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Shaalan O, Fawzy El-Sayed K, Abouauf E. Evaluation of the remineralization potential of self-assembling peptide P11-4 with fluoride compared to fluoride varnish in the management of incipient carious lesions: a randomized controlled clinical trial. Clin Oral Investig 2024; 28:438. [PMID: 39037455 PMCID: PMC11263456 DOI: 10.1007/s00784-024-05822-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/05/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVES The present trial's aim was to compare the remineralization potential of self-assembling peptide P11-4 combined with fluoride to that of fluoride varnish. MATERIALS AND METHODS Twenty-eight participants with 58 incipient carious lesions were enrolled in the present trial. Participants were randomly divided into two groups with 14 participants and 29 incipient lesions in each group. Patients were assigned either to self-assembling peptide combined with fluoride (Curodont Repair Fluoride Plus™) or sodium fluoride varnish (NaF, Bifluorid 10) groups. Both agents were applied according to the manufacturer's instructions on non-cavitated incipient carious lesions. Lesions were assessed by two calibrated and blinded assessors at baseline, and after one-, three- and six-months using a laser fluorescence device (DIAGNOdent). RESULTS Although laser fluorescence scores significantly improved in both groups over time (p < 0.05), no notable differences were evident between both groups at one-month (p > 0.05). Yet, at three- and six-months statistically lower laser fluorescence readings were evident in the self-assembling peptide combined with fluoride group in comparison to the fluoride alone group (p < 0.05). There was 60% less risk for caries progression for Curodont Repair Fluoride Plus™ when compared to NaF varnish after six months. Self-assembling peptide combined with fluoride was able to change 65.5% of non-cavitated carious lesions from DIAGNOdent score 3 (11-20) to score 1 (0-4). Fluoride varnish was able to change 13.8% of the lesions from score 3 to score 1 after six months. CONCLUSIONS The self-assembling peptide combined with fluoride varnish showed higher remineralization potential than fluoride varnish alone for incipient carious lesions over a six-months follow up. CLINICAL RELEVANCE The combination of self-assembling peptide P11-4 and fluoride could offer a new tool in managing incipient carious lesions.
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Affiliation(s)
- Omar Shaalan
- Conservative Dentistry Department, Faculty of Dentistry, Cairo University, Al Saraya Str. 11, Manial, Cairo, Egypt
- Conservative Dentistry Division, School of Dentistry, Newgiza University, First 6th of October, Egypt
| | - Karim Fawzy El-Sayed
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Giza, Egypt
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian Albrechts University, Kiel, Germany
| | - Eman Abouauf
- Conservative Dentistry Department, Faculty of Dentistry, Cairo University, Al Saraya Str. 11, Manial, Cairo, Egypt.
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Al-Qahtani AS, Almutairi B, Al-Hamdan RS, Alzahrani KM. Remineralizing pretreatment using casein phosphopeptide-amorphous calcium phosphate fluoride, self-assembling peptide, and nanohydroxyapatite gel activation via invisible infrared light on the dentin microhardness and micro shear bond strength to the composite restoration. Photodiagnosis Photodyn Ther 2024; 47:104210. [PMID: 38729233 DOI: 10.1016/j.pdpdt.2024.104210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/12/2024]
Abstract
AIM Different remineralizing pretreatments Casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), tricalcium phosphate fluoride (TCP-F), self-assembling peptide (SAP) P11-4 and 10 % Nanohydroxyapatite (nHA) gel activation via invisible infrared light on the dentin microhardness (MH) and micro shear bond strength (µSBS) of composite restoration. METHODS Seventy-five human molar teeth were collected and the dentinal surface of all the samples was exposed to different demineralizing solutions. (n = 15) Group 1 (demineralized dentin), Group 2 (CPP ACP), Group 3 (TCP-F), Group 4 (SAP P11-4), Group 5 (nHA gel activation via invisible infrared light). MH assessment was performed using Vickers hardness. Each group of 10 samples was subjected to composite restoration buildup and µSBS were tested. The debonded samples were then observed under a stereo-microscope for failure analysis. ANOVA was conducted, along with Tukey's post hoc analysis, to examine the µSBS of composite and MH of the remineralized surface. RESULTS nHA gel activation via invisible infrared light pretreated specimens showed the maximum outcomes of surface hardness (331.2 ± 77.3) and bond strength (10.38 ± 2.77). However, Group 4 (SAP P11-4) (148.3 ± 29.2) remineralized dentin displayed minimum scores of MH and µSBS (5.88 ± 1.01). CONCLUSION Remineralizing pretreatment nHA gel activation via invisible infrared light and casein phosphopeptide-amorphous calcium phosphate fluoride seem to improve the dentin MH and µSBS of the composite restoration.
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Affiliation(s)
- Amal S Al-Qahtani
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, 11545, Saudi Arabia
| | - Basil Almutairi
- Department of Restorative Dental Sciences, Division of Operative Dentistry, College of Dentistry, King Saud University, P. O. Box 60169, Riyadh, 11545, Saudi Arabia.
| | - Rana S Al-Hamdan
- Department of Restorative Dental Sciences, Division of Operative Dentistry, College of Dentistry, King Saud University, P. O. Box 60169, Riyadh, 11545, Saudi Arabia
| | - Khaled M Alzahrani
- Department of Prosthetic Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, 11942 Alkharj, Saudi Arabia
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Agusmawanti P, Ratih DN, Purwanti N, Raharjo TJ. The Potential of QP3VH-Chitosan Peptide as Biomimetic Remineralization in Early Dental Caries Treatment: An In Vitro Study. Eur J Dent 2024. [PMID: 38759995 DOI: 10.1055/s-0044-1782189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES The development of remineralization biomimetics using organic peptide molecules is expected to resemble the hydroxyapatite (HA) mineralization process in tooth enamel. The development of an amelogenin derivative peptide combined with antimicrobial peptide was designed, resulting in QP3VH. This combination then was mixed with chitosan as a carrier. This study aimed to evaluate the biomimetic efficacy of QP3VH as a remineralizing agent combined with chitosan. MATERIALS AND METHODS Fifty deciduous mandibular incisor enamel samples were used in this study. The artificial enamel lesions were created on a buccal surface and were randomly assigned to five groups of 10 each according to the remineralizing agent used: QP3VH, NaF, QP3VH + NaF, QP3VH + CS (QP3VH + chitosan), and saline distilled water (SDW). Each group was performed pH cycling for seven days. Enamel surface morphology and evaluation of mineral content Ca/P (calcium and phosphate) using scanning electron microscopy and energy dispersive X-ray analysis. The assessment was carried out, after demineralization, and after application with remineralization agents. STATISTICAL ANALYSIS Data were analyzed using a one-way analysis of variance followed by least significance difference post-hoc test. The paired t-test was utilized to compare the demineralization and remineralization results. The significance level used was 95%. RESULTS The remineralized group exhibited a significant increase in calcium and phosphate content on the enamel surface (p <0.05), and QP3VH + CS produced the maximum Ca/P mass percent after remineralization. CONCLUSION Combining QP3VH with chitosan produces greatest remineralization than QP3VH, QP3VH + NaF, Naf, and SDW; therefore, QP3VH peptide has potential as a remineralizing agent, in the future.
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Affiliation(s)
- Prima Agusmawanti
- Doctoral Program, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Departement of Pediatric Dentistry, Faculty of Dentistry, Universitas Islam Sultan Agung, Indonesia
| | - Diatri Nari Ratih
- Department of Conservative Dentistry, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nunuk Purwanti
- Department of Dental Biomedical Sciences, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tri Joko Raharjo
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Kharbot B, Askar H, Gruber D, Paris S. Biomimetic Remineralization of Artificial Caries Lesions with a Calcium Coacervate, Its Components and Self-Assembling Peptide P 11-4 In Vitro. Bioengineering (Basel) 2024; 11:465. [PMID: 38790332 PMCID: PMC11117797 DOI: 10.3390/bioengineering11050465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
The application of calcium coacervates (CCs) may hold promise for dental hard tissue remineralization. The aim of this study was to evaluate the effect of the infiltration of artificial enamel lesions with a CC and its single components including polyacrylic acid (PAA) compared to that of the self-assembling peptide P11-4 in a pH-cycling (pHC) model. Enamel specimens were prepared from bovine incisors, partly varnished, and stored in demineralizing solution (DS; pH 4.95; 17 d) to create two enamel lesions per sample. The specimens were randomly allocated to six groups (n = 15). While one lesion per specimen served as the no-treatment control (NTC), another lesion (treatment, T) was etched (H3PO4, 5 s), air-dried and subsequently infiltrated for 10 min with either a CC (10 mg/mL PAA, 50 mM CaCl2 (Ca) and 1 M K2HPO4 (PO4)) (groups CC and CC + DS) or its components PAA, Ca or PO4. As a commercial control, the self-assembling peptide P11-4 (CurodontTM Repair, Credentis, Switzerland) was tested. The specimens were cut perpendicularly to the lesions, with half serving as the baseline (BL) while the other half was exposed to either a demineralization solution for 20 d (pH 4.95; group CC + DS) or pHC for 28 d (pH 4.95, 3 h; pH 7, 21 h; all five of the other groups). The difference in integrated mineral loss between the lesions at BL and after the DS or pHC, respectively, was analyzed using transversal microradiography (ΔΔZ = ΔZpHC - ΔZbaseline). Compared to the NTC, the mineral gain in the T group was significantly higher in the CC + DS, CC and PAA (p < 0.05, Wilcoxon). In all of the other groups, no significant differences between treated and untreated lesions were detected (p > 0.05). Infiltration with the CC and PAA resulted in a consistent mineral gain throughout the lesion body. The CC as well as its component PAA alone promoted the remineralization of artificial caries lesions in the tested pHC model. Infiltration with PAA further resulted in mineral gain in deeper areas of the lesion body.
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Affiliation(s)
- Basel Kharbot
- Department of Operative, Preventive and Pediatric Dentistry, Charité—Universitätsmedizin Berlin, 14917 Berlin, Germany
| | - Haitham Askar
- Department of Operative, Preventive and Pediatric Dentistry, Charité—Universitätsmedizin Berlin, 14917 Berlin, Germany
| | - Dominik Gruber
- Physical Chemistry, Department of Chemistry, University of Konstanz, 78464 Konstanz, Germany
| | - Sebastian Paris
- Department of Operative, Preventive and Pediatric Dentistry, Charité—Universitätsmedizin Berlin, 14917 Berlin, Germany
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Gungor AS, Dalkılıç E, Alkan E, Yılmaz-Atalı P, Tağtekin D. Enamel Matrix Derivative, 58S5 Bioactive Glass, and Fluoride Varnish for Enamel Remineralization: A Multi-analysis Approach. Oper Dent 2024; 49:353-363. [PMID: 38807323 DOI: 10.2341/23-102-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE This study aimed to evaluate the enamel remineralization efficacy of enamel matrix derivative (EMD), experimental bioactive glass (BAG), and fluoride varnish in vitro. METHODS AND MATERIALS Artificial initial caries lesions were developed on fifty human enamel specimens using demineralization solution (pH 4.5, 37°C, 96 hours). Specimens were randomly assigned to five groups (n=10): I-5% NaF varnish (Enamelast), II-experimental 58S5 BAG+37% phosphoric acid (PA), III-EMD (Emdogain) + Ethylenediaminetetraacetic Acid (EDTA), IV-EMD+37% PA, V-Control (untreated). All remineralization agents were applied with pH cycling for seven days. The specimens were scanned by spectral domain optical coherence tomography (SD-OCT) at baseline, at demineralization, and after pH cycling. Lesion depths were measured using image analysis software (ImageJ). Lesions were evaluated using surface microhardness (SMH) and two fluorescence methods (FluoreCam and DIAGNOdent Pen [DDPen]). The data were statistically analyzed by Kruskal Wallis, Friedman, and Wilcoxon tests (α=0.05). RESULTS According to SD-OCT results, fluoride varnish was found to be the most effective agent in reducing lesion depth (p=0.005). All agents increased the SMH values after pH cycling. No significant difference was found among fluoride varnish, BAG, and EMD+PA groups. These SMH values were significantly higher than EMD+EDTA and control groups (p<0.001). All groups showed lower DDPen scores compared with the control group (p<0.001), however, no significant difference was found among the remineralization agents. In FluoreCam assessment, size and intensity values of all treated groups showed improvement. However, there was no significant difference between the treatment groups in terms of FluoreCam size measurements (p=0.186). CONCLUSION 58S5 BAG and EMD+PA have remineralization capacity as effective as fluoride varnish. EMD+PA showed better SMH and lesion intensity results than EMD+EDTA.
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Affiliation(s)
- A Sarialioglu Gungor
- *Ayca Sarialogu Gungor, DDS, MSc, Department of Restorative Dentistry, Faculty of Dentistry, Istanbul Galata University, Istanbul, Turkey
| | - E Dalkılıç
- Evrim Dalkılıç, DDS, MSc, PhD, Department of Restorative Dentistry, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey
| | - E Alkan
- Elif Alkan, DDS, MSc, Department of Restorative Dentistry, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - P Yılmaz-Atalı
- P Yılmaz-Atalı, DDS, MSc, PhD, Department of Restorative Dentistry, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - D Tağtekin
- Dilek Tağtekin, DDS, MSc, PhD, Department of Restorative Dentistry, Faculty of Dentistry, Marmara University, Istanbul, Turkey
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Nath SJC, Fu Y, Li KC, Loho T, Loch C, Ekambaram M. A Comparison of the Enamel Remineralisation Potential of Self-Assembling Peptides. Int Dent J 2024; 74:187-194. [PMID: 37743135 PMCID: PMC10988264 DOI: 10.1016/j.identj.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/19/2023] [Accepted: 07/04/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND The aim of this research was to compare the efficacy of the remineralising potential of self-assembling peptides (SAPs): Curodont Repair (P11-4), P26, and leucine-rich amelogenin peptides (LRAP) with the standard 5% NaF varnish (Duraphat) on early enamel caries lesions (EECLs). METHODS A demineralising solution (DS) was used to create artificial EECLs in human dental enamel specimens, which were randomly allocated to treatment groups: P11-4; P26 solution; LRAP solution; 5% NaF varnish; and deionised water (DIW). Each specimen was subjected to 8 days of pH cycling. Specimens from each test group were subjected to microcomputed tomography (micro-CT) and nanomechanical testing to assess mineral density (MD), hardness (H), and elastic modulus (EM) properties of sound, demineralised, and treated enamel. RESULTS The mean MD percentage gain was highest in the P26 and P11-4 groups, followed by the LRAP, 5% NaF varnish, and DIW groups. There were statistically significant differences amongst groups. In the outer layer of EECLs, the EM and H were highest in P26 and P11-4 groups, followed by the LRAP and 5% NaF varnish. In the inner layer of EECLs, the EM and H were highest in P11-4 and P26 groups, indicative of enhanced penetration and remineralisation of the deeper parts of the artificial EECLs. CONCLUSIONS P26 and P11-4 SAPs are more effective than 5% NaF varnish in remineralising the depth of EECLs.
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Affiliation(s)
- Suneil Jason Chand Nath
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Yipeng Fu
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand; The Fifth Outpatient Department, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Kai Chun Li
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Thomas Loho
- Faculty of Engineering, Chemical and Materials Engineering, University of Auckland, New Zealand
| | - Carolina Loch
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Manikandan Ekambaram
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
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Zhang Z, Cui Z, Zhang J, Zheng H, Zhou Z, Wu Z, Wang Z, Fu B. Remineralizing effects of hydroxypropyl methylcellulose film-loaded amorphous calcium phosphate nanoprecursors on enamel artificial caries lesions. J Mech Behav Biomed Mater 2024; 151:106408. [PMID: 38244421 DOI: 10.1016/j.jmbbm.2024.106408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVES This study was to investigate hydroxypropyl methylcellulose (HPMC) film as a carrier for amorphous fluorinated calcium phosphate (AFCP) nanoprecursors to continuously deliver biomimetic remineralization of enamel artificial caries lesions (ACL). MATERIALS AND METHODS The AFCP/HPMC films were comprised of 25 wt% AFCP nanoparticles and 75 wt% HPMC. They were characterized by transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and biocompatibility tests. Forty enamel ACL were prepared and randomly divided into four groups (n = 10): The enamel surfaces were covered with a pure HPMC film, Tooth Mousse Plus (contains 10% CPP-ACP and 0.2% NaF), and AFCP/HPMC film, or without any things (serving as negative control). Subsequently, all samples were alternatively kept in artificial saliva and a modified pH-cycling before they were characterized by Micro-CT, scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), attenuated total reflectance (ATR)-FTIR, XRD, and nanoindentation. RESULTS After the enamel ACL was challenged by pH cycling, Tooth Mousse Plus and AFCP/HPMC film groups exhibited less lesion depth and mineral loss than the negative control and pure HPMC film groups. Additionally, the AFCP/HPMC film group revealed a highest remineralization rate of 55.34 ± 3.10 % among the all groups (p < 0.001). The SEM findings showed that the enamel ACL were densely deposited with minerals in the AFCP/HPMC film group, and the EDX results suggested a higher content of fluorine in the remineralized tissues. In particular, the AFCP/HPMC film group exhibited the best nanomechanical performance after 2 weeks of pH cycling (p < 0.05), with the hardness (H) restored from 0.29 ± 0.19 to 2.69 ± 0.70 GPa, and elastic modulus (Er) restored from 10.77 ± 5.30 to 68.83 ± 12.72 GPa. CONCLUSION The AFCP/HPMC film might be used as a promising strategy for arresting or reversing incipient enamel caries lesions.
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Affiliation(s)
- Zhixin Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China; Department of Stomatology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, Fujian, China.
| | - Zihan Cui
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China
| | - Jianping Zhang
- Department of Orthopaedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou, 363000, Fujian, China
| | - Haiyan Zheng
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China
| | - Zihuai Zhou
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China
| | - Zhifang Wu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China
| | - Zhe Wang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China.
| | - Baiping Fu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China.
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Rathore K, Patnana AK, Chugh VK, Chugh A, Kumar P. Self-assembling peptides for managing white spot lesions: a systematic review and meta-analysis. Eur Arch Paediatr Dent 2023; 24:519-531. [PMID: 37702901 DOI: 10.1007/s40368-023-00821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/03/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE The primary objective of the review was to assess the effectiveness of self-assembling P11-4 peptide (SAP) with or without any fluoride agents (FA) in remineralization of the White spot lesions (WSLs)/incipient carious lesions (ICLs) compared to other enamel remineralizing agents/non-intervention/placebo. METHODS Human RCTs published during the period from 1st January 2000-30th June 2021 were searched in the electronic bibliographic databases and scanning reference lists of articles from PubMed, Google Scholar, and The Cochrane Central Register of Controlled Trials. The Risk-of-Bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) tool for all included studies. The statistical heterogeneity between studies was assessed by the Cochrane Q test and I2 test. A random-effects model was used considering the variations in true effects size between the included studies. The quality of the evidence for remineralizing effectiveness of SAP/SAP + FA was done using the GRADEpro GDT software which employs GRADE. RESULTS Four out of eight included trials were assessed to have "high risk" of bias. Mean difference for Laser fluorescence outcome assessment method (SAP v/s FA) was - 4.89 (95% CI: - 17.35 to 7.57; p = 0. 44; I2 = 89%). The combined risk ratio observed through Nyvad criteria (SAP v/s FA) was 0.12 (95% CI: 0.01-1.59; p = 0.11; I2 = 71%). Mean difference for Laser fluorescence outcome assessment method (SAP + FA v/s FA) was - 11.52 (95% CI: - 14.43 to - 8.61; p = < 0.001;I2 = 0%). The combined risk ratio for ICDAS outcome assessment method (SAP + FA v/s FA) was 0.27 (95% CI: 0.03-2.84; p = 0.15; I2 = 53%). CONCLUSION Considering the results observed from the included trials we are uncertain whether SAP/SAP + FA increases/decreases the remineralizing/regeneration of WSLs/ICLs.
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Affiliation(s)
- K Rathore
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
| | - A K Patnana
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
- Department of Dentistry, All India Institute of Medical Sciences, Rajkot, Gujarat, 360006, India
| | - V K Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - A Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - P Kumar
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
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Godenzi D, Bommer C, Heinzel-Gutenbrunner M, Horst Keeper J, Peters K. Remineralizing potential of the biomimetic P 11-4 self-assembling peptide on noncavitated caries lesions: A retrospective cohort study evaluating semistandardized before-and-after radiographs. J Am Dent Assoc 2023; 154:885-896.e9. [PMID: 37642611 DOI: 10.1016/j.adaj.2023.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/19/2023] [Accepted: 07/06/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Self-assembling peptide (SAP) P11-4 was introduced to treat initial caries lesions by means of guiding hydroxyapatite regeneration within the lesion. The objective of this study was to assess its effectiveness in a practical clinical setting. METHODS Caries lesions in permanent teeth treated with monomeric and polymeric SAP P11-4 from May 2015 through October 2020 were retrospectively analyzed at lesion and child levels by means of bite-wing radiography for changes in stage and cavitation and restoration. RESULTS Two hundred and nineteen children aged 10 through 19 years with a total of 405 proximal lesions in posterior teeth were followed from 0.4 through 5.5 years (median, 7 months; interquartile range, 6-19 months). Regression occurred in 37% of stage RA1 (radiolucency in the outer one-half of enamel) (95% CI, 31% to 44%), 38% of stage RA2 (radiolucency in the inner one-half of enamel plus or minus the enamel-dentin junction) (95% CI, 30% to 45%), and 40% of stage RA3 (radiolucency limited to the outer one-third of dentin) (95% CI, 16% to 68%) lesions. The proportion of lesions with no cavitation was 0.96 (95% CI, 0.94 to 0.98) after 1 year and 0.91 (95% CI, 0.88 to 0.95) after 2 years. CONCLUSIONS Real-world clinical data indicate that SAP P11-4 can lead to recovery and a healthier tooth stage. PRACTICAL IMPLICATIONS SAP P11-4 is a safe treatment for initial caries lesions in permanent teeth that remineralizes in the deepest zone of the lesion and can be introduced easily into routine dental practice.
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Atteya SM, Amer HA, Saleh SM, Safwat Y. Self-assembling peptide and nano-silver fluoride in remineralizing early enamel carious lesions: randomized controlled clinical trial. BMC Oral Health 2023; 23:577. [PMID: 37598194 PMCID: PMC10439642 DOI: 10.1186/s12903-023-03269-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Nanoparticles and regenerative biomineralization are new caries prevention technologies. This study assessed the remineralizing effect of self-assembling peptide (P11-4), Nanosilver Fluoride (NSF) and sodium fluoride (NaF) on white spot lesions (WSLs) in permanent teeth. METHODS Sixty six young adults with WSLs on buccal surfaces in permanent teeth and ICDAS code 1 or 2, were randomly assigned to one of three groups; P11-4, NSF or NaF. Assessment of ICDAS scores, lesion activity (Nyvad scores) and diagnodent readings of lesions were done at baseline and after 1, 3, 6 and 12 months of agents' application. Comparisons between groups were made using chi squared test and comparison within groups were made using McNemar test. Multilevel binary logistic regression was used to assess the effect of agents on change of ICDAS scores after 3, 6 and 12 months (reduction versus no reduction). RESULTS There were 147 teeth in 66 patients; mean ± SD age = 13.46 ± 4.31 years. There were significant differences in the change of ICDAS scores among the three groups after 3 and 6 months (p = 0.005). The reduction in ICDAS score increased steadily in all groups across time with the greatest increase in the P11-4 group: 54.5% after 12 months. Lesion activity (Nyvad scores) showed significant differences among the three groups with the greatest percentage of inactive cases in the P11-4 group. Multilevel binary logistic regression showed non-significant reduction of ICDAS in P11-4 and NSF varnishes compared to NaF varnish (AOR = 2.56, 95% CI: 0.58, 8.77 and AOR = 2.12, 95% CI: 0.59, 7.64 respectively). CONCLUSION P11-4 and NSF varnish reduced the ICDAS scores, caries activity and diagnodent readings of WSLs in permanent teeth. However, the change in ICDAS scores was not significantly different from NaF. TRIAL REGISTRATION This trial was prospectively registered on the clinicaltrials.gov registry with ID: NCT04929509 on 18/6/2021.
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Affiliation(s)
- Sara M Atteya
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champollion St., Azarita, 21527, Alexandria, Egypt.
| | - Hala A Amer
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champollion St., Azarita, 21527, Alexandria, Egypt
| | - Susan M Saleh
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champollion St., Azarita, 21527, Alexandria, Egypt
| | - Yara Safwat
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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11
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Chaiwat A, Chunhacheevachaloke E, Kidkhunthod P, Pakawanit P, Ajcharanukul O. Enamel Remineralization and Crystallization after Fluoride Iontophoresis. J Dent Res 2023; 102:402-411. [PMID: 36546596 DOI: 10.1177/00220345221138513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Early caries lesions consist of noncavitated subsurface demineralization caused by the dissolution of hydroxyapatite from the surface to the subsurface area of the enamel. Such lesions cannot be remineralized effectively by the conventional treatment. Thus, there is a need for a noninvasive technique capable of delivering the remineralizing agent to subsurface sites. For this purpose, fluoride iontophoresis (IP) using weak currents has been investigated with some conflicting results and no information on the crystal structure and composition. Because enamel remineralization involves the role of fluid from dentin, the presence of enamel fluid is necessary to determine the repair associated with the physiological condition. This study aimed to investigate structural and compositional characteristics, including the remineralizing effect of 5% sodium fluoride (NaF) IP with different polarities, cathodal iontophoresis (CIP), and anodal iontophoresis (AIP) for the treatment of natural enamel caries under simulated pulpal pressure. A bulk measurement of the crystal structure inside the lesion was first determined using calcium (Ca) K-edge X-ray absorption spectroscopy. IP with both polarities significantly promoted subsurface remineralization. The CIP generated a significant increase in the Ca/phosphorus ratio, and fluoride at the surface lesion significantly correlated with higher mineral density (MD) and more strengthening crystal structure of the lesion volume, while the lesion's MD and other impurities at the lesion surface, mostly the carbonate ions, affected the significant increase in MD with the unchanged structure of the lesion volume after AIP. The CIP of NaF is an ideal method for rapid enamel remineralization and recrystallization of fluoroapatite/fluorohydroxyapatite.
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Affiliation(s)
- A Chaiwat
- Department of Pediatric and Preventive Dentistry, Faculty of Dentistry, Srinakharinwirot University, Bangkok, Thailand
| | - E Chunhacheevachaloke
- Department of Pediatric and Preventive Dentistry, Faculty of Dentistry, Srinakharinwirot University, Bangkok, Thailand
| | - P Kidkhunthod
- Synchrotron Light Research Institute (Public Organization) Muang District, Nakhon Ratchasima, Thailand
| | - P Pakawanit
- Synchrotron Light Research Institute (Public Organization) Muang District, Nakhon Ratchasima, Thailand
| | - O Ajcharanukul
- Department of Stomatology, Faculty of Dentistry, Srinakharinwirot University, Bangkok, Thailand
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12
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Shubbar M, Addie A, Al-Taee L. The Effect of a Bioactive Oral System and CO2 Laser on Enamel Susceptibility to Acid Challenge. Diagnostics (Basel) 2023; 13:diagnostics13061087. [PMID: 36980395 PMCID: PMC10047757 DOI: 10.3390/diagnostics13061087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/15/2023] Open
Abstract
This study evaluated the structural changes of enamel treated by the Regenerate system and carbon dioxide (CO2) laser against acid challenge. Thirty human enamel slabs were prepared and assigned into three groups: Group I: untreated (control); Group II: treated with the Regenerate system; and Group III exposed to CO2 laser. All specimens were subjected to an acid challenge (pH 4.5–7.0) for 14 days. Specimens were evaluated and compared at 120 points using five Raman microspectroscopic peaks; the phosphate vibrations ν1, ν2, ν3, and ν4 at 960, 433, 1029, and 579 cm−1, respectively, and the carbonate at 1070 cm−1, followed by Vickers microhardness test. The ratio of carbonate to phosphate was correlated to the equivalent microhardness numbers. The intensities of phosphate peaks ν1, ν2, and ν4 were reduced in all groups post-acid challenge, while the carbonate and ν3 were significantly increased (p < 0.000). Surfaces treated by Regenerate exhibited higher peak intensity of phosphate and carbonate before and after pH-cycling (p < 0.05). The mineral content in enamel had a direct effect on tissue microhardness, and the CO2-lased surfaces showed a reduced carbonate content and higher microhardness values. Both approaches induced surface changes that can protect enamel against acid challenge resulting in a significant benefit for dental healthcare.
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Affiliation(s)
- Mustafa Shubbar
- Department of Conservative and Aesthetic Dentistry, Baghdad College of Dentistry, University of Baghdad, Baghdad P.O. Box 1417, Iraq
| | - Ali Addie
- Center of Advanced Materials, Ministry of Science and Technology, Baghdad P.O. Box 0765, Iraq
| | - Lamis Al-Taee
- Department of Conservative and Aesthetic Dentistry, Baghdad College of Dentistry, University of Baghdad, Baghdad P.O. Box 1417, Iraq
- Correspondence: ; Tel.: +964-772-812-0182
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13
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Hardan L, Chedid JCA, Bourgi R, Cuevas-Suárez CE, Lukomska-Szymanska M, Tosco V, Monjarás-Ávila AJ, Jabra M, Salloum-Yared F, Kharouf N, Mancino D, Haikel Y. Peptides in Dentistry: A Scoping Review. Bioengineering (Basel) 2023; 10:bioengineering10020214. [PMID: 36829708 PMCID: PMC9952573 DOI: 10.3390/bioengineering10020214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Currently, it remains unclear which specific peptides could be appropriate for applications in different fields of dentistry. The aim of this scoping review was to scan the contemporary scientific papers related to the types, uses and applications of peptides in dentistry at the moment. Literature database searches were performed in the following databases: PubMed/MEDLINE, Scopus, Web of Science, Embase, and Scielo. A total of 133 articles involving the use of peptides in dentistry-related applications were included. The studies involved experimental designs in animals, microorganisms, or cells; clinical trials were also identified within this review. Most of the applications of peptides included caries management, implant osseointegration, guided tissue regeneration, vital pulp therapy, antimicrobial activity, enamel remineralization, periodontal therapy, the surface modification of tooth implants, and the modification of other restorative materials such as dental adhesives and denture base resins. The in vitro and in vivo studies included in this review suggested that peptides may have beneficial effects for treating early carious lesions, promoting cell adhesion, enhancing the adhesion strength of dental implants, and in tissue engineering as healthy promotors of the periodontium and antimicrobial agents. The lack of clinical trials should be highlighted, leaving a wide space available for the investigation of peptides in dentistry.
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Affiliation(s)
- Louis Hardan
- Department of Restorative Dentistry, School of Dentistry, Saint Joseph University, Beirut 1107 2180, Lebanon
| | - Jean Claude Abou Chedid
- Department of Pediatric Dentistry, Faculty of Dentistry, Saint Joseph University, Beirut 1107 2180, Lebanon
| | - Rim Bourgi
- Department of Restorative Dentistry, School of Dentistry, Saint Joseph University, Beirut 1107 2180, Lebanon
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg, 67000 Strasbourg, France
| | - Carlos Enrique Cuevas-Suárez
- Dental Materials Laboratory, Academic Area of Dentistry, Autonomous University of Hidalgo State, San Agustín Tlaxiaca 42160, Mexico
- Correspondence: (C.E.C.-S.); (N.K.); (Y.H.); Tel.: +52-(771)-72000 (C.E.C.-S.)
| | | | - Vincenzo Tosco
- Department of Clinical Sciences and Stomatology (DISCO), Polytechnic University of Marche, 60126 Ancona, Italy
| | - Ana Josefina Monjarás-Ávila
- Dental Materials Laboratory, Academic Area of Dentistry, Autonomous University of Hidalgo State, San Agustín Tlaxiaca 42160, Mexico
| | - Massa Jabra
- Faculty of Medicine, Damascus University, Damascus 0100, Syria
| | | | - Naji Kharouf
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg, 67000 Strasbourg, France
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, 67000 Strasbourg, France
- Correspondence: (C.E.C.-S.); (N.K.); (Y.H.); Tel.: +52-(771)-72000 (C.E.C.-S.)
| | - Davide Mancino
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg, 67000 Strasbourg, France
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Youssef Haikel
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, University of Strasbourg, 67000 Strasbourg, France
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
- Correspondence: (C.E.C.-S.); (N.K.); (Y.H.); Tel.: +52-(771)-72000 (C.E.C.-S.)
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14
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Tay N, Gan H, de Sousa FB, Shen L, Nóbrega DF, Peng C, Kilpatrick-Liverman L, Wang W, Lavender S, Pilch S, Han J. Improved mineralization of dental enamel by electrokinetic delivery of F - and Ca 2+ ions. Sci Rep 2023; 13:516. [PMID: 36627315 PMCID: PMC9832158 DOI: 10.1038/s41598-022-26423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
This in vitro study evaluated the effects of the infiltration of F- and Ca2+ ions into human enamel by electrokinetic flow (EKF) on the enamel microhardness and F- content. Sound human enamel ground sections of unerupted third molars were infiltrated with de-ionized water by EKF and with F- ion by EKF respectively. All samples were submitted to two successive transverse acid-etch biopsies (etching times of 30 s and 20 min) to quantify F- ion infiltrated deep into enamel. Remarkably, sound enamel showed a large increase in microhardness (MH) after infiltration of NaF (p < 0.00001) and CaCl2 (p = 0.013) by EKF. Additionally, NaF-EKF increased the remineralization in the lesion body of artificial enamel caries lesions compared to controls (p < 0.01). With the enamel biopsy technique, at both etching times, more F- ions were found in the EKF-treated group than the control group (p << 0.05), and more fluoride was extracted from deeper biopsies in the NaF-EKF group. In conclusion, our results show that EKF treatment is superior in transporting Ca2+ and F- ions into sound enamel when compared to molecular diffusion, enhancing both the mineralization of sound enamel and the remineralization of artificial enamel caries.
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Affiliation(s)
- NamBeng Tay
- grid.486188.b0000 0004 1790 4399Engineering Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore, 138683 Singapore
| | - HiongYap Gan
- Engineering Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore, 138683, Singapore.
| | - Frederico Barbosa de Sousa
- grid.411216.10000 0004 0397 5145Department of Morphology and Graduate Program in Dentistry, Health Sciences Center, Federal University of Paraiba, Joao Pessoa, Cidade Universitaria, Paraíba, Brazil
| | - Lu Shen
- grid.486188.b0000 0004 1790 4399Engineering Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore, 138683 Singapore
| | | | - Chenhui Peng
- grid.56061.340000 0000 9560 654XDepartment of Physics and Materials Science, University of Memphis, Memphis, TN USA
| | | | - Wei Wang
- grid.418753.c0000 0004 4685 452XColgate-Palmolive Technology Center, Piscataway, NJ USA
| | - Stacey Lavender
- grid.418753.c0000 0004 4685 452XColgate-Palmolive Technology Center, Piscataway, NJ USA
| | - Shira Pilch
- grid.418753.c0000 0004 4685 452XColgate-Palmolive Technology Center, Piscataway, NJ USA
| | - Jongyoon Han
- Department of Electric Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
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15
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Hamdi K, Hamama HH, Motawea A, Fawzy A, Mahmoud SH. Long-term evaluation of early-enamel lesions treated with novel experimental tricalcium silicate paste: A 2-year randomized clinical trial. J ESTHET RESTOR DENT 2022; 34:1113-1121. [PMID: 35815478 DOI: 10.1111/jerd.12941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/07/2022] [Accepted: 06/24/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the current study is to evaluate the remineralization potential of experimental tricalcium silicate (TCS) paste in comparison with more popular remineralizing agents like silver diamine fluoride potassium iodide (SDF-KI) and casein phosphopeptide amorphous calcium phosphate (CPP-ACP) on early enamel lesions. MATERIALS AND METHODS Forty-five patients in the age range of 15-50 years had early enamel lesions on the buccal surface of molar teeth. The patients were randomly divided into three treatment groups (SDF-KI, CPP-ACP, and TCS group) with 15 patients per group. Lesions were evaluated clinically by DIAGNOdent pen immediately and after 3,6,12, and 24 months of treatment. RESULTS The study was completed with 45 patients and 92 teeth. Twice-daily application of CPP-ACP and TCS paste showed a significant remineralization effect on early enamel lesions after 24 months (p < 0.001). Also, annual application of SDF-KI showed a significant remineralization effect after 24 months (p < 0.001). There was a significant difference between (SDF-KI and CPP-ACP) and (SDF-KI and TCS) at the different follow-up periods 3,6,12, and 24 months (p < 0.001). Meanwhile, there was no significant difference between CPP-ACP and TCS at the mentioned follow-up periods (p > 0.05). CONCLUSION TCS showed potential remineralization for early enamel lesions. CLINICAL RELEVANCE Experimental TCS is a promising remineralizing agent for management of early enamel lesions.
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Affiliation(s)
- Kareem Hamdi
- Operative Dentistry Department, Faculty of Dentistry, Zagazig University, Zagazig, Egypt
| | - Hamdi H Hamama
- Operative Dentistry, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Amira Motawea
- Department of Pharmaceutics, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - Amr Fawzy
- UWA Dental School, University of Western Australia, Perth, Western Australia, Australia
| | - Salah Hasab Mahmoud
- Operative Dentistry, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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16
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Effect of a Self-Assembly Peptide on Surface Roughness and Hardness of Bleached Enamel. J Funct Biomater 2022; 13:jfb13020079. [PMID: 35735934 PMCID: PMC9224554 DOI: 10.3390/jfb13020079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 01/28/2023] Open
Abstract
After bleaching, enamel surfaces are damaged, contributing to erosion and tooth sensitivity. Although fluoride is used after bleaching to try and revert alterations, it is not capable of repairing tooth structure. This study compared the effect of a self-assembly peptide (P11-4), with and without fluoride, and sodium fluoride (NaF 2%) on the Knoop microhardness (KHN) and surface roughness (Ra (μm)) of bleached enamel with an in-office bleaching regimen. Enamel blocks of bovine teeth (5 × 5 × 2 mm) with standardized surface hardness were bleached with 35% carbamide peroxide, following the manufacturer’s instructions. The teeth were randomly divided into the following groups (n = 7) according to post-bleaching treatment: no treatment (negative control) (C-); 2% NaF (NaF); Curodont™ Repair (Repair); and Curodont™ Protect (Protect). Specimens were stored in artificial saliva at 37 °C. To evaluate the effect of the post-bleaching treatments, KHN and Ra were measured before bleaching (baseline) and 24 h and 7 days after bleaching. Data were submitted to repeated measures ANOVA and Bonferroni tests (α = 0.05). There were significant interactions between the study factors (p = 0.001). After 7 days, Repair (572.50 ± 79.04) and Protect (583.00 ± 74.76) specimens showed increased surface KHN, with values higher than the NaF (465.50 ± 41.50) and C- (475.22 ± 58.95) baseline values. There was no significant difference in KHN at 24 h among groups (p = 0.587). At 24 h after bleaching, Repair was significantly different from all groups (p < 0.05). Repair showed the lowest Ra (μm) values (0.133 ± 0.035). After seven days, there was no significant difference in Ra values among groups when compared to the baseline. The use of P11-4-based materials after bleaching resulted in the fastest recovery to baseline enamel properties.
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17
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da Silva KTL, Grazziotin-Soares R, de Miranda RR, Novais VR, Carvalho EM, da Silva GR, Bauer J, Carvalho CN. Effect of an enamel matrix derivative (Emdogain) on the microhardness and chemical composition of human root dentin: an in vitro study. Sci Rep 2022; 12:8874. [PMID: 35614202 PMCID: PMC9133032 DOI: 10.1038/s41598-022-13081-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/11/2022] [Indexed: 11/24/2022] Open
Abstract
The advantage of using an Enamel matrix derivative EMD Emdogain as an intracanal medication could be a manner to strength the tooth structure, improving the physical and chemical properties of dentin. We tested, in vitro, the effect of Emdogain on the surface microhardness and chemical composition of root dentin. Ten human teeth were used to produce dentin specimens originated from the canal walls (n = 30) that remained in contact to Emdogain gel for 90 days. Baseline and 90-days after Emdogain treatment measurements were performed using Fourier Transform Infrared Spectroscopy (ATR/FTIR), Scanning Electron Microscopy/Energy Dispersive Spectroscopy (SEM/EDS) and Knoop indenters. The use of EMD (Emdogain) for 90 days in contact with human root canal dentin specimens did not alter the microhardness and morphology of dentin. The elemental structure of dentin was altered because there was a reduction in carbonate content.
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Affiliation(s)
- Karime Tavares Lima da Silva
- Postgraduate Program of Dentistry, CEUMA University, São Luís, Maranhão, Brazil.,Department of Dentistry, Instituto Florence, São Luís, Maranhão, Brazil
| | | | - Rafael Resende de Miranda
- Department of Operative Dentistry and Dental Materials, School of Dentistry, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Veridiana Resende Novais
- Postgraduate Program of Dentistry, CEUMA University, São Luís, Maranhão, Brazil.,Department of Operative Dentistry and Dental Materials, School of Dentistry, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | | | - Gisele Rodrigues da Silva
- Postgraduate Program of Dentistry, CEUMA University, São Luís, Maranhão, Brazil.,Department of Operative Dentistry and Dental Materials, School of Dentistry, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Jose Bauer
- Dentistry Biomaterials Laboratory (Biomma), School of Dentistry, University Federal of Maranhão (UFMA), São Luis, MA, Brazil
| | - Ceci Nunes Carvalho
- Postgraduate Program of Dentistry, CEUMA University, São Luís, Maranhão, Brazil.
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Enamel Matrix Derivative Enhances the Odontoblastic Differentiation of Dental Pulp Stem Cells via Activating MAPK Signaling Pathways. Stem Cells Int 2022; 2022:2236250. [PMID: 35530415 PMCID: PMC9071913 DOI: 10.1155/2022/2236250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/27/2022] [Accepted: 04/05/2022] [Indexed: 12/03/2022] Open
Abstract
The odontoblastic differentiation of dental pulp stem cells (DPSCs) contributes to pulp-dentin regeneration. Enamel matrix derivative (EMD) is considered to be a critical epithelial signal to induce cell differentiation during odontogenesis and has been widely applied to clinical periodontal tissue regeneration. The purpose of this study was to explore the effect of EMD on DPSCs proliferation and odontoblastic differentiation, as well as the underlying mechanisms. We conducted in vitro and in vivo researches to get a comprehensive understanding of EMD. In vitro phase: cell proliferation was assessed by a cell counting kit-8 (CCK-8) assay; then, alkaline phosphatase (ALP) activity and staining, alizarin red staining, real-time RT-PCR, and western blot analysis were conducted to determine the odontoblastic potential and involvement of MAPK signaling pathways. In vivo phase: after ensuring the biocompatibility of VitroGel 3D-RGD via scanning electron microscopy (SEM), the hydrogel mixture was subcutaneously injected into nude mice followed by histological and immunohistochemical analyses. The results revealed that EMD did not interfere with DPSCs proliferation but promoted the odontoblastic differentiation of DPSCs in vitro and in vivo. Furthermore, blocking the MAPK pathways suppressed the EMD-enhanced differentiation of DPSCs. Finally, VitroGel 3D-RGD could well support the proliferation, differentiation, and regeneration of DPSCs. Overall, this study demonstrates that EMD enhances the odontoblastic differentiation of DPSCs through triggering MAPK signaling pathways. The findings provide a new insight into the mechanism by which EMD affects DPSCs differentiation and proposes EMD as a promising candidate for future stem cell therapy in endodontics.
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SARIALİOĞLU GÜNGÖR A, DÖNMEZ N, KAHYA DS, HERGÜNER SİSO Ş. Impact of a Surface Sealant Application on the Color Stability of a Nano-hybrid Composite Resin. BEZMIALEM SCIENCE 2022. [DOI: 10.14235/bas.galenos.2021.5381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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20
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B K A, R Y, Puranik MP. Remineralizsation of early enamel caries lesions using self-assembling peptides P11-4: Systematic review and meta-analysis. J Oral Biol Craniofac Res 2022; 12:324-331. [DOI: 10.1016/j.jobcr.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/19/2022] [Indexed: 10/18/2022] Open
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21
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Dawasaz AA, Togoo RA, Mahmood Z, Azlina A, Thirumulu Ponnuraj K. Effectiveness of Self-Assembling Peptide (P11-4) in Dental Hard Tissue Conditions: A Comprehensive Review. Polymers (Basel) 2022; 14:792. [PMID: 35215706 PMCID: PMC8879648 DOI: 10.3390/polym14040792] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 12/04/2022] Open
Abstract
The limitations on the use of fluoride therapy in dental caries prevention has necessitated the development of newer preventive agents. This review focusses on the recent and significant studies on P11-4 peptide with an emphasis on different applications in dental hard tissue conditions. The self-assembling peptide P11-4 diffuses into the subsurface lesion assembles into aggregates throughout the lesion, supporting the nucleation of de novo hydroxyapatite nanocrystals, resulting in increased mineral density. P11-4 treated teeth shows more remarkable changes in the lesion area between the first and second weeks. The biomimetic remineralisation facilitated in conjunction with fluoride application is an effective and non-invasive treatment for early carious lesions. Despite, some studies have reported that the P11-4 group had the least amount of remineralised enamel microhardness and a significantly lower mean calcium/phosphate weight percentage ratio than the others. In addition, when compared to a low-viscosity resin, self-assembling peptides could neither inhibit nor mask the lesions significantly. Moreover, when it is combined with other agents, better results can be achieved, allowing more effective biomimetic remineralisation. Other applications discussed include treatment of dental erosion, tooth whitening and dentinal caries. However, the evidence on its true clinical potential in varied dental diseases still remains under-explored, which calls for future cohort studies on its in vivo efficacy.
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Affiliation(s)
- Ali Azhar Dawasaz
- Department of Diagnostic Dental Sciences, College of Dentistry, King Khalid University, Abha 62529, Saudi Arabia;
- School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (Z.M.); (A.A.)
| | - Rafi Ahmad Togoo
- Department of Pediatric Dentistry and Orthodontic Sciences, College of Dentistry, King Khalid University, Abha 62529, Saudi Arabia;
| | - Zuliani Mahmood
- School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (Z.M.); (A.A.)
| | - Ahmad Azlina
- School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (Z.M.); (A.A.)
| | - Kannan Thirumulu Ponnuraj
- School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (Z.M.); (A.A.)
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
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22
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Ahmed O, Sibuyi NRS, Fadaka AO, Madiehe MA, Maboza E, Meyer M, Geerts G. Plant Extract-Synthesized Silver Nanoparticles for Application in Dental Therapy. Pharmaceutics 2022; 14:380. [PMID: 35214112 PMCID: PMC8875651 DOI: 10.3390/pharmaceutics14020380] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/16/2022] [Accepted: 01/29/2022] [Indexed: 12/22/2022] Open
Abstract
Oral diseases are the most common non-communicable diseases in the world, with dental caries and periodontitis causing major health and social problems. These diseases can progress to systematic diseases and cause disfigurement when left untreated. However, treatment of oral diseases is among the most expensive treatments and often focus on restoration of form and function. Caries prevention has traditionally relied on oral hygiene and diet control, among other preventive measures. In this paper, these measures are not disqualified but are brought into a new context through the use of nanotechnology-based materials to improve these conventional therapeutic and preventive measures. Among inorganic nanomaterials, silver nanoparticles (AgNPs) have shown promising outcomes in dental therapy, due to their unique physicochemical properties and enhanced anti-bacterial activities. As such, AgNPs may provide newer strategies for treatment and prevention of dental infections. However, numerous concerns around the chemical synthesis of nanomaterials, which are not limited to cost and use of toxic reducing agents, have been raised. This has inspired the green synthesis route, which uses natural products as reducing agents. The biogenic AgNPs were reported to be biocompatible and environmentally friendly when compared to the chemically-synthesized AgNPs. As such, plant-synthesized AgNPs can be used as antimicrobial, antifouling, and remineralizing agents for management and treatment of dental infections and diseases.
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Affiliation(s)
- Omnia Ahmed
- Department of Restorative Dentistry, University of the Western Cape, Bellville 7535, South Africa;
| | - Nicole Remaliah Samantha Sibuyi
- Department of Science and Innovation (DSI), Mintek Nanotechnology Innovation Centre (NIC) Biolabels Research Node, Department of Biotechnology, University of the Western Cape, Bellville 7535, South Africa; (N.R.S.S.); (A.O.F.); (M.A.M.)
| | - Adewale Oluwaseun Fadaka
- Department of Science and Innovation (DSI), Mintek Nanotechnology Innovation Centre (NIC) Biolabels Research Node, Department of Biotechnology, University of the Western Cape, Bellville 7535, South Africa; (N.R.S.S.); (A.O.F.); (M.A.M.)
| | - Madimabe Abram Madiehe
- Department of Science and Innovation (DSI), Mintek Nanotechnology Innovation Centre (NIC) Biolabels Research Node, Department of Biotechnology, University of the Western Cape, Bellville 7535, South Africa; (N.R.S.S.); (A.O.F.); (M.A.M.)
| | - Ernest Maboza
- Oral and Dental Research Laboratory, University of the Western Cape, Bellville 7535, South Africa;
| | - Mervin Meyer
- Department of Science and Innovation (DSI), Mintek Nanotechnology Innovation Centre (NIC) Biolabels Research Node, Department of Biotechnology, University of the Western Cape, Bellville 7535, South Africa; (N.R.S.S.); (A.O.F.); (M.A.M.)
| | - Greta Geerts
- Department of Restorative Dentistry, University of the Western Cape, Bellville 7535, South Africa;
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Memarpour M, Razmjouei F, Rafiee A, Vossoughi M. Remineralization effects of self-assembling peptide P 11 -4 associated with three materials on early enamel carious lesions: An in vitro study. Microsc Res Tech 2022; 85:630-640. [PMID: 34549853 DOI: 10.1002/jemt.23937] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/28/2021] [Accepted: 09/01/2021] [Indexed: 11/09/2022]
Abstract
The aim of this study was to assess the remineralization of enamel caries lesions using the self-assembling peptide P11 -4 associated with different materials. Artificial early enamel lesions were prepared on 154 primary teeth. The samples were randomly divided into eight groups: (1) control, (2) P11 -4, (3) fluoridate toothpaste (FT), (4) P11 -4 + FT, (5) casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), (6) P11 -4 + CPP-ACP, (7) fluoridate bioactive glass toothpaste (BT), and (8) P11 -4 + BT. The surface enamel microhardness (EMH) and energy-dispersive X-ray spectroscopy (EDS) of the teeth were then measured at the baseline, after demineralization, and after 28 days of remineralization. The enamel surfaces were assessed by field emission scanning electron microscopy (FESEM) and atomic force microscopy (AFM). The data were analyzed with one-way analysis of variance (ANOVA) (p < .05). EMH after demineralization was significantly lower than the baseline value (p < .001). The interventions led to an enhanced percentage of EMH recovery (%REMH), which was higher in Groups 6 and 7. There was no significant difference between Groups 3 and 4. Groups 1 and 2 had the lowest %REMH. The mean calcium/phosphate weight percentage ratio of P11 -4 was significantly lower than the others (p < .001). The FESEM and AFM images revealed mineral deposition on the eroded enamel and reductions in surface roughness in Groups 5 and 7.
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Affiliation(s)
- Mahtab Memarpour
- Oral and Dental Disease Research Center, Department of Pediatric Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faranak Razmjouei
- Oral and Dental Disease Research Center, Department of Pediatric Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azade Rafiee
- Oral and Dental Disease Research Center, Department of Pediatric Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Vossoughi
- Oral and Dental Disease Research Center, Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Özdemir Ş, Taran PK, Mammadlı N, Altınova İS, Gazioğlu I. Remineralization potential of P11-4 and fluoride on secondary carious primary enamel: A quantitative evaluation using microcomputed tomography. Microsc Res Tech 2022; 85:807-812. [PMID: 34981866 DOI: 10.1002/jemt.24052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/16/2021] [Accepted: 12/26/2021] [Indexed: 11/09/2022]
Abstract
The aim of this study was to assess the ability of self-assembling peptide (P11-4) diffusion, assembly, and remineralization to effect artificial secondary caries-like lesions in human primary teeth in vitro. Enamel-dentin blocks obtained from extracted human primary molars were embedded into epoxy resin blocks. Cavities (approximately 1 × 1 × 2 mm) were prepared on the surface using a high-speed diamond bur under constant water cooling and filled with composite restorative material (Filtek Z250; 3 M ESPE). The samples were immersed in demineralizing solution (20 ml) for 96 h to produce secondary caries lesions and divided into two groups according to the testing materials: fluoride varnish (Duraphat; Colgate, UK) and P11-4 (Curodont Repair; Credentis, Switzerland). Except for the control areas, all samples were remineralized for 3-5 min using the remineralizing agents, and then all the sections were placed in a pH-cycling system for 5 days at 35°C. The pH cycling procedure was followed by micro-CT analysis for the qualitative evaluation of surface changes. The Mann-Whitney U test was used to compare two independent groups. In the comparison of more than two dependent groups, Bonferroni smoothed pairwise analyses were used to determine the source of the Kruskal-Wallis H test difference. The results of the study revealed that the remineralization depths of the peptide group were higher than those of the fluoride group (p < .01). There was a statistically significant difference in remineralization effects between the fluoride and peptide groups. P11-4 can be considered as an effective remineralizing agent for secondary caries lesions.
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Affiliation(s)
- Şerife Özdemir
- Department of Pediatric Dentistry, Bezmialem Vakif University Faculty of Dentistry, Istanbul, Turkey
| | - Pınar Kınay Taran
- Department of Pediatric Dentistry, Bezmialem Vakif University Faculty of Dentistry, Istanbul, Turkey
| | - Narmin Mammadlı
- Department of Pediatric Dentistry, Bezmialem Vakif University Faculty of Dentistry, Istanbul, Turkey
| | - İlay Sena Altınova
- Department of Pediatric Dentistry, Bezmialem Vakif University Faculty of Dentistry, Istanbul, Turkey
| | - Işıl Gazioğlu
- Department of Basic Pharmaceutical Sciences, Bezmialem Vakif University Faculty of Pharmacy, Istanbul, Turkey
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Zhang Z, Shi Y, Zheng H, Zhou Z, Wu Z, Shen D, Wang Y, Zhang Y, Wang Z, Fu B. A Hydroxypropyl Methylcellulose Film Loaded with AFCP Nanoparticles for Inhibiting Formation of Enamel White Spot Lesions. Int J Nanomedicine 2021; 16:7623-7637. [PMID: 34815669 PMCID: PMC8605885 DOI: 10.2147/ijn.s335549] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study investigated the effects of mineralizing film consisting of hydroxypropyl methylcellulose (HPMC) and amorphous fluorinated calcium phosphate (AFCP) nanoparticles on enamel white spot lesions (WSLs). Material and Methods The AFCP nanoparticles and mineralizing film were prepared via nanoprecipitation and solvent evaporation, respectively. They were characterized with Fourier transform infrared spectroscopy (FTIR), X-ray powder diffraction (XRD), transmission electron microscopy (TEM), selected area electron diffraction (SAED), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), inductively coupled plasma atomic emission spectrometry (ICP-AES), and fluoride ion selective electrode. Thirty-two human enamel slices (4 mm × 4 mm × 1.5 mm) were highly polished and randomly assigned to four groups: negative control (no treatment); pure HPMC film; mineralizing film; GC Tooth Mousse Plus® (contains 10% CPP-ACP and 0.2% NaF). Subsequently, samples were challenged by a modified pH-cycling and characterized by color measurement, Micro-CT, SEM/EDX, and nanoindentation. Results The mineralizing film could sustain release of Ca, P and F ions over 24 h and maintain AFCP nanoparticles in metastable state over 8~12 h. During 4 weeks of pH cycling, the mineralizing film group exhibited least color change (∆E), mineral loss and lesion depth (120 ± 10 µm) among four groups (p < 0.05). SEM findings revealed that the porosities among enamel crystals increased in negative control and pure HPMC film groups after pH cycling, whereas in mineralizing film group, the original microstructure of enamel was well conserved and mineral deposits were detected between enamel prisms. Mineralizing film group demonstrated a least reduction of nanomechanical properties such as elastic modulus of 77.02 ± 6.84 GPa and hardness of 3.62 ± 0.57 GPa (p < 0.05). Conclusion The mineralizing film might be a promising strategy for prevention and management of WSLs via inhibiting enamel demineralization and promoting enamel remineralization.
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Affiliation(s)
- Zhixin Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Ying Shi
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Haiyan Zheng
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Zihuai Zhou
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Zhifang Wu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Dongni Shen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Yiru Wang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Yizhou Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Zhe Wang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Baiping Fu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
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26
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Effect of Amelogenin Solution in the Microhardness of Remineralized Enamel and Shear Bond Strength of Orthodontic Brackets. Int J Dent 2021; 2021:7025910. [PMID: 34754308 PMCID: PMC8572611 DOI: 10.1155/2021/7025910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/06/2021] [Accepted: 10/16/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives To evaluate the microhardness of tooth enamel remineralized with enamel matrix protein solution as well as the shear bond strength of orthodontic brackets bonded to this surface. Materials and Methods In total, 24 human premolars were selected and divided into 3 experimental groups (n = 8): SE—sound enamel, DE—demineralized enamel, and TE—demineralized enamel treated with amelogenin solution. Samples from DE and TE groups were subjected to pH cycling to induce initial artificial caries lesion. TE group was treated with amelogenin solution. Samples were placed in artificial saliva for 7 days. Knoop microhardness was measured before any intervention (T0), after pH cycling (T1) and after amelogenin solution treatment application (T2). Twenty-four hours after ceramic orthodontic brackets were bonded, samples were subjected to shear test in a universal testing machine. Microhardness and shear measurement distributions were subjected to Kolmogorov–Smirnov normality test, which was followed by parametric tests (α = 0.05): 2-way analysis of variance (factors: enamel condition × treatment) and Tukey posttest for all three groups (SE, DE, and TE) in T0 and T2 for microhardness; analysis of variance and Tukey's test, for shear bond strength test. Results Means recorded for Knoop microhardness in T2, for the SE (366.7 KHN) and TE (342.8 KHN) groups, were significantly higher than those recorded for the DE group (263.5 KHN). The shear bond strength of the SE (15.44 MPa) and TE (14.84 MPa) groups statistically differed from that of the DE group (11.95 MPa). Conclusion In vitro demineralized enamel treatment with amelogenin solution was capable of taking samples' hardness back to levels similar to those observed for sound enamel. The shear bond strength on the enamel subjected to this treatment was similar to that observed for healthy enamel and higher than that observed for demineralized enamel.
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27
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Surekha GL, Vinay C, Baliga S, Uloopi KS, RojaRamya KS, Penmatsa C. Effect of preconditioning the fractured coronal fragments with remineralizing agents on fracture resistance of re-attached teeth. J Indian Soc Pedod Prev Dent 2021; 39:384-387. [PMID: 35102962 DOI: 10.4103/jisppd.jisppd_376_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Fragment re-attachment has been considered as one of the treatment modalities for the management of fractured anterior teeth. Hydration of fractured fragments aids in inhibiting the loss of ions and maintains vitality and esthetics. AIM The study aimed to evaluate the effect of preconditioning the fractured fragments with remineralizing agents on fracture resistance of re-attached teeth. SETTINGS AND DESIGN This was an in vitro study. MATERIALS AND METHODS Sixty freshly extracted noncarious human permanent maxillary central and lateral incisors were randomly allocated into three Groups of 20 each: Group 1: 2% sodium fluoride (2%NaF), Group 2: casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and Group 3: self-assembling peptide P11-4 (SAP). These were further divided into two subgroups of 10 teeth each, based on contact time with remineralizing agents, i.e., 30 min and 2 h. Fractured fragments were treated with remineralizing agents for a specified contact time and then re-attached with flowable composite resin. Force required to fracture the re-attached tooth was recorded in Newtons using universal testing machine. STATISTICAL ANALYSIS Unpaired t-test, one-way analysis of variance test, and post hoc Tukey test were used for the statistical analysis. RESULTS A higher fracture resistance was noticed in fragments treated with 2% NaF (30 min- 215.6 N, 2 h- 188.5 N) compared to CPP-ACP (30 min- 141.3 N, 2 h- 111.1 N) and SAP (30 min- 134.8 N, 2 h- 149.5 N). At 30 min interval, it was found to be more in 2% NaF and CPP-ACP groups compared to 2 h. However, it increased with time in the SAP group. A statistically significant difference was found between the groups at both time intervals (P = 0.007 and 0.017). CONCLUSION Preconditioning of fractured coronal fragments with 2% NaF showed higher fracture resistance compared to CPP-ACP and self-assembling peptide P11-4. Samples treated with SAP P11-4 exhibited good fracture resistance at 2 h contact time.
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Affiliation(s)
- Gadisetti Lakshmi Surekha
- Department of Pedodontics and Preventive Dentistry, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - C Vinay
- Department of Pedodontics and Preventive Dentistry, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | | | - K S Uloopi
- Department of Pedodontics and Preventive Dentistry, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - Kakarla Sri RojaRamya
- Department of Pedodontics and Preventive Dentistry, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - Chaitanya Penmatsa
- Department of Pedodontics and Preventive Dentistry, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
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Genovez-Júnior G, Paloco EAC, Berger SB, González AHM, Lopes MB, Amânicio DC, Guiraldo RD. Effect of Protein-Based Treatment on Chemical Composition, Hardness and Bond Strength of Remineralized Enamel. Braz Dent J 2021; 32:85-90. [PMID: 33914007 DOI: 10.1590/0103-6440202103438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/25/2020] [Indexed: 11/21/2022] Open
Abstract
This study evaluated the chemical composition and microhardness of human enamel treated with an Enamel Matrix Derivative (EMD) solution, and the bond strength between composite resin and this enamel. Thirty human enamel samples were randomly divided into three groups: Untouched Enamel (UE), Demineralized Enamel (DE) and Demineralized Enamel Treated with EMD (ET). DE and ET groups were subjected to acid challenge and ET treated with EMD (EMD was directly applied over conditioned enamel and left for 15 min). Samples from each group (n=4) had chemical composition assessed through to attenuated total reflectance Fourier transform infrared (ATR-FTIR). Knoop microhardness of enamel samples from each group (n=10) was measured. For the microshear bond strength, the samples were etched for 30 s, and the adhesive was applied and cured for 10 s. Two matrixes were placed on the samples, filled with Filtek Z350 XT composite and cured for 20 s, each. The matrix was removed, and the microshear bond strength of each group (n=10) was tested. Data were subjected to Kruskal-Wallis test (for microhardness), to analysis of variance and to Tukey's test (for microshear bond strength); (α=0.05). FTIR results have shown phosphate (hydroxyapatite indicator) in 900-1200 cm-1 bands in the UE and ET groups, which were different from the DE group. Microhardness and microshear analyses recorded higher statistical values for the UE and ET groups than for DE. EMD application to demineralized enamel seems to have remineralized the enamel; thus, the microhardness and bond strength was similar between UE and ET groups.
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Affiliation(s)
- Guilherme Genovez-Júnior
- Department of Restorative Dentistry, School of Dentistry, UNOPAR - Universidade Norte do Paraná, Londrina, PR, Brazil
| | | | - Sandrine Bittencourt Berger
- Department of Restorative Dentistry, School of Dentistry, UNOPAR - Universidade Norte do Paraná, Londrina, PR, Brazil
| | | | - Murilo Baena Lopes
- Department of Restorative Dentistry, School of Dentistry, UNOPAR - Universidade Norte do Paraná, Londrina, PR, Brazil
| | | | - Ricardo Danil Guiraldo
- Department of Restorative Dentistry, School of Dentistry, UNOPAR - Universidade Norte do Paraná, Londrina, PR, Brazil
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29
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Wierichs RJ, Carvalho TS, Wolf TG. Efficacy of a self-assembling peptide to remineralize initial caries lesions - A systematic review and meta-analysis. J Dent 2021; 109:103652. [PMID: 33798639 DOI: 10.1016/j.jdent.2021.103652] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION/OBJECTIVES The present review systematically analyzed clinical studies investigating the efficacy of self-assembling peptides (SAP) to reduce initiation of or to remineralize initial caries lesions. DATA Prospective controlled (non-)randomized clinical trials investigating the efficacy of a self-assembling peptide compared to any other (placebo) treatment or untreated/standard control. Outcomes were visual analog scale (VAS), laser fluorescence, ICDAS score or morphometric measurements. SOURCES Three electronic databases (Central, PubMed, Ovid EMBASE) were screened. No language or time restrictions were applied.. Risk of Bias and level of evidence was graded using Risk of Bias 2.0 tool and Grade Profiler 3.6. STUDY SELECTION/RESULTS Seven studies with 508 teeth being affected in 294 patients were included. All studies were randomized controlled trials (RCT), five with a split-mouth and two with a parallel-arm design. Meta-analysis could be performed for SAP (plus fluoride varnish (FV)) vs. no treatment (plus FV) (control treatment). Depending on the outcome after up to 12 months SAP showed a significantly higher optical improvement than the control treatment (laser fluorescence: Standardized Mean Difference (SMD)[95 %CI] = -0.87[-1.39,-0.34; VAS: Mean Difference (MD)[95 %CI] = -35.38[-43.13,-27.64]) or no significant difference could be observed (ICDAS/activity score; Relative Risk (RR)[95 %CI] = 0.6[0.21,1.74]; morphometric measurements: SMD[95 %CI] = -1.95[-4.54,0.65]). Level of evidence was very low for all 4 outcomes. Furthermore, six studies showed a high risk of bias and six studies were (partially) funded by the manufactures of the tested products. CONCLUSION Based on a low number of clinical trials with relatively short follow up-periods and high risks of bias, self-assembling peptides may be a viable option to remineralize enamel caries. CLINICAL SIGNIFICANCE Self-assembling peptides may be a viable option to remineralize enamel caries. However, results should be interpretated with caution due the low number of clinical trials, the short follow-up periods and the limiting grade of evidence.
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Affiliation(s)
- R J Wierichs
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland.
| | - T S Carvalho
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
| | - T G Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
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Mohamed RN, Basha S, Al-Thomali Y, Saleh Alshamrani A, Salem Alzahrani F, Tawfik Enan E. Self-assembling peptide P 11-4 in remineralization of enamel caries - a systematic review of in-vitro studies. Acta Odontol Scand 2021; 79:139-146. [PMID: 33026894 DOI: 10.1080/00016357.2020.1825799] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The present systematic review was conducted to investigate the effect of the self-assembling peptide (SAP) - P11-4 in the remineralization of enamel caries. MATERIAL AND METHODS The systematic search for studies was conducted through CINAHL, EMBASE, MEDLINE, Scopus, PsychINFO, and various key journals. This review was conducted in adherence to PRISMA standards and was registered in PROSPERO with registration number CRD42019110156. The methodological quality of the studies was graded through Cochrane's tool of risk of bias in non-randomized studies - of interventions (ROBINS-I). RESULTS In total, 91 studies were identified for screening, and 12 studies were eligible. Ten studies showed effective enamel remineralization with P11-4 compared to controls. One study showed a combination of P11-4 with fluoride varnish or Casein Phosphopeptide-Amorphous Calcium Phosphate Fluoride (CPP-ACPF) leads to significantly higher remineralization compared to P11-4 alone. Quality assessment of study showed 6 (50%) studies as medium risk of bias and 6 (50%) studies as low risk of bias. CONCLUSION To conclude, the present study results showed SAP- P11-4 is effective in the remineralization of enamel caries.
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Affiliation(s)
- Roshan Noor Mohamed
- Department of Pedodontics, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Sakeenabi Basha
- Department of Preventive and Community Dentistry, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Yousef Al-Thomali
- Department of Orthodontics, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Ammar Saleh Alshamrani
- Department of Pedodontics, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
- Department of Restorative Dentistry, Taif University, Taif, Saudi Arabia
| | - Fatma Salem Alzahrani
- Department of Pedodontics, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Enas Tawfik Enan
- Department of Dental Biomaterials, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
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31
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Lena Sezici Y, Yetkiner E, Aykut Yetkiner A, Eden E, Attin R. Comparative evaluation of fluoride varnishes, self-assembling peptide-based remineralization agent, and enamel matrix protein derivative on artificial enamel remineralization in vitro. Prog Orthod 2021; 22:4. [PMID: 33491110 PMCID: PMC7829296 DOI: 10.1186/s40510-020-00345-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022] Open
Abstract
Background One of the most unfavorable side effects of fixed orthodontic treatment is white spot lesions (WSLs). Although the most important approach is prevention of WSLs, it is also essential to evaluate the efficacy of the remineralization agents. However, there is no concurrence in the literature with respect to the remineralization process of these agents. The objective of the present study was to evaluate the effects of different fluoride varnishes, enamel matrix protein, and self-assembling peptide derivatives with varying chemical compositions on remineralization of artificially created WSLs in vitro using quantitative light-induced fluorescence (QLF). Methods Artificial WSLs were created on bovine enamel samples using acidic buffer solution (pH 5, 10 days). Specimens were randomly allocated to six groups (n = 10/group): (1) Emdogain (Straumann, Basel, Switzerland), (2) Curodont Repair (Credentis AG, Switzerland), (3) Duraphat (Colgate-Palmolive, New York, NY), (4) Clinpro XT (3 M ESPE, Pymble, New South Wales, Australia), (5) Enamel Pro Varnish (Premier Dental Products, PA, USA), and (6) control (untreated). The agents were applied to the WSLs according to the manufacturers’ instructions. Fluorescence loss (ΔF), lesion area (area), and impact (ΔQ) values of enamel surfaces were quantified by QLF-D BiluminatorTM (Inspektor-Pro, Amsterdam, The Netherlands) at baseline and after 7, 14, and 21 days of application of the respective materials. Results ΔF value presented a significantly decreasing trend throughout the 21 days for all groups except the Duraphat and Enamel Pro varnishes. The changes between 14th and 21st days of the Clinpro XT varnish application were significantly higher than Emdogain, Curodont, and Enamel Pro. The Curodont group showed higher lesion area changes between the first and second week in comparison to the Emdogain, Clinpro XT, and Enamel Pro groups, whereas Clinpro XT assured the highest reduction from the second to the third week of the observation period. Conclusions The fluorescence loss was significantly reduced with enamel matrix protein, self-assembling peptide, and light-curable fluoride varnishes in the analysis for 21 days. Curodont and Clinpro XT were effective in diminishing the fluorescence loss and lesion area compared to the Duraphat, Enamel Pro fluoride varnishes, and Emdogain in different time points.
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Affiliation(s)
| | - Enver Yetkiner
- Department of Orthodontics, Faculty of Dentistry, Ege University, Izmir, Turkey
| | - Arzu Aykut Yetkiner
- Department of Pedodontics, Faculty of Dentistry, Ege University, Izmir, Turkey.
| | - Ece Eden
- Department of Pedodontics, Faculty of Dentistry, Ege University, Izmir, Turkey
| | - Rengin Attin
- Clinic for Orthodontics and Pediatric Dentistry, University of Zurich, Zurich, Switzerland
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Adhesion of Streptococcus mutans on remineralized enamel surface induced by poly(amido amine) dendrimers. Colloids Surf B Biointerfaces 2021; 197:111409. [DOI: 10.1016/j.colsurfb.2020.111409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 11/21/2022]
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Sedlakova Kondelova P, Mannaa A, Bommer C, Abdelaziz M, Daeniker L, di Bella E, Krejci I. Efficacy of P 11-4 for the treatment of initial buccal caries: a randomized clinical trial. Sci Rep 2020; 10:20211. [PMID: 33214593 PMCID: PMC7678830 DOI: 10.1038/s41598-020-77057-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/09/2020] [Indexed: 11/09/2022] Open
Abstract
To investigate the safety and efficacy of Self-Assembling Peptide P11-4 (SAP P11-4) compared to placebo or fluoride varnish (FV), a randomized, controlled, blinded, split-mouth study with sequential design was conducted. Subjects presenting two teeth with White-Spot-Lesions (WSLs) were included and teeth were randomly assigned to test or control. Control received placebo at baseline (D0) and test SAP P11-4, all received FV at Day 90 (D90). Standardized photographs were taken at each visit, and WSL size changes were morphometrically assessed. Hierarchical Linear Modelling, considering paired and sequential design, was used to test four hypotheses. SAP P11-4 lesions (test, D90–D0) showed significant WSL size reduction compared to placebo (control, D90–D0; p = 0.008) or FV (control, D180–D90; p = 0.001). Combination of SAP P11-4 and delayed FV after 90 days (test, D180–D0), showed a significant difference compared to FV alone (control D270–D90; p = 0.003). No significant difference on FV efficacy was found when SAP P11-4 was applied 3 months before FV (test D270–D90; control D270–D90, p = 0.70). SAP P11-4 treatment resulted in superior caries regression compared to either placebo or FV, and FV efficacy seems not to be affected by SAP P11-4. SAP P11-4 was found to be a safe and effective WSL treatment.
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Affiliation(s)
| | - Alaa Mannaa
- Division of Operative Dentistry, Department of Restorative Dentistry, Faculty of Dentistry, King Abdulaziz University, P.O. Box 80209, Jeddah, 21589, Kingdom of Saudi Arabia
| | | | - Marwa Abdelaziz
- University of Geneva, University Dental Clinics CUMD, rue Michel-Servet 1, 1211, Geneva 4, Switzerland
| | - Laurent Daeniker
- University of Geneva, University Dental Clinics CUMD, rue Michel-Servet 1, 1211, Geneva 4, Switzerland
| | - Enrico di Bella
- Department of Political Sciences, University of Genova, P.le E. Brignole 3a, 16126, Genova, Italy
| | - Ivo Krejci
- University of Geneva, University Dental Clinics CUMD, rue Michel-Servet 1, 1211, Geneva 4, Switzerland.
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El-Sayed B, Davies RPW, El-Zehery RR, Ibrahim FM, Grawish ME, Kirkham J, El-Gendy R. An in-vivo Intraoral Defect Model for Assessing the Use of P 11-4 Self-Assembling Peptide in Periodontal Regeneration. Front Bioeng Biotechnol 2020; 8:559494. [PMID: 33117779 PMCID: PMC7550851 DOI: 10.3389/fbioe.2020.559494] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/31/2020] [Indexed: 12/02/2022] Open
Abstract
Periodontal disease is one of the most common diseases worldwide. It has a significant impact on oral health and subsequently the individual’s quality of life. However, optimal regeneration of periodontal tissues, using current treatments, has yet to be achieved. Peptide self-assembly has provided a step-change in nanobiotechnology and regenerative medicine fields. Our aim was to investigate the effects of a self-assembling peptide (SAP; P11-4) on periodontal regeneration in a preclinical model. Twenty-six bilateral maxillary critical-sized periodontal defects were created surgically in 13 rats. Defects on one side of the mouth were filled with P11-4 hydrogel; the contra-lateral defect was untreated (control). Rats were sacrificed immediately post-surgery (time 0) and after 2 and 4 weeks. Retrieved maxillae were processed for histological, immunohistochemical, and histomorphometric assessments. The results of histological analysis showed greater organization of periodontal fibers in defects treated with P11-4, at both time points, when compared to untreated defects. Histomorphometry showed that treated defects had both a significant increase in functional periodontal ligament length and a reduction in epithelial down growth after 4 weeks. At 2 weeks, treated defects showed a significant increase in expression of osteocalcin and osteoprotegerin as judged by immunohistochemistry. Also, a significantly higher osteoprotegerin/RANKL ratio was shown in treated defects. In conclusion, the results demonstrated enhanced regeneration of periodontal tissues when SAP P11-4 was used to fill periodontal defects in rats. The findings of this study suggest that SAP P11-4 is a promising novel candidate for periodontal regenerative therapy. Further investigations are required for optimization before clinical use.
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Affiliation(s)
- Basmah El-Sayed
- Division of Oral Biology, School of Dentistry, University of Leeds, Leeds, United Kingdom.,Department of Oral Biology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | | | - Rehab R El-Zehery
- Department of Oral Biology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Fatma Mohamed Ibrahim
- Department of Oral Biology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Mohammed E Grawish
- Department of Oral Biology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.,Department of Oral Biology, Faculty of Oral and Dental Medicine, Delta University for Science and Technology, Mansoura, Egypt
| | - Jennifer Kirkham
- Division of Oral Biology, School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - Reem El-Gendy
- Division of Oral Biology, School of Dentistry, University of Leeds, Leeds, United Kingdom.,Department of Oral Pathology, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt
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Tulumbaci F, Gungormus M. In vitro remineralization of primary teeth with a mineralization-promoting peptide containing dental varnish. J Appl Oral Sci 2020; 28:e20200259. [PMID: 32901695 PMCID: PMC7480669 DOI: 10.1590/1678-7757-2020-0259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/30/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022] Open
Abstract
Mineralization-promoting peptides are attractive candidates for new remineralization systems. In previous studies, peptides have been applied as aqueous solutions, which is not a clinically relevant form. OBJECTIVE This study aims to investigate the efficiency of a mineralization-promoting peptide, applied in varnish, on remineralizing artificial caries on primary teeth. METHODOLOGY 55 primary molars were collected. Specimens were immersed in a demineralizing solution for 7 days and then, divided into 7 groups: Baseline: No-remineralization, Placebo: Blank colophony, F: Colophony 5% fluoride, P: Colophony 10% peptide, P+F: Colophony 5% fluoride and 10% peptide, Embrace: Embrace™ varnish, Durashield: Durashield™ varnish. A mixture of 35% w/v colophony varnishes were prepared in ethanol and applied accordingly. Specimens were immersed in a remineralization solution for 4 weeks and it was evaluated using PLM and SEM. Lesion depth reduction was examined by one-way ANOVA. RESULTS There was no significant difference in mean lesion depths between baseline (147.04 ± 10.18 μm) and placebo groups (139.73 ± 14.92 μm), between F (120.95 ± 12.23 μm) and Durashield (113.47 ± 14.36 μm) groups and between P (81.79 ± 23.15 μm) and Embrace (90.26 ± 17.72 μm) groups. Lesion depth for the P+F group (66.95±10.59 μm) was significantly higher compared to all other groups. All groups contained samples with subsurface demineralized regions. Number of subsurface demineralized regions were higher in fluoride-containing groups. CONCLUSIONS We conclude that the mineralization-promoting peptide (MPP3) is effective in this in vitro study and the peptide shows benefits over fluoride as it yields less subsurface demineralized regions.
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Affiliation(s)
- Fatih Tulumbaci
- Ankara Yildirim Beyazit University, School of Dentistry, Department of Pediatric Dentistry, Ankara, Turkey
| | - Mustafa Gungormus
- Ankara Yildirim Beyazit University, School of Dentistry, Department of Basic Sciences, Ankara, Turkey
- Ankara Yildirim Beyazit University, School of Engineering and Natural Sciences, Biomedical Engineering, Ankara, Turkey
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Amaechi BT, AbdulAzees PA, Okoye LO, Meyer F, Enax J. Comparison of hydroxyapatite and fluoride oral care gels for remineralization of initial caries: a pH-cycling study. BDJ Open 2020; 6:9. [PMID: 32714565 PMCID: PMC7376056 DOI: 10.1038/s41405-020-0037-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/01/2020] [Accepted: 06/07/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The present in vitro study investigated if simulated daily use of hydroxyapatite-based gel (15% HAP) remineralizes early caries lesions as effective as weekly use of high fluoride (12,500 ppm) concentration gel, comparing them with artificial saliva alone. MATERIALS AND METHODS Three tooth blocks were produced from each of 20 bovine teeth. Caries-like lesion was created on each block by 4-day demineralization in acidified gel. The blocks were randomized into three remineralization groups (20 blocks/group); Hydroxyapatite-based gel (Karex gelée, 15% HAP, fluoride-free), fluoride-based gel (Elmex gelée, 12,500 ppm F-), and artificial saliva (AS). Remineralization was conducted using pH-cycling model for 28 days with storage in AS. The pH cycling model consisted of 2 h demineralization once daily for all groups, and 3 min HAP gel application once daily, 3 min fluoride gel application once weekly, or remain in AS only respectively. Baseline and post-test mineral loss were quantified using microradiography. RESULTS Paired t-tests (baseline vs. post-Test) indicated significant (p < 0.0001) remineralization in all groups. When compared against each other using Games-Howell's multiple comparison test, no significant difference in remineralization was observed between the two gels, but both gels exhibited significantly (p < 0.001) higher percentage mineral gain (HAP:39 ± 7%; fluoride:41 ± 11%) than AS alone (6 ± 2%). CONCLUSION Hydroxyapatite-based gel (15% HAP) was as effective as fluoride-based gel (12,500 ppm F-) in remineralizing initial caries lesion.
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Affiliation(s)
- Bennett T. Amaechi
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 USA
| | - Parveez Ahamed AbdulAzees
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 USA
| | - Linda O. Okoye
- Department of Restorative Dentistry, Faculty of Dentistry, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Frederic Meyer
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611 Bielefeld, Germany
| | - Joachim Enax
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611 Bielefeld, Germany
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Welk A, Ratzmann A, Reich M, Krey KF, Schwahn C. Effect of self-assembling peptide P 11-4 on orthodontic treatment-induced carious lesions. Sci Rep 2020; 10:6819. [PMID: 32321955 PMCID: PMC7176635 DOI: 10.1038/s41598-020-63633-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/31/2020] [Indexed: 02/07/2023] Open
Abstract
This study aimed to evaluate the effect of self-assembling peptide P11-4 (SAP) in the therapy of initial smooth surface caries (white spot lesions, WSL) following orthodontic multibracket treatment. Twenty-three patients (13f/10m; average age 15.4 years) with at least two teeth with WSL were recruited for the randomised controlled clinical trial with split-mouth design. In opposite to the control teeth, the test teeth were treated with SAP on Day 0. The primary endpoint was the impedance measurement of WSL using customised tray to ensure reproducibility of the measurement location. The secondary endpoint was the morphometric measurement of WSL using a semi-automated approach to determine the WSL size in mm2. Treatment effects were adjusted for site-specific baseline values using mixed models adapted from the cross-over design. Test WSL showed a mean baseline impedance value of 46.7, which decreased to 21.1, 18.4, and 19.7 after 45, 90, and 180 days, respectively. Control WSL showed a mean baseline value of 42.0, which decreased to 35.0, 29.5, and 33.7, respectively. The overall treatment contrast was -13.7 (95% CI: -19.6 - -7.7; p < 0.001). For the secondary endpoint, the test WSL size decreased from 8.8 at baseline to 6.5 after 180 days. The control WSL decreased from 6.8 to 5.7, respectively. The related treatment contrast was -1.0 in favour of test WSL (95% CI: -1.6 - -0.5; p = 0.004). The treatment of initial carious lesions with self-assembling peptide P11-4 leads to superior remineralisation of the subsurface lesions compared with the control teeth.
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Affiliation(s)
- A Welk
- Dental school of the University Medicine Greifswald, Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, Greifswald, Germany.
| | - A Ratzmann
- Dental school of the University Medicine Greifswald, Department of Orthodontics, Greifswald, Germany
| | - M Reich
- Dental school of the University Medicine Greifswald, Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, Greifswald, Germany
| | - K F Krey
- Dental school of the University Medicine Greifswald, Department of Orthodontics, Greifswald, Germany
| | - Ch Schwahn
- Dental school of the University Medicine Greifswald, Department of Prosthodontics, Greifswald, Germany
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Tomaz PLS, Sousa LAD, Aguiar KFD, Oliveira TDS, Matochek MHM, Polassi MR, D'Alpino PHP. Effects of 1450-ppm Fluoride-containing Toothpastes Associated with Boosters on the Enamel Remineralization and Surface Roughness after Cariogenic Challenge. Eur J Dent 2020; 14:161-170. [PMID: 32168543 PMCID: PMC7069749 DOI: 10.1055/s-0040-1705072] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This in vitro study investigated the remineralization potential of 1450 ppm, fluoride-containing toothpastes containing different active remineralization agents after cariogenic challenge with pH cycling. The enamel surface roughness after brushing and the chemical and physical characteristics of the toothpastes tested were also analyzed. MATERIALS AND METHODS Fifty-six bovine enamel blocks were obtained (4 × 4 × 6 mm) and divided into three thirds: intact (untreated), demineralized (artificial caries lesion), and treated (caries lesion, pH cycling, and brushing with dentifrices). Seven commercially available fluoride toothpastes (1450 ppm F): three with anti-erosion claims (Candida Professional [CPP], Colgate Total 12 Daily Repair [CDR], Regenerate Enamel Science [RES]); three with desensitizing claims (Bianco Pro Clinical [BPP], Elmex Sensitive [ESS], and Regenerador Diário DentalClean [RDC]); and one standard regular-fluoride toothpaste Colgate Total 12 (CTT) were selected. During pH cycling (demineralization 6 h/remineralization 18 h) for 7 days, the treated third was brushed with the different dentifrices for 10 minutes in a brushing machine before immersion in a remineralizing solution. The Knoop hardness (25 g, 10 second of the surface, and longitudinal section were then evaluated at eight depths (10 to 330 μm). Mean and percentage of surface hardness recovery (% SHR) were calculated. Surface enamel roughness (Ra) was also evaluated. The pH, %weight of particles, zeta potential, and polydispersity index of toothpaste slurries were also evaluated. STATISTICAL ANALYSIS Data were statistically analyzed (ANOVA/Tukey, 5%). RESULTS The %SHR of CPP was significantly lower than the others (p < 0.05). The enamel subsurface was more effectively remineralized when treated with BPP, ESS, and RDC. The surface roughness was higher when the demineralized third was treated with CTT, RDC, and RES and after the cariogenic challenge (p < 0.05). For some of the products tested, there was no relationship between surface remineralization and subsurface remineralization. Although toothpastes CPP and RDC present the lowest %SHR means, both products effectively remineralize within the subsurface carious lesion. Regression analysis demonstrated no strong correlations of the enamel surface roughness with the chemical and physical parameters. CONCLUSIONS Most but not all the fluoride toothpastes were able to remineralize the enamel surface. No specific chemical or physical parameter alone correlated with the surface roughness.
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Affiliation(s)
- Pedro Luiz Santos Tomaz
- Biotechnology and Innovation in Health Program, Universidade Anhanguera de São Paulo (UNIAN-SP), São Paulo, São Paulo, Brazil
| | - Letícia Almeida de Sousa
- Biotechnology and Innovation in Health Program, Universidade Anhanguera de São Paulo (UNIAN-SP), São Paulo, São Paulo, Brazil
| | - Kayanne Freire de Aguiar
- Biotechnology and Innovation in Health Program, Universidade Anhanguera de São Paulo (UNIAN-SP), São Paulo, São Paulo, Brazil
| | - Thales de Sá Oliveira
- Biotechnology and Innovation in Health Program, Universidade Anhanguera de São Paulo (UNIAN-SP), São Paulo, São Paulo, Brazil
| | - Marcelo Henrick Maia Matochek
- Biotechnology and Innovation in Health Program, Universidade Anhanguera de São Paulo (UNIAN-SP), São Paulo, São Paulo, Brazil
| | - Mackeler Ramos Polassi
- Biotechnology and Innovation in Health Program, Universidade Anhanguera de São Paulo (UNIAN-SP), São Paulo, São Paulo, Brazil
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Doberdoli D, Bommer C, Begzati A, Haliti F, Heinzel-Gutenbrunner M, Juric H. Randomized Clinical Trial investigating Self-Assembling Peptide P 11-4 for Treatment of Early Occlusal Caries. Sci Rep 2020; 10:4195. [PMID: 32144336 PMCID: PMC7060217 DOI: 10.1038/s41598-020-60815-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/14/2020] [Indexed: 02/04/2023] Open
Abstract
Non-invasive caries treatment is a major focus in modern dentistry. The present study was designed to evaluate the effectiveness of monomeric self-assembling peptide P11-4 (SAP P11-4) in combination with fluoride varnish or polymeric self-assembling peptide matrix (SAPM) in treatment of non-cavitated occlusal caries. Ninety children and adolescents were included in this randomized, gold-standard-controlled clinical trial. Test Group 1 received SAP P11-4 and twice fluoride varnish at baseline and Day 180, Test Group 2 received SAP P11-4 on baseline and twice weekly SAPM (home-application), and Control Group received fluoride varnish on baseline and Day 180. Caries progression was measured by laser fluorescence, Nyvad Caries Activity, ICDAS-II-codes, and investigator assessments. Laser fluorescence changes demonstrated superior results for Test Group 1 and 2, as values decreased compared to an increase for the Control Group (p < 0.0005). ICDAS-II codes at Day 360 showed partial regression for Test Group 1 (6.7%) and Test Group 2 (20.0%) and partial progression for Control Group (23.3%) (p < 0.01). Nyvad Caries Activity yielded superior caries inactivation for Test Groups, compared to Control Group (p = 0.002). This trial showed that SAP P11-4, applied either in combination with fluoride varnish or twice weekly SAPM, was a superior treatment for early caries compared to fluoride varnish alone.
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Affiliation(s)
- Dafina Doberdoli
- Department of Pediatric Dentistry and Prevention, University Dentistry Clinical Center of Kosovo, Rrethi I spitalit p.n, Pristina, 10000, Kosovo. .,School of Dental Medicine - Department of Pediatric Dentistry and Prevntion, University of Zagreb, Gundulićeva 5, Zagreb, 10000, Croatia.
| | | | - Agim Begzati
- Department of Pediatric Dentistry and Prevention, University Dentistry Clinical Center of Kosovo, Rrethi I spitalit p.n, Pristina, 10000, Kosovo
| | - Fehim Haliti
- Department of Pediatric Dentistry and Prevention, University Dentistry Clinical Center of Kosovo, Rrethi I spitalit p.n, Pristina, 10000, Kosovo
| | | | - Hrvoje Juric
- School of Dental Medicine - Department of Pediatric Dentistry and Prevntion, University of Zagreb, Gundulićeva 5, Zagreb, 10000, Croatia
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Kamal D, Hassanein H, Elkassas D, Hamza H. Complementary remineralizing effect of self-assembling peptide (P11-4) with CPP-ACPF or fluoride: An in vitro study. J Clin Exp Dent 2020; 12:e161-e168. [PMID: 32071698 PMCID: PMC7018478 DOI: 10.4317/jced.56295] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/08/2019] [Indexed: 11/21/2022] Open
Abstract
Background Self-assembling peptide has been recently introduced to promote hard tissue regeneration for treating early non-cavitated carious lesions. This study investigates the efficacy of biomimetic self-assembling peptide (P11-4) on enamel remineralization combined with CPP-ACPF or fluoride.
Material and Methods Artificial enamel lesions were created on buccal surface of 60 specimens and were randomly assigned to six groups according to the remineralizing agent: G1-(Control, artificial saliva), G2-(Fluoride varnish), G3-(CPP-ACPF varnish), G4-(Self-assembling peptide), G5-(Self-assembling peptide+fluoride varnish), G6-(Self-assembling peptide+CPP-ACPF varnish). All products were applied according to manufacturer’s instructions and specimens were stored in a daily renewed artificial saliva. Surface microhardness (SMH) and scanning electron microscope (SEM) were assessed at baseline, after demineralization, 1 week and 4 weeks storage. SMH values were analyzed using ANOVA and Tukey’s post-hoc test.
Results The highest statistically significant SMH values were found in G6 followed by G5, G4, G2 and G3 while the lowest values were found in G1. No statistically significant difference was found between G5 and G6. Also, no statistically significant difference was found between G2 and G3. SEM showed that G4, G5, G6 resulted in more pronounced remineralization, reversing the demineralized enamel fish scale pattern compared to G2 and G3 after 1 week and 4 week remineralization.
Conclusions Complementary effect was obtained after combining self-assembling peptide with CPP-ACPF or fluoride showing the highest remineralizing potential early after 1 week and even after 4 weeks compared to when each agent used alone. Added benefits can be obtained through combining self-assembling peptide with other remineralzing agents allowing faster and enhanced regeneration of non-cavitated caries lesions. Key words:Enamel regeneration, biomimetic remineralization, self-assembling peptide, CPP-ACPF, fluoride.
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Affiliation(s)
- Dina Kamal
- Conservative Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | | | - Dina Elkassas
- Operative Dentistry Department, Faculty of Oral and Dental Medicine, Misr International University, Cairo, Egypt
| | - Heba Hamza
- Conservative Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
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Amaechi BT, AbdulAzees PA, Alshareif DO, Shehata MA, Lima PPDCS, Abdollahi A, Kalkhorani PS, Evans V. Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children. BDJ Open 2019; 5:18. [PMID: 31839988 PMCID: PMC6901576 DOI: 10.1038/s41405-019-0026-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/12/2019] [Accepted: 10/21/2019] [Indexed: 12/18/2022] Open
Abstract
Objective This in situ study compared the effectiveness of two toothpastes containing hydroxyapatite or 500 ppm fluoride in promoting remineralization and inhibiting caries development. Materials and methods Two enamel blocks (human primary teeth), one sound and one with artificially-produced caries lesion, were exposed to toothpaste containing either 10% hydroxyapatite or 500 ppm F− (amine fluoride) via intra-oral appliance worn by 30 adults in two-arm double blind randomized crossover study lasting 14 days per arm (ClinicalTrials.gov: NCT03681340). Baseline and post-test mineral loss and lesion depth (LD) were quantified using microradiography. One-sided t-test of one group mean was used for intragroup comparison (baseline vs. post-test), while two-sided t-test of two independent means was used to compare the two toothpaste groups. Results Pairwise comparison (baseline vs. test) indicated significant (p < 0.0001) remineralization and LD reduction by either toothpaste; however, when compared against each other, there was no statistically significant difference in remineralization or LD reduction between the two toothpastes. No demineralization could be observed in sound enamel blocks exposed to either toothpaste. While F− induced lesion surface lamination, HAP produced a more homogenous lesion remineralization. Conclusions 10% hydroxyapatite achieved comparable efficacy with 500 ppm F− in remineralizing initial caries and preventing demineralization. Thus the HAP toothpaste is confirmed to be equal to the fluoride toothpaste in this study.
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Affiliation(s)
- Bennett T Amaechi
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 USA
| | - Parveez Ahamed AbdulAzees
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 USA
| | - Dina Ossama Alshareif
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 USA
| | - Marina Adel Shehata
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 USA
| | | | - Azadeh Abdollahi
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 USA
| | - Parisa Samadi Kalkhorani
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 USA
| | - Veronica Evans
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 USA
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Remineralization of Artificial Dentin Caries Using Dentin and Enamel Matrix Proteins. MATERIALS 2019; 12:ma12132116. [PMID: 31266157 PMCID: PMC6651374 DOI: 10.3390/ma12132116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/26/2019] [Accepted: 06/29/2019] [Indexed: 01/02/2023]
Abstract
To assess the remineralizing potential of dentin matrix proteins and enamel matrix derivatives (DMPs and EMDs) after application on artificially induced dentin lesions, given the hypothesis that these materials increase the mineral uptake, binding, and mineralization. Forty-eight caries-free human premolars were used. Teeth were cut, polished, and embedded, leaving an open window on the root surface, of which one-third was covered with a flowable composite to preserve the healthy untreated dentin. Then, samples were demineralized in Buskes solution for 33 days. A micro-CT scan prior to treatment was performed. Next, the samples were randomly allocated into four groups: (A) An untreated negative control (CON), (B) application of porcine dentin matrix proteins (DMP), (C) treatment with enamel matrix derivatives (EMD, Emdogain, Straumann), and (D) amine fluoride application (AMF, Elmex fluid, GABA). All samples were placed in artificial saliva for 21 days. A second micro-CT scan was performed, after which the change in gray scaling within a defined region of interest (0.25 mm3) was analyzed. ANCOVA was applied to discover statistical differences between the different treatments. Both, treatment with AMF; (P = 0.011 versus CON) as well as with DMP (P = 0.043 versus CON) yielded a statistically significant difference compared to the control treatment. EMD treatment was not found to differ (P > 0.05). Mainly the top layer of the defects showed clear signs of remineralization, which was also evident in CON. This study was able to visually confirm the remineralization potential of demineralized dentin especially after DMP application, which, however, did not outperform AMF. Based on this, additional studies combining proteins and fluorides are now warranted and ongoing.
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Randomised clinical trial investigating self-assembling peptide P 11-4 in the treatment of early caries. Clin Oral Investig 2019; 24:123-132. [PMID: 31037343 DOI: 10.1007/s00784-019-02901-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This prospective, randomised, split-mouth, clinical trial compared the efficacy of the self-assembling peptide P11-4 to fluoride varnish in the treatment of early buccal carious lesions. MATERIALS AND METHODS Subjects presenting at least two clinically affected teeth were treated at D0 (day 0) and D90 with P11-4 (test) or fluoride varnish (control). At D180, fluoride varnish was applied on all study lesions. Standardised photographs were taken at D0, D30, D90, D180 and D360 and blindly morphometrically assessed. Hierarchical linear models (HLM) under allowance of confounders were used to compare the decrease in size between test and control groups. The visual analog scale (VAS) and Global Impression of Change Questionnaire (GICQ) were used as clinical assessments. RESULTS Overall, 37 subjects (13-36 years) with 90 early carious lesions were included. HLM analysis showed a significant difference between test and control groups, indicating a decrease in test lesions and stabilisation of control lesions size (p = 0.001). The test lesion's mean size (SD) relative to baseline decreased to D30 = 0.936(0.127), D90 = 0.874(0.173), D180 = 0.844(0.215) and D360 = 0.862(0.352), whereas control lesions remained stable at D30 = 1.018(0.209), D90 = 1.013(0.207), D180 = 1.029(0.235) and D360 = 1.068(0.401). The effect sizes ranged from 0.47 to 0.82. CONCLUSIONS Within the limits of this study, it was shown that the size of early carious lesions treated with P11-4 was significantly reduced; this result was superior to that of fluoride varnish treatment (DRKS00012941). CLINICAL RELEVANCE The self-assembling peptide P11-4 is the first caries treatment approach aiming to regenerate decayed enamel. P11-4 initiates formation of de novo hydroxyapatite in the depth of early carious lesions, adding a new advanced therapy option for preventive dentistry.
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Üstün N, Aktören O. Analysis of efficacy of the self‐assembling peptide‐based remineralization agent on artificial enamel lesions. Microsc Res Tech 2019; 82:1065-1072. [DOI: 10.1002/jemt.23254] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/04/2019] [Accepted: 02/28/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Nilüfer Üstün
- Department of Pediatric DentistryIstanbul University Faculty of Dentistry Istanbul Turkey
| | - Oya Aktören
- Department of Pediatric DentistryIstanbul University Faculty of Dentistry Istanbul Turkey
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Alkilzy M, Santamaria RM, Schmoeckel J, Splieth CH. Treatment of Carious Lesions Using Self-Assembling Peptides. Adv Dent Res 2018; 29:42-47. [PMID: 29355413 DOI: 10.1177/0022034517737025] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Modern approaches in caries treatment involve lesion management without tissue removal. Regenerative medicine focuses on replacing damaged tissues with biologically similar tissues. This article discusses the scientific evidence and clinical results for self-assembling peptides in modern caries management. The biomimetic remineralization promoted by self-assembling peptide P11-4 has been proven in vitro as an effective therapy for initial caries. P11-4 was rationally designed to promote formation of hydroxyapatite on its surface. The formulation was optimized to ensure the ability of monomeric P11-4 to penetrate past the subsurface lesions and assembly into a biomatrix within. Furthermore, P11-4 has shown that it assembles into fibers within carious lesions, and promotes the remineralization thereof. In a recent clinical study, the safety and efficacy of P11-4 in treatment of initial caries were evaluated. The additional effect of the application of P11-4 (Curodont Repair) was compared to the application of fluoride varnish (Duraphat) alone in active occlusal initial caries lesions on erupting permanent molars. In the 3- and 6-month recalls, the test group showed, both in the laser fluorescence readings and in the clinical assessment of the caries stage and activity, significantly superior lesion regression compared to the control group. No adverse events, medical complications, or allergic reactions related to the treatments were reported. Clinical applicability of treatment was regarded as satisfactory. Patients were happy to receive noninvasive caries treatments. In conclusion, biomimetic mineralization facilitated by P11-4 in combination with fluoride may present a simple, safe, and effective noninvasive treatment for early carious lesions.
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Affiliation(s)
- M Alkilzy
- 1 Department of Preventive and Pediatric Dentistry, Centre for Oral Health, University of Greifswald, Greifswald, Germany
| | - R M Santamaria
- 1 Department of Preventive and Pediatric Dentistry, Centre for Oral Health, University of Greifswald, Greifswald, Germany
| | - J Schmoeckel
- 1 Department of Preventive and Pediatric Dentistry, Centre for Oral Health, University of Greifswald, Greifswald, Germany
| | - C H Splieth
- 1 Department of Preventive and Pediatric Dentistry, Centre for Oral Health, University of Greifswald, Greifswald, Germany
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Angelova Volponi A, Zaugg LK, Neves V, Liu Y, Sharpe PT. Tooth Repair and Regeneration. CURRENT ORAL HEALTH REPORTS 2018; 5:295-303. [PMID: 30524931 PMCID: PMC6244610 DOI: 10.1007/s40496-018-0196-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Current dental treatments are based on conservative approaches, using inorganic materials and appliances.This report explores and discusses the newest achievements in the field of "regenerative dentistry," based on the concept of biological repair as an alternative to the current conservative approach. RECENT FINDINGS The review covers and critically analyzes three main approaches of tooth repair: the re-mineralization of the enamel, the biological repair of dentin, and whole tooth engineering. SUMMARY The development of a concept of biological repair based on the role of the Wnt signaling pathway in reparative dentin formation offers a new translational approach into development of future clinical dental treatments.In the field of bio-tooth engineering, the current focus of the researchers remains the establishment of odontogenic cell-sources that would be viable and easily accessible for future bio-tooth engineering.
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Affiliation(s)
- Ana Angelova Volponi
- Centre for Craniofacial and Regenerative Biology, Dental Institute, King’s College London, London, UK
| | - Lucia K. Zaugg
- Centre for Craniofacial and Regenerative Biology, Dental Institute, King’s College London, London, UK
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Vitor Neves
- Centre for Craniofacial and Regenerative Biology, Dental Institute, King’s College London, London, UK
| | - Yang Liu
- Centre for Craniofacial and Regenerative Biology, Dental Institute, King’s College London, London, UK
| | - Paul T. Sharpe
- Centre for Craniofacial and Regenerative Biology, Dental Institute, King’s College London, London, UK
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Philip N. State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management. Caries Res 2018; 53:284-295. [PMID: 30296788 DOI: 10.1159/000493031] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/11/2018] [Indexed: 12/17/2022] Open
Abstract
The principles of minimally invasive dentistry clearly dictate the need for clinically effective measures to remineralize early enamel caries lesions. While fluoride-mediated remineralization is the cornerstone of current caries management philosophies, a number of new remineralization strategies have been commercialized or are under development that claim to promote deeper remineralization of lesions, reduce the potential risks associated with high-fluoride oral care products, and facilitate caries control over a lifetime. These non-fluoride remineralizing systems can be broadly categorized into biomimetic enamel regenerative technologies and the approaches that repair caries lesions by enhancing fluoride efficacy. This paper discusses the rationale for non-fluoride remineralization and the mechanism of action, challenges, and evidence behind some of the most promising advances in enamel remineralization therapies.
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Affiliation(s)
- Nebu Philip
- School of Dentistry, University of Queensland, Brisbane, Queensland, Australia,
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Suda S, Takamizawa T, Takahashi F, Tsujimoto A, Akiba S, Nagura Y, Kurokawa H, Miyazaki M. Application of the Self- Assembling Peptide P11-4 for Prevention of Acidic Erosion. Oper Dent 2018. [PMID: 29513639 DOI: 10.2341/17-175-l] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this study was to use ultrasonography to evaluate the effect of the self-assembling peptide P11-4 on acid erosion prevention. Curodont Repair (CR), which includes peptide P11-4, was used. Rectangular prisms of bovine enamel (4×1×1 mm) were immersed in pure orange juice for a period of 5 minutes six times per day for 28 days. These samples were divided into four groups of six specimens each and treated differently for an additional period of 28 days: 1) baseline group specimens were stored in artificial saliva; 2) CR group specimens were exposed to curodont without acid challenge; 3) NCRA (no curodont+acid challenge) specimens were treated with orange juice without curodont exposure; and 4) CRA (CR+acid challenge) specimens were treated with curodont before treatment with orange juice. The propagation time of longitudinal ultrasonic velocity (UV) was measured. Ultrastructural observation of each tested enamel surface was carried out using field-emission scanning electron microscopy (SEM). The UV data were analyzed using two-way analysis of variance with time and treatment as confounding factors. Post hoc pairwise tests among groups were performed using the Tukey honestly significant difference test. The average UV in intact bovine enamel for the baseline group ranged from 4,483 to 4,549 m/s and did not vary significantly within the test period. The average ultrasonic velocity (UV) in all samples decreased after the initial erosion. The UV in NCRA decreased further over time. Increased UVs were found for CR and CRA. For CR and CRA, there was no significant difference in UV at the end of the experiment from the initial value before erosion. In the results of SEM observation, the CR and CRA groups had similar morphologic features in that etching patterns were not clearly due to precipitation between the enamel rods. From the results of this in vitro study, it might be concluded that applying enamel matrix derivatives and self-assembling peptides on erosive lesions can improve remineralization.
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Kamal D, Hassanein H, Elkassas D, Hamza H. Comparative evaluation of remineralizing efficacy of biomimetic self-assembling peptide on artificially induced enamel lesions: An in vitro study. J Conserv Dent 2018; 21:536-541. [PMID: 30294117 PMCID: PMC6161534 DOI: 10.4103/jcd.jcd_123_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The biomimetic self-assembling peptide technology is a paradigm for dental hard tissue regeneration. Aim To investigate the efficacy of biomimetic self-assembling peptide (P11-4) on enamel remineralization compared to casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) and fluoride-based delivery systems. Materials and Methods Artificial enamel lesions were created on buccal surfaces of 40 extracted human molars. Specimens were randomly assigned to four groups (n = 10) according to the remineralizing agent used: G1 - control: artificial saliva, G2 - fluoride varnish, G3 - CPP-ACPF varnish, G4 - self-assembling peptide agent. All products were applied according to the manufacturer's instructions and the specimens were stored in daily renewed artificial saliva. Surface microhardness (SMH) was assessed at baseline, after demineralization, after 1 week and after 4 weeks storage. SMH values were analyzed using ANOVA and Tukey's post hoc test. Results Self-assembling peptide showed the highest statistically significant mean SMH followed by fluoride and CPP-ACPF while the lowest mean SMH was found in artificial saliva. However, no statistically significant difference was found between fluoride and CPP-ACPF. Higher statistically significant mean SMH was found after 4 weeks compared to 1 week remineralization in all groups. Conclusions Self-assembling peptide confers the highest remineralizing efficacy compared to fluoride and CPP-ACPF, showing a promising, noninvasive regeneration potential. Furthermore, extended period of time helped attain more benefits from the remineralizing regimens applied.
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Affiliation(s)
- Dina Kamal
- Department of Conservative Dentistry, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | | | - Dina Elkassas
- Department of Operative Dentistry, Faculty of Oral and Dental Medicine, Misr International University, Cairo, Egypt
| | - Heba Hamza
- Department of Conservative Dentistry, Faculty of Dentistry, Cairo University, Cairo, Egypt
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