Comparison of the physical, thermal, and biological effects on implant bone site when using either zirconia or stainless-steel drill for implant bone site preparation.

BACKGROUND/PURPOSE: Zirconia has been a popular material in dental implantology with good biocompatibility. But few research focused on its application in implant drills. This study aimed to investigate the physical, thermal, and biological effects on using the zirconia and stainless-steel drills for implant bone site preparation. METHODS: We performed a series of experiments to evaluate the physical wearing properties of zirconia and stainless-steel drills of identical diameter and similar shape. During the implant site preparation thermal test, we subjected both drills onto a resin-embedded bone, utilizing a thermal couple device without irrigation. Moreover, we conducted a cell study by collecting bone cells in vivo while preparing the implant site with both tested drills. The cell activity was evaluated through cell proliferation colorimetric analysis (XTT) and alkaline phosphatase (ALP) activity measurements. RESULTS: The zirconia drill outperforms the stainless-steel drill in terms of requiring less force, maintaining stability over repeated cutting tests, and generating lower temperatures during drilling (stainless-steel drill: 45.48 ± 1.31 °C; zirconia-coated drill: 32.98 ± 1.21 °C, P = 0.000247). Meanwhile, both types of drills show similar results in XTT colorimetric analysis and ALP activity test. CONCLUSION: The thermal effect study is more favorable for using the zirconia drill than the stainless-steel drill for bone preparation. Cytological analysis indicate that the zirconia drill produces a similar impact on bone cells activity as the stainless-steel drill. Therefore, we conclude that the zirconia drills offer a good cutting effect similar to currently available stainless-steel drills in various aspects.

Efficacy of polyacrylate silver salt/polyvinylpyrrolidone-based liquid oral gel in management of concurrence chemoradiotherapy-induced oral mucositis.

BACKGROUND/PURPOSE: Acute oral mucositis (OM) is a painful complication of concurrent chemoradiotherapy (CCRT). This severe adverse symptom may impact on patient's quality of life, lead to malnutrition. Thus, finding more effective methods in OM management is very important. The purpose of this study is to evaluate the efficacy of polyacrylate silver salt/Polyvinylpyrrolidone-based liquid oral gel (named as polyacrylate silver salt oral gel) in improving the symptomatic relief of CCRT-induced oral mucositis and oral dysfunction in neck and head cancer patients. METHODS: In this study, 24 oral cancer patients underwent CCRT and having OM grade 2 or higher were randomly assigned into the test group and the control group. Both groups followed Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) clinical practice guidelines for the management of mucositis, but adding rinsing with 15 g oral gel right after oral hygiene treaded the test group. Clinical OM and oral function were assessed weekly for 4 consecutive weeks till 5-10 days after the completion of radiotherapy. For evaluation, Common Terminology Criteria for Adverse Events (CTCAE) v3.0 was used for collecting the data of OM grade. RESULTS: The results showed that polyacrylate silver salt oral gel had better effect for relieving the oral mucositis. There were statistically significant differences in OM grades (1.59 vs. 2.8, p < 0.0001) between the test group and the control group. CONCLUSION: Our clinical studies demonstrated that polyacrylate silver salt oral gel is an effective interventional option in terms of rapid mucositis healing.

Resolution of Excessive Interocclusal Restoration Space Post-Mandibulectomy Using a Two-Layer Retrievable Fixed Implant-Supported Prosthesis: A Case Report.

Patients treated with segmental mandibulectomy often require complicated rehabilitation. Maintenance of mandibular continuity and provision of adequate soft and hard tissue volumes are two key factors required for good clinical outcomes. Moreover, excessive interocclusal restoration space is a common problem in these patients. This case report describes the process of prosthetic rehabilitation from extensive surgical excision to final rehabilitation by using a creative two-layer fixed implant prosthesis in a 70-year-old patient with oral squamous cell carcinoma.

Prognosis of medication-related osteonecrosis of the jaws in metastatic prostate cancer patients.

OBJECTIVES: The aim of this study was to find out the prognosis of medication-related osteonecrosis of the jaws (MRONJ) in prostate cancer patients who received two different types of antiresorptive agents for bone metastasis. MATERIALS AND METHODS: We retrospectively surveyed a cohort of 95 metastatic prostate cancer patients with 122 MRONJ lesions treated in a single medical center. Treatment outcomes and prognostic factors were investigated. The cumulative complete response rate was calculated with the Kaplan-Meier method, and significance was examined with the log-rank and Breslow tests. Cox regression was used for the univariate and multivariate analyses of prognostic factors. RESULTS: The cumulative complete response rate of all patients at 12 months was 37.8%, and that of patients treated with zoledronic acid and denosumab was 22.9% and 70.5%, respectively. Denosumab, pretreatment C-terminal telopeptide of collagen I (CTX) level > 150 pg/ml, and anemia were identified as independent prognostic factors in a multivariate analysis with adjusted hazard ratios of 3.18 (95% confidence interval [CI], 1.24-8.11), 3.24 (95% CI, 1.39-7.53), and 0.42 (95% CI, 0.19-0.93), respectively. CONCLUSION: A higher pretreatment level of CTX, using denosumab as the antiresorptive agent and without anemia, indicates a better treatment outcome of MRONJ in prostate cancer patients.

Challenge Tooth Regeneration in Adult Dogs with Dental Pulp Stem Cells on 3D-Printed Hydroxyapatite/Polylactic Acid Scaffolds.

Tooth regeneration is an important issue. The purpose of this study was to explore the feasibility of using adult dental pulp stem cells on polylactic acid scaffolds for tooth regeneration. Three teeth were extracted from each side of the lower jaws of two adult dogs. In the experimental group, dental pulp stem cells were isolated and seeded in the 3D-printed hydroxyapatite/polylactic acid (HA/PLA) scaffolds for transplantation into left lower jaw of each dog. The right-side jaw of each dog was transplanted with cell-free scaffolds as the control group. Polychrome sequentially labeling was performed for observation of mineralization. Dental cone beam computed tomography (CBCT) irradiation was used for assessment. Nine months after surgery, dogs were euthanized, and the lower jaws of dogs were sectioned and fixed for histological observation with hematoxylin and eosin staining. The results showed that the degree of mineralization in the experimental group with cells seeded in the scaffolds was significantly higher than that of the control group transplanted with cell-free scaffolds. However, the HA/PLA scaffolds were not completely absorbed in both groups. It is concluded that dental pulp stem cells are important for the mineralization of tooth regeneration. A more rapid absorbable material was required for scaffold design for tooth regeneration.

Effects of low-dose rhBMP-2 on peri-implant ridge augmentation in a canine model.

AIMS: The aim of this study was to investigate the potential of low-dose rhBMP-2 combined with Hydroxyapatite (HAp)/ß-tricalcium phosphate (TCP)/ Collagen (Col) composite in repairing the peri-implant critical size defect and to determine the optimal rhBMP-2 concentration. MATERIALS AND METHODS: Fifty saddle-type alveolar defects (10 mm mesiodistally and 4 mm apicocoronally) were surgically prepared on edentulous ridges in ten beagle dogs. Following implant placement, the defects with vertically exposed implant fixtures either received (a) no graft, (b) HAp/TCP/Col composite, (c) HAp/TCP/Col +0.02 mg/ml rhBMP-2, (d) HAp/TCP/Col +0.08 mg/ml rhBMP-2 or (e) HAp/TCP/Col +0.2 mg/ml rhBMP-2. After healing for 4 or 8 weeks, bone regeneration and mineralization were assessed through radiography, micro-CT, fluorescence labelling and histologic analyses. Implant stability was measured through resonance frequency analysis. RESULTS: It was evident HAp/TCP/Col with 0.2 mg/ml rhBMP-2 manifested strong osteogenic potential in this large animal model, as significantly more and faster new bone formation with better implant stability was identified compared to the HAp/TCP/Col-alone control group (adjusted p < .05). CONCLUSIONS: Our results highlight the constructs of HAp/TCP/Col +0.2 mg/ml rhBMP-2 without barrier membranes as a promising tool for peri-implant ridge augmentation.

Differences in the biomechanical behaviors of natural teeth and dental implants.

OBJECTIVE: The lack of a PDL, which acts as an energy absorber, is a contributor to implants' early failure; however, these discrepancies are not well understood because of limited in vivo research. This study investigated the discrepancy in biomechanical behaviors between natural teeth and dental implants by detecting micro-movements in vivo. METHODS: We designed a device that could measure precisely mechanical behaviors such as creep, stress relaxation, and hysteresis by using load-control displacement on teeth and implants. We also compared energy dissipation between natural teeth and dental implants by subtracting the area of the hysteresis loop of natural teeth from that of dental implants. RESULTS: Biphasic curves with an initial phase of rapid response and a subsequent phase of slow response were confirmed in creep and stress relaxation curves for the load-time relationship in natural teeth. By contrast, the behavior of creep or stress relaxation was less prominent when the dental implants were tested. We observed that the periodontal ligament under an axial intrusive load of 300g in a loading rate 3g/s could dissipate the energy of 7.35±1.18×10-2 mJ, approximately 50 times that of the dental implants (1.47±1.22×10-3) with statistically significant (p<0.05). SIGNIFICANCE: We confirmed natural teeth could achieve greater energy dissipation compared to dental implants, which owe to that natural teeth exhibited fluid and viscoelastic properties.

Preliminary evaluation of BMP-2-derived peptide in repairing a peri-implant critical size defect: A canine model.

BACKGROUND/PURPOSE: A synthetic bone morphogenetic protein (BMP)-2-derived peptide has been discovered to promote bone regeneration. The present study investigated the potential of the BMP-2 peptide combined with hydroxyapatite (HAp)/ß-tricalcium phosphate (TCP)/collagen (Col) composite in repairing a peri-implant critical size defect. METHODS: Twenty-four saddle-type alveolar defects (10 mm mesiodistally and 4 mm apicocoronally) were surgically prepared in edentulous ridges in four male beagle dogs. Following implant placement, the defects with vertically exposed implant fixtures received (a) HAp/TCP/Col composite, (b) HAp/TCP/Col + 4 mg/mL BMP-2 peptide, (c) HAp/TCP/Col + 20 mg/mL BMP-2 peptide, or (d) HAp/TCP/Col + 0.2 mg/mL recombinant human BMP-2 (rhBMP-2). Bone regeneration and mineralization were assessed using radiography, micro-computed tomography (micro-CT), fluorescence labeling, and histologic analyses after healing for 4 or 8 weeks. Implant stability was measured using resonance frequency analysis. RESULTS: The 20 mg/mL BMP-2 peptide groups demonstrated a distinguishable advantage in bone regeneration potential over the control groups, as observed on radiographic imaging and histologic examination, although no significant difference was found in implant stability and histomorphometric analysis of mineralization levels. However, the performance of the 20 mg/mL BMP-2 peptide groups were inferior to that of the 0.2 mg/mL rhBMP-2 groups. CONCLUSION: The BMP-2 peptide may accelerate peri-implant bone regeneration. The BMP-2 peptide at 20 mg/mL still cannot complete bone repair of peri-implant critical size defect. The BMP-2 peptide at 20 mg/mL has similar osteoinductive performance to the rhBMP-2 at 0.02 mg/mL.

Prognosis of medication-related osteonecrosis of the jaws in cancer patients using antiresorptive agent zoledronic acid.

BACKGROUND/PURPOSE: Anti-resorptive agents are commonly used in cancer patients with bone metastasis or multiple myeloma (MM). An adverse event termed medication-related osteonecrosis of the jaws (MRONJ) was discovered in patients using these agents but relatively little attention has been paid to its prognosis. Our aims were to find out the treatment outcomes and prognostic indicators of MRONJ in cancer patients who received zoledronic acid as antiresorptive therapy. METHODS: We retrospectively surveyed a cohort of 133 cancer patients who received zoledronic acid. A total of 150 MRONJ lesions were included for investigation. Cumulative complete response rate after treatment was calculated with the Kaplan-Meier method, and significance was examined with the log-rank tests. Cox regression was used for univariate and multivariate analyses of prognostic factors. RESULTS: The cumulative complete response rate of all patients at 24 months was 53.2%, and those of patients with MM, breast cancer and prostate cancer were 27.8%, 60.7% and 68.0%, respectively. Having MM was identified as an independent prognostic factor in a multivariate analysis with adjusted hazard ratios of 0.28 (95% confidence interval, 0.09-0.83). CONCLUSION: For cancer patients with ONJ related to zoledronic acid, patients with MM endure a worse treatment outcome.

Comparing image qualities of dental cone-beam computed tomography with different scanning parameters for detecting root canals.

BACKGROUND/PURPOSE: Cone-beam computed tomography (CBCT) is a useful device in creating 3-dimensional images in the examining area of dentistry and is one of the most common clinical methods in detecting second mesiobuccal (MB2) canals in maxillary molars. The aim of this in vitro study was to compare the image quality of the small field of view (FOV) CBCT with different rotation arcs and scanning speeds in the use of detecting root canals. METHODS: A dentate human skull was scanned in Morita 3D Accuitomo 170 with 4 × 4 cm FOV under 5 mA and 90 kVp. Two different rotation arcs (360° and 180°) and three different scanning modes (slow-speed mode, standard mode and high-speed mode) combined into six different groups. Five different levels of axial sections were selected from each group. Five endodontic specialists rated the image quality by focusing on the sharpness of the MB2 canal of the upper right first molar and the surrounding structures. RESULTS: Despite the rotation arcs, all the observers gave excellent ratings to images taken with slow-speed mode. The high-speed mode taken with 360° and 180° got the second lowest and the lowest ratings, respectively. Under the same scanning speed, the rotation arc did not have a significant difference in image quality. CONCLUSION: Slow-speed mode is inevitable in maintaining adequate image quality during taking CBCT. However, endodontists can use the half rotation mode to significantly reduce radiation dose, exposure time, and still maintain sufficient image quality for root canal anatomy assessment.

Regeneration of Tooth with Allogenous, Autoclaved Treated Dentin Matrix with Dental Pulpal Stem Cells: An In Vivo Study.

INTRODUCTION: Biomaterials designed for tissue engineering should be nontoxic and nonimmunogenic and should achieve their intended functions. Treated dentin matrix (TDM), a bioactive extracellular matrix, is promising for tooth regeneration. However, the effect of sterilization on the surface properties of allogenous TDM in the animal model is unclear. METHODS: The biological characteristics and influences of dental pulp stem cells (DPSCs) with autoclaved TDM (a-TDM) were studied using scanning electron microscopy, immunofluorescence microscopy, immunohistochemistry, and reverse transcription polymerase chain reaction in vitro. In addition, a-TDM was implanted in a mouse model for 6 weeks and was a substrate with DPSCs for tooth reconstruction in a goat animal model in vivo. RESULTS: Allogenous a-TDM induced and supported DPSCs to develop new dentin pulp-like tissues, enamel dental pulp, and cementum periodontal complexes. Immunohistochemistry data showed that the markers dentin sialoprotein, ßⅢ-tubulin, dentin matrix protein 1, amelogenin, VIII factors, type I collagen, cementum-derived attachment protein, and scleraxis transcription factor were positive stained in toothlike tissue. CONCLUSIONS: Allogenous a-TDM served as an effective scaffold enabling DPSCs to proliferate and differentiate into a broad array of resident cells including odontoblasts, fibroblasts, vascular cells, and neural endings. Allogenous a-TDM with DPSCs can provide an ideal biomaterial for optimizing the regeneration of tooth material.

Development of calcium phosphate/calcium sulfate biphasic biomedical material with hyaluronic acid containing collagenase and simvastatin for vital pulp therapy.

OBJECTIVE: In vital pulp therapy (VPT), a barrier is created with appropriate capping to protect the remaining pulp and thus maintain pulp vitality. Here, we evaluated the feasibility of a biphasic calcium phosphate cement (CPC)-calcium sulfate hemihydrate (CSH) biomaterial containing simvastatin (Sim) and collagenase (Col) for VPT. METHODS: Combinations of varying CPC and CSH concentrations were analyzed for their handling properties and setting times, with their structures observed through scanning electron microscopy-energy dispersive X-ray spectrometry (SEM-EDS). Drug release patterns of simvastatin and collagenase combined with CPC-CSH (CPC-CSH-Sim-Col) were also analyzed, followed by biocompatibility and bioactivity tests on human dental pulp stem cells (hDPSCs) and in vivo animal study in canine models; the in vivo results were obtained through microcomputed tomography and histological analysis. RESULTS: The results revealed that 70 wt% CPC (CPC7) with 30 wt% CSH (CSH3) exhibited optimal setting time and porous structure for clinical use. The cell viability and cytotoxicity analysis demonstrated that CPC7-CSH3 with or without simvastatin or collagenase did not injure hDPSCs. In vivo, the CPC7-CSH3-Sim-Col induced dentin bridge formation. SIGNIFICANCE: CPC7-CSH3-Sim-Col in this study has great potential as a VPT biomaterial to enhance the dentin bridge formation.

Crystal growth in dentinal tubules with bio-calcium carbonate-silica sourced from equisetum grass.

BACKGROUND/PURPOSE: One effective way to deal with dentin hypersensitivity is to develop materials to seal the tubules. The porous bio-calcium carbonate-silica (BCCS) contained well-dispersed CaCO3 would form calcium phosphates to seal the dentinal tubules when mixed with an acidic solution. The acidic hydrothermal treatment and calcination to isolate the BCCS from the agricultural waste like equisetum grass was used, which would be more environmentally friendly than chemically synthesized mesoporous biomaterials. The aim of this study was to develop mesoporous materials from natural resources to occlude the dentinal tubules which could be more environmentally-friendly. METHODS: Dentin disc samples were prepared and treated with different methods as follows: (1) BCCS mixed with H3PO4; (2) BCCS mixed with KH2PO4; (3) Seal & Protect® was used as a comparison group. Sealing efficacy was evaluated by measuring the depths and percentages of precipitate occlusion in dentinal tubules with SEM. RESULTS: The N2 adsorption-desorption isotherm of the BCCS demonstrated a pore size of around 15.0 nm and a surface area of 61 m2g-1. From the results of occlusion percentage and depth, the BCCS treated with H3PO4 or KH2PO4 demonstrated promising sealing efficacy than the commercial product. CONCLUSION: This synthetic process used the agricultural waste equisetum grass to produce bio-calcium carbonate-silica would be environmentally friendly, which has great potential in treating exposed dentin related diseases.

Evaluation of Carbon Dioxide-Based Urethane Acrylate Composites for Sealers of Root Canal Obturation.

A new root canal sealer was developed based on urethane acrylates using polycarbonate polyol (PCPO), a macrodiol prepared in the consumption of carbon dioxide as feedstock. The superior mechanical properties and biostability nature of PCPO-based urethane acrylates were then co-crosslinked with a difunctional monomer of tripropylene glycol diarylate (TPGDA) as sealers for resin matrix. Moreover, nanoscale silicate platelets (NSPs) immobilized with silver nanoparticles (AgNPs) and/or zinc oxide nanoparticles (ZnONPs) were introduced to enhance the antibacterial effect for the sealers. The biocompatibility and the antibacterial effect were investigated by Alamar blue assay and LDH assay. In addition, the antibacterial efficiency was performed by using Enterococcus faecalis (E. faecalis) as microbial response evaluation. These results demonstrate that the PCPO-based urethane acrylates with 50 ppm of both AgNP and ZnONP immobilized on silicate platelets, i.e., Ag/ZnO@NSP, exhibited great potential as an antibacterial composite for the sealer of root canal obturation.

Neutralized Dicalcium Phosphate and Hydroxyapatite Biphasic Bioceramics Promote Bone Regeneration in Critical Peri-Implant Bone Defects.

The aim of this study was to evaluate the efficacy of bone regeneration in developed bioceramics composed of dicalcium phosphate and hydroxyapatite (DCP/HA). Critical bony defects were prepared in mandibles of beagles. Defects were grafted using DCP/HA or collagen-enhanced particulate biphasic calcium phosphate (TCP/HA/Col), in addition to a control group without grafting. To assess the efficacy of new bone formation, implant stability quotient (ISQ) values, serial bone labeling, and radiographic and histological percentage of marginal bone coverage (PMBC) were carefully evaluated four, eight, and 12 weeks after surgery. Statistically significant differences among the groups were observed in the histological PMBC after four weeks. The DCP/HA group consistently exhibited significantly higher ISQ values and radiographic and histological PMCB eight and 12 weeks after surgery. At 12 weeks, the histological PMBC of DCP/HA (72.25% ± 2.99%) was higher than that in the TCP/HA/Col (62.61% ± 1.52%) and control groups (30.64% ± 2.57%). After rigorously evaluating the healing of biphasic DCP/HA bioceramics with a critical size peri-implant model with serial bone labeling, we confirmed that neutralized bioceramics exhibiting optimal compression strength and biphasic properties show promising efficacy in fast bone formation and high marginal bone coverage in peri-implant bone defects.

Role and Mechanism of LIF in Oral Squamous Cell Carcinoma Progression.

Background: Metastasis is a severe problem in patients with oral squamous cell carcinoma (OSCC), which is the fifth most common cancer worldwide. Leukemia inhibitory factor (LIF) has been studied in different cancers, while the role of LIF in OSCC remains unclear. Methods: LIF expression was detected in 100 OSCC samples by immunohistochemistry. Effects of LIF on cell motility were evaluated in OSCC cell lines. High-throughput microarray analysis was also conducted. The correlation between LIF and the downstream effector was analyzed by real-time quantitative reverse transcription PCR. Results: Patients with OSCC who had lymph node metastasis or advanced cancer stages showed high LIF expression. OSCC patients with higher LIF expression, advanced stage, large tumor size, or lymph node metastasis had significantly shorter overall survival. LIF regulated cancer cell motilities through outside-in signaling. The inhibin beta A subunit (INHBA) gene was identified as a crucial downstream effector of LIF-promoted OSCC progression and restored migration and invasion abilities in LIF knockdown transfectants. Conclusion: LIF enhances regional lymphatic spread, thus leading to an advanced cancer stage. Regulation of LIF downstream molecules such as INHBA inhibits the invasion or migration ability of cancer cells. Thus, LIF can be a potential target in preventing cancer metastasis and spread.

Effect of different zinc concentrations on partially-stabilized cement for vital pulp therapy.

BACKGROUND/PURPOSE: We have developed and investigated the partially-stabilized cements (PSC) with Zn for vital pulp therapy due to their short setting time and high cell biocompatibility. However, the effect of PSC with different concentrations of Zn on setting time and biocompatibility remained unknown. Therefore, the purpose of this study was to determine the optimal concentration of Zn to be synthesized with PSC for vital pulp therapy. METHODS: PSC with different weight percentages of Zn (5%, 7%, 10%) were synthesized to attain 5%Zn-PSC, 7%Zn-PSC, and 10%Zn-PSC. The initial and final setting times were measured using the Gillmore needles method, and the compressive strength tests were conducted using a universal testing machine. The phases of Zn-PSC powders were observed using an X-ray diffractometer (XRD). Human dental pulp stem cells (hDPSCs) were used to evaluate the biocompatibility and cytotoxicity of the materials via Alamar blue and LDH assays. Mineral trioxide aggregate (MTA) was used to be compared with Zn-PSC samples. RESULTS: The initial and final setting times of PSC with different concentrations of Zn were reduced considerably compared to those of MTA. The results also indicated that the initial and final setting times decreased as the weight % of Zn increased. 5%Zn-PSC had the highest compressive strength among all tested materials. 5%Zn-PSC samples also displayed comparatively higher cell biocompatibility than 7% and 10% Zn-PSC samples. However, there was no significant difference between the 5%Zn-PSC and MTA in cell biocompatibility. In addition, the results of the LDH release assay indicated a low level of cytotoxicity among all the test samples. CONCLUSION: 5%Zn-PSC has a shorter setting time, better mechanical properties, and good biocompatibility and thus it has great potential for vital pulp therapy.

Novel calcium encapsulated mesocellular siliceous foams for crystal growth in dentinal tubules.

OBJECTIVES: The aim of this study was to investigate the novel mesocellular siliceous foams (MCF) containing CaCO3 nanoparticles (denoted as CMCF) combined with phosphoric acid could occlude dentinal tubules through the formation of biomimetic crystal barrier. METHODS: Ultrastructures of MCF and CMCF were examined by transmission electron microscopy (TEM). Elemental components were analyzed with energy dispersive X-ray spectrometry (EDX). CMCF was mixed with distilled water, 10%, 20% and 30% phosphoric acid then applied on dentine discs. Crystals were characterized by X-ray powder diffractometry (XRD). The sealing efficacy of the dentinal tubules was examined by scanning electron microscopy. RESULTS: TEM images showed MCF presented a pore size of approximately 30.0 nm and CMCF contained abundant nano-CaCO3. Sealing efficacy showed that CMCF, when reacted with 30% phosphoric acid, would form crystals in the dentinal tubules to a depth of 83.2 ± 17.6 µm at an occlusion percentage of 75.6 ± 12.8% on average; both occlusion percentage and depth were higher than those obtained with 10% or 20% phosphoric acid (p < 0.05). The results of XRD and EDS indicated that the crystal growth in the dentinal tubules could be transformed into the biomimetic crystals. CONCLUSION: This study showed that the CMCF with 30% phosphoric acid could effectively occlude the dentinal tubules through the formation of biomimetic crystal barrier. CLINICAL SIGNIFICANCE: The novel CMCF combined with phosphoric acid may have potential for the treatment of dentine hypersensitivity.

Strontium ion can significantly decrease enamel demineralization and prevent the enamel surface hardness loss in acidic environment.

BACKGROUND/PURPOSE: Strontium ion may play a role similar to calcium ion in enamel remineralization. The aim of this study was to investigate the effect of strontium ion concentration gradient on the demineralization of enamel. METHODS: Citric acid and sodium citrate were used to prepare 16 different experimental acidic solutions with four different pH values (2.5, 3.5, 4.5, and 5.5) and four different strontium ion concentrations (0 M, 10-4 M, 10-3 M, and 10-2 M). Forty-eight human enamel samples were divided into 16 groups (n = 3) and immersed into the 16 different acidic solutions for 3 min. The phosphorus ion concentrations in 16 different acidic solutions were measured and compared. The enamel surface hardness was measured with a Vickers hardness tester. The energy dispersive spectrometer was used to detect the strontium ion content in the enamel surface. RESULTS: Addition the strontium ions to the acidic solution could reduce the dissolution of the enamel. At pH 3.5 and pH 5.5, significantly lower phosphorus ion concentrations were detected in the acidic solutions with the addition of 10-2 M strontium ions. There was a less reduction of enamel surface hardness, while the strontium ion concentration increased in the acidic solution. At pH 2.5, the addition of 10-4 M, 10-3 M, or 10-2 M strontium ions to the acidic solution resulted in a significant increase in the strontium ion content in the enamel surface. CONCLUSION: Strontium ion can decrease the dissolution of the enamel and prevent the enamel surface hardness loss in acidic environment.