Theobromine versus casein phospho-peptides/Amorphous calcium phosphate with fluoride as remineralizing agents: effect on resin-dentine bond strength, microhardness, and morphology of dentine.

BACKGROUND: This study aimed to assess the impact of theobromine and casein phospho-peptides/amorphous calcium phosphate with fluoride (CPP-ACPF) on the resin-dentine bond strength, microhardness, and dentine morphology. METHODS: A total of 18 sound human molars for micro-tensile bond strength (µTBS), 20 sound human premolars for microhardness, and 30 premolars for Scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDX) were used. Based on the pre-treatment used, teeth were split into six groups; sound dentine, demineralized dentine, and demineralized dentine treated with theobromine (Sigma Aldrich) and MI paste plus (GC International, USA) for two-time intervals; 5 min and 1 month. The bonded teeth were sectioned to produce 1 mm2 resin-dentine sticks which were evaluated for µTBS using a universal testing device (Instron 3365, USA). The dentine microhardness was tested by using the Vickers microhardness tester (Nexus 4000 TM, Netherlands). The pre-treated dentine surface was examined using SEM/EDX (Neoscope JCM-6000 plus Joel benchtop SEM, Japan). µTBS results were analysed with two-way ANOVA. Microhardness and EDX results were analysed with two-way mixed model ANOVA. The significance level was set at (p ≤ 0.05). RESULTS: While both remineralizing materials at the two-time intervals demonstrated µTBS comparable to sound dentine (46.38 ± 12.18), the demineralized group demonstrated statistically the lowest µTBS (p < 0.001). Whether used for 5 min or 1 month, theobromine significantly increased the microhardness (50.18 ± 3.43) and (54.12 ± 2.66) respectively (p < 0.001), whereas MI paste only increased the hardness (51.12 ± 1.45) after 1 month (p < 0.001). CONCLUSIONS: The pre-treatment of demineralized dentine with theobromine for 5 min or 1 month could enhance its bond strength and microhardness while for MI paste plus, only 1-month application was efficient to ensure remineralization.

Bleaching gel mixed with MI Paste Plus reduces penetration of H2O2 and damage to pulp tissue and maintains bleaching effectiveness.

OBJECTIVES: MI Paste Plus remineralizer (Rem) strengthens dental structures after bleaching. We investigated the effect of Rem on the penetration of hydrogen peroxide (H2O2), bleaching effectiveness, and pulp inflammation after bleaching. MATERIALS AND METHODS: Bovine disks were grouped as follows (n = 10): control (untreated), bleached (Ble; 35% H2O2, 30 min), Ble-Rem (H2O2 followed by Rem, 30 min), Rem-Ble (Rem followed by H2O2), Rem-Ble-Rem (Rem before and after H2O2), and Ble+Rem (mixture of Rem with H2O2, 1:1, 30 min). The penetration of H2O2 was quantified and bleaching efficacy was analyzed. Upper rat molars (n = 10) received the same treatments at random. The rats were euthanized after two days and 30 days, and their jaws were removed for histological analysis. Statistical tests were performed (P < 0.05). RESULTS: The bleached groups, except Ble+Rem (P > 0.05), showed significant H2O2 penetration compared with control (P < 0.05). Color alteration analysis showed that ΔL and ΔE were significantly higher in the bleached groups than those in control (P < 0.05); the Δb of the bleached groups differed from that of control at 24 h (P < 0.05). At two days, necrosis or inflammation was observed in the bleached groups compared with control (P < 0.05), except Ble+Rem, which was similar to control (P > 0.05). At 30 days, tertiary dentin formation was significant in the bleached groups (P < 0.05), except Ble+Rem (P > 0.05). CONCLUSION: The mixture of MI Paste Plus and bleaching gel reduces H2O2 penetration and pulp damage and maintains bleaching effectiveness. CLINICAL RELEVANCE: Because bleaching can damage dental tissues, we studied a new bleaching protocol that reduces damage to the pulp tissue while maintaining bleaching efficiency: a single application of 30 min of MI Paste Plus mixed with 35% H2O2 bleaching gel (1:1).

MI Varnish and MI Paste Plus in a caries prevention and remineralization study: a randomized controlled trial.

OBJECTIVES: White spot lesions (WSLs) are a complication of orthodontic therapy. This study investigated the effect of MI (minimally invasive) Paste Plus (MIPP) and MI Varnish (MIV) on WSLs in orthodontic patients during a 12-month, randomized, single-blind, prospective, standard-of-care controlled clinical trial. MATERIALS AND METHODS: Forty subjects, recruited from the UCSF School of Dentistry Orthodontics Clinic, were randomly assigned to the experimental (twice-daily 1100 ppm fluoride toothpaste, daily MIPP, quarterly MIV application) or control group (twice-daily 1100 ppm fluoride toothpaste, fluoride rinse recommendation). Facial surfaces of incisors, canines, and first bicuspids were evaluated at baseline, 3, 6, and 12 months using the enamel decalcification index (EDI) and the international caries detection and assessment system (ICDAS). RESULTS: Findings from 37 subjects are reported. At 12 months, teeth receiving experimental treatment were at lower but not significantly different odds of increased EDI scores (odds ratio, OR 0.63; intra-patient cluster-adjusted 95% CI 0.43, 1.18) and not associated with increased ICDAS scores (OR 0.99; 95% CI 0.64, 1.54). There was no statistically significant difference in mean patient-level EDI sum (experimental group 40.2; control 41.3; t test p = 0.80), ICDAS score (experimental 22.3; control 22.6; Mann-Whitney U test p = 0.80), or percentage of scored surfaces with ICDAS > 0 (experimental 54.6%; control 55.2%; t test p = 0.88). Salivary fluoride levels were significantly higher at 12 months for the experimental than for the control group (0.20 ± 0.26 versus 0.04 ± 0.04 ppm, Mann-Whitney U test p < 0.01). CONCLUSIONS: Applying daily MIPP and quarterly MIV resulted in no statistically significant differences in EDI sum and ICDAS scores. Higher salivary fluoride levels in the experimental group suggest that MIPP and MIV effectively deliver fluoride when used clinically. CLINICAL RELEVANCE: Daily MIPP and quarterly MIV applications do not appear to reduce significantly WSLs incidence during fixed orthodontic treatment.

The Effect of MIpaste Plus and Reminpro on Incipient Caries Using DIAGNOdent and SEM: An Invitro Study.

BACKGROUND: The remineralization of early caries lesion has an effective role on decreasing caries. For initial remineralization of caries lesion, using Compounds of Casein phosphopeptides (CPP) in different studies has been proposed. REMINPRO including Fluoride, Xylitol and Calcium phosphate has just been offered in the market. This study aims to investigate the efficacy of Reminpro and MI paste plus in terms of remineralization of early enamel lesions. MATERIALS AND METHODS: In 15 samples of healthy enamels of the maxillary first premolar teeth and 15 samples of Primary Mandibular First Molar under the effect of demineralized gel, artificial caries has been created. The samples have been divided in 3 groups of 20. After performing the cycles of demineralization and remineralization during 5 weeks, the samples were investigated by DIAGNOdent and two samples from each group were compared with SEM. To investigate the remineralization of enamel, two-way ANOVA and to compare the groups in pair, the post hoc tests were used. RESULTS: The mean of mineralization of teeth in the group using reminpro was 25.2 ± 6.16 and in the group using MI paste plus was 23 ± 5.60, which was significantly high. CONCLUSIONS: MI paste plus in mineralization of initial enamel caries were more efficient that reminpro pate.

The preventive/therapeutic effect of CO2 laser and MI Paste Plus® on intact and demineralized enamel against Streptococcus mutans (In Vitro Study).

Background: To evaluate the preventive and therapeutic effects of CO2 laser and MI paste plus on intact and demineralized enamel surfaces and their impact on bacterial adhesion. Methods: 160 enamel slabs were prepared and randomly allocated into two main groups; sound and demineralized enamel (n = 80 per group), in which specimens were immersed in a demineralizing solution (50 mM acetic acid, pH 4.5) for 72 h at 37 °C. Each group was further divided into four subgroups (n = 20); the control (un treated surfaces), surfaces treated by CO2 laser, MI paste plus (Recaldent™, GC corporation/Germany), and those received a combination of CO2 and MI paste plus. Streptococcus Mutans biofilm was isolated, quantified, and then applied on treated enamel surfaces and incubated anaerobically for 24 h and then quantified by colony-forming unit (CFU). Meanwhile, surface changes were assessed by Vickers microhardness and Scanning Electron Microscope combined with Energy-Dispersive X-Ray Spectroscopy (SEM-EDX). Results: The combined use of CO2 laser followed by MI paste plus significantly (p < 0.000) enhanced surface microhardness of sound and demineralized enamel with a significant reduction in bacterial counts. However, each technique alone was beneficial as they exhibited higher microhardness with lower bacterial viability in comparison to the control. The treatment of demineralized enamel surfaces with MI paste significantly reduced the number of bacterial colonies with the presence of dispersed mineral deposits over the surface. Conclusions: The combined use of CO2 laser and MI paste plus was effective as a preventive and/or therapeutic measures in enhancing surface properties of enamel and reducing the bacterial viability.

Analysis of Dental Enamel Remineralization: A Systematic Review of Technique Comparisons.

The demineralization process conditions the structure of the enamel and begins with a superficial decalcification procedure that makes the enamel surface porous and gives it a chalky appearance. White spot lesions (WSLs) are the first clinical sign that can be appreciated before caries evolves into cavitated lesions. The years of research have led to the testing of several remineralization techniques. This study's objective is to investigate and assess the various methods for remineralizing enamel. The dental enamel remineralization techniques have been evaluated. A literature search on PubMed, Scopus, and Web of Science was performed. After screening, identification, and eligibility processes 17 papers were selected for the qualitative analysis. This systematic review identified several materials that, whether used singly or in combination, can be effective in the process of remineralizing enamel. All methods have a potential for remineralization when they come into contact with tooth enamel surfaces that have early-stage caries (white spot lesions). From the studies conducted in the test, all of the substances used to which fluoride has been added contribute to remineralization. It is believed that by developing and researching new remineralization techniques, this process might develop even more successfully.

Recharge and increase in hardness of GIC with CPP-ACP/F.

OBJECTIVE: To assess the effect of CPP-ACP/F recharging on ion release and hardness of GIC Fuji-Triage (VII) and Fuji-Triage-EP (VII-EP) containing CPP-ACP/F. METHODS: CPP-ACP distribution in Fuji-Triage-EP was determined using immunofluorescence. Thirty blocks of Fuji-Triage and Fuji-Triage-EP with the same surface area were placed individually in 5mL of 50mM lactic acid (pH 5) for three days. Every 12h ten Fuji-Triage and ten Fuji-Triage-EP blocks were treated with 2mL of either MI Paste Plus (CPP-ACP/F) solution (1g paste+4mL water), Placebo MI paste solution (no CPP-ACP/F), or distilled water for 2min. After each 2min treatment the blocks were rinsed with distilled water and placed back into the acid. Calcium, inorganic phosphate and fluoride levels in the acid solution were measured using atomic absorption spectrophotometry, colorimetry and ion specific electrode respectively. Vickers surface hardness of the GIC was also determined. Data were analysed using a two-sample t-test and one-way ANOVA with a Bonferroni-Holm correction for multiple comparisons. RESULTS: CPP-ACP was distributed throughout Fuji-Triage-EP. Significantly (p<0.001) higher calcium, inorganic phosphate and fluoride ion release and greater surface hardness (acid resistance) was observed in both GIC's treated with the CPP-ACP/F paste. Fuji-Triage-EP released higher ion levels and exhibited greater surface hardness (acid resistance) than Fuji-Triage. SIGNIFICANCE: Topical application of CPP-ACP/F paste to GIC Fuji-Triage-EP recharged ion release and increased surface hardness (acid resistance) which may help improve properties and resistance to degradation as well as improve ion release for caries control.

Combined effects of Er: YAG laser and casein phosphopeptide-amorphous calcium phosphate on the inhibition of enamel demineralization: An in vitro study.

BACKGROUND: Development of white spot lesions on enamel is a significant and common problem during the fixed orthodontic treatment. Various preventive methods have been suggested. The purpose of this study was to evaluate the preventive potential of MI Paste Plus, Er: YAG Laser and combined under similar in vitro conditions against demineralization. MATERIALS AND METHODS: In this experimental in vitro study, 60 extracted premolars were randomly allocated to four groups (n = 15) of control, MI Paste Plus, Laser and MI + Laser (MIL). Enamel surface of each group was treated with one of above materials before and during the pH cycling for 12 days through a daily procedure of demineralization and remineralization for 3 h and 20 h, respectively. Teeth were sectioned and evaluated quantitatively by cross-sectional microhardness testing at 20 µm intervals from the outer enamel surface toward dentinoenamel junction up to 160 µm and data were analyzed using the one-way analysis of variance and Tukey test. P < 0.05 was considered as significant. RESULTS: MIL group had the least amount of demineralization (P < 0.001). Control group (C group) had the greatest relative mineral loss and the laser group (L group) had 45% less mineral loss than the C group and there was no significant difference between the MI Paste Plus and L group (P = 0.154). CONCLUSION: BASED ON THESE RESULTS, ER: YAG laser was able to decrease demineralization and was a potential alternative to preventive dentistry and was more effective when combined with casein phosphopeptide-amorphous calcium phosphate products.