Efficacy of Self-assembling Peptide P11-4 in Remineralizing In Vitro Caries-like Lesions in Primary Enamel Samples in Combination with Calcium Phosphate-based Remineralization Agents.

Aims and background: The efficacy of self-assembling peptide P11-4 in combination with calcium-phosphate-based remineralization agents in remineralizing caries-like lesions in primary enamel was evaluated using a 21-day pH cycling experiment by Vickers microhardness [Vickers hardness number (VHN)] and scanning electron microscopy (SEM). Materials and methods: A total of 120 primary enamel samples were made to undergo a demineralization cycle to produce caries-like lesions. They were divided into six groups, namely negative control (NC), positive control (P11-4), and four interventional groups in which each of the following calcium-phosphate-based agents were used in combination with P11-4-calcium sucrose phosphate (CSP), bioactive glass (BG), casein phosphopeptides, and casein phosphopeptides with fluoride. A 21-day pH cycling experiment was carried out with alternating demineralization and remineralization phases. The enamel samples were analyzed at baseline, post production of caries-like lesions, and post 21-day pH cycling using Vickers microhardness and SEM. Results were statistically analyzed using repeated measures of analysis of variance (ANOVA), keeping the level of significance at 0.05. Results: Supplementing P11-4 with calcium-phosphate-based agents improved the surface hardness of the demineralized primary enamel samples, among which the fluoridated milk protein-based remineralization agent yielded a statistically significant improvement. Conclusion: P11-4 promoted the regeneration of incipient caries-like lesions. However, there is added benefit when this peptide is used in combination with a fluoridated calcium-phosphate-based agent. Clinical significance: This study would help the clinician compose an effective regimen for the patient to follow at home posttreatment with P11-4, in-office treatment. How to cite this article: Krishnamoorthi A, Shanbhog RS, Godhi BS, et al. Efficacy of Self-assembling Peptide P11-4 in Remineralizing In Vitro Caries-like Lesions in Primary Enamel Samples in Combination with Calcium Phosphate-based Remineralization Agents. Int J Clin Pediatr Dent 2024;17(5):552-557.

Evaluation of the efficacy of various remineralization agents and grape seed extract on microhardness and lesion depth of primary tooth enamel: An in vitro study.

Background: This study evaluated the efficacy of grape seed extract (GSE) on the remineralization of primary tooth enamel alone or in combination with remineralizing agents. Methods: The initial microhardness value of 90 primary tooth enamel samples was calculated; then, the samples were demineralized. The post-demineralization hardness of the samples was measured and the samples were randomly divided into 6 groups as follows: G1: negative control, G2: GSE, G3: NaF, G4:Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), G5: GSE+NaF, and G6: GSE+CPP-ACP (n=15). Oral environment pH cycle was applied and hardness measurements were repeated after treatments. The samples were stained with 1% rhodamine B dye and sectioned, and the lesion depth was measured. Statistical significance was set at P<0.05. Results: The hardness decrease of the GSE and GSE+NaF groups was less than the other groups (P<0.05). The decrease was also less in the other groups than in the control group (P>0.05). GSE showed a positive effect when combined with NaF in maintaining microhardness but did not show the same effect when combined with CPP-ACP (P<0.05). Concerning penetration depth, all the groups had statistically lower values than the control group (P<0.05). The lowest penetration rates were observed in the GSE+NaF and GSE+CPP-ACP groups (P<0.05). Conclusion: The lowest hardness decrease was observed in the GSE and GSE+NaF groups, and the lowest penetration rates were observed in the GSE+NaF and GSE+CPP-ACP groups. It has been determined that a 15% GSE solution might be used as an alternative to fluoride in primary tooth remineralization and can increase the effectiveness of fluoride when used together.

Comparison of the Effect of Bioglass, Chitosan, and SDF Compounds on Remineralization of Primary Caries Lesions in Primary Teeth: An in vitro Study.

Statement of the Problem: Dental caries are among the most common oral and dental diseases affecting adults and children. To prevent caries, either the factors that cause caries should be reduced or the host resistance should be increased. Several compounds, such as bioglass, chitosan, and silver diamine fluoride (SDF), can enhance enamel remineralization. Purpose: This study was conducted to investigate the effects of chitosan, bioglass, chitosan-bioglass, and SDF compounds on remineralizing primary enamel lesions. Materials and Method: In this in vitro study, seventy-two primary canine teeth were collected. The teeth were exposed to a demineralization solution for 72 hours to create primary caries lesions. The primary Vickers microhardness test (VMT) was conducted to measure the initial values. The samples were randomly divided into six groups (n=12): Group 1: bioglass-chitosan solution; Group 2: chitosan; Group 3: bioglass solution; Group 4: SDF; Group 5: remineralization solution; Group 6: distilled water. The solutions of Groups 1, 2, and 3 were applied to the samples for 7 days, while the SDF solution was applied only once. The samples were immersed in an artificial saliva solution, which was refreshed daily. After the treatment, the final Vickers microhardness test (VMT) values were recorded. The data were analyzed statistically using a two-way ANOVA and Tukey's test (p< 0.05). Results: The results indicated a statistically significant effect of remineralizing compounds on both pre-treatment and post-treatment microhardness (p< 0.0001). However, no significant difference in microhardness was observed between the groups studied (p= 0.225). Conclusion: All the compounds utilized in this study demonstrated a significant remineralizing effect on enamel lesions caused by primary caries in primary teeth. The chitosan-bioglass and bioglass groups exhibited the highest levels of remineralization, respectively. However, the comparison between the groups yielded insignificant results due to the dispersion of the samples. Therefore, further studies with larger sample sizes are recommended.

Effect of Curing Light with Different Intensities on the Penetration of Silver and Fluoride Ions and Dentin Hardness in Primary Carious Molars Following Silver Diamine Fluoride Application: A Comparative Microscopic Ex Vivo Study.

Background: A paradigm shift from surgical to medical approach for caries management has popularized silver diamine fluoride (SDF) as a preventive and interim caries arrest medicament. Few studies conducted have explored the effect of curing light on SDF's microbial property, its penetration, and effect on dentin. However, there is a research gap regarding the effect of different intensities of curing light on SDF performance. Aim: To determine the effect of different curing light intensities on SDF penetration depth and dentin hardness in carious lesions of primary molars. Materials and methods: Silver diamine fluoride was applied on 30 extracted carious primary molars. Teeth were randomly allocated into three groups-(1) control group, no light curing after application of SDF; (2) light curing of SDF with low intensity (1000 mW/cm2); and (3) light curing of SDF with high intensity (2500 mW/cm2). A scanning electron microscopy (SEM) with energy dispersive X-ray (EDX) analysis was performed to check ion penetration after 1 week, and a Vickers hardness test was used to assess dentin hardness of both infected and affected dentin layers at 1-week and 1-month intervals. Based on the distribution of data, parametric and nonparametric tests were applied. Statistical Package for the Social Sciences (SPSS) version 26 was used for statistical analysis. The level of significance was set at 5%. Results: Silver diamine fluoride penetrated beyond the carious lesion in all three groups. The mean silver ion precipitation in infected dentin in group III (16.90 ± 0.68) was maximum, whereas it was found to be minimum in group II (7.31 ± 0.63). The mean fluoride ion precipitation in affected dentin in group III (4.06 ± 0.41) was highest and least in group II (3.09 ± 0.58). A considerable increase in mean dentin hardness of infected dentin was observed in all three groups (214.00 ± 89.06, 218.00 ± 75.17, 231.00 ± 98.86, respectively; p < 0.001) after 1 month. Conclusion: Applying SDF to carious lesions using a high-intensity dental curing light induced more silver ion precipitation in infected dentin and increased its hardness. How to cite this article: Bhatt R, Patel M, Thakkar A, et al. Effect of Curing Light with Different Intensities on the Penetration of Silver and Fluoride Ions and Dentin Hardness in Primary Carious Molars Following Silver Diamine Fluoride Application: A Comparative Microscopic Ex Vivo Study. Int J Clin Pediatr Dent 2024;17(7):766-772.

Preventing dentin erosion with silver diamine fluoride and salivary pellicle: an in vitro study.

OBJECTIVES: To investigate the preventive and discoloring effects of a single and two weekly applications of 38% silver diamine fluoride (SDF) against dentin erosion. MATERIALS AND METHODS: 180 dentin blocks were divided into four groups. Group 1 (SDF2) received two weekly applications of 38% SDF. Group 2 (SDF1) received a single application of 38% SDF. Group 3 (SNF) received a daily application of stannous chloride/amine fluoride/sodium fluoride (standard of care for dental erosion). Group 4 (DW) received a daily application of deionized water. The treated blocks were subjected to a 14-day erosive challenge. Crystal characteristics, elemental composition, surface morphology, percentage of surface microhardness loss (%SMHL), surface loss, and color change (ΔE) were investigated using X-ray diffraction (XRD), energy-dispersive spectrometry (EDS), scanning electron microscopy (SEM), hardness testing, profilometry, and digital spectrophotometry, respectively. RESULTS: XRD and EDS showed dentin surfaces had silver compounds in SDF2 and SDF1, and stannous chloride in SNF. SEM revealed less dentin demineralization with tubular occlusion in SDF2, SDF1, and SNF, but severe demineralization in DW. The %SMHL of SDF2, SDF1, SNF, and DW were 10.8 ± 2.1, 15.7 ± 2.1, 17.9 ± 2.1, and 28.7 ± 2.0 (SDF2 < SDF1 < SNF < DW, p < 0.05). Surface loss (µm) of SDF2, SDF1, SNF, and DW were 5.0 ± 0.6, 6.0 ± 0.6, 6.0 ± 0.7, and 9.0 ± 0.5 (SDF2 < SDF1 = SNF < DW, p < 0.001). ΔE of SDF2, SDF1, SNF, and DW were 26.0 ± 3.4, 12.1 ± 3.8, 6.9 ± 3.5, and 3.9 ± 3.6 (SDF2 > SDF1 > SNF = DW, p < 0.001). CONCLUSION: 38% SDF with two weekly applications provided better preventive effects against dentin erosion, but it might discolor dentin. CLINICAL RELEVANCE: The increased 38% SDF application showed a better anti-erosive potential against dentin erosion. However, SDF caused black staining on the dentin.

The effect of nano-hydroxyapatite and casein phosphopeptide-amorphous calcium phosphate with and without laser irradiation on the microhardness and surface morphology of demineralized primary enamel: An in vitro experimental study.

Background: Various topical gels, varnishes, and fluoride gels are being used by dentists for the treatment of White spot lesions (WSLs). The remineralizing effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), nano-hydroxyapatite (nHAp), and lasers has been proven earlier. This study was designed to evaluate the remineralizing effect of nHAp and CPP-ACP with and without erbium-doped yttrium aluminum garnet (Er: YAG) laser irradiation on demineralized primary enamel. The aim of this study was to evaluate the effect of CPP-ACP and nHAp with and without Er:YAG laser irradiation on the microhardness and surface morphology of demineralized primary enamel. Materials and Methods: The present study is an experimental in vitro study. Fifty extracted primary incisors were selected for the study. Following cleaning and sectioning, teeth were embedded in acrylic. The tooth models were divided into four groups randomly - Group 1 (CPP-ACP), Group 2 (nHAp), Group 3 (CPP-ACP + laser), and Group 4 (nHAp + laser). The baseline, postdemineralization, and postremineralization Vickers hardness testing was performed. One sample from each group was analyzed by scanning electron microscopy. Descriptive statistics such as frequencies and percentages for categorical data, mean and standard deviation for numerical data were depicted. The normality of numerical data was checked using the Shapiro-Wilk test. The level of significance was kept at 5%. Intergroup comparison (>2 groups) was done using one-way analysis of variance followed by pair-wise comparison using the post hoc test. Results: There was a statistically significant increase in surface microhardness in each group after remineralization. The highest increase in microhardness value was seen in Group 4 (nHAp + laser) followed by Group 3 (CPP-ACP + laser) and the least in Group 1 (CPP-ACP). Similar observations were made in scanning electron microscopic images. This indicated that nHAp has a comparable, if not better ability for remineralization than CPP-ACP. The remineralizing capacity of both the remineralizing agents was seen to be improved in this study when simultaneous laser application was employed. Conclusion: Currently, the evidence supporting the efficacy of nHAp dentifrices and laser in primary teeth is limited. Additional long-term in vivo studies employing standardized protocols and large sample sizes are necessary to draw definitive findings about the effect of remineralizing agents and lasers on primary enamel.

Effects of Dentifrices With Antierosive Potential on the Surface of Bovine Enamel Submitted to Acidic Beverage.

OBJECTIVES: To evaluate the effects of dentifrices containing sodium fluoride (NaF) combined with NovaMin (Sensodyne Repair & Protect-SRP), NaF combined with stannous fluoride (SnF2, Oral-B Pro-Gengiva-OBP), and amine fluoride (AmF, Colgate Elmex-ELM) on enamel subjected to simulated erosive cycling. MATERIALS AND METHODS: Bovine enamel-dentin discs (n = 10/group) were subjected to erosive cycling with orange juice (pH = 3.29, 5 min, 3x/day), artificial saliva (SA-2 h, 3x/day and overnight) and treated with dentifrice (2 min, 2x/day) or without treatment (CONT). Surface microhardness (SMH) was evaluated at baseline (T0), on the first (T1) and fifth (T5) days. SMH loss (%SHL) was calculated. Surface roughness (Ra, µm) was determined at T0 and T5. Morphology and mineral content were evaluated under scanning electron microscopy and energy-dispersive x-ray spectroscopy. Data were analyzed using ANOVA/Tukey or Bonferroni (α = 5%). RESULTS: No differences in %SHL were detected among groups at T1. At T5, OBP promoted %SHL, Ra, and ΔRa significantly lower than all the other groups (p < 0.05). All groups exhibited morphological changes in topography and similar Ca/P means before and after treatments. CONCLUSIONS: Dentifrice containing SnF2 minimized the negative effects on the SMH and Ra caused by exposure to orange juice after 5 days of simulated cycling. CLINICAL RELEVANCE: Patients who are more exposed to risk factors for dental erosion could benefit from the use of dentifrice containing SnF2.

Promising potential effects of resveratrol on oral and dental health maintenance: a comprehensive review.

Resveratrol (RV-3, 5, 4'-trihydroxystilbene) is a natural compound found in plants like red grapes, berries, and peanuts, with promising effects on dental health. It helps strengthen tooth enamel by promoting remineralization, making the teeth more resistant to decay caused by acid-producing bacteria. RV also shields dentin, a vulnerable layer beneath the enamel, from erosion and sensitivity. Its anti-inflammatory properties can reduce inflammation associated with dental conditions such as pulpitis and endodontic diseases. Moreover, RV's antimicrobial activity inhibits the growth of bacteria involved in dental plaque and biofilm formation, preventing their accumulation on the tooth surface. This contributes to a healthier oral environment and prolongs the lifespan of dental restorative materials. However, the research on RV's impact on dental health is in its early stages, and further studies are needed to confirm potential benefits. Important factors such as determining the optimal dosage, understanding its bioavailability, and assessing potential side effects require further investigation. This review focuses on the important role of RV in promoting dental health. It delves into various aspects, including its impact on root health, maintenance of the dental pulp, care for tooth enamel, effectiveness of dental restorative materials, and health of dentin.

Investigation of the effect of Tideglusib on the hydroxyapatite formation, crystallinity and elasticity of conditioned resin-dentin interfaces.

OBJECTIVES: To investigate the effect of dentin infiltration with polymeric nanoparticles (NPs) doped with tideglusib (TDg) (TDg-NPs) on hydroxyapatite formation, crystallinity and elasticity of conditioned resin-dentin interfaces. METHODS: Dentin conditioned surfaces were infiltrated with NPs or TDg-NPs. Bonded interfaces were created, stored for 24 h and submitted to mechanical and thermal challenging. Resin-dentin interfaces were evaluated through nanoindentation to determine the modulus of elasticity, X-ray diffraction and transmission electron microscopy through selected area diffraction and bright-filed imaging. RESULTS: TDg-NPs provoked peaks narrowing after the diffraction-intensity analysis that corresponded with high crystallinity, with an increased modulus of Young after load cycling in comparison with the samples treated with undoped NPs. New minerals, in the group of TDg-NPs, showed the greatest both deviation of line profile from perfect crystal diffraction and dimension of the lattice strain, i.e., crystallite, grain size and microstrain and 002 plane-texture. The new minerals generated after TDg-NPs application and mechanical loading followed a well defined lineation. Undoped NPs mostly produced small hydroxyapatite crystallites, non crystalline or amorphous in nature with poor maturity. CONCLUSIONS: Tideglusib promoted the precipitation of hydroxyapatite, as a major crystalline phase, at the intrafibrillar compartment of the collagen fibrils, enabling functional mineralization. TDg-NPs facilitated nucleation of crystals randomly oriented, showing less structural variation in angles and distances that improved crystallographic relative order of atoms and maturity. Nanocrystals inducted by TDg-NPs were hexagonal prisms of submicron size. Thermal challenging of dentin treated with TDg-NPs have provoked a decrease of functional mineralization and crystallinity, associated to immature hydroxyapatite. CLINICAL SIGNIFICANCE: New polycrystalline lattice formation generated after TDg-NPs infiltration may become correlated with high mechanical performance. This association can be inferred from the superior crystallinity that was obtained in presence of tideglusib. Immature crystallites formed in dentin treated with undoped NPs will account for a high remineralizing activity.

Morphological study of remineralization of the eroded enamel lesions by tyrosine-rich amelogenin peptide.

BACKGROUND: Tyrosine-rich amelogenin peptide (TRAP) is the main amelogenin digestion product in the developmental enamel matrix. It has been shown to promote remineralization of demineralized enamel in our previous study. However, direct evidence of the effect of TRAP on the morphology and nanostructure of crystal growth on an enamel surface has not been reported. This study aimed to examine the effect of TRAP on the morphology of calcium phosphate crystals grown on early enamel erosion using a pH-cycling model. METHODS: Eroded lesions were produced in human premolars by 30-second immersion in 37% phosphoric acid. Forty-five samples of eroded human premolar enamel blocks were selected and randomly divided into 3 groups: deionized water (DDW, negative control); 100 µg/mL TRAP, and 2 ppm sodium fluoride (NaF, positive control group). For 14 days, the specimens were exposed to a pH-cycling model. Using scanning electron microscopy (SEM) and atomic force microscopy (AFM) methods, the surface morphology, calcium-phosphorus ratio, and enamel surface roughness were examined. X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FT-IR) were used to assess crystal characteristics. RESULTS: After pH-cycling, compared to the two control groups, the surface of the eroded enamel of the peptide TRAP group shows a large number of new, densely arranged rod-like crystals, parallel to each other, regularly arranged, forming an ordered structure, with crystal morphology similar to that of natural enamel. The crystals are mostly hydroxyapatite (HA). CONCLUSION: This study demonstrates that the peptide TRAP modulates the formation of hydroxyapatite in eroded enamel and that the newly formed crystals resemble natural enamel crystals and promote the remineralization of enamel, providing a promising biomaterial for remineralization treatment of enamel lesions.

A bifunctional lactoferrin-derived amyloid coating prevents bacterial adhesion and occludes dentinal tubules via deep remineralization.

Dentin hypersensitivity (DH) manifests as sharp and uncomfortable pain due to the exposure of dentinal tubules (DTs) following the erosion of tooth enamel. Desensitizing agents commonly used in clinical practice have limitations such as limited depth of penetration, slow remineralization and no antimicrobial properties. To alleviate these challenges, our study designed a lactoferrin-derived amyloid nanofilm (PTLF nanofilm) inspired by the saliva-acquired membrane (SAP). The nanofilm utilises Tris(2-carboxyethyl)phosphine (TCEP) to disrupt the disulfide bonds of lactoferrin (LF) under physiological conditions. The PTLF nanofilm modifies surfaces across various substrates and effectively prevents the early and stable adhesion of cariogenic bacteria, such as Streptococcus mutans and Lactobacillus acidophilus. Simultaneously, it adheres rapidly and securely to demineralized dentin surfaces, facilitating in-situ remineralization of HAP through a simple immersion process. This leads to the formation of a remineralized layer resembling natural dentin, with an occlusion depth of dentinal tubules exceeding 80 µm after three days. The in vivo and vitro results confirm that the PTLF nanofilm possesses good biocompatibility and its ability to exert simultaneous antimicrobial effects and dentin remineralization. Accordingly, this innovative bifunctional PTLF amyloid coating offers promising prospects for the management of DH-related conditions. STATEMENT OF SIGNIFICANCE.

Nanotechnology and Its Application in Dentistry: A Systematic Review of Recent Advances and Innovations.

Background: This study looks at the clinical applications of nanotechnology in dentistry, with an emphasis on implantology, preventive care, orthodontics, restorative dentistry, and endodontics. Methods: Following PRISMA criteria and registered in PROSPERO (ID: CRD 564245), a PubMed, Scopus, and Web of Science search was conducted for studies from January 2014 to April 2024. The criteria were English-language research on nanotechnology in dental coatings, with a focus on clinical trials and observational studies. The electronic database search yielded 8881 publications. Following the screening process, 17 records were selected for qualitative analysis. Results: Nanotechnology has revolutionized dentistry. In orthodontics, nanoparticles improve antibacterial characteristics, durability, and biocompatibility, lowering bacterial colonization and plaque. In preventative care, Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) combined with stannous fluoride (SnF2) and nano-sized sodium trimetaphosphate (TMPnano) substantially remineralizes enamel. Nanostructured surfaces in dental implants, particularly those containing calcium, improve osseointegration and stability. Nanoparticles in restorative dentistry improve composite and adhesive strength, aesthetics, and longevity. Conclusions: Nanotechnology improves dental materials and equipment, resulting in better treatment outcomes and increased patient comfort. Its integration provides more effective treatments, which improves dental care and patient outcomes. More research is needed to overcome present problems and expand nanotechnology's medicinal applications.

Promotion effect of proanthocyanidin on dentin remineralization via the polymer induced liquid precursor process.

Proanthocyanidin (PA) has demonstrated promise as a dental biomodifier for maintaining dentin collagen integrity, yet there is limited evidence regarding its efficacy in dentin repair. The aim of this study was to investigate the effect of PA on dentin remineralization through the polymer induced liquid precursor (PILP) process, as well as to assess the mechanical properties of the restored dentin. Demineralized dentin was treated with a PA-contained remineralization medium, resulting in the formation of PA-amorphous calcium phosphate (ACP) nanoparticles via the PILP process. The kinetics and microstructure of remineralized dentin were examined through the use of Fourier transform infrared spectroscopy(FTIR), attenuated total reflectance-FTIR, scanning electron microscopy, transmission electron microscopy. The results showed that the application of PA facilitated the process of dentin remineralization, achieving completion within 48 h, demonstrating a notable reduction in time required. Following remineralization, the mechanical properties of the dentin exhibited an elastic modulus of 15.89 ± 1.70 GPa and a hardness of 0.47 ± 0.08 GPa, which were similar to those of natural dentin. These findings suggest that combining PA with the PILP process can promote dentin remineralization and improve its mechanical properties, offering a promising new approach for dentin repair in clinical practice.

Comparing the remineralization potential of undemineralized dentin powder versus chicken eggshell powder on artificially induced initial enamel carious lesions: an in-vitro investigation.

BACKGROUND: White spot lesions are a widespread undesirable effect, especially prevalent during fixed orthodontic treatments. The study compared the in vitro enamel remineralization potential of undemineralized dentin matrix (UDD) versus chicken eggshell powder (CESP) for artificially induced enamel lesions. METHODS: 100 caries-free and sound maxillary premolars were randomly divided into four groups each contain 25 teeth: Group I (Baseline): No treatment was done to the enamel surface. Group II (Negative control ): The enamel surface of the teeth underwent demineralization using demineralizing solution to create artificial carious lesions then kept in artificial saliva. Group III (CESP treated): After demineralizing the tooth surface, the teeth have been suspended in the CESP remineralizing solution. Group IV (UDD treated): After enamel demineralization, the teeth were suspended in UDD remineralizing solution. The remineralization potential was assessed by Vickers microhardness testing, scanning electron microscopic examination (SEM), and energy dispersive X-ray (EDX). RESULTS: The current study demonstrated an increase in the mean microhardness of CESP and UDD-treated groups; however, It was nearer to the baseline level in the UDD group. SEM imaging revealed greater enamel remineralization in the UDD group compared to the remaining groups. The UDD group disclosed complete coverage for the prismatic enamel compared to the CESP group, which revealed a partially remineralized enamel surface. Interestingly, the Ca/P ratio increased significantly in the CESP group compared to the negative control group. In contrast, a higher significant increase in the mean Ca/P ratios was recorded in the UDD group compared to the test groups. CONCLUSION: biomimetic UDD and CESP powder should be utilized to treat enamel early carious lesions. However, UDD demonstrated the most significant remineralization potential.

Comparison of various chitosan-based in situ forming gels with sodium fluoride varnish for enamel biomineralization: an in-vitro pH cycling model.

This study aimed to evaluate chitosan (CS)-based formulations loaded with 5% sodium fluoride (NaF) and/or 10% nanohydroxyapatite (nHA) to remineralize the demineralized primary tooth enamel surface. Ninety enamel blocks were demineralized and were divided into six groups (n = 15): (1) CS-based hydrogel, (2) CS-based hydrogel loaded with NaF, (3) CS-based hydrogel loaded with nHA, (4) CS-based hydrogel loaded with NaF and nHA, (5) 5% NaF varnish, and (6) negative control with no intervention. After intervention, the specimens were pH cycled by 2 h immersion in demineralizing solution and 22 h immersion in remineralizing solution for 8 days. The remineralization effects were evaluated by Vickers microhardness measurements and field emission scanning electron microscopy coupled with energy-dispersive X-ray spectrometry (FESEM-EDS). The best mean ± SD percentage microhardness recovery in remineralized enamel (%REMH) was found in group 4 (56.90 ± 5.49). The %REMH of groups 2 (30.74 ± 3.51) and 5 (29.23 ± 5.65) were statistically the same (p = 0.943). FESEM images confirmed partial coverage of the porous demineralized enamel with a newly formed mineralized layer. Based on EDS findings, the Ca/P ratio values of the treated enamel surfaces with CS-based hydrogels ranged between 1.71 and 1.87, and the highest F content was noticed in group 2 (1.02 ± 0.03). Although, all tested CS-based hydrogels demonstrated the potential to repair demineralized enamel, nHA- and NaF-containing CS-based hydrogel showed the highest remineralization effect. We infer that this new hybrid hydrogel is a potentially useful dental material for tooth biomineralization.

Evaluation of REFIX Technology on the Remineralization of Artificial Early Enamel Caries Lesion by Laser Speckle Tracking Analysis.

OBJECTIVE: To assess the effectiveness of the REFIX technology in the remineralization process of initial caries simulated on bovine enamel. The assessment involved the analysis of backscatter intensity, which was determined from laser speckle images. METHOD: Twenty-one bovine teeth were divided into three groups: G1 and G7 were submitted to treatment with the REFIX technology for 1 and 7 days, respectively. The control group was treated with deionized water. RESULTS: A significant difference in backscatter was found between the carious and sound areas in all groups (p = 0.0038, p < 0.0001, and p = 0.0002 for the control group, G1, and G7, respectively). The intergroup comparison revealed no significant difference among the groups studied. CONCLUSION: REFIX technology did not alter the optical properties of the samples of bovine teeth with simulated initial caries lesions after 1 and 7 days of treatment.

Effects of silver diammine fluoride with/without potassium iodide on enamel and dentin carious lesions in primary teeth.

Aim: To assess the effects of SDF and SDF+KI treatment on enamel and dentin carious lesions in primary teeth using x-ray Microtomography (XMT) and back scattered scanning electron microscopy (BSE-SEM). Methods: Artificial enamel caries of 3 caries free primary teeth were created by immersion of the samples in 50 ml demineralization solution for 72 h. Three other teeth with natural dentin caries were selected. Both groups were divided into 3 subgroups: EC-Enamel Control; ES-Enamel with SDF application; ESK-Enamel with SDF followed by KI application; DC-Dentin Control; DS-Dentin with SDF application; DSK-Dentin with SDF followed by KI application. Each tooth was imaged using XMT at 3 time points: (1) Pretreatment; (2) after immersion in remineralization solution for 120 h, with or without SDF or SDF+KI; (3) after subsequent immersion in demineralization solution for 72 h. The change of radiopacities of the lesions in these time points were assessed from the XMT images. After the XMT scans, all teeth were investigated microscopically using BSE-SEM. Results: In EC, no change in linear attenuation coefficient (LAC) was observed after remineralization, but LAC reduction was observed after subsequent demineralization. For ES, thin layer of high LAC material was deposited on the enamel surface after remineralization, and further reduction of LAC was observed after demineralization. In ESK, the surface layer was lost after SDF+KI, and small reduction of LAC was observed after demineralization. In DC, no LAC change was observed after remineralization, but reduction of LAC was detected after demineralization. In DS, high LAC material was formed on the carious dentin surface and randomly inside the lesion. No further LAC change was found after demineralization. In DSK, thick layer of high LAC material was deposited on the carious surface and inside the dentinal tubules. No further LAC reduction was found after subsequent demineralization. Conclusion: SDF and SDF+KI did not protect artificial enamel under acid attack even though Ag products were deposited in the porous enamel. However, SDF and SDF+KI shows protective properties against acid challenges and Ag products are deposited in carious dentin lesion without tubular structure randomly; and within dentinal tubules when these structures are retained.

Remineralizing effect of NSF on artificial enamel caries.

INTRODUCTION: Nanotechnology offers new approaches and endless opportunities for remineralizing tooth decay without being toxic or causing allergies. This study aimed to determine the effect of nanosilver fluoride (NSF) on the remineralization potential of enamel caries-like lesions compared to 5% sodium fluoride varnish in permanent teeth. METHODS: Fifteen teeth (molars and premolars) were gathered, cleaned, and polished using a scaler. After sectioning the teeth mesiodistally and removing the roots, the thirty specimens were subjected to a demineralized solution to induce early enamel lesions and then assigned randomly into two equal groups. The test materials were applied, and then all the specimens were subjected to a pH cycling model for 30 days. DIAGNOdent and surface roughness were investigated, and an evaluation of the enamel Ca and P weight% for Ca/P ratio calculation was done using SEM-EDX to analyze the specimens at the end of the study. The data were analyzed using an independent t-test. RESULTS: The mean values for the DIAGNOdent measurements for NSF and NaF at baseline and after demineralization were not significantly different (p > 0.05). After treatment, NaF varnish showed a significantly higher mean DIAGNOdent measurement (11.8 ± 5.80) than NSF (4.7 ± 1.6). The mean surface roughness of the NaF group (1.64 ± 0.39) was much higher than NSF's mean surface roughness (1.07 ± 0.21). Specimens treated with NSF had statistically significant smoother surfaces (p < 0.001). The NSF group had a higher mean Ca/P ratio (2.9 ± 0.35) than NaF (2.2 ± 0.11). This difference was statistically significant (p = 0.012). CONCLUSION: The study reveals that nano silver fluoride is a more effective treatment than sodium fluoride varnish in enhancing teeth's clinical characteristics, particularly in terms of mineral content and surface roughness, suggesting it could be an improved strategy to prevent dental caries and maintain enamel integrity.

White Spot Lesions in Fixed Orthodontics: A Literature Review on Etiology, Prevention, and Treatment.

White spot lesions (WSLs) are a common complication after treatment using fixed orthodontic appliances. Decalcification of enamel surrounding fixed orthodontic appliances, known as WSLs, poses a significant aesthetic difficulty during and after treatment, as the purpose of fixed orthodontic therapy is to improve facial and dental appearance. Modern dentistry utilizes remineralization therapies to non-invasively treat WSLs to prevent the progression of disease and enhance the strength, appearance, and functionality of the affected tooth. This review aims to identify and assess the etiology, formation, and risk factors, as well as current treatment approaches used in achieving WSLs remineralization, induced by fixed orthodontic appliances. An electronic search on the PubMed and ScienceDirect databases was performed using a selected keyword. A total of 172 studies (from 2013 to 2023) were retrieved. Their references were also checked to find other relevant studies. Duplicate copies were excluded. After the abstract and full-text screening, only 39 studies were included. Even though numerous studies address the different treatment modalities for managing post-orthodontic WSLs, such as antiseptics; fluorides such as dentifrices, mouthwash, and varnish, and remineralizing agents such as casein phosphopeptides amorphous calcium phosphate, biomimetic self-assembling peptides, lasers, bleaching, microabrasion, and resin infiltration. There is a lack of evidence-based studies that examine the long-term effects of WSL treatment. Further well-performed controlled clinical trials with long-term follow-up are needed to establish best clinical practice.

Unraveling Nanomaterials in Biomimetic Mineralization of Dental Hard Tissue: Focusing on Advantages, Mechanisms, and Prospects.

The demineralization of dental hard tissue imposes considerable health and economic burdens worldwide, but an optimal method that can repair both the chemical composition and complex structures has not been developed. The continuous development of nanotechnology has created new opportunities for the regeneration and repair of dental hard tissue. Increasingly studies have reported that nanomaterials (NMs) can induce and regulate the biomimetic mineralization of dental hard tissue, but few studies have examined how they are involved in the different stages, let alone the relevant mechanisms of action. Besides their nanoscale dimensions and excellent designability, NMs play a corresponding role in the function of the raw materials for mineralization, mineralized microenvironment, mineralization guidance, and the function of mineralized products. This review comprehensively summarizes the advantages of NMs and examines the specific mineralization mechanisms. Design strategies to promote regeneration and repair are summarized according to the application purpose of NMs in the oral cavity, and limitations and development directions in dental hard tissue remineralization are proposed. This review can provide a theoretical basis to understand the interaction between NMs and the remineralization of dental hard tissue, thereby optimizing design strategy, rational development, and clinical application of NMs in the field of remineralization.