[Cup-shaped tooth wear defects: more than erosive challenges?] / Komvormige defecten in occlusale vlakken van molaren: meer dan alleen erosieve belasting?

The underlying mechanism of the development of cups and grooves on occlusal tooth surfaces is still unclear. The aim of this study was to evaluate factors contributing to in-vitro cup formation, and to elucidate the clinical process. Extracted human molar teeth were exposed to acidic aqueous solutions at pH of 4.8 and 5.5 in combination with different loading conditions: no load (0N, control), 30N or 50N. Before and after 3 months exposure, the samples were scanned using a non-contact profilometer. A statistically significant difference between a loading of 0N and 50N was found at pH 4.8 (p < 0.002). Cup shaped lesions had formed only at pH of 4.8, in the 30N and 50N groups. The study showed that a cup can arise fully in enamel and that this requires simultaneous acidic and mechanical loading.

Gap size and wall lesion development next to composite.

This in situ study investigated whether there is a relationship between gap size and wall lesion development in dentin next to 2 composite materials, and whether a clinically relevant threshold for the gap size could be established. For 21 days, 14 volunteers wore a modified occlusal splint containing human dentin samples with 5 different interfaces: 4 gaps of 50 µm, 100 µm, 200 µm, or 400 µm and 1 non-bonded interface without a gap. Eight times a day, the splint with samples was dipped in a 20% sucrose solution for 10 minutes. Before and after caries development, specimens were imaged with transversal wavelength-independent microradiography (T-WIM), and lesion depth (LD) and mineral loss (ML) were calculated at the 5 different interfaces. After correction for the confounder location (more mesial or distal), a paired t test clustered within volunteers was performed for comparison of gap widths. Results showed no trend for a relationship between the corrected lesion depth and the gap size. None of the differences in lesion depth for the different gap sizes was statistically significant. Also, the composite material (AP-X or Filtek Supreme) gave no statistically significant differences in lesion depth and mineral loss. A minimum gap size could not be established, although, in a non-bonded interface without a measurable gap, wall lesion development was never observed.

A multifunctional device to simulate oral ageing: the "Rub&Roll".

UNLABELLED: This article describes an in vitro fatigue and/or wear simulator enabling controlled application of force, speed, type of liquids and duration, to mimic challenges representative for the human oral environment. The device consists of a container in which a cylinder with specimen holder is placed which drives another cylinder (rod). The rod rotates in an opposite direction to the rotation of the stirring motor, rolling over the specimens mounted in the cylinder. When the rod contacts the specimen a force is applied to mimic processes in the oral environment. The design, working and construction principles of a new device, the Rub&Roll, and some of the possible applications are described Four different application examples are presented: occlusal wear in an low acidic abrasive slurry; combined erosive and abrasive wear of enamel exposed to apple juice or apple pulp; the wear of sealant material in natural teeth in an abrasive slurry; and the influence of mechanical loading cycles on micro tensile bond strength of an adhesive system to dentin Application of the "Rub & Roll" device showed results which are clinically relevant, reproducible and in accordance with existing literature. CONCLUSIONS: The Rub&Roll enables controlled application of chemical and mechanical loading, allowing variation of force, sliding distance, velocity, number of cycles, and frequency, and a combination with erosive and abrasive challenges representative of those in the oral environment.

Hydrodynamic flow through loading and in vitro secondary caries development.

This in vitro study investigated the effect of hydrodynamic flow through mechanical loading on development of secondary caries lesions. Forty-eight bovine tooth specimens (enamel and dentin; sizes 3.2 x 3.2 x 2.0 mm) were restored with resin-composite on polystyrene bars; 18 samples were bonded, and 30 were not bonded. Specimens were suspended in a lactic acid solution (pH = 5; 14 days) in a modified brushing machine, and artificial caries lesions were formed. During caries development, specimens were mechanically loaded at the surface of the polystyrene bar, bent so that the tooth- composite interfaces were subjected to opening forces (16x/min). Loads applied were either none (Control Bonded, CB, n = 6; and Control Non-bonded, CNB, n = 6), 200 gr (NB200, n = 12), or 350 gr (NB350 and B350, both n = 12). Before and after caries development, specimens were imaged with transverse wavelength-independent microradiography (T-WIM), and lesion depth (LD) and mineral loss (ML) were calculated at 4 different locations. An independent t test was used to compare the LD and ML at the 4 different locations. A statistically significant effect of the level of loading (comparing groups NB200 and NB350) and of bonding (comparing groups NB350 and B350) could be observed, with a higher load and absence of bonding leading to more advanced lesions.

Estimated erosive potential depends on exposure time.

OBJECTIVES: Evaluate erosive potential of beverages, using exposure times from 3 to 30 min, and to analyse the relationship between erosion and several drink parameters. METHODS: pH, calcium, phosphate and fluoride concentration, saturation, titratable-acidity to pH 5.5 and the viscosity of sixteen beverages were measured or calculated. Enamel samples (N = 90) were serially exposed to 1 ml of the beverages for 3, 6, 9, 15 and 30 min and erosion was measured as the loss of calcium to the beverage. Rate of erosion per min was calculated by linear curve fitting using all exposure times. Linear regression analysis was performed to determine the correlation between erosion and the drink parameters. A limited multivariate analysis was performed for the outcome parameter with the highest univariate correlations (erosion per minute) and 4 drink variables. RESULTS: A negative relationship was observed only for pH for all exposure times. Only for erosion per min a significant relationship with pH and saturation was found. In a model for erosion per min using only saturation, fluoride concentration, titratable acidity and viscosity, both saturation and viscosity were shown to have a significant effect (p = 0.01 and p = 0.05, respectively). CONCLUSION: Exposure times between 3 and 30 min result in very different estimates of erosive potential. There is no sound theoretical ground for preferring one or other exposure time/outcome as being more clinically relevant. CLINICAL RELEVANCE: This study shows that effect of the choice of study methodology on the measurement of erosive potential of beverages is large.

Reduction of erosive wear in situ by stannous fluoride-containing toothpaste.

BACKGROUND/AIMS: Stannous fluoride (SnF) has been suggested as a dental erosion-preventive agent. The aim of this single-centre, randomized, double-blind, in situ study was to evaluate the effect of toothpastes with SnF in the prevention of erosive enamel wear. METHODS: A combined split-mouth (extra-oral water or toothpaste brushing) and crossover (type of toothpaste) set-up was used. Twelve volunteers wore palatal appliances containing human enamel samples. Three toothpastes were used, in three consecutive runs, in randomized order: two toothpastes containing SnF (coded M and PE) and one toothpaste containing only sodium fluoride (coded C). On day 1 of each run the appliances were worn for pellicle formation. On days 2-5 the samples were also brushed twice with a toothpaste-water slurry or only water (control). Erosion took place on days 2-5 extra-orally 3 times a day (5 min) in a citric acid solution (pH 2.3). Enamel wear depth was quantified by optical profilometry. The effect of toothpastes was tested using General Linear Modeling. RESULTS: Average erosive wear depth of control samples was 23 µm. Both SnF toothpastes significantly reduced erosive wear: M by 34% (SD 39%) and PE by 26% (SD 25%). The control toothpaste reduced erosive wear non-significantly by 7% (SD 20%). Both SnF-containing toothpastes significantly reduced erosive wear compared to the sodium fluoride toothpaste. CONCLUSION: We conclude that SnF-containing toothpastes are able to reduce erosive tooth wear in situ.

In vitro reduction of dental erosion by low-concentration TiF4 solutions.

The aims of this study were to compare daily versus single applications of low-concentration TiF(4) solutions for reduction of enamel erosion and to evaluate the enamel surface loss due to application of these solutions. Sixty bovine enamel samples were randomly divided into 2 groups: single versus daily treatment with TiF(4) solution (ST vs. DT), which were subdivided into 5 subgroups (n = 6): 0% (control); 0.1, 0.5, 0.75 and 1% TiF(4) concentration. Fluoride treatment was performed by immersing specimens in 10 ml of the TiF(4) solutions for 5 min and rinsing them with tap water for 30 s. ST specimens were treated once only, DT specimens were treated before each erosion cycle. All specimens were subjected to 4 erosion cycles: 6 immersions of 2 min in Sprite, tap water rinse for 1 min and storage in artificial saliva for 1.5 h. Erosive enamel loss was measured using light profilometry, after each fluoride treatment and each erosive cycle. The values of surface loss/gain at application of the TiF(4) solutions did not significantly differ from zero. At the end of the 4 erosion cycles, 0.5% showed the least (ST: 3.45 ± 0.27 µm, DT: 1.08 ± 1.69 µm) and 1% showed the most surface loss (ST: 4.87 ± 1.13 µm, DT: 6.56 ± 1.49 µm). A significant reduction of surface loss was found only for 0.5% DT (p = 0.009). Within the limitations of an in vitro study, it was concluded that multiple applications of a 0.5% TiF(4) solution significantly reduced enamel erosion in vitro and caused no enamel loss at application.

Vivosorb as a barrier membrane in rat mandibular defects. An evaluation with transversal microradiography.

Vivosorb is a new degradable membrane composed of poly(DL-lactide-epsilon-caprolactone) (PDLLCL). The aim of this study was to appraise its performance in guided bone regeneration procedures. In 192 rats a 5.0 mm defect was drilled in the mandibular angle. The defects were covered with a membrane (PDLLCL, collagen, or expanded polytetrafluoroethylene (ePTFE)) or left uncovered (control). Defect closure, mineralization and thickness of the new bone were assessed by means of transversal microradiography at three different time intervals (2, 4 and 12 weeks). The data were analysed using multiple regression analyses. The regression analyses showed significant effect modification between time and collagen and time and ePTFE for mineralization of the newly formed bone. For defect closure and bone thickness all membrane-treated groups showed effect modification between time and membrane; these effects were more significant and larger in the collagen and ePTFE groups. In the non-treated controls no effect modification was observed. The membrane groups showed significantly better results than the control groups. The ePTFE and collagen membranes performed equally well and better than the PDLLCL membrane during this experiment. It was concluded that a PDLLCL membrane is not suitable for clinical application in its current form.

The influence of barrier membranes on autologous bone grafts.

In implant dentistry, there is continuing debate regarding whether a barrier membrane should be applied to cover autologous bone grafts in jaw augmentation. A membrane would prevent graft remodeling with resorption and enhance graft incorporation. We hypothesized that membrane coverage does not effect resorption and incorporation of autologous onlay bone grafts. We treated 192 male Sprague-Dawley rats. A 4.0-mm-diameter bone graft was harvested from the right mandibular angle and transplanted to the left. Poly(DL-lactide-epsilon-caprolactone), collagen, and expanded polytetrafluoroethylene membranes were used to cover the grafts. The controls were left uncovered. Graft resorption at 2, 4, and 12 weeks was evaluated by post mortem microradiography and microCT. Analysis of the data showed no significant differences among the 4 groups. This demonstrates that the indication of barrier membrane use, to prevent bone remodeling with resorption and to enhance incorporation of autologous onlay bone grafts, is at least disputable.

Influence of beverage composition on the results of erosive potential measurement by different measurement techniques.

The influence of beverage composition on the measurement of erosive potential is unclear. The aim of this study was to evaluate whether beverage composition influences the measurement of erosive potential and to evaluate the influence of exposure in small and large volumes. Eleven beverages were included: water (control), 3 alcopops, 2 beers and 5 soft drinks. For each beverage 15 bovine enamel samples were used: 5 for chemical and 10 for profilometric analysis. After exposure to the beverages (63 min) the resulting solutions were analyzed for Ca and inorganic phosphorus (P(i)) content. The samples for optical profilometry were submersed sequentially in 500 ml or in 1 ml of the drinks for 3, 6, 9, 15 and 30 min (total 63 min). For some of the beverages high baseline concentrations of Ca (energy drink) or P(i) (cola drink, cola lemon drink, beer, beer lemon) were found. Some of the beverages showed a good correlation between the chemical methods. Profilometry (both for 1 and 500 ml) showed generally lower enamel losses than the chemical methods. Lower enamel losses were found for the profilometry 1 ml compared to the profilometry 500 ml only for the cola drinks. It can be concluded that the composition of the beverages had a significant effect on the determination of the erosive potential with chemical analyses. Drink composition also influenced the effect of small versus large exposure volumes, indicating the need for standardization of exposure parameters.

Approximal secondary caries lesion progression, a 20-week in situ study.

There is no consensus about the definition and progression of outer and wall lesions in secondary caries. In this study we investigated whether lesion progression is influenced by an adjacent composite restoration and whether wall lesions develop at the composite-tooth interface. In order to study the appearance and progression of approximal primary caries lesions and lesions next to composite restorations, 16 samples were placed in a full denture of each of 8 subjects. Each denture housed 4 restored and 4 unrestored enamel samples and similarly 8 dentin samples. All samples were distributed over 2 sample holders, in each of which 4 approximal spaces were simulated. Every 4 weeks the sample holders were microradiographed using transversal wavelength independent microradiography and lesion depth was measured. At the end of the study, after 20 weeks, the lesion depth of the outer lesions was 0-350 microm for enamel and 0-750 microm for dentin. The estimated difference in progression between secondary and primary lesions (1.1 microm/4 weeks, 95% CI: -9.2 to 11.4 microm) was not statistically significant (p = 0.83). Secondary outer lesions appeared and progressed as primary caries lesions. No clear wall lesions were found next to composite, but they were observed next to acrylic resin.

Inhibition of erosive wear by fluoride varnish.

It has been suggested that fluoride products with a protective mechanical component are advantageous in the prevention of erosive wear. The aim of this study was to evaluate in situ the effect of fluoride varnish (FV) in the prevention of wear due to erosion and combined erosion and toothbrush abrasion. Eleven volunteers wore for 3 weeks, during working hours, appliances containing 2 control and 2 FV-treated human enamel samples. Erosion took place extraorally 3 times a day (5 min) in the soft drink Sprite. At the end of each experimental day one control and one FV sample (C-er+abr and FV-er+abr) were brushed (5 s) with fluoridated dentrifice. The remaining control and FV sample (C-er and FV-er) were left unbrushed. Enamel volume loss was quantified by optical profilometry at day 5, 10 and 15. A statistically significant progression in enamel loss was found for the C-er, C-er+abr and FV-er+abr groups (p < 0.001, p < 0.001 and p = 0.001, respectively) but not for the FV-er group (p = 0.053). The values of cumulative normalized volume loss (x10(8) mum) at day 15 were: C-er 5.53 +/- 2.14, C-er+abr 5.70 +/- 2.07, FV-er 0.79 +/- 0.67 and FV-er+abr 2.76 +/- 1.35. The FV-er and FV-er+abr groups showed significant lower volume loss than the C-er group (p < 0.001 and p = 0.005, respectively) and the C-er+abr group (p < 0.001 and p = 0.002, respectively). The results indicate that fluoride varnish is effective in the reduction of erosive wear.

Transversal wavelength-independent microradiography, a method for monitoring caries lesions over time, validated with transversal microradiography.

This paper describes a microradiographic method for measuring mineral concentration in a transversal geometry with thick (< or =3.2 mm) sections: transversal wavelength-independent microradiography (T-WIM). It was tested on bovine enamel and dentin samples in vitro, and the results were validated with those of transversal microradiography (TMR). 48 enamel and 48 dentin samples (3.2 x 3.2 x 1.5 mm) were embedded in acrylic resin, randomly divided into six groups of 8 dentin or 8 enamel samples, and demineralized for 0 (sound control), 1, 2, 3, 4, or 5 weeks. For T-WIM, samples were imaged on film with polychromatic 40-kV Cu X-rays with an Al (0.25 mm)/Ni (0.02 mm) filter together with an aluminium/zinc step wedge. TMR slices (about 80 mum for enamel and about 130 mum for dentine) were subsequently cut from the centre of the samples and subjected to TMR. Microradiographs from both methods were digitized and image analysis software was used to calculate lesion depth and mineral loss. The relations between T-WIM and TMR results for mineral loss (DeltaZ) and lesion depth were nearly linear (r > or = 0.96) for both enamel and dentin. The slopes of the regression lines were between 0.99 and 1.02 except for DeltaZ in dentine, which was 0.89. It was concluded that T-WIM is a suitable method for TMR on thick samples.

Brushing abrasion of eroded bovine enamel pretreated with topical fluorides.

Topical fluorides have been proposed for the prevention of erosive dental wear. This study evaluated the in vitro effect of a single professional application of 4% titanium tetrafluoride (TiF4), 1% amine fluoride (AmF) and 0.1% difluorosilane varnish (FV) in preventing wear due to combined erosion and brushing abrasion. One hundred and eight bovine enamel samples were used. Control groups were not pretreated with any product (C), pretreated with a fluoride-free varnish (FV-bl) or pretreated with fluoride varnish and subsequently submitted to varnish removal (FV-r). Wear was modeled by submitting the fluoride-treated and control groups to 3 cycles of the following regimens: erosion/remineralization (er/remin), abrasion/remineralization (abr/remin) or erosion/abrasion/remineralization (er/abr/remin). Erosion was simulated by immersion of the samples for 10 min in citric acid 50 mM (pH 3). Abrasion was carried out for 1 min (200 strokes, load 150 g) in a wear device. Remineralization (2 h artificial saliva) took place between the cycles. Two-way ANOVA showed that there was a significant interaction (p

[Erosion effect of a newly developed soft drink]. / De erosiepotentie van een nieuwe frisdrank.

In this article, the erosion effect of a newly developed soft drink available in 3 different flavours is compared with the erosion effect of some common soft drinks. Several basic parameters of the soft drinks were determined: pH, titratable acidity, and the calcium as well as phosphate concentration. Three methods were used to assess in vitro the erosion depth of the soft drinks in enamel specimens. Erosion depth is defined as the mean height of lost enamel. The methods used were atomic absorption spectroscopy for calcium loss, a colorimetric ammonium molybdate method for phosphate loss and non-contact profilometry for enamel volume loss. The newly developed soft drink realized statistically significantly less erosion depth when compared with cola and apple juice and statistically non-significantly less erosion depth when compared with orange soda.

Toothbrush abrasion, simulated tongue friction and attrition of eroded bovine enamel in vitro.

OBJECTIVES: Enamel erosion results in the formation of a softened layer that is susceptible to disruption by mechanical factors such as brushing abrasion, tongue friction and attrition. The aim of this study was to investigate the individual contribution of those mechanical insults to the enamel loss caused by dental erosion. METHODS: Forty two bovine enamel samples were randomly divided into seven groups (n=6 per group) that were submitted to 3cycles of one of the following regimes: erosion and remineralization (er/remin); toothbrush abrasion and remineralization (abr/remin); erosion, toothbrush abrasion and remineralization (er/abr/remin); attrition and remineralization (at/remin); erosion, attrition and remineralization (er/at/remin); simulated tongue friction and remineralization (tg/remin); erosion, simulated tongue friction and remineralization (er/tg/remin). Erosion took place in a demineralization solution (50mM citric acid, pH 3) for 10min under agitation. Brushing abrasion, tongue friction and attrition were simulated for 1min using a home-made wear device. Remineralization was carried out in artificial saliva for 2h. Enamel loss was quantified using optical profilometry. RESULTS: One-way ANOVA indicated a significant difference between the amounts of enamel lost due to the different wear regimes (p

Effect of titanium tetrafluoride, amine fluoride and fluoride varnish on enamel erosion in vitro.

This study aimed at evaluating the effect of 1 and 4% titanium tetrafluoride (TiF4) gels, amine fluoride (AmF) 1 and 0.25% and a fluoride varnish (FP) on the prevention of dental erosion. Two experimental groups served as controls, one with no pretreatment and another one pretreated with a fluoride-free varnish (FP-blanco). Dental erosion was modelled using bovine enamel samples submitted to alternate cycles of acid exposure in citric acid and remineralization in artificial saliva. Calcium loss of all samples involved in the study was quantified by atomic absorption spectroscopy and erosion depths were estimated. Two samples of each experimental group were also analyzed by white light confocal microscopy. The cumulative erosion depth (in mum) after 72 min was: TiF4 gel 1% 8.29 +/- 0.39; TiF4 gel 4% 8.27 +/- 0.55; AmF 1% 8.69 +/- 0.66; AmF 0.25% 8.86 +/- 0.33; FP 3.43 +/- 1.07; FP-blanco 14.86 +/- 1.59 and control 9.77 +/- 0.49. A statistically significant protective effect (p < or = 0.001) was found only for the group pretreated with the fluoride varnish. Within the limitations of an in vitro study it may be concluded that topical applications of the fluoride varnish tested have a protective effect on the prevention of dental erosion.

Effect of fluoridated toothpicks and dental flosses on enamel and dentine and on plaque composition in situ.

The aim was to evaluate the effect of two toothpicks and two dental flosses on demineralized enamel and dentine and on plaque composition, using an in situ model with simulated approximal spaces within dentures. Fifteen subjects with full dentures were recruited and 14 completed the study. It consisted of two crossover periods, the first comparing a birch toothpick with AmF and a birch toothpick with NaF, and the second comparing a dental floss with AmF + NaF and a dental floss without F. Between these four periods, there was a control period without any approximal cleaning. In small, rectangular sample holders, one enamel and one dentine specimen were embedded, forming a triangular, approximal-like space. Two sample holders were mounted in the premolar-molar region of the upper or lower dentures. The subjects used the toothpicks or dental flosses 3 times/day for 4 weeks. The results showed that all toothpicks and dental flosses inhibited further demineralization compared to the control period (p < 0.001). The dental flosses were somewhat more effective in this respect than the toothpicks, especially in dentine. There were relatively small numerical differences between AmF and NaF toothpicks, but in favour of NaF regarding mineral gain (p < 0.05). The fluoridated floss gave somewhat less lesion depth in dentine than the non-fluoridated floss (p < 0.01). Toothpicks and flosses resulted in lower counts of microorganisms in plaque compared to the control period (p < 0.001); the AmF toothpick gave a more pronounced reduction than the NaF toothpick (p < 0.001).

The influence of drying on quantitative laser fluorescence and optical pathlengths in incipient natural caries lesions.

Drying effects in 14 natural lesions were studied with quantitative light-induced fluorescence and optical pathlength spectroscopy. Results were compared with clinical judgments of the lesion surface and microradiographical characterizations of the lesions. Relative fluorescence and average pathlength decreased as a function of drying time with a decay time ranging from 35.5 to <1 min. Depth and mineral loss correlated with average pathlength total changes (r = -0.79/-0.60, respectively) and poorly with total fluorescence changes (r approximately = 0.3). The decay time of the drying process for the relative fluorescence correlated well with a theoretical model based on water diffusion in lesion and surface layer, but only for large decay times. Clinical judgments could not be related to the surface layer properties or the changes in the average pathlength, but were weakly related to the changes in the relative fluorescence. We conclude that (i) fluorescence effects are mostly due to the screening by the lesion of the fluorescence from the dentin and enamel-dentin junction; (ii) water evaporation in lesions conforms to the diffusion laws only in large lesions with low surface layer penetrability; (iii) the evaporation process is controlled by the surface layer only for small surface penetrabilities (approximately 0.1 vol% microm(-1)).

Penetration of varnishes into demineralized root dentine in vitro.

In this paper the penetration of three different varnishes employed in caries prevention (Duraphat, Fluor Protector and Cervitec) into demineralized dentine is quantified using confocal laser scanning microscopy. The results show that the varnish penetration into lesions about 85 microns in depth if for Cervitec about 35 microns and considerably less for Duraphat and Fluor Protector. The penetration is into the dentinal tubules and is influenced by dentinal tubule direction. The drying procedure--pretreatment of the dentine--influences the penetration, though sizeably only for Cervitec applications. This paper shows that varnish penetration into the tissue and presumably 'sealing' tubules completely or partly is valuable with respect to root caries prevention and hypersensitivity.