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Ivette Guanipa Ortiz M, Gomes de Oliveira S, de Melo Alencar C, Baggio Aguiar FH, Alves Nunes Leite Lima D. Remineralizing effect of the association of nano-hydroxyapatite and fluoride in the treatment of initial lesions of the enamel: A systematic review. J Dent 2024; 145:104973. [PMID: 38556192 DOI: 10.1016/j.jdent.2024.104973] [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: 01/18/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE Assessed the effect of dental products containing nano-hydroxyapatite (nano-HA) + fluoride on the remineralization of white spot lesions (WSL) in vivo or in situ. METHODS Seven databases were explored using a two-pronged approach (intervention/treatment). After screening, full-text assessment, and further exclusion, the qualitative synthesis of five studies (four clinical and one in situ) was performed. Based on the Cochrane collaboration guidelines relevant data of the studies were collected and summarized. The Cochrane risk of bias tool for randomized trials (RoB 2.0) was used to appraise the studies' methodological quality and the GRADE guidelines to assess their level of evidence. The RoB 2.0 domains were rated on their risk of bias (RoB) as low, high, or with some concerns, and an adaptation of the tool was used to the in situ study. RESULTS The included studies assessed 151 WSL in anterior permanent teeth, on patients with varying ages. The protocol application, treatment length (7d-12 w), and control groups varied greatly between the studies making the performance of a quantitative analysis unfeasible. The general RoB of the clinical studies was classified as being of low risk (n = 2) or some concerns (n = 2). The in situ study was considered as being of low risk. The level of the evidence was moderate. Most of the studies found moderate evidence regarding the superiority of this association in clinical settings. CONCLUSION Even with the nano-HA + fluoride promising results for the remineralization treatment of WSL, due to the restricted number of studies and types of products, its extended use cannot be recommended based on the current systematic review, especially when considering the moderate level of the evidence found. CLINICAL SIGNIFICANCE Due to the biocompatibility and higher surface coverage of nano-HA and the remineralization capacity of fluoride formulations, the association of these elements to remineralize WSL has been positively reported. After the collection and qualitative appraise of the data, the clinical evidence of the use of these dental products is promising but limited.
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Affiliation(s)
| | - Simone Gomes de Oliveira
- Department of Restorative Dentistry, Piracicaba Dental School, University of Campinas -UNICAMP, Brazil
| | - Cristiane de Melo Alencar
- Department of Dental Materials of the Graduate Program in Dentistry, Federal University of Pará, Belém, PA, Brazil
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Ahrari F, Nazifi M, Mazhari F, Ghazvini K, Menbari S, Fekrazad R, Babaei K, Banihashemrad A. Photoinactivation Effects of Curcumin, Nano-curcumin, and Erythrosine on Planktonic and Biofilm Cultures of Streptococcus mutans. J Lasers Med Sci 2024; 15:e7. [PMID: 38655044 PMCID: PMC11033858 DOI: 10.34172/jlms.2024.07] [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: 08/11/2023] [Accepted: 12/06/2023] [Indexed: 04/26/2024]
Abstract
Introduction: This in vitro study was conducted to assess the phototoxic effects of curcumin, nano-curcumin, and erythrosine on the viability of Streptococcus mutans (S. mutans) in suspension and biofilm forms. Methods: Various concentrations of curcumin (1.5 g/L, 3 g/L), nano-curcumin (3 g/L), and erythrosine (100 μM/L, 250 μM/L) were examined for their impact on planktonic and biofilm cultures of S. mutans, either individually or in conjunction with light irradiation (photodynamic therapy or PDT). A blue light-emitting diode (LED) with a central wavelength of 450 nm served as the light source. The results were compared to 0.12% chlorhexidine digluconate (CHX) as the positive control, and a solution containing neither a photosensitizer (PS) nor a light source as the negative control group. The dependent variable was the number of viable microorganisms per experiment (CFU/mL). Results: Antimicrobial PDT caused a significant reduction in the viability of S. mutans in both planktonic and biofilm forms, compared to the negative control group (P<0.05). The highest cell killing was observed in PDT groups with curcumin 3 g/L or erythrosine 250 μmol/L, although the difference with PDT groups using curcumin 1.5 g/L or erythrosine 100 μmol/L was not significant (P>0.05). Antimicrobial treatments were more effective against planktonic S. mutans than the biofilm form. Conclusion: PDT with either curcumin 1.5 g/L or erythrosine 100 μmol/L may be suggested as an alternative to CHX to inactivate the bacteria in dental plaque or deep cavities. Nano-curcumin, at the selected concentration, exhibited lower efficacy in killing S. mutans compared to Curcumin or erythrosine.
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Affiliation(s)
- Farzaneh Ahrari
- Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Morteza Nazifi
- Student Research Committee, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Mazhari
- Dental Materials Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kiarash Ghazvini
- Antimicrobial Resistance Research Center, Department of Microbiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shaho Menbari
- Department of Medical Laboratory Sciences, School of Paramedical, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Fekrazad
- Radiation Sciences Research Center, AJA University of Medical Sciences, Tehran, Iran
- International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research, Network (USERN), Tehran, Iran
| | - Kourosh Babaei
- Student Research Committee, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Banihashemrad
- Department of Restorative, Preventive, and Pediatric Dentistry, University of Bern, Bern, Switzerland
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Xie Z, Yu L, Li S, Li J, Liu Y. Comparison of therapies of white spot lesions: a systematic review and network meta-analysis. BMC Oral Health 2023; 23:346. [PMID: 37264364 DOI: 10.1186/s12903-023-03076-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE White spot lesions (WSLs), the earliest evidence of enamel demineralization, are considered amenable to intervention to achieve a remineralized or arrested state of caries. The management of WSLs is quite challenging, and there is no definitive cure as yet. We performed a network meta-analysis to assess the efficacy of seven therapies for WSLs and gave a hierarchy of them. MATERIALS AND METHODS We systematically searched the PubMed, EMBASE, Cochrane, and Web of Science databases (last search: July 2022) to identify all relevant studies. We limited our search to studies published in English. Randomized controlled designed in vitro/clinical trials related to the efficacy of the seven therapies for WSLs were included. Data extraction was performed independently by two reviewers. The risk of bias (ROB) 2.0 tool from Cochrane and a previous in vitro methodological tool will be used for the quality assessment. Variations in quantitative light-induced fluorescence (QLF), laser fluorescence (LF), and lesions area were the primary outcome measures. Standard mean difference (SMD) was used as the effect size for the Network meta-analysis (NMA). Consistency and inconsistency tests were conducted. The hierarchy of 7 treatment effects was evaluated using surface probabilities under cumulative ranking (SUCRA). Publication bias was evaluated using a bias plot. RESULTS Forty-two articles were included in the systematic review. Thirty-one of them, with a total of 1906 participants, were included in the network meta-analysis. The studies owned a low and moderate risk of bias. This analysis does not suffer from significant inconsistency. The difference between 4 groups 'self-assembled peptide (SAP) P11-4', 'P11-4 + Fluoride Varnish (FV)', 'Resin Infiltration (RI)', 'casein phosphor peptides-amorphous calcium fluoride phosphate (CPP-ACFP)' and the 'Control' group was found to be statistically significant. Compared to the 'FV' and 'casein phosphor peptides-amorphous calcium phosphate (CPP-ACP)' groups, the 'P11-4 + FV" group and 'RI" group made a significant difference. The hierarchy was evident in the SUCRA values of 7 therapies. P11-4 + FV and RI were considered effective therapies compared to the control group or the FV group (gold standard group). CONCLUSIONS The available evidence suggests that resin infiltration and P11-4 in combination with fluoride varnish had advantages over gold standard (FV). The effect of tricalcium phosphate-based drugs and fluoride is not very noticeable. Overall, drugs based on P11-4 and resin infiltration will be better therapies. Using more than two drugs in combination also would increase efficacy.
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Affiliation(s)
- Zunxuan Xie
- Department of Endodontics, Hospital of Stomatology, Jilin University, Jilin, China
| | - Lei Yu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Jilin, China
| | - Sining Li
- Department of Prosthodontics, Hospital of Stomatology, Jilin University, Jilin, China
| | - Jianing Li
- Department of Endodontics, Hospital of Stomatology, Jilin University, Jilin, China
| | - Yuyan Liu
- Department of Endodontics, Hospital of Stomatology, Jilin University, Jilin, China.
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Malcangi G, Patano A, Morolla R, De Santis M, Piras F, Settanni V, Mancini A, Di Venere D, Inchingolo F, Inchingolo AD, Dipalma G, Inchingolo AM. Analysis of Dental Enamel Remineralization: A Systematic Review of Technique Comparisons. Bioengineering (Basel) 2023; 10:bioengineering10040472. [PMID: 37106659 PMCID: PMC10135549 DOI: 10.3390/bioengineering10040472] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/01/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
The demineralization process conditions the structure of the enamel and begins with a superficial decalcification procedure that makes the enamel surface porous and gives it a chalky appearance. White spot lesions (WSLs) are the first clinical sign that can be appreciated before caries evolves into cavitated lesions. The years of research have led to the testing of several remineralization techniques. This study's objective is to investigate and assess the various methods for remineralizing enamel. The dental enamel remineralization techniques have been evaluated. A literature search on PubMed, Scopus, and Web of Science was performed. After screening, identification, and eligibility processes 17 papers were selected for the qualitative analysis. This systematic review identified several materials that, whether used singly or in combination, can be effective in the process of remineralizing enamel. All methods have a potential for remineralization when they come into contact with tooth enamel surfaces that have early-stage caries (white spot lesions). From the studies conducted in the test, all of the substances used to which fluoride has been added contribute to remineralization. It is believed that by developing and researching new remineralization techniques, this process might develop even more successfully.
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Affiliation(s)
- Giuseppina Malcangi
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Assunta Patano
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Roberta Morolla
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Matteo De Santis
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Fabio Piras
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Vito Settanni
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Antonio Mancini
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Daniela Di Venere
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | | | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
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Comparative Efficacy of Novel Biomimetic Remineralising Technologies. Biomimetics (Basel) 2023; 8:biomimetics8010017. [PMID: 36648803 PMCID: PMC9844379 DOI: 10.3390/biomimetics8010017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
Biomimetic technologies for the remineralisation of enamel subsurface lesions (ESLs) have been developed and include: fluorocalcium phosphosilicate bioglass (BG/F); casein phosphopeptide-amorphous calcium phosphate (CPP−ACP) and with fluoride (CPP−ACFP); and self-assembling oligopeptide P11-4 (SAP). The aim of this study was to compare the remineralisation of ESLs in vitro using these technologies. Human enamel slabs with ESLs were cut into two half-slabs; one half-slab was untreated (control), and the other half was treated by exposure to one of the four technologies with artificial saliva (AS) or AS alone for 14 days at 37 °C. The technologies were applied to the ESL surface according to the manufacturer’s instructions. At the completion of each treatment, the treated half-slabs and their paired control half-slabs were embedded, sectioned and the mineral content was determined using transverse microradiography. The change in mineral content (remineralisation) between treatments was statistically analysed using one-way ANOVA. The order from highest to lowest remineralisation was CPP−ACFP (52.6 ± 2.6%) > CPP−ACP (43.0 ± 4.9%) > BG/F (13.2 ± 2.5%) > SAP (5.8 ± 1.6%) > AS (2.1 ± 0.5%). Only CPP−ACFP and CPP−ACP produced remineralisation throughout the body of the lesions. All four biomimetic technologies had some effect on the remineralisation of ESLs; however, CPP−ACFP with calcium, phosphate and fluoride ions stabilised by CPP was superior in the level and pattern of remineralisation obtained.
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Evaluation of the remineralizing effect of biomimetic self-assembling peptides in post-orthodontic white spot lesions compared to fluoride-based delivery systems: randomized controlled trial. Clin Oral Investig 2023; 27:613-624. [PMID: 36287272 PMCID: PMC9889428 DOI: 10.1007/s00784-022-04757-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/13/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate the clinical performance of self-assembling peptides versus fluoride-based delivery systems in post-orthodontic white spot lesions. MATERIALS AND METHODS The participants were randomly assigned into two groups (n = 58) according to the remineralizing agent used, where (A) group represented participants receiving a varnish containing 22.600 fluoride ppm and tricalcium phosphate, while the second group (B) represented participants receiving self-assembling peptide. The remineralizing process of the white spot lesion was assessed using the DIAGNOdent pen and ICDAS scoring system according to the time when the remineralizing agent was used (T), where T0 represented the score taken at baseline. T1 represented the score taken after 3 months of follow-ups and T2 score represented the score taken after 6 months of follow-up. Data were collected and statistically analyzed. The parametric data: two-way ANOVA was used to test the effect of interaction among different variables. The non-parametric data: Mann-Whitney test was used. The significance level was set at p ≤ 0.05. RESULTS There was a quantitative statistically significant difference via DIAGNOpen readings between Group A (fluoride material) and Group B (self-assembling peptides). The highest mean value of 10.51 was found in Group A, while the least mean value of 6.45 was found in Group B. Besides, there was a significant difference in each group concerning the time factors T0, T1, and T2 groups where (p < 0.001. As for the qualitative results concerning the ICDAS score, there was no significant difference between the two groups along with the follow-up periods T0, T1, and T2 where the p value is equal to 0.064, 0.087, and 0.277 respectively. CONCLUSIONS The visual assessment using ICDAS reveals that the biomimetic remineralization using self-assembling peptides and the fluoride-based varnish material showed a similar effect in masking post-orthodontic white spot lesions. However, the laser fluorescence using DIAGNOpen showed that the self-assembling peptides reveal higher performance in subsurface remineralization than the fluoride-based varnish material. Therefore, self-assembling peptides are considered a promising material for lesion regression in post-orthodontics white spot lesions. CLINICAL RELEVANCE Self-assembling peptide SAP-14 is a new approach to reverse and mask off post-orthodontics white spot lesions.
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Melo M, Fioresta R, Sanz JL, Pecci-Lloret MP, Llena C. Effect of highly concentrated bleaching gels on enamel microhardness and superficial morphology, and the recovery action of four remineralizing agents. BMC Oral Health 2022; 22:645. [PMID: 36575416 PMCID: PMC9793581 DOI: 10.1186/s12903-022-02693-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Dental bleaching is a common clinical practice. The aim of this study is to investigate the effect of 35% hydrogen peroxide (HP) bleaching gel on the morphology and microhardness of enamel, and to analyze the effect of four remineralizing agents. METHODS One hundred blocks were prepared. The enamel surfaces were bleached with 35% HP in one session. The specimens were divided into four remineralization treatment groups (n = 25). G1: Tooth Mousse, G2: Remin-Pro, G3: Colgate Pro-Relif, G4: Mirafluor. The remineralizing protocol was applied 3 min per day for one week. Vickers microhardness (HV) measurements and SEM observations were performed at baseline, after bleaching, and after remineralizing treatment in all groups. Statistical analyses were performed using the paired t-test and ANOVA. RESULTS After bleaching, SEM showed an increase of irregularities on the surface of the samples. Enamel microhardness decreased a mean of 47.7 HV, equivalent to a mean decrease of 18.3% (p < 0.05). After remineralization, the HV increased in all groups between 16 and 33% (p < 0.01), recovering the initial microhardness of enamel samples. SEM images revealed a higher quantity of superficial mineral deposits in groups 1 and 2 compared to the rest of the groups. CONCLUSIONS The application of remineralizing products generates a significant increase in enamel microhardness. Tooth Mousse-treated samples showed a greater microhardness recovery, followed by Remin Pro. The superficial morphology of the samples reflects the results obtained in the HV tests.
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Affiliation(s)
- María Melo
- grid.5338.d0000 0001 2173 938XDepartament of Stomatology, Universitat de València, València, Spain
| | - Rossella Fioresta
- grid.5338.d0000 0001 2173 938XDepartament of Stomatology, Universitat de València, València, Spain
| | - José Luís Sanz
- grid.5338.d0000 0001 2173 938XDepartament of Stomatology, Universitat de València, València, Spain
| | - María Pilar Pecci-Lloret
- grid.10586.3a0000 0001 2287 8496Special Care and Gerodontology Unit, Department of Dermatology, Stomatology, Radiology and Physical Medicine, School of Dentistry, University of Murcia, 30008 Murcia, Spain
| | - Carmen Llena
- grid.5338.d0000 0001 2173 938XDepartament of Stomatology, Universitat de València, València, Spain
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MOOSAVİ H, REZAEE F, AFSHARİ S, SEKANDARİ S, AHRARİ F. The effect of minimally invasive treatments on enamel microhardness and resistance to further demineralization. CUMHURIYET DENTAL JOURNAL 2022. [DOI: 10.7126/cumudj.1106247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objectives: The present study aimed to compare microhardness of inactive proximal lesions treated by resin infiltration, Er:YAG laser + resin infiltration and Bioactive glass, and investigate the resistance of treated lesions to further demineralization challenge.
Methods: In this in-vitro study, 30 human molars with inactive proximal lesions were selected and randomly divided into three groups of 10. In group 1 (resin infiltration), the lesions were treated by a resin infiltrant (Icon). In group 2, the surface was conditioned by an Er:YAG laser prior to resin infiltration. The specimens in group 3 were remineralized by bioactive glass. The treated specimens were kept in artificial saliva for 1 week and then immersed in a demineralization solution for 8 weeks. Surface microhardness was measured at baseline (T0), after remineralization (T1) and after exposure to the demineralization solution (T2), and the difference in microhardness between time points (ΔVHN) was calculated.
Results: Microhardness after demineralization (T2) was significantly lower than those of other intervals (P0.05). The statistical analysis revealed no significant difference either in ΔVHNT1-T0 or in ΔVHNT2-T1 among the study groups (P>0.05)
Conclusion: Pretreatment by the Er:YAG laser prior to resin infiltration was more effective that other treatments in enhancing microhardness and protecting the tooth against acidic challenge. However, the difference between groups did not reach a statistical significance, implying the need for further studies to achieve more conclusive results.
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Youssef MN, Abo Elezz AF, Elddamony EA, Ghoniem AF. Clinical Evaluation of Different Minimal Invasive Treatment Modalities of Mild to Moderate Dental Fluorosis Using an Intra-oral Spectrophotometer. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND: Various treatment modalities are available to improve esthetics of fluorosed teeth based on its severity.
AIM: The aim of the study was to evaluate the clinical performance of different minimal invasive treatment protocols on mild to moderate fluorosed teeth.
METHODS AND MATERIALS: Before the interventions, tooth color coordinates L, a and b were recorded for 160 fluorosed teeth by Vita Easyshade V. Participants were randomly allocated in eight treatment protocols with 20 teeth (n = 20) included in each protocol. Protocol one (P1) Opalescence boost PF 40%. Protocol two (P2) Opalustre. Protocol three (P3) MI-Paste Plus. In protocol four (P4) teeth were treated with Opalustre followed by Opalescence boost PF 40%. In protocol five (P5) Opalescence boost PF 40% was applied followed by MI-Paste Plus, while in protocol six (P6) Opalustre was applied followed by MI-Paste Plus whereas protocol seven (P7) teeth were treated with Opalustre, followed by Opalescence boost PF 40% and finally MI-Paste Plus. Protocol eight (P8) control. All teeth were evaluated immediately for color change (ΔE) after treatment (T1), after 14 days (T2), after 3 months (T3) and after 6 months (T4). Color change (ΔE) was calculated from ΔL, Δa, and Δb recorded at each evaluation time point.
STATISTICAL ANALYSIS: Two-way ANOVA was applied to test the interaction between different variables. ANOVA repeated measures were followed by Duncan multiple range tests (DMRTs) to compare between groups.
RESULTS: In accordance to time, all treatment protocols showed significant color change can be recognized by unexperienced eye (ΔE ≥ 3.7). Immediately after application (T1), the highest color change (ΔE) was recorded in P7. While at 14 days and 3 months follow ups, color change in P4 exceeded P7. After 6 months the highest ΔE was recorded in both P4 and P7 with no significant difference between them. Meanwhile, in Accordance to treatment Protocol, The highest color change was recorded at 3 months (T3) in all treatment protocols. These records were preserved at 6 months follow-up (T4) for all treatment protocols except P1 and P3.
CONCLUSION: Combined treatment protocols of Opalustre and Opalescence boost PF 40% have the highest effect on ΔE regardless of using MI-Paste Plus. MI-Paste Plus provides stability of ΔE results at 6 months’ follow-up.
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Changes in the Color and Brightness of White Spots Associated with Orthodontic Treatment 6 Months after the Application of Infiltrative Resins: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159277. [PMID: 35954634 PMCID: PMC9368113 DOI: 10.3390/ijerph19159277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 12/10/2022]
Abstract
One of the risks that we find after orthodontic treatment is the secondary appearance of white spot lesions (WLS) after the removal of fixed multi-bracket appliances. Today, there are several treatment methods, resin infiltration being the most used in the most serious cases. The objective of this study is to carry out a systematic review and meta-analysis to determine the efficacy and stability in the variables of color and gloss, six months after resin infiltration. A comprehensive search was performed in the following databases: PubMed, Embase, Google Scholar, Scopus, Medline, and Web of Science. Articles published in the last 10 years were selected, including in vivo studies with a six-month follow-up. PRISMA guidelines were followed to carry out this systematic review. All studies where the application of resin was performed on carious lesions were discarded. Once the inclusion and exclusion criteria were applied, a final sample of four articles was obtained, on which the review and meta-analysis were carried out. Once examined, all authors considered that there was an immediate improvement in both variables. However, statistically significant differences were obtained in the color change outcome, but not in the brightness outcome in the subgroup analysis after six months of icon resin infiltration.
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Effect of Silver Diamine Fluoride and Potassium Iodide Solution on Enamel Remineralization and Discoloration in Artificial Caries. MATERIALS 2022; 15:ma15134523. [PMID: 35806648 PMCID: PMC9267504 DOI: 10.3390/ma15134523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/11/2022] [Accepted: 06/24/2022] [Indexed: 01/25/2023]
Abstract
Silver diamine fluoride (SDF) is a strong fluoride agent for caries control, remineralization, and reducing the incidence of dental caries. This study used 38% SDF with potassium iodide (KI) on enamel remineralization and compared it with the currently used 38% SDF and 5% sodium fluoride (NaF) varnish to treat artificial caries. Bovine incisors were demineralized for 120 h and randomly distributed for treatment by the remineralization agents for 120 h as follows: control (n = 15), SDF/KI (n = 15), SDF (n = 15), and NaF (n = 15). Colorimetric analysis was performed using the ΔE value. The Vickers microhardness (VHN) was determined to evaluate the enamel remineralization of the specimens. Polarized light microscopy (PLM) and scanning electron microscopy (SEM) were performed to confirm the surfaces precisely and histologically. SDF/KI caused no significant difference in discoloration between the control and NaF groups. There was also no significant difference in the VHN after remineralization, but SDF/KI exhibited the highest mean microhardness. PLM revealed that SDF/KI had the greatest remineralization ability. In conclusion, SDF/KI is effective for dental enamel remineralization even with KI, which reduces discoloration.
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Wang Y, Qin D, Guo F, Levey C, Huang G, Ngan P, Hua F, He H. Outcomes used in trials regarding the prevention and treatment of orthodontically induced white spot lesions: A scoping review. Am J Orthod Dentofacial Orthop 2021; 160:659-670.e7. [PMID: 34366187 DOI: 10.1016/j.ajodo.2021.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The objective was to identify and summarize the outcomes and evaluation methods used in clinical trials regarding the prevention and treatment of orthodontically induced white spot lesions (WSLs). METHODS Three electronic databases were searched to identify studies that were (1) clinical trials on prevention and/or treatment of orthodontically induced WSLs, (2) reported in English, and (3) published between January 2010 and October 2019. At least 2 authors assessed the eligibility and extracted the characteristics, outcomes, and evaluation methods from included studies. All disagreements were resolved through discussion. RESULTS Among 1328 studies identified, 51 were eligible and included. A total of 48 different outcomes and 11 different evaluation methods were used in these studies. The most frequently used outcomes were WSLs clinical visual examination scores (n = 22, 43.1%), DIAGNOdent values (n = 14; 27.5%), fluorescence loss measured with quantitative light-induced fluorescence (QLF) (n = 10; 19.6%), and lesion area measured with QLF (n = 10; 19.6%). The most frequently used evaluation methods were clinical examination (n = 25; 49.0%), visual inspection by photographs (n = 15; 29.4%), DIAGNOdent (n = 14; 27.5%), and QLF (n = 10; 19.6%). None of the included studies reported data on quality of life. CONCLUSIONS Substantial outcome heterogeneity exists among studies regarding the prevention and treatment of orthodontically induced WSLs. Most of the identified outcomes are aimed to assess morphologic changes of WSLs and may not reflect patient perspectives. REGISTRATION The Core Outcome Set for trials on the prevention and treatment of enamel White Spot Lesions (COS-WSL) project was registered in the COMET Initiative database (No. 1399).
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Affiliation(s)
- Yunlei Wang
- Department of Orthodontics, School and Hospital of Stomatology, Hubei-MOST KLOS & KLOBM, Wuhan University, Wuhan, China
| | - Danchen Qin
- Department of Orthodontics, School and Hospital of Stomatology, Hubei-MOST KLOS & KLOBM, Wuhan University, Wuhan, China
| | - Feiyang Guo
- Department of Orthodontics, School and Hospital of Stomatology, Hubei-MOST KLOS & KLOBM, Wuhan University, Wuhan, China
| | - Colin Levey
- School of Dentistry, University of Dundee, Dundee, United Kingdom
| | - Greg Huang
- Department of Orthodontics, School of Dentistry, University of Washington, Seattle, Wash
| | - Peter Ngan
- Department of Orthodontics, West Virginia University, Morgantown, WVa
| | - Fang Hua
- Department of Orthodontics and Center for Evidence-Based Stomatology, School and Hospital of Stomatology, Hubei-MOST KLOS & KLOBM, Wuhan University, Wuhan, China; Division of Dentistry, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
| | - Hong He
- Department of Orthodontics, School and Hospital of Stomatology, Hubei-MOST KLOS & KLOBM, Wuhan University, Wuhan, China.
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Bilge K, Kılıç V. Effects of different remineralizing agents on color stability and surface characteristics of the teeth following vital bleaching. Microsc Res Tech 2021; 84:2206-2218. [PMID: 33852758 DOI: 10.1002/jemt.23774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 11/06/2022]
Abstract
The aim of the study was to investigate the effects of various remineralizing agents on the color stability and surface characteristics of the teeth after vital bleaching. The extracted 96 human incisors were used for the study. Initially, the samples were randomly divided into two groups and exposed to in-office and at-home bleaching agents. Then, the groups were divided into six subgroups (n = 8), including the control group did not undergo remineralization after bleaching, according to five remineralizing agents (Gelato APF Gel, Remin Pro, Tooth Mousse, MI Paste Plus, Curodont Protect). Surface roughness was assessed at baseline, after bleaching and remineralization procedures. Color measurements of the samples were obtained at baseline, after bleaching and then after immersion in the staining solution following remineralization process. Scanning electron microscopy and atomic force microscopy (AFM) analyzes were carried out in order to examine the morphological changes on the surface of the enamel. The independent t-test, paired-samples t-test, and one-way ANOVA was used to compare the data and post-hoc LSD test to compare the difference among the study groups (α = .05). Surface roughness increased following in-office and at-home bleaching in all groups, and reduced after application of remineralizing agents in all groups. Significant differences were found among the groups with respect to changes in surface roughness and color values following treatment with remineralizing agents (p <.05). AFM analyses revealed increased surface roughness after bleaching and a reduction of rough surfaces following treatment with remineralizing agents. Remineralizing agents can be used to reduce postbleaching increase in surface roughness and to maintain color stability after bleaching.
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Affiliation(s)
- Kübra Bilge
- Department of Restorative Dentistry, Faculty of Dentistry, Firat University, Elazig, Turkey
| | - Vahti Kılıç
- Department of Restorative Dentistry, Faculty of Dentistry, Firat University, Elazig, Turkey
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Vicente A, Ortiz-Ruiz AJ, González-Paz BM, Martínez-Beneyto Y, Bravo-González LA. Effectiveness of a toothpaste and a serum containing calcium silicate on protecting the enamel after interproximal reduction against demineralization. Sci Rep 2021; 11:834. [PMID: 33437013 PMCID: PMC7804454 DOI: 10.1038/s41598-020-80844-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/23/2020] [Indexed: 01/08/2023] Open
Abstract
To evaluate the effectiveness of a calcium silicate/phosphate fluoridated tooth paste and a serum compared with a toothpaste containing hydroxyapatite on protecting the enamel after interproximal reduction against demineralization. 3 sets of eleven incisors were created. The teeth underwent interproximal enamel reduction (IER) of 0.5 mm. Each set was allocated to one of three groups: (1) Brushing without toothpaste (control group); (2) Vitis toothpaste + Remin Pro; (3) Regenerate toothpaste + Regenerate Serum. The agents were applied three times a day and specimens subjected to demineralization cycles for 30 days. The weight percentages of calcium (Ca) and phosphorous (P) were quantified by X-ray microfluorescence spectroscopy. Surface microhardness measurements and electron scanning microscopy (SEM) observations were made. Ca data and the Ca/P ratio were significantly higher in Group 3 than the other groups (p < 0.017), while P was significantly lower in Group 3 (p < 0.017). No significant differences were found between Groups 1 and 2 (p > 0.017). Group 3 showed significantly higher microhardness values (p < 0.05) than Group 1. No significant differences were found for other comparisons between groups (p < 0.05). SEM images showed less demineralization in Group 3. The application of a calcium silicate/phosphate fluoridated tooth paste (Regenerate advance) and a dual serum (Regenerate advance enamel serum) protect the enamel with interproximal reduction against demineralization. Therefore, this treatment could be used to prevent the dissolution of hydroxyapatite after IER.
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Affiliation(s)
- Ascensión Vicente
- Unit of Orthodontics, University Dental Clinic, University of Murcia, Murcia, Spain
| | - Antonio J Ortiz-Ruiz
- Department of Child Integrated Dentistry, Faculty of Medicine-Dentistry, University of Murcia, Murcia, Spain
| | - Belén M González-Paz
- Unit of Orthodontics, University Dental Clinic, University of Murcia, Murcia, Spain
| | - Yolanda Martínez-Beneyto
- Department of Preventive and Community Dentistry, Faculty of Medicine-Dentistry, University of Murcia, Avda Marqués de los Vélez. Morales Meseguer, Clínica Odontológica Universitaria 2ºplanta, 30008, Murcia, Spain.
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Effectiveness of remineralizing agents in the prevention and reversal of orthodontically induced white spot lesions: a systematic review and network meta-analysis. Clin Oral Investig 2020; 24:4153-4167. [PMID: 33057826 DOI: 10.1007/s00784-020-03610-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare the effectiveness of remineralizing agents in the prevention and reversal of white spot lesions (WSLs), which occur during fixed orthodontic treatment, through a systematic review and network meta-analysis. MATERIALS AND METHODS We reviewed controlled randomized clinical trial (RCT) data querying nine databases combined with a manual search (last search date: March 10, 2020). Of 2273 identified studies, 36 RCTs were finally included. After study selection and data extraction, pair-wise and network meta-analyses were performed to analyze the effectiveness of remineralizing agents in the prevention and reversal of WSLs in the short term (≤ 3 months) and long term (> 3 months). The risk of bias was assessed based on the Cochrane guidelines. Statistical heterogeneity, inconsistencies, and cumulative ranking were also evaluated. RESULTS In terms of WSL prevention, sodium fluoride (NaF) varnish had the highest cumulative ranking for the short-term decalcification index (99.3%); acidulated phosphate fluoride (APF) foam ranked first for long-term incidence (96.9%), followed by difluorosilane (Dfs) varnish and high-concentration fluoride toothpaste (HFT) (79.4% and 77.4%, respectively). In the reversal of WSLs, no significant difference was found among different agents or their combinations for the two available outcomes (short-term integrated fluorescence loss and short-term percentage of fluorescence loss). CONCLUSIONS In the prevention of WSLs, APF foam showed the best remineralizing effectiveness in the long term (after debonding), followed by Dfs varnish and HFT. It is unclear whether remineralizing agents can effectively reverse WSLs based on the existing evidence. CLINICAL RELEVANCE APF foam may be recommended as a remineralizing agent for preventing orthodontically induced WSLs. PROSPERO REGISTRATION NUMBER CRD42019116852.
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Yassaei S, Motallaei MN. The Effect of the Er:YAG Laser and MI Paste Plus on the Treatment of White Spot Lesions. J Lasers Med Sci 2020; 11:50-55. [PMID: 32099627 DOI: 10.15171/jlms.2020.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: White spot lesions (WSLs) occurring after orthodontic treatment lead to patient dissatisfaction and aesthetic problems. The role of calcium-phosphate demineralization systems and the Er:YAG laser in the treatment of these lesions has recently been taken into account. This study aimed to investigate the effect of the Er:YAG laser and MI Paste Plus on the treatment of WSLs. Methods: A total of 65 premolars extracted due to orthodontic treatment were studied in this research. To create enamel lesions, the teeth were placed in a demineralizing solution. The teeth were then randomly divided into five groups (n=13) as follows: first group, control; second group, saliva; third group, MI Paste Plus; fourth group, Er:YAG laser; and fifth group, MI Paste Plus together with the Er:YAG laser. The teeth were kept in artificial saliva between treatment processes. Artificial saliva was replaced daily with fresh artificial saliva. The teeth were sectioned longitudinally by a disc from the middle of the exposed enamel and each section was mounted in polyester resin. The surface of the samples was serially polished and the microhardness of the teeth was measured at depths of 0, 50, 100, and 150 µm. Results: The microhardness was significantly higher in the fifth group than other groups at depths of 50 and 150 µm (P <0.005). Using the laser or MI Paste Plus alone did not significantly increase the microhardness. Conclusions: The combined application of the Er:YAG laser and MI Paste Plus is effective in the treatment of WSLs.
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Affiliation(s)
- Soghra Yassaei
- Department of Orthodontics, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Nima Motallaei
- Research Center of Prevention and Epidemiology of Non-communicable Disease, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Rafiei E, Fadaei Tehrani P, Yassaei S, Haerian A. Effect of CO 2 laser (10.6 μm) and Remin Pro on microhardness of enamel white spot lesions. Lasers Med Sci 2020; 35:1193-1203. [PMID: 32006264 DOI: 10.1007/s10103-020-02970-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/22/2020] [Indexed: 11/28/2022]
Abstract
This study investigated the combined effect of CO2 laser irradiation and Remin Pro paste on microhardness of enamel white spot lesions (WSLs). Seventy-eight intact premolars were randomly assigned into six groups and then stored in a demineralizing solution to create WSLs. Afterwards, the teeth in group 6 (negative control) remained untreated, while groups 1 and 4 were exposed to CO2 laser irradiation (20 Hz, 1 W, 30 s) and Remin Pro paste, respectively. In groups 2 and 3, the teeth were exposed to laser either before (group 2) or after (group 3) Remin Pro application. The teeth in groups 1 to 5 were then immersed in artificial saliva for 90 days while subjected to fluoride mouthwash and weekly brushing. Finally, the teeth were sectioned, and Vickers microhardness was measured at the enamel surface and at 50, 100, and 150 μm from the surface. One sample of each group was also examined with scanning electron microscope (SEM). Data were analyzed by two-way analysis of variance (ANOVA) and Tukey's test. The significance was set at 0.05. Laser irradiation followed by Remin Pro application (group 2) caused a significant increase in total WSLs' microhardness compared with laser alone (group 1) and control groups (P < 0.05). Microhardness at depths of 100 and 150 μm was also significantly greater in group 2 compared with those of group 3 and control groups (P < 0.05). Combined application of CO2 laser with Remin Pro paste, when laser is irradiated before the paste, is suggested for re-hardening of WSLs in deep layers of enamel.
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Affiliation(s)
- Elahe Rafiei
- Department of Orthodontics, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Pooya Fadaei Tehrani
- Dental Students Research Center, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Soghra Yassaei
- Department of Orthodontics, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Alireza Haerian
- Department of Orthodontics, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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An In Vitro Study on the Effect of Amorphous Calcium Phosphate and Fluoride Solutions on Color Improvement of White Spot Lesions. Dent J (Basel) 2018; 6:dj6030024. [PMID: 29932119 PMCID: PMC6162429 DOI: 10.3390/dj6030024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/05/2018] [Accepted: 06/12/2018] [Indexed: 11/25/2022] Open
Abstract
The ability of remineralizing agents to improve the color of white spot lesions (WSL) is an important aspect that should be investigated. The aim of this study was to evaluate the effects of 0.05% amorphous calcium phosphate (ACP), 0.5% ACP, and 0.05% fluoride solutions, as well as artificial saliva on the color improvement of white spot lesions (WSLs). In this in vitro study, 50 human premolar teeth were randomly classified into five groups. At baseline, all the samples were assessed by using a colorimeter (E0). Then, white spot lesions were induced on the surface of the teeth by means of a pH-cycling model, and the colorimeter was used again (E1). Afterwards, samples of the 1st and 2nd groups were kept in 0.05% ACP and 0.5% ACP solutions for 1 min/day, respectively. The 3rd group specimens were placed in 0.05% fluoride solution for 1 min/day. The other two groups were kept in artificial saliva and distilled in water separately. All the samples were assessed by the colorimeter for a third time (E2). We found no significant difference between the groups in ∆E1. There was also no significant difference among 0.05% ACP solution, 0.5% ACP solution, 0.05% fluoride solution, and artificial saliva considering ∆E2. However, a significant difference was noted between the above-mentioned solutions and distilled water in ∆E2. With respect to ∆E3, there were considerable differences between ACP solution and artificial saliva. The same results were obtained for the difference between fluoride solution and artificial saliva. However, no significant difference was found among 0.05% ACP, 0.5% ACP, and 0.05% fluoride solutions in terms of ∆E3. In Conclusion, ACP is as effective as fluoride in the color improvement of WSLs and the recommended treatment for this purpose is daily use of 0.05% ACP, 0.5% ACP or 0.05% fluoride solutions.
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