Bleaching as a complement to fluoride-enhanced remineralization or resin infiltration in masking white spot lesions.

OBJECTIVE: There are many suitable strategies for addressing caries, which is an ongoing worldwide problem. Although white spot lesions (WSLs) can be either remineralized naturally or treated with non- or micro-invasive strategies, their whitish and opaque appearance may persist. To evaluate the effects of tooth bleaching as a complement to fluoride-enhanced remineralization or resin infiltration in masking WSLs, as well as in enamel surface roughness relative to that of the adjacent enamel. METHODOLOGY: Flattened rectangular bovine enamel fragments (6×3×~2.9 mm length, width and thickness) were divided into six groups (L/N, F/N, F.BL/BL, I/N, I.BL/BL, N/N; n=15). Treatments applied to the 3×3 mm left half included: L (Lesion) - WSL simulation with 50 mM acetate buffer, 96 hours, 37ºC; F (Fluoride) - WSL treatment with 2% NaF neutral gel, 1x/week, 8 weeks; I (Infiltration) - WSL treatment with H3PO4 37%/10 s; Icon®-Dry/30 s; Icon®-Infiltrant/3 min+1 min; N (Nothing) - sound enamel/control. Treatments applied to both halves after F and I included: BL (Bleaching) - Opalescence Boost 40%, 3×/20 min each; N (Nothing) - control. The differences in color (ΔE00, ΔL, Δa, Δb) and surface roughness (ΔRa) between the left and right halves were measured. Kruskal-Wallis/post-hoc tests were applied to ΔE00, ΔL, Δa and ΔRa, and 1-way ANOVA/Tukey tests to Δb (α=0.05). RESULTS: The factor under study significantly influenced ΔE00 (p=0.0001), ΔL (p=0.0024), Δb (p=0.0015), and ΔRa (p<0.001), but not Δa (p=0.1592). Both fluoride-enhanced remineralization and resin infiltration were able to mask WSL, regardless of subsequent bleaching. However, when bleaching was performed, ΔE00 median values did not exceed the acceptability threshold for color difference. Only resin infiltration reduced ΔRa between WSL and the adjacent enamel. CONCLUSIONS: Both remineralization and infiltration, particularly if complemented by bleaching, fostered satisfactory esthetic results. Only infiltration without bleaching led to really good results in surface roughness.

Incorporating an artificially synthesized fluoride complex into urethane-acrylate-based 3D printing resin: Effects on mechanical properties, cytotoxicity, antimicrobial actions, and its long-term fluoride-releasing properties.

OBJECTIVES: To synthesize a 3D printing resin with antibacterial and long-term fluoride-releasing properties. METHODS: (4,4-Bis-4-[2­hydroxy-3-(2-methacryloyloxy)propoxy]-phenyl-pentanol-amine)-N,N-diacetic acid zirconium (IV) fluoride complex was synthesized from 4,4-bis-(4-hydroxyphenyl)-pentanoic acid and monitored using proton nuclear magnetic resonance spectroscopy. The synthesized complex was incorporated into a urethane-acrylate-based (UA) resin at 5 wt% and 10 wt% (5F-UA and 10F-UA groups, respectively). The UA resin without the synthesized complex was considered as the control group. All groups were 3D printed using a DLP printer, followed by 10 min of washing and 20 min of curing. Surface characteristics were observed using scanning electron microscopy. The mechanical properties were assessed by measuring its flexural strength and Vickers hardness. The antibacterial property was investigated with direct and indirect contact tests and a WST-8 metabolic activity assay. The suspension was fully mixed and diluted for counting the number of colony-forming units. The cell viability test was performed using a cell proliferation assay. The amount of fluoride released was measured daily for 28 days using ion chromatography. One-way analysis of variance was performed for statistical analyses using SPSS software. RESULTS: The amount of fluoride released increased with the concentration of fluoride complex in the resin. The fluoride ions were constantly released at a low concentration from the 3D printed specimens (5F-UA: around 0.13 ppm daily; 10F-UA: around 0.22 ppm daily). The antibacterial efficacy was acceptable in both the 5F-UA and 10F-UA groups, and higher in the latter. No cytotoxicity of the resin was detected. The mechanical properties were significantly influenced by the addition of the fluoride-releasing complex. CONCLUSIONS: The present 3D printing UA resin incorporating a fluoride complex effectively inhibited the growth of S. mutans and demonstrated the ability to slowly release fluoride over an extended period of time. CLINICAL SIGNIFICANCE: This study provided informative composition of a fluoride-releasing UA-based 3D printing resin, ideal for dental applications such as crowns, bridges, removable partial dentures, and orthodontic appliances, which can benefit from sustained fluoride release and antimicrobial properties. Further modifications to the resin composition can be easily achieved to enhance the resin qualities.

In-vitro and in-vivo comparative studies of treatment effects on enamel demineralization during orthodontic therapy: implications for clinical early-intervention strategy.

OBJECTIVES: This study aimed to investigate if CPP-ACP / infiltrating resin was superior in treating enamel demineralization during orthodontic therapy compared with fluoride varnish, in order to provide early-intervention implications for dental professionals. MATERIALS AND METHODS: In the in-vitro study, premolars were grouped into four: remineralization with fluoride varnish / CPP-ACP, sealing with infiltrating resin, and negative control. Experimental demineralization of enamel surfaces was analyzed using techniques of QLF, SEM, EDS and micro-hardness testing. An in-vivo intervention study was conducted on patients randomly assigned into three groups. At the baseline and every-3-month follow-up, QLF parameters were compared temporally and parallelly to yield potential implications for promotion in clinical practice. RESULTS: The in-vitro study performed on 48 experimental tooth surfaces demonstrated that sealing with infiltrating resin reduced enamel surface porosity and increased surface micro-hardness significantly. In the in-vivo intervention study on 163 tooth surfaces, it was suggested that for those who meet the criteria of -10 < ΔF < -6 and - 1000 < ΔQ < -20 at the baseline, all these treatment methods could achieve acceptable outcomes; with the rising of absolute values of ΔF and ΔQ, sealing with infiltrating resin showed more evident advantages. CONCLUSION: For enamel demineralization during orthodontic therapy, all the treatment methods involved in this study showed acceptable effectiveness but had respective characteristics in treatment effects. QLF parameters could be used as indicators for clinical early-intervention strategy with regards to this clinical issue. CLINICAL RELEVANCE: With QLF parameters, clinical early-intervention strategy for enamel demineralization during orthodontic therapy could be optimized.

Effect of combining aminomethacrylate and fluoride against erosive and abrasive challenges on enamel and dentin.

This study evaluated the effect of solutions containing aminomethacrylate copolymer (AA) and sodium fluoride (F; 225 ppm F-) or fluoride plus stannous chloride (FSn; 225 ppm F-, 800 ppm Sn2+) against enamel and dentin erosion/abrasion. Solutions F, FSn, AA, F+AA, FSn+AA, and deionized water as negative control were tested. Bovine enamel and dentin specimens (n = 13/solution/substrate) underwent a set of erosion-abrasion cycles (0.3% citric acid [5 min, 4×/day], human saliva [1 h, 4×/day], brushing [15 s, 2×/day], and treatments [2 min, 2×/day]) for each of five days. Initial enamel erosion was evaluated using Knoop microhardness after the first and second acid challenge on day 1, and surface loss with profilometry after day 5. KOH-soluble fluoride was assessed. Data were analyzed with ANOVA/Tukey tests. The combination of fluoride and AA resulted in higher protection against enamel erosion, whereas this was not the case for the combination of AA and FSn. All treatments protected against enamel and dentin loss. The lowest surface loss values were observed with F+AA and FSn+AA. The polymer did not significantly influence the KOH-soluble fluoride formation on enamel/dentin specimens. The aminomethacrylate copolymer effectively enhanced the efficacy of sodium fluoride against initial erosion and improved the control of enamel and dentin wear of F and FSn solutions.

Effects of graphene oxide and graphene quantum dots on enhancing CPP-ACP anti-caries ability of enamel lesion in a biofilm-challenged environment.

OBJECTIVE: To investigate the anticaries effects of graphene oxide (GO) and graphene quantum dots (GQDs) combined with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on enamel in a biofilm-challenged environment. MATERIAL AND METHODS: GO and GQDs were synthesised using citric acid. The antibiofilm and biofilm inhibition effects for Streptococcus mutans were evaluated by scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM), and colony-forming units (CFU). Remineralisation ability was determined by assessing mineral loss, calcium-to-phosphorus ratio, and surface morphology. To create a biofilm-challenged environment, enamel blocks were immersed in S. mutans to create the lesion and then subjected to artificial saliva/biofilm cycling for 7 days. Anticaries effects of GO, GQDs, GQDs@CPP-ACP, GO@CPP-ACP, and CPP-ACP were determined by broth pH and mineral changes after 7-day pH cycling. Biocompatibility was tested using a Cell Counting Kit-8 (CCK8) assay for human gingival fibroblasts (HGF-1). RESULTS: GQDs and GO presented significant antibiofilm and biofilm inhibition effects compared to the CPP-ACP and control groups (P < 0.05). The enamel covered by GQDs and GO showed better crystal structure formation and less mineral loss (P < 0.05) than that covered by CPP-ACP alone. After 7 days in the biofilm-challenged environment, the GO@CPP-ACP group showed less lesion depth than the CPP-ACP and control groups (P < 0.05). GO and GQDs showed good biocompatibility compared to the control group by CCK8 (P > 0.05) within 3 days. CONCLUSION: GO and GQDs could improve the anti-caries effects of CPP-ACP, and CPP-ACP agents with GO or GQDs could be a potential option for enamel lesion management. CLINICAL SIGNIFICANCE: GO and GQDs have demonstrated the potential to significantly enhance the anticaries effects of CPP-ACP. Incorporating these nanomaterials into CPP-ACP formulations could provide innovative and effective options for the management of enamel lesions, offering improved preventive and therapeutic strategies in dental care.

Synergistic effects of arginine and fluoride on human dental biofilm control.

OBJECTIVES: The aim of this study was to quantitatively and comprehensively investigate the combined effects of arginine and fluoride on the suppression of pathogenicity using an in situ biofilm model and next-generation sequencing (NGS). METHODS: Using the in situ model, dental biofilms were formed and the viable bacterial counts and arginine activity in the arginine- and fluoride-containing dentifrice and control groups were measured. We also compared their effects on the bacterial microbiota and predictive functional factors in the control, arginine (arg), and arginine + fluoride (argF) groups using NGS analysis. RESULTS: Compared to the control treatment, the use of 8 % arginine and 1450 ppm fluoride toothpaste resulted in significantly high oral NH4+ concentrations without affecting the number of viable bacteria (P < 0.05). NGS analysis revealed that the oral microbiota of the control, arg, and argF groups were significantly different. Heat map analysis of the predicted functional factors revealed that the arg group had different properties from the other groups and activated specific substrate metabolic pathways; contrastingly, argF treatment inhibited the activity of these pathways and prevented an increase in the abundance of bacterial genera that utilize substrates such as sucrose, suggesting the synergistic effect of arginine and fluoride. CONCLUSIONS: This study indicates that the combination of arginine and fluoride has a synergistic effect on the bacterial microbiota and pathogenicity of dental biofilms compared with arginine alone. CLINICAL SIGNIFICANCE: Our findings suggest that the combination of arginine and fluoride could be used as an effective prebiotic and may inhibit the growth of bacteria associated with dental diseases.

Antimicrobial effect of two fluoride-releasing adhesive tapes on Streptococcus mutans biofilm.

Fluoride-releasing adhesive tapes have been developed as a new fluoride delivery agent. However, application as caries prevention agents remains underexplored. This study aimed at evaluating the antimicrobial activity of two fluoride-releasing adhesive tapes against S. mutans biofilm. Two polyvinyl alcohol (PVA) tapes were investigated: (i) a fluoride-PVA (F-PVA) tape, (ii) a pullulan incorporated F-PVA (PF-PVA) tape. S. mutan strains were cultured and treated with the tapes. Antimicrobial effects were evaluated using the agar diffusion test, field-emission scanning electron microscopy (FE-SEM), and confocal laser scanning microscopy (CLSM). F-PVA tapes showed higher inhibition-zone diameters than PF-PVA at 48 h and 72 h. However, there were no significant differences (p > 0.05) between the effects of F-PVA and PF-PVA. The bio-volume of S. mutans and extracellular polymeric substances significantly decreased in the F-PVA tapes than in the PF-PVA tapes (p < 0.05). FE-SEM micrographs revealed less S. mutans colonization in F-PVA. F-PVA exhibited better antimicrobial activity against S. mutans than PF-PVA.

Adding calcium phosphate agents alongside fluorides may enhance caries prevention and remineralization, although evidence is limited.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Effectiveness of Calcium Phosphate derivative agents on the prevention and remineralization of caries among children- A systematic review & meta-analysis of randomized controlled trials. Singal K, Sharda S, Gupta A, Malik VS, Singh M, Chauhan A, Agarwal A, Pradhan P, Singh M. J Evid Based Dent Pract. 2022; 22(3):101746. SOURCE OF FUNDING: Indian Council of Medical Research. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

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.

The use of silver diamine fluoride to prevent/treat enamel carious lesions: a narrative review.

This comprehensive literature review examines the use of silver diamine fluoride (SDF) for the prevention and treatment of enamel carious lesions. SDF has been approved by different international drug associations as a caries-preventing agent to be used on deep carious lesions (dentin). However, SDF can cause staining of exposed tooth structures. Furthermore, the effect of SDF on the bond of adhesives to the tooth structure is still being determined. This review explores various studies on the use of SDF to treat enamel carious lesions, highlighting its effectiveness and preventive action. The literature suggests that SDF inhibits bacterial growth, promotes remineralization, and does not negatively affect adhesive retentions. Potassium iodide (KI) or glutathione (GSH) can reduce staining and discoloration. However, the reviewed studies have limitations. Further research, including well-designed clinical trials, is necessary to validate the findings and evaluate the long-term implications of SDF treatment. Conclusion: Despite the above-mentioned limitations, SDF shows potential as a therapy for enamel caries prevention, remineralization, and use as an adjuvant to other dental treatments, warranting further investigation and the refinement of application methods.

Preventing proximal enamel caries in neighboring tooth with glass ionomer cement restoration and silver diamine fluoride pretreatment.

OBJECTIVE: To investigate caries preventive effects of 38 % silver diamine fluoride (SDF) pretreatment on neighboring tooth proximal to glass ionomer cement (GIC), including conventional GIC (CGIC) and resin-modified GIC (RMGIC) restorations in an in vitro model. METHODS: HUMAN TOOTH BLOCKS WERE RESTORED WITH: SDF+CGIC (Group 1), CGIC (Group 2), SDF+RMGIC (Group 3) or RMGIC (Group 4). Enamel specimen simulating proximal surface of neighboring tooth was placed in proximity to the restorations. The specimen underwent cariogenic challenge with cross-kingdom biofilm of Streptococcus mutans, Lacticaseibacillus casei and Candida albicans. After cariogenic challenge, the biofilm's growth kinetics, viability, and morphology were evaluated by propidium monoazide-quantitative polymerase chain reaction (PMA-qPCR), confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM), respectively. The enamel lesion depth, surface morphology and crystal characteristics were determined by micro-computed tomography (micro-CT), SEM and X-ray diffraction (XRD), respectively. RESULTS: PMA-qPCR demonstrated lower microbial growth in Group 1 and 3 compared with Group 2 and 4 (p < 0.05). CLSM showed the dead-to-live ratio in Groups 1-4 were 1.15±0.12, 0.53±0.13, 1.10±0.24 and 0.63±0.10, respectively (Group 1,3 > 2,4, p < 0.05). SEM revealed Groups 1 and 3 had scattered biofilm whereas Group 2 and 4 had confluent biofilm. Micro-CT showed the enamel lesion depths (µm) were 98±9, 126±7, 103±6 and 128±7 for Group 1 to 4, respectively (Group 1,3 < 2,4, p < 0.05). SEM revealed oriented and ordered enamel prismatic patterns in Group 1 and 3, not in Group 2 and 4. XRD showed the reflections of hydroxyapatite in Groups 1 and 3 were sharper than Groups 2 and 4. CONCLUSION: SDF pretreatment enhances the preventive effect of GIC on proximal enamel surface on neighboring tooth through inhibiting cariogenic biofilm, reducing enamel demineralization and promoting enamel remineralization. CLINICAL SIGNIFICANCE: SDF pretreatment of GIC restorations can help prevent caries on neighboring teeth, particular for patients with high caries risk.

In vitro assessment of NaF/Chit supramolecular complex: Colloidal stability, antibacterial activity and enamel protection against S. mutans biofilm.

OBJECTIVES: This study assessed the effect of NaF/Chit suspensions on enamel and on S. mutans biofilm, simulating application of a mouthrinse. METHODS: The NaF/Chit particle suspensions were prepared at molar ratio [NaF]/Chitmon]≈0.68 at nominal concentrations of 0.2 % and 0.05 % NaF and characterized by Fourier transform infrared spectroscopy (FTIR), dynamic light scattering and zeta potential. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were measured. The S. mutans biofilm was formed for 7 days on eighty human enamel blocks that were divided into eight groups (n = 10/group): i) 0.05 % NaF solution; ii) 0.31 % Chit solution; iii) NaF/Chit(R=0.68) suspension at 0.05 % NaF; iv) 1.0 % HAc solution (Control); v) 0.2 % NaF solution; vi) 1.25 % Chit solution; vii) NaF/Chit(R=0.68) suspension at 0.2 % NaF; viii) 0.12 % chlorhexidine digluconate. The substances were applied daily for 90 s. S. mutans cell counts (CFU/mL) were performed, and the Knoop microhardness (KHN) of enamel samples were measured before and after biofilm formation. The KHN and CFU/mL data were analyzed by repeated measure ANOVA and Tukey's test (α = 0.05). RESULTS: Interactions between NaF and Chit were evidenced in solid state by FTIR spectra. The NaF/Chit complexes showed spontaneous microparticle formation and colloidal stability. The MIC and MBC ranged from 0.65 to 1.31 mg/mL. The NaF/Chit(R=0.68) suspension at 0.2 %NaF Group showed lower CFU/mL values than other groups. The NaF/Chit(R=0.68) suspensions Groups had the highest KHN values after biofilm formation. CONCLUSIONS: The NaF/Chit(R=0.68) complexes exhibited an antibacterial effect against S. mutans biofilm and reduced the enamel hardness loss. CLINICAL SIGNIFICANCE: The NaF/Chit(R=0.68) suspensions showed potential to be used as a mouthrinse for caries prevention.

Developing a novel antibacterial copper tetraamine fluoride.

OBJECTIVE: To develop a novel and biocompatible copper tetraamine fluoride (CTF) with antibacterial and nondiscolouring properties. METHOD: This study used copper fluoride and ammonia solution to develop CTF solution. The CTF was characterized by X-ray photoelectron spectroscopy (XPS). Cytotoxicity was evaluated by stem cells from human exfoliated deciduous teeth (SHED) and human gingival fibroblasts (HGF-1). The fluoride concentration was determined using ion-selective electrode. The alkalinity was measured by a pH electrode. The human dentine blocks were treated with CTF and then incubated with Streptococcus mutans to evaluate the antimicrobial and discolouring effects. The silver diamine fluoride (SDF) was employed as the positive control, and water was the negative control. The colony-forming units (CFUs) and confocal laser scanning microscopy (CLSM) were used to examine the kinetics and viability of the biofilm. The discolouring property on dentine was assessed by spectrophotometry. One-way analysis of variance with the Bonferroni post hoc test was performed to assess and compare the data. RESULTS: XPS confirmed synthesis of CTF solution. The half-maximal inhibitory concentration of CTF on SHED and HGF-1 was 195±16 ppm and 137±11 ppm. The fluoride concentration was 121,000±5,000 ppm. The pH value was 9. Log10 CFU of the CTF, SDF and water group were 5.0 ± 0.2, 4.9 ± 0.1 and 7.4 ± 0.1 (p < 0.001, CTF, SDFWater). Spectrophotometry showed that the ΔE of the CTF, SDF and water group were 5 ± 2, 6 ± 3 and 45±2 (p < 0.001, CTF, Water

The combination of arginine and fluoride-containing bioactive glass acted synergistically in inhibiting enamel demineralization in permanent teeth.

OBJECTIVES: To evaluate the in-vitro efficacy of inhibiting enamel demineralization using arginine in combination with fluoride-containing bioactive glass (FBG). METHODS: In this study, the healthy enamel blocks were first demineralized in acetic acid for 24 h, then soaked in anti-demineralization treatment solutions containing either arginine or FBG or both for 96 h.The specimens treated in acetic acid were applied as the control group. The pH, calcium and phosphorus ion concentrations of the solutions were measured before and after treatment. Changes in enamel mineral weight, microhardness, and composition were also analyzed. RESULTS: The present of arginine facilitated fluorine release from treatment solutions with the presence of FBG. Both arginine and FBG significantly increased the pH of treatment solutions and prevented the further mineral weight loss compared to the control group. All anti-demineralization treatment groups showed significant increases in microhardness, but there was no statistical difference among the treatment groups. The SEM analysis showed enamel restoration in the arginine and FBG groups upon treatment, while the combined groups showing a superior anti-demineralization efficacy. 19F NMR showed the formation of fluorapatite in samples treated with solutions containing FBG. CONCLUSIONS: Both arginine and FBG could inhibit enamel demineralization to some extent, and their combination demonstrated an enhanced anti-demineralization efficacy. The low-concentration combination group exhibited anti-demineralization effects comparable to those of high-concentration ones. CLINICAL SIGNIFICANCE: This study introduces a new approach for caries prevention by combining the application of arginine and FBG. The release of fluorine promoted by the presented arginine along with calcium and phosphorus ions from FBG facilitated FAP formation. Additionally, the increment of pH resulting from arginine and FBG degradation further prevents enamel demineralization.

Effect of Biomin F toothpaste and Diode laser on remineralization of white spot lesions (in vitro study).

BACKGROUND: White-spot lesions are considered an initial carious stage characterized by an outer enamel layer with significantly reduced mineralization. This study was conducted to assess the combined effect of Biomin F toothpaste and Diode laser on remineralization of white spot lesions. MATERIALS AND METHODS: An invitro study conducted on a total of 30 premolars divided into three groups; Group A (Biomin F Tooth paste), Group B (Biomin F with laser application for 30 sec), Group C (Negative control). The three groups were submitted to three stages; stage 1:Baseline,stage 2:After demineralization ,and stage 3:After remineralization. In each stage, elemental analysis(calcium, phosphorus, and fluoride)was measured quantitatively using Energy Dispersive X-ray (EDX) analysis and qualitatively by micrographs using scanning electron microscope. The data were tested to find significant difference between mineral changes during stages by using (ANOVA) test and Bonferroni test. RESULTS: Calcium, phosphorus and fluoride ions decreased in all groups after demineralization. In stage 3, after application of remineralizing agents, Calcium ions increased significantly in groups A and B where p<.05. As regards to the phosphorus ions, a significant increase was observed in all groups with group A showed the highest gain as phosphorus level percentage change (%mass) was 56.52±18.02 . Fluoride ions increased significantly in groups A and B (p<0.05) but decreased significantly in group C. There was no statistical significant difference between group A and B (p ≥.05) in calcium, phosphorus, and fluoride level after remineralization. CONCLUSION: Within the limitation of the present study, we concluded that Biomin F toothpaste is promising in the repairing of white spot lesions on the surface of the demineralized enamel. Diode laser did not affect the remineralizing ability of Biomin F toothpaste.

Effect of the use of remineralization agents before resin infiltration on the treatment of initial enamel lesions: an in-vitro study.

AIM: This study aimed to evaluate the effect of the use of remineralization agents before the application of resin infiltration on the treatment of initial enamel lesions. MATERIALS AND METHODS: Eighty buccal enamel samples were prepared from human molars, and artificial initial lesions were formed after 96 h of incubation with a demineralizing solution. The samples were randomly divided into 8 groups (n = 10) including a remineralizing agent (Tooth Mousse, Medical Mineral Gel, Remin Pro), resin infiltration (ICON), and a combined treatment of both. Remineralizing agents were applied in pH cycle for 7 days. Baseline, demineralization, and after-treatment fluorescence (FluoreCam and DIAGNOdent Pen), surface microhardness (HMV-2T), surface roughness (M300C), OCT (Maestro-2) and ultrasonic system (Novascope 4500) data were obtained for all groups. The sample surfaces were examined under SEM/EDX (SU3500) at x1000. Data were statistically analyzed using the Two-Way Robust ANOVA and Bonferroni tests (p < 0.05). RESULTS: There was no statistically significant difference between the groups for microhardness, roughness, OCT, DIAGNOdent Pen, ultrasound, and FluoreCam size/intensity values (p = 0.582; p = 0.963; p = 0.884; p = 0.923; p = 0.051; p = 0.268; p = 0.793 respectively). The effect of the treatment procedure showed a significant difference (p < 0.001), except for the roughness values (p = 0.984). The lowest Calcium (Ca) ratio (%atomic) was observed in the RI group in the EDX analysis. CONCLUSION: Remineralizing agents and resin infiltration methods may be used in combination or alone in the treatment of initial enamel lesions. Combining remineralizing agents with resin infiltration does not alter the efficacy of the treatment.

Evaluation of Staining Propensity of Silver Diamine Fluoride With and Without Potassium Iodide in Children (Project Healthy Smiles): Protocol for a Randomized Controlled Trial.

BACKGROUND: Silver diamine fluoride (SDF) is becoming more widely recognized as a simple, cost-effective approach to minimize sensitivity and arrest caries. However, SDF results in caries that are stained black. Potassium iodide (KI) treatment with SDF may minimize or lessen the staining. However, the effectiveness of KI on staining has not been investigated. Studies demonstrating that potassium iodide reduces the black staining are still insufficient. This paper presents the study protocol for Healthy Smiles, a randomized controlled trial implemented to compare the staining propensity of SDF and SDF+KI. OBJECTIVE: This study, Healthy Smiles, aims to evaluate the staining propensity of SDF and SDF+KI using a Nix Mini color sensor among children aged 4 to 6 years. Another objective of the study is to evaluate the caries-arresting effect of SDF and SDF+KI in the treatment of carious primary teeth. METHODS: This study is a randomized controlled trial. A total of 60 children with caries that meet the criteria of the International Caries Detection and Assessment System (code 1 or above) will be randomly assigned to treatment groups, where group 1 will be treated with SDF and group 2 will be treated with SDF+KI. Discoloration of treated lesions will be assessed digitally using a Nix Mini color sensor. Participants will be followed up at 1, 3, and 6 months after treatment to digitally record the ∆L and ∆E values using the Nix Mini color sensor. Data will be analyzed using SPSS (version 28; IBM Corp). Independent sample t tests and the Mann-Whitney U test will be used to compare the 2 groups. RESULTS: Enrollment started in October 2023. It is estimated that the enrollment period will be 12 months. Data collection is planned to be completed in 2024. CONCLUSIONS: The presented paper describes Happy Smiles, a project that provides an opportunity to address the aesthetic inconvenience of patients without compromising the effectiveness of the SDF treatment. The trial findings will contribute to the limited evidence base related to discoloration after SDF intervention to improve aesthetic appearances in child oral health. If the results from the trial are promising, it will lead to the development of a model for child oral health and pave the way for further research in child oral health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/51087.

Qualitative and quantitative evaluation of enamel surface roughness and remineralization after interproximal reduction: An in vivo study.

INTRODUCTION: Interproximal reduction (IPR) damages the caries protective superficial layer of the enamel, making the enamel surface prone to caries because of the increase in surface roughness. Remineralizing solutions can help in preventing these undesirable side effects. Therefore, this study aimed to compare the effect of nanohydroxyapatite (nHAp) and sodium fluoride (NaF) application on enamel remineralization after IPR and to evaluate changes in surface roughness, composition, and microhardness of the treated enamel. METHODS: A total of 25 patients with Angle's Class I malocclusion, requiring 4 premolar extractions, were selected and randomly divided into 5 groups (n = 5). Group 1 served as the control. In group 2, the extraction of premolars was done immediately after IPR, and in group 3, the extraction of premolars was done 3 months after IPR. In group 4, the extraction of premolars was performed 3 months after IPR with weekly application of nHAp serum. In group 5, the extraction of premolars was performed 3 months after IPR, along with once-a-month application of NaF varnish. The proximal reduction of premolars in all the groups was done using Strauss IPR burs (Strauss Diamond Instruments, Palm Coast, Fla). The extracted teeth were sectioned, and the enamel surfaces were subjected to energy-dispersive x-ray spectroscopy to evaluate elemental composition. Vicker's microhardness test was used to evaluate enamel hardness and atomic force microscopy for enamel surface roughness. Descriptive statistics were calculated for the 5 groups using a 1-way analysis of variance, and Tukey's multiple post-hoc test was used for intergroup comparison. RESULTS: Calcium-to-phosphorous ratio, enamel microhardness, and surface roughness were found to be closest to untouched enamel in patients treated with nHAp, followed by patients who were treated with NaF. A lower calcium-to-phosphorous ratio and weakened and roughest enamel surface was seen in teeth, which were extracted immediately after IPR. CONCLUSIONS: Among the remineralizing agents tested, nHAp serum can be recommended for better remineralization of enamel surfaces after IPR.

In vitro effect of TiF4/NaF solution on the development of radiation-induced dentin caries.

OBJECTIVE: To evaluate the protective effect of an experimental solution containing TiF4/NaF on the development of radiation-induced dentin caries lesions. METHODOLOGY: bovine root samples were irradiated (70Gy) and distributed as following (n=12/group): Commercial Saliva (BioXtra), NaF (500 ppm F-), TiF4 (500 ppm F), TiF4/NaF (TiF4: 300 ppm F-, NaF: 190 ppm F-), and Phosphate buffer solution (PBS, negative control). Biofilm was produced using biofilm from irradiated patients and McBain saliva (0.2% of sucrose, at 37oC and 5% CO2) for five days. The treatments were applied 1x/day. Colony-forming units (CFU) were counted and demineralization was quantified by transversal microradiography. The ANOVA/Tukey test was applied for all parameters. RESULTS: All treatments reduced CFU for total microorganisms. TiF4 reduced Lactobacillus sp. (7.04±0.26 log10 CFU/mL) and mutans streptococci (7.18±0.28) CFU the most, when compared to PBS (7.58±0.21 and 7.75±0.17) and followed by NaF (7.12±0.31 and 7.34±0.22) and TiF4/NaF (7.16±0.35 and 7.29± 0.29). TiF4 and Commercial saliva showed the lowest integrated mineral loss (ΔZ-vol%.mm) (1977±150 and 2062±243, respectively) when compared to PBS (4540±335), followed by NaF (2403±235) and TiF4/NaF (2340±200). Commercial saliva was the only to significantly reduce mineral loss (LD-µm) (111±25) compared to PBS (153±24).Mean mineral loss (R-vol%) decreased by 35.2% for TiF4 (18.2±3.3) when compared to PBS (28.1±2.9) Conclusion: TiF4/NaF has a comparable anti-cariogenic effect to TiF4 and Commercial saliva under the model in this study.