Erosive loss of tooth substance is dependent on enamel surface structure and presence of pellicle - An in vitro study.

OBJECTIVE: Aim of this in vitro study was to investigate erosive tooth loss in dependence of the enamel surface structure and presence of an acquired pellicle. METHODS: Enamel specimens from 19 bovine incisors (4 specimens/incisor) were allocated to four experimental groups (n = 19). The surfaces of half of the specimens were polished (two groups), while the other half was left native (two groups). Specimens of one polished and one native group were placed in pooled human saliva (30 min) for the formation of an acquired pellicle. Thereafter, all specimens were demineralized by superfusion with hydrochloric acid (17 min, pH 2.3) with collection of the superfluent. Erosive substance loss was determined by measuring the dissolved calcium content using a colorimetric assay with Arsenazo III reagent. Differences in erosive substance loss were statistically analyzed with respect to enamel surface and pellicle. A linear mixed effects model was fitted to the data and pairwise differences between groups were evaluated (significance level α= 0.05). RESULTS: Enamel surface structure (p < 0.001) and presence of pellicle (p = 0.01) had a significant effect on erosive substance loss. Polished surfaces with pellicle showed the lowest cumulative calcium release [nmol Ca/mm2] (means ± standard deviation: 48+/-5), followed by polished specimens without (51+/-9) and native specimens with pellicle (54+/-10). No significant differences were found between these groups. Highest cumulative calcium release was found for native specimens without pellicle (61+/-9; p < 0.05). CONCLUSIONS: Both enamel surface structure and the acquired pellicle are important determinants of the susceptibility to erosive tooth loss.

Change of erosive potential of apple and orange juice at different dilutions

The aim of this in vitro study was to investigate the change of erosive properties of apple and orange juice after dilution with tap water. Apple juice, orange juice and citric acid were assessed for pH and titratable acidity at different aqueous dilutions (100% ­ pure liquid, 60% ­ 3 : 2 mixing ratio, and 40% ­ 2 : 3 mixing ratio respectively). Thus, 72 bovine enamel specimens were distributed to 9 groups (n = 8 specimens per group), followed by 25 minutes of erosion by superfusion with the described test liquids according to group allocation. Erosive substance loss (µm) was determined profilometrically. The different substance losses within a dilution series were tested using the Wilcoxon rank sum test. The significance level was set to p ≤ 0.05. Erosive substance loss [µm] for 100% concentrations (median ± interquartile range) was highest for apple juice (5.7 ± 0.8), followed by citric acid (4.6 ± 0.4) and orange juice (1.5 ± 0.5). The dilution of apple juice (60%: 4.2 ± 0.7; 40%: 3.1 ± 0.5) and citric acid (60%: 3.7 ± 0.9; 40%: 2.8 ± 0.7) with tap water lead to a significant (p < 0.05) reduction of erosive potential in comparison to 100% concentrations. This effect was not consistent for orange juice, where significantly more substance loss was found for pure juice (100%) than for 60% diluted juice (60%: 1.1 ± 0.3, p < 0.05), but no significant difference was found between 100% and 40% (40%: 0.9 ± 0.6, p > 0.05), and 60% and 40%, respectively. In conclusion, dilution of apple juice with tap water led to a significant reduction of its erosive potential. For orange juice, the effect of dilution on the erosive substance loss was only limited.

Pure hydroxyapatite as a substitute for enamel in erosion experiments.

OBJECTIVES: The study evaluated the suitability of pure crystalline hydroxyapatite (HA) as a substitute for human (H) and bovine (B) enamel in erosion experiments. METHODS: Human and bovine enamel and hydroxyapatite specimens (n = 18 each) were submitted to demineralisation by HCl at pH values of 3.0, 2.6 and 2.0 (1.0, 2.5, and 10 mmol/l concentration). Specimens were eroded in a superfusion chamber for 7 min (flow rate: 1 µl/s). Multiple fluid samples were taken per specimen throughout the exposure period. The dissolved calcium content was measured using a colorimetric assay with Arsenazo III reagent, to serve as surrogate for erosive substance loss. Additionally, erosive tissue loss was quantified by profilometry. Differences in erosive substance loss were assessed by the Kruskal-Wallis and Conover's posthoc test. RESULTS: Good agreement in erosive substance loss between HA and human specimens was found at pH 2.6, as no statistically significant difference and considerable overlap of their respective interquartile ranges was observed. At pH 2.0 and 3.0, a statistically significant difference between HA and human and bovine enamel was determined. HA consistently tended to have lower mean dissolution rates, with a maximum deviation from human enamel of -16% at pH 3. It displayed lower specimen variability with an average coefficient of variation of 17%, compared to 25% (H) and 25% (B), respectively. CONCLUSIONS: Crystalline hydroxyapatite may not be suitable for full substitution of biologic enamel in erosion experiments focusing on absolute measurement values, but is useful for establishing consistent relative trends between erosive agents due to biosimilar erosion behavior and lower experimental variability. This is especially true for preliminary studies where approval for use of biological samples is restricted. CLINICAL SIGNIFICANCE: Crystalline hydroxyapatite is a useful substitute of human or bovine enamel in experiments studying chemical aspects of dental erosion.

Comparison of Profilometric and Microindentation Analyses for Determining the Impact of Saliva on the Abrasion of Initially Eroded Enamel.

The aim of this in vitro study was to investigate the impact of saliva on the abrasion of eroded enamel using two measuring methods. A total of 80 bovine enamel specimens from 20 bovine incisors were allocated to four experimental groups (n = 20 specimens per group). After baseline surface microhardness (SMH) measurements and profilometry all specimens were subjected to erosion (2 min, 1% citric acid, pH: 3.6, 37°C). SMH was determined again, and the depths of the Knoop indentations were calculated. Thereafter, specimens were incubated in human saliva (group 1 - no incubation/control, group 2 - 0.5 h, group 3 - 1 h, group 4 - 2 h) before toothbrush abrasion was performed. After final SMH measurements and profilometry, indentations were remeasured, and surface loss was calculated. SMH did not return to baseline values regardless of the length of saliva incubation. Further, an irreversible substance loss was observed for all specimens. With the indentation method, significantly (p < 0.05) more substance loss was found for controls (least square means ± standard error of 198 ± 19 nm) than for groups 2-4 (110 ± 10, 114 ± 11, and 105 ± 14 nm). Profilometric assessment showed significantly more substance loss for controls (122 ± 8 nm) than for group 4 (106 ± 5 nm). Intraclass correlation for interrater reliability between measurement methods was low (0.21, CI: 0.1-0.3), indicating poor agreement. Exposure of eroded enamel to saliva for up to 2 h could not re-establish the original SMH. The amount of measured substance loss depended on the measurement method applied.

Assessment of peri-implant defects at titanium and zirconium dioxide implants by means of periapical radiographs and cone beam computed tomography: An in-vitro examination.

OBJECTIVE: To test the accuracy of measurement of interproximal peri-implant bone defects at titanium (Ti) and zirconium dioxide (ZrO2 ) implants by digital periapical radiography (PR) and cone beam computed tomography (CBCT). MATERIAL AND METHODS: A total of 18 models, each containing one Ti and one ZrO2 implant, were cast in dental stone. Six models each were allocated to following defect groups: A-no peri-implant defect, B-1 mm width defect, C-1.5 mm width defect. The defect width was measured with a digital sliding caliper. Subsequently, the models were scanned by means of PR and CBCT. Three examiners assessed the defect width on PR and CBCT. Wilcoxon signed-rank test and Wilcoxon rank sum test were applied to detect differences between imaging techniques and implant types. RESULTS: For PR, the deviation of the defect width measurement (mm) for groups A, B, and C amounted to 0.01 ± 0.03, -0.02 ± 0.06, and -0.00 ± 0.04 at Ti and 0.05 ± 0.02, 0.01 ± 0.03, and 0.09 ± 0.03 at ZrO2 implants. The corresponding values (mm) for CBCT reached 0.10 ± 0.11, 0.26 ± 0.05, and 0.24 ± 0.08 at Ti and 1.07 ± 0.06, 0.64 ± 0.37, and 0.54 ± 0.17 at ZrO2 implants. Except for Ti with defect A, measurements in PR were significantly more accurate in comparison to CBCT (p ≤ 0.05). Both methods generally yielded more accurate measurements for Ti than for ZrO2 . CONCLUSIONS: The assessment of interproximal peri-implant defect width at Ti and ZrO2 implants was more accurate in PR in comparison to CBCT. Measurements in CBCT always led to an overestimation of the defect width, reaching clinical relevance for ZrO2 implants.

Temperature-dependent erosivity of drinks in a model simulating oral fluid dynamics.

OBJECTIVES: Aim of this investigation was to study the temperature-dependent in vitro enamel erosion of five acidic drinks and citric acid under controlled conditions in an artificial mouth. METHODS: The erosive potential of Orange juice, Coca-Cola Zero, Sprite Zero, two fruit teas and citric acid (control) was investigated on bovine enamel specimens at temperatures between 5 °C and 55 °C. The pH values and total calcium content of all test drinks were determined. Specimens were immersed into an artificial mouth to imitate physiological oral conditions for 60 h. Cyclic de- and re-mineralization was performed, imitating the intake of six drinks in six h followed by a six-hour remineralization phase, where only artificial saliva ran over the specimens. Total erosive enamel loss was determined by contact profilometry. Differences in substance loss at different temperatures were tested for statistical significance (p-values ≤ 0.05) by means of ANOVA. RESULTS: Rising liquid temperature did not result in a considerable change of pH. Highest substance loss was observed for citric acid (33.6 ±â€¯6 µm to 38.7 ±â€¯6 µm), while only little erosion was induced by fruit tea (0.8 ±â€¯1 µm to 5.9 ±â€¯1 µm). Rising liquid temperature did not result in significantly increased substance loss for citric acid, orange juice and Coca-Cola Zero. Sprite Zero and both fruit teas, however, caused significantly (p < 0.001) more enamel loss at elevated temperature. CONCLUSIONS: Not all investigated drinks showed a temperature-induced change in erosivity. CLINICAL SIGNIFICANCE: For some erosive beverages it can be recommended to keep the consummation temperature as low as possible to decrease the risk of erosive tooth substance loss.

Location of unaccessible implant surface areas during debridement in simulated peri-implantitis therapy.

BACKGROUND: An in vitro model for peri-implantitis treatment was used to identify areas that are clinically difficult to clean by analyzing the pattern of residual stain after debridement with commonly employed instruments. METHODS: Original data from two previous publications, which simulated surgical (SA) and non-surgical (NSA) implant debridement on two different implant systems respectively, were reanalyzed regarding the localization pattern of residual stains after instrumentation. Two blinded examiners evaluated standardized photographs of 360 initially ink-stained dental implants, which were cleaned at variable defect angulations (30, 60, or 90°), using different instrument types (Gracey curette, ultrasonic scaler or air powder abrasive device) and treatment approaches (SA or NSA). Predefined implant surface areas were graded for residual stain using scores ranging from one (stain-covered) to six (clean). Score differences between respective implant areas were tested for significance by pairwise comparisons using Wilcoxon-rank-sum-tests with a significance level α = 5%. RESULTS: Best scores were found at the machined surface areas (SA: 5.58 ± 0.43, NSA: 4.76 ± 1.09), followed by the tips of the threads (SA: 4.29 ± 0.44, NSA: 4.43 ± 0.61), and areas between threads (SA: 3.79 ± 0.89, NSA: 2.42 ± 1.11). Apically facing threads were most difficult to clean (SA: 1.70 ± 0.92, NSA: 2.42 ± 1.11). Here, air powder abrasives provided the best results. CONCLUSION: Machined surfaces at the implant shoulder were well accessible and showed least amounts of residual stain. Apically facing thread surfaces constituted the area with most residual stain regardless of treatment approach.

The in Vitro Antimicrobial Efficacy of PDT against Periodontopathogenic Bacteria.

Periodontitis, an inflammatory disease, is caused by biofilms with a mixed microbial etiology and involves the progressive destruction of the tooth-supporting tissues. A rising number of studies investigate the clinical potential of photodynamic therapy (PDT) as an adjunct during active therapy. The aim of the present review was to evaluate the available literature for the in vitro antimicrobial efficacy of photodynamic therapy focusing on the periodontopathogenic bacteria Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Fusobacterium nucleatum. The focused question was: "Is it possible to decrease (at least 3 log steps or 99.9%) or even eliminate bacterial growth by photodynamic therapy in vitro when compared to untreated control groups or control groups treated by placebo?" In general, PDT resulted in a substantial reduction of surviving bacteria. However, not all studies showed the desired reduction or elimination. The ranges of log10-reduction were 0.38 (58%) to a complete eradication (100%) for P. gingivalis, 0.21 (39%) to 100% for A. actinomycetemcomitans and 0.3 (50%) to 100% for F. nucleatum. In conclusion, further and particularly more comparable studies are needed to evaluate if PDT can be clinically successful as an adjuvant in periodontal therapy.