected, while the other half was submitted to erosive cycles. Afterward, 23 samples were irradiated with Er:YAG laser, resulting in four experimental groups: SD, sound irradiated dentine (SID—Er:YAG, 50  μs 50  μs , 2 Hz, 80 mJ, and 12.6  J/cm 2 12.6  J/cm2 ), ED, and eroded irradiated dentin (EID—erosion + Er:YAG laser). A self-etching adhesive system was used, and then cylinders of composite resin were prepared. A microshear bond strength test was performed after 24 h storage (n=20 n=20 ). The morphology of SD and ED, with or without Er:YAG laser irradiation, was evaluated under scanning electron microscopy (n=3 n=3 ). Bond strength values (MPa) were subjected to analysis of variance followed by Tukey’s test. Statistically significant differences were found among the experimental groups: SD (9.76±3.39  B 9.76±3.39  B ), SID (12.77±5.09 A 12.77±5.09 A ), ED (5.12±1.72 D 5.12±1.72 D ), and EID (7.62±3.39 C 7.62±3.39 C ). Even though erosion reduces the adhesion to dentin, the surface irradiation with a short-pulse Er:YAG laser increases adhesion to both ED and SD.

Effects of Erosion Protocol Design on Erosion/Abrasion Study Outcome and on Active Agent (NaF and SnF2) Efficacy

There is no standard for testing anti-erosive/anti-abrasive agents, making the assessment and comparison of study results difficult. Factors which are varied in study designs are amongst others the erosive medium regarding concentration and pH or movement type of acid. The present study therefore investigated the impact of these factors on dimension of tissue loss and on efficacy of active agents used as anti-erosive/anti-abrasive therapeutics. In 8 experiments, consisting of 8 groups each (n = 20 each), resulting in a total of 64 groups, enamel specimens were demineralised (10 days, 6 × 2 min/day) using different acids (1, 0.5 and 0.3% citric acid at native pH 2.3, 2.5 and 2.8, respectively, and 0.3% citric acid adjusted to pH 3.6) with two different movement types (jerky or smooth). Specimens were immersed (2 × 2 min/day) in slurries of 1,450 ppm F- toothpaste (NaF), 1,450 ppm F- and 3,436 ppm Sn2+ toothpaste (NaF/SnF2), 970 ppm F- and 3,000 ppm Sn2+ gel (SnF2) or placebo, or were additionally brushed during immersion (15 s, 200 g). All groups were in between stored in a mineral salt solution. Tissue loss was determined profilometrically. Movement type, pH and concentration of acid had a substantial impact on study outcome. The combination of jerky movement and concentrated acid masked, to some extent, differences between erosive and erosive-abrasive tissue loss. The acid at low concentration (0.3%), independent of pH, was too mild to produce any tissue loss. The model with the best ability to demonstrate effects of abrasive impacts and active agents used the 1% acid concentration combined with smooth acid movements.

The effect of enamel proteins on erosion

Enamel proteins form a scaffold for growing hydroxyapatite crystals during enamel formation. They are then almost completely degraded during enamel maturation, resulting in a protein content of only 1% (w/v) in mature enamel. Nevertheless, this small amount of remaining proteins has important effects on the mechanical and structural properties of enamel and on the electrostatic properties of its surface. To analyze how enamel proteins affect tooth erosion, human enamel specimens were deproteinated. Surface microhardness (SMH), surface reflection intensity (SRI) and calcium release of both deproteinated and control specimens were monitored while continuously eroding them. The deproteination itself already reduced the initial SMH and SRI of the enamel significantly (p < 0.001 and p < 0.01). During the course of erosion, the progression of all three evaluated parameters differed significantly between the two groups (p < 0.001 for each). The deproteinated enamel lost its SMH and SRI faster, and released more calcium than the control group, but these differences were only significant at later stages of erosion, where not only surface softening but surface loss can be observed. We conclude that enamel proteins have a significant effect on erosion, protecting the enamel and slowing down the progression of erosion when irreversible surface loss starts to occur.

Effect of foods and drinks on primary tooth enamel after erosive challenge with hydrochloric acid

The aim of this study was to evaluate the effect of industrialised foods and drinks on primary tooth enamel previously eroded with hydrochloric acid (HCl). The crowns of one hundred two specimens were subjected to an erosive challenge with HCl and randomly divided into six groups (n = 17): Chocolate Milk (Toddynho® - Pepsico) - negative control; Petit Suisse Yogurt (Danoninho® - Danone); Strawberry Yogurt (Vigor); Apple puree (Nestlé); Fermented Milk (Yakult® - Yakult); and Home Squeezed Style Orange Juice (del Valle) - positive control. The 28-day immersion cycles for the test products were performed twice daily and were interspersed with exposure of the test substrate to artificial saliva. Measurements of enamel surface microhardness (SMH) were performed initially, after immersion in HCl and at 7, 14, 21 and 28 days of experimentation. A two-way ANOVA, according to a split-plot design, followed by the sum of squares decomposition and Tukey's test, revealed a significant effect for the interaction between Foods and Drinks and Length of Exposure (p < 0.00001). Orange juice resulted in greater mineral loss of enamel after 28 days. None of the test products was associated with recovery of tooth enamel microhardness.

Laser speckle imaging: a novel method for detecting dental erosion

Erosion is a highly prevalent condition known as a non-carious lesion that causes progressive tooth wear due to chemical processes that do not involve the action of bacteria. Speckle images proved sensitive to even minimal mineral loss from the enamel. The aim of the present study was to investigate the use of laser speckle imaging analysis in the spatial domain to quantify shifts in the microstructure of the tooth surface in an erosion model. 32 fragments of the vestibular surface of bovine incisors were divided in for groups (10 min, 20 min. 30 min and 40 min of acid etching) immersed in a cola-based beverage (pH approximately 2.5) twice a day during 7 days to create an artificial erosion. By analyzing the laser speckle contrast map (LASCA) in the eroded region compared to the sound it was observed that the LASCA map shifts, proportionally to the acid each duration, by: 18%; 23%; 39% and 44% for the 10 min; 20 min; 30 min and 40 min groups, respectively. To the best of our knowledge, this is the first study to demonstrate the correlation between speckle patterns and erosion progression.

In Vitro Effects of Resin Infiltration on Enamel Erosion Inhibition

Resin-based materials that show promising effects for preventing the progression of erosion have been studied. This in vitro study evaluated the effects of applying resin-based materials, including resin infiltration, on previously eroded enamel subjected to erosive challenges. The influence of enamel surface etching prior to application of the material was also studied. Bovine enamel blocks were immersed in hydrochloric acid (HCl), 0.01 M (pH 2.3), for 30 seconds in order to form a softened erosion lesion. The blocks were then randomly divided into nine groups (n=12) and treated as follows: C = control without treatment; Hel = pit & fissure resin sealant (Helioseal Clear); Adh = two-step self-etching adhesive system (AdheSe); Tet = two-step conventional adhesive system (Tetric N-bond); and Inf = infiltrant (Icon). The Helno, Adhno, Tetno, and Infno groups received the same materials without (or with no) surface conditioning. The depth of the material's penetration into softened erosion lesions was qualitatively analyzed using reflection and fluorescence confocal microscopy. After application of the materials, the blocks were immersed in HCl for two minutes; this step was followed by immersion in artificial saliva for 120 minutes four times a day for five days (erosive cycling). Both the enamel alteration and material thickness were analyzed using profilometry, and the results were submitted to Kruskal-Wallis and Dunn tests (p>0.05). Images from the confocal microscopy showed minimal penetration of Adh/Adhno and deep penetration of Inf/Infno into the erosive lesions. The groups Hel, Adh, Inf, Tetno, and Infno resulted in the formation of a layer of material over the enamel, which was effective in inhibiting the progression of erosion. In conclusion, the infiltrant, with or without etching, was able to penetrate and protect the enamel against dental erosion. The other resin-based materials, except for the two-step conventional adhesive, were able to penetrate and inhibit the progression of erosive lesions only when they were applied after enamel etching.

Potential of CO2 lasers (10.6 µm) associated with fluorides in inhibiting human enamel erosion

This in vitro study aimed to investigate the potential of CO2 lasers associated with different fluoride agents in inhibiting enamel erosion. Human enamel samples were randomly divided into 9 groups (n = 12): G1-eroded enamel; G2-APF gel; G3-AmF/NaF gel; G4-AmF/SnF2 solution; G5-CO2 laser (λ = 10.6 µm)+APF gel; G6-CO2 laser+AmF/NaF gel; G7-CO2laser+AmF/SnF2solution; G8-CO2 laser; and G9-sound enamel. The CO2 laser parameters were: 0.45 J/cm2; 6 μs; and 128 Hz. After surface treatment, the samples (except from G9) were immersed in 1% citric acid (pH 4.0, 3 min). Surface microhardness was measured at baseline and after surface softening. The data were statistically analyzed by one-way ANOVA and Tukey's tests (p < 0.05). G2 (407.6 ± 37.3) presented the highest mean SMH after softening, followed by G3 (407.5 ± 29.8) and G5 (399.7 ± 32.9). Within the fluoride-treated groups, G4 (309.0 ± 24.4) had a significantly lower mean SMH than G3 and G2, which were statistically similar to each other. AmF/NaF and APF application showed potential to protect and control erosion progression in dental enamel, and CO2 laser irradiation at 0.45J/cm2 did not influence its efficacy. CO2 laser irradiation alone under the same conditions could also significantly decrease enamel erosive mineral loss, although at lower levels.

Erosion protection comparison of stabilised SnF2 , mixed fluoride active and SMFP/arginine-containing dentifrices

PURPOSE

To investigate the relative erosion protection potential of marketed dentifrices formulated with either stabilised stannous fluoride (SnF2 ), sodium fluoride (NaF) and/or sodium monofluorophosphate (SMFP) using an established laboratory erosion cycling model.

METHODS

Sound enamel cores from extracted, human enamel were cleaned, ground and polished, soaked in pooled saliva (pellicle formation) and treated with a 1:3 slurry of dentifrice and saliva. Specimens were subjected to daily challenges with 1% citric acid, a potentially damaging acid found in common food and drinks. Marketed dentifrices compared were: (1) a stabilised stannous fluoride product formulated with 1,100 ppm F as SnF2 ; (2) a cavity protection product containing 1,100 ppm F as NaF; (3) a cavity protection product comprising a mixed active fluoride system with 1,000 ppm F as SMFP + 450 ppm F as NaF; and (4) a sensitivity product containing 1,450 ppm F as SMFP + 8% arginine bicarbonate.

RESULTS

Specimens from Group 1 demonstrated an average loss of 5.5 (±1.2) μm of tooth surface enamel; Groups 2, 3 and 4 lost an average of 18.3 (±0.9) μm, 16.0 (±2.0) μm and 17.1 (±1.1) μm, respectively, of tooth surface enamel. Group 1 provided a statistically significant difference in protection compared with the other products.

CONCLUSIONS

These results suggest that the marketed dentifrice formulated with stabilised SnF2 may provide enhanced protection of exposed tooth surfaces against dietary acid attack compared with the other products tested.