Effects of fluoride on the calcium phosphate precipitation method for dentinal tubule occlusion

Oyster shell-derived nano-hydroxyapatite and proanthocyanidin pretreatment on dentinal tubule occlusion and permeability before and after acid challenge-an in vitro study

This in vitro study evaluated the dentinal tubule occlusion (TO), depth of penetration (DoP), and dentin permeability (DP) of oyster shell-derived nanohydroxyapatite (os-nHAp) with and without 15% proanthocyanidin (PA) pretreatment. os-nHAp was synthesized via the precipitation method and it was characterized. The morphology and particle size of os-nHAp were analyzed using a high-resolution transmission electron microscope (HRTEM). Cytotoxicity of os-nHAp, PA/os-nHAp, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) was assessed by (3-(4,5-dimethythiazol-2-yl) 2,5-diphenyl tetrazolium bromide (MTT) assay using human osteosarcoma (MG-63) cell line. One hundred and ninety-seven dentin discs of 3 mm thickness were prepared from the crown portion of extracted human teeth. The dentinal surfaces of the discs were etched for 2 min with 6% citric acid to simulate dentin hypersensitivity. Five discs were randomly selected and the patency of dentinal tubules was confirmed using a scanning electron microscope (SEM). The remaining 192 discs were divided into four groups (n = 48) depending on the type of remineralization as follows: group 1: os-nHAp, group 2: PA/os-nHAp, group 3: CPP-ACP, and group 4: no treatment. The remineralization protocol was followed for 21 days. Out of the 48 dentin discs in each group, 32 discs were used to evaluate dentinal tubule occlusion (TO) and depth of penetration (DoP) using SEM. The remaining 16 discs were subjected to an assessment of dentin permeability (DP) using a hydraulic conductance model. TO, DoP and DP were evaluated after remineralization and acid challenge. Characterization studies confirmed the presence of pure phase apatite. HRTEM confirmed the nanometric particle size of os-nHAp. MTT assay results showed that all the tested materials exhibited >80% cell viability when tested up to a concentration of 100 µg/mL. The results demonstrated a significantly higher mean percentage of TO, DoP, and lesser mean DP after remineralization in groups 1, 2, and 3 (p < 0.05). After the acid challenge, group 3 showed a significant reduction in TO and DoP, and increased DP (p < 0.05). However, no such changes were observed in groups 1 and 2. Within the limitations of this study, it can be concluded that os-nHAp and PA/os-nHAp could serve as potential and durable therapeutic agents in the treatment of dentin hypersensitivity.

A randomized clinical trial for comparing the efficacy of desensitizing toothpastes on the relief of dentin hypersensitivity

The 4-week double-blind clinical trial to manage dentin hypersensitivity (DH) using different desensitizing toothpastes was conducted. 53 participants with DH were enrolled in this trial. The participants were randomized into 3 groups: Group N; no active ingredient-containing toothpaste (Pleasia fluoride-free), Group SC; a toothpaste containing strontium chloride (Sensodyne Original), and Group TP; a toothpaste containing tricalcium phosphate (Vussen S). They were instructed to brush their teeth manually for 3 min, 3 times per day for 4 weeks with the allocated toothpastes, and were assessed at baseline (0), 2, and 4 weeks, respectively. Schiff sensitivity score was recorded to 3 different stimuli (air-blast, cold, and acid) at each assessment. Overall DH was also assessed using a visual analog scale (VAS). The longer participants used the toothpastes, the greater reduction in DH in all groups to the three stimuli. Group TP demonstrated significant reduction of DH compared to group N for air-blast and cold stimuli. Group TP showed significantly lower VAS than group N and SC. Tricalcium phosphate containing toothpaste used in this trial was most useful to reduce DH. It can be one of the treatment options that alleviate DH.

Comparative Study of Technologies for Tubule Occlusion and Treatment of Dentin Hypersensitivity

This study aimed to evaluate the occluding/remineralization performance and resistance to acid attacks of the mineralization layer formed by a tooth-desensitizing gel containing amorphous calcium magnesium phosphate (ACMP) particles and compare it to six other desensitizing products available on the market. Similar comprehensive studies are few and there is especially a lack of studies that are up to date. A dentin-disc model was used for in vitro evaluation of the desensitizing toothpastes/gels. Application of the products was performed twice daily for seven days. One set of specimens were evaluated using scanning electron microscopy (SEM) directly after the final treatment and another set was evaluated after an acid challenge, exposing specimens to 2 wt% citric acid. The ACMP desensitizing gel was the only product resulting in complete occlusion by the formation of mineralized material on the dentin surface and inside the tubules. Particle deposition was dominant after treatment with the other desensitizing products, with little or no mineralization, resulting in partial occlusion only. Sensodyne Repair & Protect and Oral-B Pro-Expert showed the highest resistance toward acid attacks. Material inside the tubules remained relatively unaffected by acid attacks in all specimens. The results in this study indicated a great variability among the occluding agents in terms of occlusion and acid resistance of the mineralization layer. The high degree of occlusion and intra-tubular mineralization that could mitigate the effect of acid solubilization indicate that the ACMP desensitizing gel may be a superior option for the treatment of dentin hypersensitivity.

Association of Nd:YAG laser and calcium-phosphate desensitizing pastes on dentin permeability and tubule occlusion

Objective

To evaluate the efficacy of Nd:YAG laser associated with calcium-phosphate desensitizing pastes on dentin permeability and tubule occlusion after erosive/abrasive challenges.

Methodology

Dentin specimens were exposed to 17% ethylene diamine tetra-acetic acid (EDTA) solution for 5 min and randomly allocated into five groups: G1, control (no treatment); G2, Nd:YAG laser (1 W, 10 Hz, 100 mJ, 85 J/cm2); G3, Laser + TeethmateTM Desensitizer; G4, Laser + Desensibilize Nano P; and G5, Laser+Nupro^®. Specimens underwent a 5-day erosion-abrasion cycling. Hydraulic conductance was measured post-EDTA, post-treatment, and post-cycling. Post-treatment and post-cycling permeability (%Lp) was calculated based on post-EDTA measurements, considered 100%. Open dentin tubules (ODT) were calculated at the abovementioned experimental moments using scanning electron microscopy and ImageJ software (n=10). Data were analyzed using two-way repeated measures ANOVA and Tukey’s test (α=0.05).

Results

G1 presented the highest %Lp post-treatment of all groups (p<0.05), without significantly differences among them. At post-cycling, %Lp significantly decreased in G1, showed no significant differences from post-treatment in G3 and G4, and increased in G2 and G5, without significant differences from G1 (p>0.05). We found no significant differences in ODT among groups (p>0.05) post-EDTA. At post-treatment, treated groups did not differ from each other, but presented lower ODT than G1 (p<0.001). As for post-cycling, we verified no differences among groups (p>0.05), although ODT was significantly lower for all groups when compared to post-EDTA values (p<0.001).

Conclusion

All treatments effectively reduced dentin permeability and promoted tubule occlusion after application.

Combining Nd

YAG laser with calcium-phosphate pastes did not improve the laser effect. After erosive-abrasive challenges, treatments presented no differences when compared to the control.

Duration of dentin tubule occlusion by the calcium phosphate precipitation method: An in vivo study in beagle dogs

The aim of the present study was to assess the duration of dentin tubule occlusion by the calcium phosphate precipitation (CPP) method in the vital teeth of beagle dogs. Vital teeth were treated using the CPP method, potassium oxalate, or a bonding agent (Liner bond II) after cavity preparation and acid etching. The dentin tubules of all groups, except for the bonding agent, opened more widely with time in the absence of plaque control. Dentin tubules treated with the CPP method were open and no precipitate remained in the absence of plaque control. Differences were observed in dentin tubule occlusion when plaque control was achieved by daily tooth brushing. The majority of dentin tubules were occluded with an apatitic precipitate seven days after the CPP method with plaque control. The present results demonstrated that the CPP method is useful with proper plaque control.

Kinetic Study of Calcium Phosphate Precipitation in the System H3PO4-Ca(OH)2-H2O at 30°C

The precipitation kinetics of calcium phosphates, namely, hydroxyapatite (HAP), dicalcium phosphate dihydrate (DCPD), dicalcium phosphate anhydrous (DCPA), and monocalcium phosphate monohydrate (MCPM), were studied at 30°C by mixing calcium hydroxide, water, and phosphoric acid. The studied mixture was selected according to the stability domain of different calcium phosphates by referring to the phase diagram of the ternary system of H3PO4-Ca(OH)2-H2O at 30°C. The precipitation reaction has been monitored by following the changes in the conductivity, pH, and calcium concentration. The solid phases formed at different stages of this precipitation were characterized by X-ray diffraction.

Combined effect of casein phosphopeptide-amorphous calcium phosphate and sodium trimetaphosphate on the prevention of enamel demineralization and dental caries: an in vitro study

OBJECTIVE

To evaluate the effect of treatment with fluoridated toothpaste supplemented with a combination of sodium trimetaphosphate (TMP) and casein phosphopeptide-amorphous calcium phosphate (MI Paste Plus^®) on the demineralization of dental enamel.

METHODS

Bovine enamel blocks selected by initial surface hardness (SHi) were randomly allocated into six groups (n = 12), according to the test toothpastes: (1) without F-TMP-MI Paste Plus^® (Placebo); (2) 1100 ppm F (1100F); (3) MI Paste Plus^®; (4) 1100F + MI Paste Plus^® (1100F-MI Paste Plus), (5) 1100F + 3 % TMP (1100F-TMP); and (6) 1100F-TMP + MI Paste Plus^® (1100F-TMP-MI Paste Plus). Blocks were treated two times per day with slurries of toothpaste (1 min), and groups 4 and 6 received an application of MI Paste Plus (3 min). Next, the samples were subjected to five pH cycles (demineralizing/remineralizing solutions) at 37 °C, to produce subsurface enamel lesions.Thereafter, the blocks were maintained for 2 days in fresh remineralizing solution. After pH cycling, the following were obtained: percentage of surface hardness loss (%SH); integrated loss of subsurface hardness (ΔKHN); profile analysis and lesion depth subsurface through polarized light microscopy (PLM); scanning electron microscopy (SEM); and fluoride (F), calcium (Ca), and phosphorus (P) in the enamel. The data were subjected to ANOVA (1-criterion), followed by the Student-Newman-Keuls test (p < 0.001).

RESULTS

The 1100F-TMP-MI Paste Plus group showed better results for SHR, ΔKHN, and PLM (p < 0.001). The F concentration was similar among all groups (p > 0.001). The 1100F-TMP-MI Paste Plus group showed the highest concentration of Ca and P in the enamel (p < 0.001).

CONCLUSION

The application of 1100F-TMP-MI Paste Plus promoted a higher inhibitory effect against enamel demineralization.

CLINICAL SIGNIFICANCE

The combination of treatments with F, TMP, and MI Paste Plus^® can be an effective alternative to improve the oral health of individuals, especially those with high activity of dental caries and at high risk for its development.

Hydraulic conductance of dentin after treatment with fluoride toothpaste containing sodium trimetaphosphate microparticles or nanoparticles

OBJECTIVES

To evaluate the hydraulic conductance of dentin after treatment with fluoride toothpastes containing sodium trimetaphosphate microparticles (TMPmicro) or nanoparticles (TMPnano).

MATERIALS AND METHODS

The dentinal tubules of bovine dentin blocks (4 × 4 × 1 mm) were unobstructed for determination of the maximum hydraulic conductance of the dentin. The dentin blocks were randomized into four groups (n = 15/group) of toothpastes (placebo, 1100 ppm F, and 1100 with 3% TMPmicro or 3% TMPnano) which were applied for 7 days (2×/day) using a brushing machine. The dentin surface (5/group) was analyzed by scanning electron microscopy. The hydraulic conductance post-treatment was measured in the other ten blocks. Thereafter, the same blocks were immersed in citric acid (pH 3.2) for 1 min, and the conductance was determined again. The data were submitted to 2-way ANOVA repeated measures, followed by the Student-Newman-Keuls test (p < 0.05).

RESULTS

The percentage conductance reduction post-treatment for the groups were placebo = 1100 ppm F < 1100 TMPnano < 1100 TMPmicro (p < 0.001). After acid attack, the percentage reduction was placebo < 1100 ppm F < 1100 TMPnano < 1100 TMPmicro (p < 0.001). The toothpastes containing TMP showed the highest obliteration of dentinal tubules.

CONCLUSIONS

The addition of TMPmicro to fluoride toothpaste produced a greater reduction in hydraulic conductance when compared with 1100 ppm F toothpaste.

CLINICAL RELEVANCE

The increased capacity of toothpastes containing TMP to reduce hydraulic conductance indicates their potential to reduce symptoms of dentinal hypersensitivity.

Dentinal tubule obliteration using toothpastes containing sodium trimetaphosphate microparticles or nanoparticles

OBJECTIVES

This in vitro study evaluated the effect of microparticles (TMPmicro) or nanoparticles (TMPnano) TMP associated with fluoride (F) in toothpaste formulations on the obliteration of dentinal tubules (DT).

MATERIALS AND METHODS

The dentinal tubules of bovine dentin blocks were unobstructed by immersion in 37% phosphoric acid solution. Blocks (n = 20/group) underwent mechanical brushing (2×/day) during 7 days with toothpastes: placebo, 1100 ppm F, and 1100 with 3% TMPmicro or 3% TMPnano. After that, ten blocks of each group were immersed in citric acid (pH 3.2) for 1 min. The number, diameter and area of unobstructed DT, atomic % of chemical elements from precipitates, and the mineral concentration were quantified. Data were submitted to two-way ANOVA, followed by Student-Newman-Keuls test (P < 0.05).

RESULTS

Toothpastes containing TMPmicro and TMPnano promoted greater obliteration of DT and greater mineral concentration compared to other groups (P < 0.05). Placebo and 1100 ppm F group presented similar obliteration but 1100 ppm F group promoted higher mineral concentration. Higher Ca/P ratios were observed in groups treated with TMP; the acid challenge reduced Ca/P ratio for all groups. The atomic % of C and N was significantly lower for TMP toothpastes before acid challenge, but increased afterwards.

CONCLUSIONS

It was concluded that the addition of TMPmicro or TMPnano to F toothpastes produced greater obliteration of dentinal tubules and higher mineral concentration when compared with 1100 ppm F.

CLINICAL RELEVANCE

By the addition of TMP, fluoride toothpastes may occlude the dentinal tubules, with potential to reduce dentin hypersensitivity.

Calcium Phosphate Bioceramics: A Review of Their History, Structure, Properties, Coating Technologies and Biomedical Applications

Calcium phosphate (CaP) bioceramics are widely used in the field of bone regeneration, both in orthopedics and in dentistry, due to their good biocompatibility, osseointegration and osteoconduction. The aim of this article is to review the history, structure, properties and clinical applications of these materials, whether they are in the form of bone cements, paste, scaffolds, or coatings. Major analytical techniques for characterization of CaPs, in vitro and in vivo tests, and the requirements of the US Food and Drug Administration (FDA) and international standards from CaP coatings on orthopedic and dental endosseous implants, are also summarized, along with the possible effect of sterilization on these materials. CaP coating technologies are summarized, with a focus on electrochemical processes. Theories on the formation of transient precursor phases in biomineralization, the dissolution and reprecipitation as bone of CaPs are discussed. A wide variety of CaPs are presented, from the individual phases to nano-CaP, biphasic and triphasic CaP formulations, composite CaP coatings and cements, functionally graded materials (FGMs), and antibacterial CaPs. We conclude by foreseeing the future of CaPs.

Activity assessment of root caries lesions with thermal and near-IR imaging methods

The purpose of this study was to evaluate thermal and near-infrared (NIR) reflectance imaging methods for the assessment of the activity of root caries lesions. In addition, changes in the lesion structure were monitored with polarization sensitive optical coherence tomography (PS-OCT). Artificial bovine and natural root caries lesions were imaged with PS-OCT, and their dehydration rate was measured with thermal and NIR cameras. The lesion activity of the natural root caries samples was also assessed by two clinicians by conventional means according to ICDAS II guidelines. The thickness of the highly mineralized transparent surface layer measured using PS-OCT increased and the area enclosed by the time-temperature curve, ΔQ, measured with thermal imaging decreased significantly with longer periods of remineralization in simulated dentin lesions, but the NIR reflectance intensity differences, ΔI, failed to show any significant relationship with the degree of remineralization. The PS-OCT algorithm for the automated assessment of remineralization successfully detected the highly mineralized surface layer on both natural and simulated lesions. Thermal imaging provided the most accurate diagnosis of root caries lesion activity. These results demonstrate that thermal imaging and PS-OCT may be ideally suited for the nondestructive root caries lesion activity during a clinical examination.

Evaluation of dentinal tubule occlusion and depth of penetration of nano-hydroxyapatite derived from chicken eggshell powder with and without addition of sodium fluoride: An in vitro study

Aim:

This in vitro study evaluated the degree of dentinal tubule occlusion and depth of penetration of nano-hydroxyapatite (nHAp) derived from chicken eggshell powder with and without the addition of 2% sodium fluoride (NaF) using scanning electron microscope (SEM) and confocal laser scanning microscope (CLSM).

Materials and Methods:

nHAp was synthesized and characterized using X-ray diffraction and SEM-energy dispersive spectroscopy. Dentin discs were obtained from extracted teeth, pretreated with 17% ethylenediaminetetraacetic acid for 5 min and were divided into four groups based on the experimental agents as follows: Group 1: Untreated (control), Group 2: 2% NaF, Group 3: nHAp, Group 4: Combination of nHAp and 2% NaF. The treatment protocol was carried out for 7 days, after which the specimens were viewed under SEM and CLSM.

Statistical Analysis Used:

One-way ANOVA and Tukey's post hoc multiple comparison tests (P < 0.05).

Results:

All the experimental agents occluded the dentinal tubules, but to varying degrees and depths. Specimens treated with the combination of nHAp and 2% NaF showed complete dentinal tubular occlusion and significantly greater depth of penetration than those treated with nHAp and 2% NaF alone.

Conclusion:

The combination of nHAp and 2% NaF was the most effective in occluding dentinal tubules.

The Influence of Post Bleaching Treatments in Stain Absorption and Microhardness

Objectives:

This study investigated the effects of post bleaching treatments to prevent restaining and the change of enamel surface microhardness after dental bleaching in vitro.

Methods:

Sixty intact human incisor teeth were stained in tea solution and randomly assigned into four groups (n=15). Then samples were bleached for two weeks (8 hours daily) by 15% carbamide peroxide. Tooth color was determined both with a spectrophotometer and visually before bleaching (T1) and immediately after bleaching (T2). Next, it was applied in group 1 fluoride (Naf 2%) gel for 2 minutes, and in group 2 a fractional CO₂ laser (10 mJ, 200 Hz, 10 s), and in group 3, nanohydroxyapatite gel for 2 minutes. The bleached teeth in group 4 remained untreated (control group). Then teeth placed in tea solution again. Color examinations were repeated after various post bleaching treatments (T3) and restaining with tea (T4) and color change values recorded. The microhardness was measured at the enamel surface of samples. Data was analyzed using ANOVA, Tukey HSD test and Dunnett T3 (α = 0.05).

Results:

Directly after bleaching (ΔE _T3-T2), the treatment with nanohydroxyapatite showed significantly the least color lapse in colorimetric evaluation. In experimental groups, the color change between T3 and T4 stages (ΔE _T4-T3) was significantly lower than control group (P < 0.05). Different methods of enamel treatment caused a significant increase in surface microhardness compared to control group (P < 0.05).

Significance:

Application of fluoride, fractional CO₂ laser and nanohydroxyapatite as post bleaching treatments are suggested for prevention of stain absorption and increasing the hardening of bleached enamel.

Use of poly (amidoamine) dendrimer for dentinal tubule occlusion: a preliminary study

The occlusion of dentinal tubules is an effective method to alleviate the symptoms caused by dentin hypersensitivity, a significant health problem in dentistry and daily life. The in situ mineralization within dentinal tubules is a promising treatment for dentin hypersensitivity as it induces the formation of mineral on the sensitive regions and occludes the dentinal tubules. This study was carried out to evaluate the in vitro effect of a whole generation poly(amidoamine) (PAMAM) dendrimer (G3.0) on dentinal tubule occlusion by inducing mineralization within dentinal tubules. Dentin discs were treated with PAMAM dendrimers using two methods, followed by the in vitro characterization using Attenuated total reflection Fourier-transform infrared spectroscopy (ATR-FTIR), X-ray diffraction (XRD), Field emission scanning electron microscopy (FE-SEM) and Energy-Dispersive X-ray Spectroscopy (EDS). These results showed that G3.0 PAMAM dendrimers coated on dentin surface and infiltrated in dentinal tubules could induce hydroxyapatite formation and resulted in effective dentinal tubule occlusion. Moreover, crosslinked PAMAM dendrimers could induce the remineralization of demineralized dentin and thus had the potential in dentinal tubule occlusion. In this in vitro study, dentinal tubules occlusion could be achieved by using PAMAM dendrimers. This could lead to the development of a new therapeutic technique for the treatment of dentin hypersensitivity.

Short-term response of three resin-based materials as desensitizing agents under oral environmental exposure

OBJECTIVE

This paper focuses on clinical responses after 7 days of oral exposure to two resin-based materials as desensitizing agents compared to a fluoride varnish and on morphological and analytical study as a means to elucidate the mechanism of action.

MATERIALS AND METHODS

The elemental composition of Vertise™ Flow (VF), Universal Dentine Sealant (UDS) and Flor-Opal® Varnish (FOV) were investigated by using an X-ray energy dispersive spectrometer (EDX) in conjunction with a scanning electron microscope (SEM). SEM morphology of the material-treated dentine surfaces and pain reduction ability according to the Visual Analogue Scale (VAS) were evaluated in selected hypersensitive teeth. Post treatments and 7 day controls were recorded with SEM and VAS measurements. Clinical data was analysed with the Student's t-test for paired data, with a 5% significance level.

RESULTS

Silicon, ytterbium and alumina were the most present elements in VF, whilst calcium, chloride, silicon and alumina were highest in UDS. Within a 7 day oral environment all the tested materials modified the treated-dentine surfaces showing tubular occlusion of different morphology. Clinically, the efficacy of all materials was similar after a 7-day examination. However, VAS scores were significantly reduced if compared with the baseline (p < 0.05).

CONCLUSIONS

Within the limits of this study, data indicate that both resins are effective in sealing tubules and reducing VAS. A resin-related effect on the dentine's morphology was observed, which may influence the long-term response of the resins in the treatment of dental hypersensitivity, which requires further investigation.

Effects of desensitizing agents on dentinal tubule occlusion

The aim of this study was to evaluate the features of dentinal tubules occlusion following application of three commercially available desensitizing agents: potassium oxalate-based / Oxa-Gel (OX), HEMA and glutaraldehyde-based / Gluma Desensitizer (GD) and acidulated phosphate fluoride-based / Nupro Gel (AF). Buccal cervical areas of twenty-four extracted human third molars were smoothed and wet-polished with SiC papers and diamond pastes, in order to simulate the clinical aspect of hypersensitive dentin cervical surfaces. The teeth were randomly divided into four groups (n=6), according to the dentin surface treatments: G1: untreated; G2: OX; G3: GD; G4: AF. Specimens were fractured in the lingual-buccal direction and prepared for SEM analysis. OX promoted tubule occlusion by crystal-like deposits in the lumen of the tubules. While GL created a thin layer over the dentin surface, AF application produced precipitates that occluded the tubules. According to the SEM analysis, all desensitizing agents were able to occlude the dentinal tubules.

Efficacy of casein phosphopeptide-amorphous calcium phosphate to prevent stain absorption on freshly bleached enamel: An in vitro study

BACKGROUND

Teeth when subjected to bleaching bring about the desiccation of the enamel, making it more susceptible to stain absorption. While subjecting the freshly bleached enamel surface to various surface treatments of Fluoride and Casein Phosphopeptide - Amorphous Calcium phosphate (CPP-ACP) brought about the reduction in stain absorption, which is assessed in this study.

AIMS

The study aims to evaluate the tea stain absorption on freshly bleached enamel surface of extracted human teeth with varied surface treatment. The stain absorption was evaluated at the end of one hour and 24 hours post bleaching.

MATERIALS AND METHODS

Forty extracted human permanent maxillary central incisors were subjected to bleaching with 10% carbamide peroxide for eight days. They were divided into four groups of 10 each. Group I was control group. Group II was immersed in tea solution without surface treatment, while Group III and IV were immersed in tea solution with surface treatment of topical Fluoride and CPP-ACP respectively. Spectrophotometer was used for color analysis.

RESULTS

Surface treatment with CPP-ACP and topical fluoride on freshly beached enamel surface, significantly reduced the stain absorption.

CONCLUSION

Remineralizing agents reduce stain absorption after tooth bleaching.

Dentin hypersensitivity after treatment with desensitizing agents: a randomized, double-blind, split-mouth clinical trial

The aim of this study was to evaluate the efficacy of two desensitizing agents in the reduction of dentin hypersensitivity in a randomized, double-blind, split-mouth clinical trial. Seventy-seven teeth from 13 patients that presented some degree of sensitivity to probing and/or air stimulation were treated with one of the following desensitizing agents: Oxa-Gel (G1), Sensi Kill (G2) and placebo gel (G3 - control). According to paired t-test, all treatments, even the placebo gel, were capable of reducing sensitivity scores for both stimuli. Analysis of data by ANOVA and Tukey's test (?=0.05) showed that the sensitivity scores were significantly lower only for Sensi Kill in comparison to the other products (Oxa-Gel and placebo), when air stimulus was applied. It may be concluded that treatment with Sensi Kill presented a slightly better performance in reducing dentin hypersensitivity when compared to the other desensitizing agent.

Dentin permeability reduction by a sequential application of calcium and fluoride-phosphate solutions

OBJECTIVE

A sequential topical application of calcium and fluoride-phosphate solutions was reported to occlude open dentin tubules, mainly with fluoroapatite precipitates by a rapid ionic reaction, and to be effective at treating dentin hypersensitivity. However, its ability to reduce dentin permeability (Lp) is unknown. The aim of this in vitro study was to evaluate the effect of this treatment on Lp.

METHODS

Nine extracted human third molars were sectioned transversely to obtain 0.5 mm-thick discs, which were then etched and rinsed. Aqueous solutions of 5% (w/w) disodium phosphate containing 0.3% (w/w) sodium fluoride (A) and 10% (w/w) calcium chloride (B) were prepared. The sequential application of the A&B solutions was repeated three times on each disc, which was then rinsed with distilled water. The Lp of the discs was measured before and after the application using a modified Pashley's fluid flow measuring system. The differences in the Lp values between the conditions before and after the solution applications were analysed using a generalized estimating equation method and paired t-test. Scanning Electron Microscopy (SEM) was used to observe the dentin surfaces.

RESULTS

All nine discs consistently indicated reduced Lp following the application of the A&B solutions. There was a significant decrease in the mean Lp [microL/(cm(2) s cm H(2)O)] from baseline (-0.27+/-0.25, p=0.011). Overall, an average decrease of 34% Lp occurred after the application of the A&B solutions. SEM observation indicated that the reaction products covered the entire dentin disc surface.

CONCLUSION

The application of the A&B solutions was effective at reducing the Lp of the dentin discs.

Combining casein phosphopeptide-amorphous calcium phosphate with fluoride: synergistic remineralization potential of artificially demineralized enamel or not?

Recaldent is a product of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). The remineralizing potential of CPP-ACP per se, or when combined with 0.22% Fl gel on artificially demineralized enamel using laser florescence, is investigated. Mesial surfaces of 15 sound human molars are tested using a He-Cd laser beam at 441.5 nm with 18-mW power as an excitation source on a suitable setup based on a Spex 750-M monochromator provided with a photomultiplier tube (PMT) for detection of collected autofluorescence from sound enamel. Mesial surfaces are subjected to demineralization for ten days. The spectra from demineralized enamel are measured. Teeth are divided into three groups according to the remineralizing regimen: group 1 Recaldent per se, group 2 Recaldent combined with fluoride gel and ACP, and group 3 artificial saliva as a positive control. After following these protocols for three weeks, the spectra from the remineralized enamel are measured. The spectra of enamel autofluorescence are recorded and normalized to peak intensity at about 540 nm to compare spectra from sound, demineralized, and remineralized enamel surfaces. A slight red shift occurred in spectra from demineralized enamel, while a blue shift may occur in remineralized enamel. Group 2 shows the highest remineralizing potential. Combining fluoride and ACP with CPP-ACP can give a synergistic effect on enamel remineralization.

Effects of calcium phosphate precipitation method on acid resistance to apatite powder and bovine tooth

The aims of this study were to evaluate the effects of CPP method on the crystallinity of apatite powder and on the acid resistance of bovine enamel. Crystallinity degrees of apatite powder before and after CPP treatment were measured by powder X-ray diffraction analysis. Polished bovine enamel specimens treated with CPP method or NaF were immersed in a lactic acid solution for up to five days. The demineralized depth of enamel was measured with a surface roughness analyzer. XRD peaks became sharper after the CPP treatment, indicating an increased crystallinity of the apatite powder. The demineralized depth of bovine enamel treated with CPP method was shallower than that of enamel treated with NaF. Results of this study revealed that the CPP method increased the crystallinity of apatite powder and the acid resistance of enamel. Therefore, the CPP method would be useful not only for treating dentin hypersensitivity, but also for the prevention of dental caries.

Reduction in dentin permeability using a slurry containing dicalcium phosphate and calcium hydroxide

Treatments that obdurate dentin tubules have been used for reducing dentin hypersensitivity. The purpose of this study was to determine the effect of a treatment with a slurry of micron sized calcium phosphate on the hydraulic conductance (L(p)) of etched dentin discs in vitro. The treatment slurry was prepared by mixing a powder mixture of dicalcium phosphate anhydrous and calcium hydroxide with a solution that contained sodium fluoride and carboxymethyl cellulose. The mean baseline L(p) (in mL cm(-2) s(-1) H(2)O cm(-1)) was 2.07 +/- 1.45 (mean +/- SD; n = 13)). After one treatment and 2, 4, and 7 days of incubation in a protein-free saliva-like solution (SLS), the mean relative L(p), presented as % of baseline, were 65 +/- 16, 42 +/- 27, 36 +/- 26, and 33 +/- 27 (n = 13), respectively. The L(p) values of the baseline and treatment after incubation in the SLS were significantly (p < 0.05) different. Scanning electron microscopic examination showed partial obturation of dentin tubules in the treated dentin. X-ray diffraction and chemical analyses indicated the major product formed from the slurry was a fluoride-containing hydroxyapatite. Treatment appeared effective in further reducing L(p) of dentin discs after incubation in the SLS.

Inhibition of compound action potentials following administration of dental self-etching primer/adhesives

Self-etching dentin adhesive systems, a new generation of dental-bonding agents, were investigated for their ability to block nerve conductance in the rat sciatic nerve model. Clearfil SE Bond, Mac Bond and FL Bond were used as test materials. Isolated rat sciatic nerves obtained from female albino rats were placed between two electrodes in a bath containing Tyrode solution. The bonding agents were brought into contact with the nerves and the evoked compound action potentials were recorded versus time before and after contact with the materials. Statistical analysis was performed using the Friedman and Wilcoxon Signed-Ranks tests (P = 0.01) to compare the mean percentage of inhibition between test materials versus time. All test materials were able to block nerve transmission rapidly (3.3 +/- 0.5, 5.1 +/- 2.3 and 8.0 +/- 1.9 min for SE Bond, Mac Bond and FL Bond, respectively). Significant differences were found between FL Bond and SE and Mac Bond (P < 0.01). These results indicated that the bonded systems tested, intended primarily as dentinal tubule occluders, may also exert some direct desensitizing effect on intratubular or pulpal nerve terminals in extremely deep cavities or pulpal microexposures, contributing to decreased postoperative pain.

Reduction in dentin permeability using mildly supersaturated calcium phosphate solutions

Treatments that obturate dentin tubules have been used for reducing dentin hypersensitivity. The objective of this study was to determine the effects of multiple treatments with a mildly supersaturated calcium phosphate solution on the hydraulic conductance (Lp) of partially occluded dentin discs in vitro. The treatment solution contained 6.5 mmoll(-1) each of calcium and phosphate, 0.25 mmoll(-1) fluoride, 30 mmoll(-1) KCl, and 50 mmoll(-1) HEPES buffer (pH adjusted to 7.0). The mean baseline Lp (in microlcm(-2)min(-1) H(2)O cm(-1)) was 0.108+/-0.041 (mean +/- S.D.; n=9, microlcm(-2)min(-1) H(2)O cm(-1) = 10.20 microlcm(-2)min(-1)KPa(-1)) and after five consecutive treatments, the mean relative Lp, presented as percentage of baseline, were 71+/-11, 58+/-10, 46+/-18, 40+/-14, and 25+/-10, respectively. The Lp values of the baseline and treatment groups were significantly (P<0.05) different. Consecutive treatments appeared effective in further reducing Lp of dentin discs.

Occluding effect of dentifrices on dentinal tubules

OBJECTIVES

The objective of this study was to evaluate the tubule occluding ability of three commercial available dentifrices (Sensodyne, Emoform and Sorriso) by Scanning Electron Microscopy.

METHODS

Fifty cervical areas from buccal and lingual surfaces of sound third human molars were used. Cervical enamel was wet abraded to expose flat dentin surfaces and further polished with diamond pastes. Specimens were randomly divided into five groups (n=10): G1-no brushing; G2-brushing without dentifrice; G3-brushing with Sensodyne; G4-brushing with Emoform; G5-brushing with Sorriso. Brushed specimens were treated for 4 min per day, for 7 days in a toothbrushing machine. Specimens were prepared and observed under SEM for calculation of the percentage of occluded tubules. In addition, slurries of toothpastes were analyzed by X-ray microanalysis. Data were statistically analyzed by ANOVA and Tukey test (p<0.05).

RESULTS

Means of occluded tubules in descending order were: G5-98.83+/-3.31% (a), G4-96.02+/-5.24% (a), G3-80.12+/-24.65% (a), G1-37.31+/-24.22% (b); G2-22.92+/-15.19% (b). The three tested dentifrices produced increased dentinal occlusion as compared to controls (p<0.05) but equivalent occlusion among each other. Calcium from calcium-carbonate abrasive was identified in all dentifrices.

CONCLUSIONS

Results indicated that the use of all dentifrices occluded tubules more than no brushing and brushing without dentifrices groups. Thus, the tested dentifrices seem effective for desensitization by tubule occlusion.

Replica of human dentin treated with different desensitizing agents: a methodological SEM study in vitro

This is a preliminary study to determine a methodological sequence in vitro which may allow the reproduction of dentin for SEM analysis, after the use of different desensitizing agents. Dentin discs obtained from extracted human third molars were etched with 6% citric acid, an artificial smear layer was created and the surface dentin discs were divided into four quadrants. Quadrants 2, 3 and 4 of each disc were conditioned with 6% citric acid. The desensitizing agents (Oxa-Gel, Gluma Desensitizer and an experimental agent) were applied to quadrants 3 and 4. To evaluate the acid resistance of the treatment, quadrant 4 was etched again with 6% citric acid. An impression was then taken with Aquasil ULV. After a setting period of 6 min, each disc was removed from the impression and stored in a moist-free environment for 24 h at 37 degrees C. After that time, a low-viscosity epoxy resin (Araltec GY 1109 BR) was poured into the impression and cured for 24 h. All specimens were metal-coated for SEM analysis. Comparison of the photomicrographs of dentin discs with their respective impressions and resin replicas showed that this technique can reproduce the characteristics of the dentin surface treated with desensitizing agents.

Evaluation of post-treatment solutions for clinical use with the calcium phosphate precipitation method

OBJECTIVE

We have proposed a calcium phosphate precipitation (CPP) method that occludes dentine tubules with apatitic minerals for the treatment of dentine hypersensitivity. The current CPP method uses 1 mol/l NaOH as the post-treatment solution. However, its high pH is not desirable for clinical use. The aim of this study was to evaluate several solutions, especially buffer solutions, as post-treatment solutions for the CPP method.

METHODS

The CPP solution was mixed with several post-treatment solutions at various mixing ratios in test tubes. The precipitates were collected, and freeze-dried in a vacuum. Their weights were measured to evaluate the feasibility of buffer solution for the post-treatment solutions. Among the solutions, we selected one buffer solution and have done further evaluation using human dentine disks. The degree of occlusion of dentine tubules was evaluated by scanning electron microscopic observation and measurement of dentine permeability. Also, the composition of the precipitate was analyzed using energy-dispersive X-ray microanalysis and powder X-ray diffraction.

RESULTS

Among the solutions, 1 mol/l NaHCO3 gave sufficient amounts of precipitate at a relatively mild pH, and thus was considered to be a good candidate for a post-treatment solution. Scanning electron microscopic observation showed that dentine tubules were occluded with the precipitate to a depth of approximately 10 microns from the surface when the CPP treatment was done twice, and dentine permeability was reduced to 98.8%. The precipitate was dicalcium phosphate dihydrate (DCPD; CaHPO4-2H2O) when the post-treatment solution was free of NaF. In contrast, the precipitate was an apatitic mineral with CaF2 as a by-product when the post-treatment solution contained NaF.

CONCLUSIONS

We concluded that 1 mol/l NaHCO3 containing 0.3 mol/l NaF would be suitable as the post-treatment solution for the CPP method as it has a relatively mild pH and occludes dentinal tubules well.

The effect of fluoride on apatite structure and growth

Fluoride participates in many aspects of calcium phosphate formation in vivo and has enormous effects on the process and on the nature and properties of formed mineral. The most well-documented effect of fluoride is that this ion substitutes for a column hydroxyl in the apatite structure, giving rise to a reduction of crystal volume and a concomitant increase in structural stability. In the process of enamel mineralization during amelogenesis (a unique model for the cell-mediated formation of well-crystallized carbonatoapatite), free fluoride ions in the fluid phase are supposed to accelerate the hydrolysis of acidic precursor(s) and increase the driving force for the growth of apatitic mineral. Once fluoride is incorporated into the enamel mineral, the ion likely affects the subsequent mineralization process by reducing the solubility of the mineral and thereby modulating the ionic composition in the fluid surrounding the mineral, and enhancing the matrix protein-mineral interaction. But excess fluoride leads to anomalous enamel formation by retarding tissue maturation. It is worth noting that enameloid/enamel minerals found in vertebrate teeth have a wide range of CO3 and fluoride substitutions. In the evolutionary process from elasmobranch through enameloid to mammalian enamel, the biosystems appear to develop regulatory functions for limiting the fluoridation of the formed mineral, but this development is accompanied by an increase of carbonate substitution or defects in the mineral. In research on the cariostatic effect of fluoride, considerable emphasis is placed on the roles of free fluoride ions (i.e., preventing the dissolution and accelerating the kinetics of remineralization) in the oral fluid bathing tooth mineral. Fluoride also has been used for the treatment of osteoporosis, but much still remains to be learned about maximizing the benefit and minimizing the risk of fluoride when used as a public health measure.

Effects of hexafluorosilicate on the precipitate composition and dentine tubule occlusion by calcium phosphate

OBJECTIVES

To improve the calcium phosphate precipitation (CPP) method for the occlusion of dentine tubules with calcium phosphate, the addition of calcium hexafluorosilicate (CaSiF6) to CPP solution was evaluated in vitro with respect to its occluding capacity and the composition of the precipitate.

METHODS

The occlusion of dentine tubules was evaluated by SEM observations and by measurements of dentine permeability. The composition of the precipitate was determined by measuring the calcium to phosphorus (Ca/P) ratio of the precipitate in dentine tubules by energy dispersive X-ray spectroscopy (EDS).

RESULTS

The addition of CaSiF6 to the CPP solution resulted in an increase of the Ca/P ratio in the precipitate not only on the dentine surface but also inside the dentine tubules; indicating that the precipitate became more apatitic in nature. The addition of CaSiF6 had no effect on occluding capacity in terms of measurements of dentine permeability or SEM observations. Dentine permeability decreased to approximately 4% of pretreatment values and the dentine tubules were occluded for approximately 10-15 microns from the dentine surface.

CONCLUSION

It is concluded that the addition of CaSiF6 to CPP solution was desirable, since it provided a more apatitic precipitate in the dentine tubules, not only on the dentine surface but also inside the tubules, and there were no drawbacks with respect to its occluding capacity.

Dynamics of the pulpo-dentin complex

Dentin has a relatively high water content due to its tubular structure. Once dentin is exposed, this intratubular water is free to move in response to thermal, osmotic, evaporative, or tactile stimuli. Fluid shifts across dentin are thought to cause sufficient shear forces on odontoblasts, nerve endings, nearby fibroblasts, and blood vessels to cause significant mechanical irritation, disruption, or damage, depending on the magnitude of the fluid shift. Even in the absence of fluid shifts, the water-filled tubules provide diffusion channels for noxious (i.e., bacterial products) substances which diffuse inward toward the pulp, where they can activate the immune system, provide chemotactic stimuli, cytokine production, and produce pain and pulpal inflammation. Viewed from this perspective, dentin is a poor barrier to external irritants. However, pulpal tissues react to these challenges by increasing the activity of nerves, blood vessels, the immune system, and interstitial fluid turnover, to make the exposed dentin less permeable either physiologically, via increased outward fluid flow, or microscopically, by lining tubules with proteins, mineral deposits, or tertiary dentin, thereby enhancing the barrier properties of dentin, and providing additional protection to pulpal tissues. These reactions involve dentin and pulp, both in the initiation of the processes and in their resolution. These responses of the dental pulp to irritation of dentin demonstrate the dynamic nature of the pulpo-dentin complex.

Duration of dentinal tubule occlusion formed by calcium phosphate precipitation method: in vitro evaluation using synthetic saliva

The use of a calcium phosphate precipitation method occluded dentin tubules with apatitic mineral and, thus, showed good potential for the treatment of dentin hypersensitivity. The aim of this study was to elucidate the occluding behavior of the precipitate in the oral environment. Dentin disks treated by the calcium phosphate precipitation method, and disks treated with potassium oxalate, NaF, and SrCl2 solutions, were immersed in synthetic saliva, which was regularly replenished so that ionic concentration would be maintained. Treatment of dentin disks by the calcium phosphate precipitation method immediately reduced dentin permeability to 6 +/- 8%. When the disk was immersed in synthetic saliva, dentin permeability remained low, even seven days after immersion. Scanning electron microscopic observation showed no distinct boundary line between the precipitate and intertubular dentin; this indicated further mineralization on the precipitate. Potassium oxalate treatment also reduced the dentin permeability to 8 +/- 3%. However, the dentin permeability gradually but steadily increased with immersion time, reaching 39 +/- 14% at seven days. To elucidate the mechanism underlying dentin permeability changes in synthetic saliva, we immersed the precipitates, i.e., apatitic mineral and calcium oxalate, in a fixed volume of synthetic saliva. When calcium oxalate was immersed in synthetic saliva, there was a large concentration of oxalate ions, indicating dissolution of the calcium oxalate; this phenomenon was ascribed to the increase in dentin permeability. In contrast, calcium and phosphate ions decreased when apatitic powder, the precipitate formed by the calcium phosphate precipitation method, was immersed in synthetic salvia. The decrease in the calcium and phosphate ions in synthetic saliva indicated further precipitation of calcium phosphate on the apatitc precipitate.(ABSTRACT TRUNCATED AT 250 WORDS)