Analysis of Dental Enamel Remineralization: A Systematic Review of Technique Comparisons

The interaction between gut microbiome and bone health

PURPOSE OF REVIEW

This review critically examines interconnected health domains like gut microbiome, bone health, interleukins, chronic periodontitis, and coronavirus disease 2019 (COVID-19), offering insights into fundamental mechanisms and clinical implications, contributing significantly to healthcare and biomedical research.

RECENT FINDINGS

This review explores the relationship between gut microbiome and bone health, a growing area of study. It provides insights into skeletal integrity and potential therapeutic avenues. The review also examines interleukins, chronic periodontitis, and COVID-19, highlighting the complexity of viral susceptibility and immune responses. It highlights the importance of understanding genetic predispositions and immune dynamics in the context of disease outcomes. The review emphasizes experimental evidence and therapeutic strategies, aligning with evidence-based medicine and personalized interventions. This approach offers actionable insights for healthcare practitioners and researchers, paving the way for targeted therapeutic approaches and improved patient outcomes.

SUMMARY

The implications of these findings for clinical practice and research underscore the importance of a multidisciplinary approach to healthcare that considers the complex interactions between genetics, immune responses, oral health, and systemic diseases. By leveraging advances in biomedical research, clinicians can optimize patient care and improve health outcomes across diverse patient populations.

Fluoride-amorphous calcium phosphate and biomimetic nano-hydroxyapatite for enamel remineralization: An in-vitro study of surface microhardness and composition

AIM

Fluoride-Amorphous Calcium Phosphate and Biomimetic Nano-Hydroxyapatite for Enamel Remineralization; An In-Vitro Study of Surface Microhardness and Composition.

MATERIAL AND METHODS

Ninety-six extracted human premolars with sound buccal surface were divided using a randomization computer-generating software into four groups; Group I (control) sound untreated enamel, Group II (demineralized) demineralized to create white spot lesions, Group III (biom-n-HA) demineralized and then treated with biomimetic nanohydroxyapatite cream, and Group IV (F-ACP) demineralized and then treated using Fluoride-Amorphous Calcium Phosphate varnish. Each group was divided into two subgroups; subgroup "A" evaluated for mineral content using energy dispersive x-ray spectroscopy (EDX) and for surface microhardness using the Vickers microhardness test and Subgroup "B" evaluated for white spot lesion depth using a polarized light microscope (PLM).

RESULTS

The highest microhardness (VHN) was found in the (F-ACP) group (mean=428.61±54.43) and then in the (Biom-n-HA) group (mean=408.11±70.16) followed by the (Control) group (mean=402.13±53.40) with no significant difference between them and finally in the significantly different (Demineralized) group (mean=256.99±45.83). The weight percentage of Ca (30.29±1.04 and 33.44±1.07) and Ca/P ratio (1.87±0.06 and 2.03±0.05) were significantly different between Group III and Group IV respectively. PLM measurements in Group II (198.83μm), Group III (60.17μm), and Group IV (26.33μm) were significantly different.

CONCLUSIONS

Both the (Biom-n-HA) cream and the (F-ACP) varnish showed promising results for enamel remineralization. The increased enamel surface microhardness was consistent with the mineral content and the changes in the birefringence.

Structural and Color Alterations of Teeth following Orthodontic Debonding: A Systematic Review

AIM

The objective of this study was to explore the effects of fixed orthodontic appliances on enamel structure by assessing microfractures, surface roughness, and alterations in color.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of online databases was conducted using the keywords 'enamel' AND 'orthodontic debonding'. Eligibility criteria included both in vivo and ex vivo clinical trials conducted on human teeth.

RESULTS AND DISCUSSION

A total of 14 relevant papers were analyzed. Various instruments and techniques were utilized across different studies to assess surface roughness, color change, and surface fractures.

CONCLUSIONS

The findings of this study suggest that ceramic brackets may lead to an increase in enamel fractures, particularly during bracket removal. The surface roughness of enamel exhibits variability depending on the adhesive substance and polishing methods used post-removal. Fixed orthodontic appliances could induce changes in enamel color, which may be alleviated by the use of nano-hydroxyapatite or specific polishing techniques. Further research is necessary to identify effective strategies for managing these color changes and improving the overall outcomes of fixed orthodontic treatment.

A Comparison of the Fluoride 'Paint- On' vs Tray Application Techniques for Enamel Remineralisation

BACKGROUND

Fluoride gel treatment is not recommended for children < 6 years old due to its potential toxicity. Hence the aim of this study was to compare the effect of 1.23% acidulated-phosphate fluoride (APF) gel paint-on and the conventional tray application techniques on artificial, deciduous enamel carious lesions embedded on wearable appliances.

METHODS

In a randomised crossover study, the volunteer children (n = 29) wore mandibular removable appliances containing embedded tooth specimens with artificial carious lesions. The volunteers had 3 different treatment protocols: (I) 0.4 mL non-fluoride (control) gel, (II) 0.4 mL paint-on 1.23% APF gel or (III) 5 mL 1.23% APF gel, 4 minutes tray application. After 1 hour, the appliances were removed and the specimens underwent an in vitro, 14 days of pH-cycling. The mean percentage reduction in fluorescence (ΔF, %) at baseline (ΔF0) and after the pH-cycling (ΔF1) were determined using quantitative light-induced fluorescence-digital analysis. The mean ΔΔF (ΔF1-ΔF0) was calculated to compare the differences between groups.

RESULTS

The mean ΔΔF of groups I to III were -1.42 ± 1.49, 1.06 ± 2.11, and 1.12 ± 3.57 and -1.25 ± 1.44, 1.13 ± 1.84 and 1.44 ± 3.62 for the smooth surface and proximal surface lesions, respectively. The mean ΔΔF in the 2 treatment groups were significantly greater compared with the control group (P < .001). There was no significant difference in ΔΔF between the APF gel tray and paint-on groups either in the smooth surfaces, or the proximal surfaces (P = .629 and P = .613, respectively).

CONCLUSION

Our study, for the first time, indicates that the paint-on application of APF gel or the tray application of APF had a similar enamel remineralisation effect. Clinically, this implies that, particularly in younger children, the paint-on application of fluoride is less cumbersome, and possibly more tolerable with a lesser likelihood of fluoride ingestion than the tray application technique.

TRIAL REGISTRATION

Thai Clinical Trial Registry (https://www.thaiclinicaltrials.org/show/TCTR20190724001).

Ultrastructural investigation of the effect of toothpastes containing different remineralizing agents on demineralized enamel

OBJECTIVE

The present study aimed to evaluate the effect of remineralizing agents on demineralized enamel intended for use as fluoride substitutes or supplements for oral hygiene applications.

METHODOLOGY

Enamel samples were obtained from 30 bovine teeth. The enamel blocks were stored in 20 mL of demineralization solution for 72 h. They were then brushed with the following toothpaste for the remineralization protocol: NaF, NaF/SnF2 combination, NovaMin, or nano-hydroxyapatite. SEM/EDX examinations and microhardness measurements of the samples were performed to investigate the remineralization efficacy of the studied toothpaste. One-way analysis of variance (ANOVA) with post hoc Tukey's HSD test was used to analyze the change in microhardness values in different remineralization protocols (p < 0.05).

RESULTS

Differences in the mean remineralization (%RP) and hardness recovery (%HR) were determined between the groups (p < 0.05). Groups 1 and 4 showed significant differences in %RP (p < 0.05). In the SEM/EDX examinations, the samples treated with n-HAp showed an accumulation of crystal deposits on the enamel surface, although at a lower density than those treated with NaF and NaF/SnF2 combination.

CONCLUSION

The remineralization strategy in toothpaste plays an important role in enamel remineralization. NovaMin-containing toothpaste showed positive effects on the enamel surface with better Ca/P ratio. Toothpastes containing n-HAp triggered less change in the increase of microhardness values compared to other toothpastes. The use of SnF2 in toothpaste in combination with NaF significantly increased the binding of fluoride to demineralized enamel compared to toothpaste containing NaF alone.

Preventive management of carious lesions: from non-invasive to micro-invasive operative interventions

Understanding that dental carious lesions occur as a result of the action of micro-organisms in the dental plaque biofilm, where demineralisation on the tooth surface is the first sign of the disease, such incipient lesions can be treated using preventive, non-operative and minimally invasive operative dentistry. If the caries process is left unmanaged, the lesions progress towards cavitation, leading to more invasive treatments. This article discusses the principles of preventive, non-invasive and micro-invasive treatments of early carious lesions, outlining the clinical situations where these therapies can be applied.

The effect of combined use of resin infiltration with different bioactive calcium phosphate-based approaches on enamel white spot lesions: An in vitro study

OBJECTIVES

This in vitro study aimed to evaluate the effect of resin infiltration combined with casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF) or bioactive glass (BAG) on the stability of enamel white spot lesions (WSLs) treatment.

MATERIALS AND METHODS

Eighty-four enamel blocks were prepared from the buccal surfaces of sound human premolars. All enamel blocks were placed in a demineralisation solution for 3 days to establish the artificial enamel WSLs. Enamel blocks with WSLs were randomly divided into three groups (n = 28 each group): RI/B: one-off resin infiltration followed by twice daily BAG treatment; RI/C: one-off resin infiltration followed by twice daily CPP-ACPF treatment; RI: one-off resin infiltration treatment only (as control) and subjected to pH cycling for 7 days. Surface morphology, elemental analysis, crystal characteristics, surface roughness and microhardness of enamel surfaces were investigated by scanning electron microscopy and energy-dispersive spectrometry observation, X-ray diffraction (XRD), atomic force microscope and Vickers' hardness testing, respectively.

RESULTS

Mean values of the surface roughness (mean±standard deviation (nm)) were 24.52±5.07, 27.39±5.87 and 34.36±4.55 for groups RI/B, RI/C and RI respectively (p = 0.003). The calcium to phosphate ratios were 1.32±0.16, 1.22±0.26 and 0.69±0.24 for groups RI/B, RI/C and RI respectively (p < 0.001). XRD revealed apatite formation in all three groups. The mean enamel surface microhardness (kg/mm2) of the groups were 353.93±28.49, 339.00±27.32 and 330.38±22.55 for groups RI/B, RI/C and RI respectively (p = 0.216).

CONCLUSIONS

Resin infiltration combined with CPP-ACPF or BAG remineralisation appears to improve the surface properties of WSLs.

CLINICAL SIGNIFICANCE

The combination of resin infiltration and CPP-ACPF/BAG remineralisation may be a potential treatment for the management of the WSLs.

New generation of orthodontic devices and materials with bioactive capacities to improve enamel demineralization

OBJECTIVE

The article reviewed novel orthodontic devices and materials with bioactive capacities in recent years and elaborated on their properties, aiming to provide guidance and reference for future scientific research and clinical applications.

DATA, SOURCES AND STUDY SELECTION

Researches on remineralization, protein repellent, antimicrobial activity and multifunctional novel bioactive orthodontic devices and materials were included. The search of articles was carried out in Web of Science, PubMed, Medline and Scopus.

CONCLUSIONS

The new generation of orthodontic devices and materials with bioactive capacities has broad application prospects. However, most of the current studies are limited to in vitro studies and cannot explore the true effects of various bioactive devices and materials applied in oral environments. More research, especially in vivo researches, is needed to assist in clinical application.

CLINICAL SIGNIFICANCE

Enamel demineralization (ED) is a common complication in orthodontic treatments. Prolonged ED can lead to dental caries, impacting both the aesthetics and health of teeth. It is of great significance to develop antibacterial orthodontic devices and materials that can inhibit bacterial accumulation and prevent ED. However, materials with only preventive effect may fall short of addressing actual needs. Hence, the development of novel bioactive orthodontic materials with remineralizing abilities is imperative. The article reviewed the recent advancements in bioactive orthodontic devices and materials, offering guidance and serving as a reference for future scientific research and clinical applications.

Treatment Approaches to Molar Incisor Hypomineralization: A Systematic Review

AIM

This systematic review aimed to comprehensively evaluate the available literature on treating molar incisor hypomineralization (MIH) or enamel hypomineralization published between 2013 and 2023, focusing on identifying relevant studies and their characteristics.

MATERIALS AND METHODS

The search process encompassed reputable academic databases, including PubMed, Scopus, Cochrane Library, and Web of Science, using a precise keyword strategy ("((molar incisor hypomineralization) OR (enamel hypomineralization)) AND (treatment)"). A total of 637 articles were initially retrieved, followed by a strict selection process adhering to PRISMA guidelines. The inclusion criteria encompassed Randomized Control Trials (RCTs), case series with more than five clinical cases (CSs), studies involving human participants, availability as free full-text or accessible with university credentials, and English-language publications. Exclusion criteria included systematic or literature reviews, editorials, single-case reports, studies conducted in vitro, those involving animals, paid articles, and non-English-language publications.

RESULTS

The search yielded 864 articles, of which 23 met the stringent inclusion criteria after a meticulous selection process. These studies will serve as the basis for a comprehensive analysis of MIH treatment approaches. The systematic review ensures the quality and relevance of the chosen studies for a detailed assessment of MIH treatment strategies.

CONCLUSIONS

This systematic review will provide valuable insights into the characteristics of selected studies, patient profiles, and available treatment options for molar incisor hypomineralization, contributing to a better understanding of this dental condition's management.