Comparative Effect of Calcium Mesoporous Silica Versus Calcium and/or Fluoride Products on the Reduction of Erosive Tooth Wear and Abrasive Enamel Lesion

Abstract Objective: To evaluate the effect of a calcium nanocompound on the reduction of erosive tooth wear and abrasion. Material and Methods: Bovine enamel specimens (BE), were randomly assigned to the following groups (n = 10): G1 = Calcium mesoporous silica nanoparticles (Ca2+MSNs); G2 = casein phosphopeptide-amorphous calcium phosphate (CPP-ACP, 2% CPP-ACP, GC®); G3 = casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP, 2% CPP-ACP + 900 ppm F-, GC®); G4 = sodium fluoride NaF (900 ppm F-, positive control); and G5 = distilled and deionized water (negative control). Each product was applied to the exposed area for one minute, three times per day for three consecutive days, and followed by the immersion of the specimens in Sprite Zero™ - a low-pH solution (2.58) for five minutes (Coca-Cola™). After the first and last erosive challenges of the day, the specimens were submitted to abrasion in a toothbrush machine for 15 seconds (200 g/BE). The specimens were analysed using 3D non-contact optical profilometry, with tooth structure loss (TSL) measurements and scanning electron microscopy (SEM). TSL values were analysed by Kruskal-Wallis and Mann-Whitney tests (p<0.05). Results: There were no significant differences between G1 (10.95 µm) and G3 (10.80 µm) treatments for TSL values; however both resulted in significantly reduced TSL values compared with the G5 (16.00 µm) (p<0.05). The G4 (12.26 µm) showed no statistically significant difference when compared to the G5 (16.00 µm). The groups G1 and G3 presented higher surface preservation than the G5. Conclusion: Ca2+MSNs was effective for reducing tooth surface loss caused by erosive tooth wear and abrasion.

Effect of fluoride varnish supplemented with sodium trimetaphosphate on enamel erosion and abrasion: an in situ/ex vivo study.

OBJECTIVE: To evaluate the effect of fluoride (F) varnishes supplemented or not with sodium trimetaphosphate (TMP) on enamel erosive wear followed or not by abrasion in situ. METHODS: Ten volunteers were selected and randomly divided into four groups, according to the varnishes tested: placebo (no F or TMP), 5% NaF (positive control), 2.5% NaF and 2.5% NaF/5% TMP. Enamel blocks (n=4) were mounted in palatal devices and received an application of each test varnish, following a double-blind, crossover protocol. After 6h, varnishes were completely removed and the blocks were subjected to erosive challenges by ex vivo immersion in citric acid (5 min, 4×/dia, 5 days). Following, half of the blocks were subjected to abrasion by brushing with a placebo dentifrice slurry for 15s. Enamel wear (µm), surface hardness (SHf) and cross-sectional hardness (ΔKHN) were assessed after each experimental period. Results were analyzed by ANOVA, Student-Newman-Keuls's test and Pearson correlation coefficient (p<0.05). RESULTS: The fluoride varnish supplemented with TMP promoted significantly lower wear and ΔKHN when compared to the other groups after erosive challenges, followed or not by abrasion (p<0.05). As for (SHf) the fluoride varnish supplemented with TMP promoted similar results to the 5% NaF product, being significantly higher than the remaining groups after erosive and erosive+abrasive challenges (p<0.05). CONCLUSION: TMP significantly enhanced the effects of F on enamel wear after erosive challenges, followed or not by abrasion.

Effect of fluoride varnish supplemented with sodium trimetaphosphate on enamel erosion and abrasion.

PURPOSE: To assess in vitro the effect on enamel erosion (ERO) and erosion followed by abrasion (ERO+ABR) of varnishes with different fluoride concentrations, supplemented or not with sodium trimetaphosphate (TMP). METHODS: Bovine enamel blocks were randomly divided into six groups according to the type of varnish used: placebo (no F), NaF 5%, NaF 2.5%, NaF 2.5% plus TMP 3.5%, NaF 2.5% plus TMP 5%, NaF 2.5% plus TMP 10%. Varnishes were tested for ERO and ERO+ABR, separately for 3 and 5 days. ERO was done by immersion in Sprite Zero (5 minutes, 4x/day), while ERO+ABR was performed by brushing for 15 seconds after each erosive challenge. Enamel wear (microm) and cross-sectional hardness (AKHN) were assessed after the experimental periods. Data were analyzed by ANOVA, Tukey's test and Pearson's correlation coefficient (P< 0.05). RESULTS: Varnishes supplemented with TMP promoted significantly lower wear and hardness loss when compared to the other treatments in all conditions studied (P< 0.05). Similar wear rates were observed for the placebo, NaF 2.5% and NaF 5% varnishes (P> 0.05). Greater wear was observed after 5 days of ERO and ERO+ABR when compared with 3 days (P< 0.05). Positive and significant correlations were found between enamel wear and AKHN. No dose-response relationship was found between TMP concentration and wear and hardness. It was concluded that fluoride varnishes supplemented with TMP had a higher protective effect against ERO and ERO+ABR, which was associated with a reduction in enamel softening.

[Tooth wear, a proposal for an evaluation system]. / Een beoordelingssysteem voor gebitsslijtage.

The present-day terminology and definitions of tooth wear are not unambiguous. For diagnosing tooth wear, however, it is essential that they are unambiguous. In this article a proposal is presented for a tooth wear evaluation system with simplified definitions. This system consists ofa number of modules and can be used for various aspects of the diagnostic procedure. It can be used for the quantification of tooth wear, both for periodic screening and for the monitoring of tooth wear in individual patients. The scoring of occlusal/incisal tooth wear as well as of non-occlusal/non-incisal tooth wear is possible. The evaluative system is also suitable for determining which type of tooth wear, such as attrition, abrasion and erosion, is most likely to have caused any observed loss of hard tooth tissue.

Non-carious cervical lesions associated with gingival recessions: a decision-making process.

BACKGROUND: A method to predetermine the maximum root coverage level (MRC) was recently demonstrated to be reliable in predicting the position of the soft tissue margin after root coverage surgery. The aim of the present study is to suggest a decision-making process for treating non-carious cervical lesions (NCCLs) associated with gingival recessions based upon the topographic relationship between the MRC and NCCL and to assess patient and independent-periodontist esthetic evaluations. METHODS: Five treatments were performed in 94 patients with NCCLs associated with a single gingival recession: 1) coronally advanced flap (CAF); 2) bilaminar procedure; 3) coronal odontoplasty plus restoration plus root odontoplasty plus CAF; 4) restoration plus CAF; and 5) restorative therapy. Clinical and esthetic evaluations made by the patient and an independent periodontist were done 1 year after treatments. RESULTS: The satisfaction of the patient and periodontist with esthetics was very high in all NCCL treatments and Miller Class gingival recessions. The patient satisfaction and evaluation of root coverage and the periodontist evaluation of root coverage were statistically correlated with color-match evaluations and not with the amount of root coverage clinically achieved in each patient. CONCLUSION: The proposed approaches provided good esthetic appearance and correct emergence profile for the great majority of NCCLs associated with gingival recessions.

Oral manifestations of smokeless tobacco use.

Smokeless tobacco (SLT) has been smoked, chewed, and inhaled in various forms for hundreds of years. The primary oral, mucosal, and hard tissue changes associated with SLT use include SLT keratosis (STK); gingival inflammation, periodontal inflammation, and alveolar bone damage; and dental caries, tooth abrasion, and dysplasia and oral squamous cell carcinoma (SCC). Some high-risk STKs are human papillomavirus associated, and the highest level of transition of STK to dysplasia or oral SCC appears to be in those lesions that have a diffuse velvety or papillary texture clinically. There is minimal risk for oral cancer associated with SLT use.

Effect of different fluoride concentrations of experimental dentifrices on enamel erosion and abrasion.

It has been suggested that fluoride products are able to reduce erosive tooth wear. Thus, the purpose of this in vitro study was to evaluate the effect of dentifrices with different fluoride concentrations as well as of a low-fluoridated dentifrice supplemented with trimetaphosphate (TMP) on enamel erosion and abrasion. One hundred twenty bovine enamel blocks were assigned to the following experimental dentifrices: placebo, 1,100 microg F/g, 500 microg F/g plus 3% TMP and 5,000 microg F/g. The groups of enamel blocks were additionally subdivided into conditions of erosion (ERO) and of erosion plus abrasion (ERO + ABR). For 7 days, the blocks were subjected to erosive challenges (immersion in Sprite 4 times a day for 5 min each time) followed by a remineralizing period (immersion in artificial saliva between erosive challenges for 2 h). After each erosive challenge, the blocks were exposed to slurries of the dentifrices (10 ml/sample for 15 s). Sixty of the blocks were additionally abraded by brushing using an electric toothbrush (15 s). The alterations of the enamel were quantified using the Knoop hardness test and profilometry (measurements in micrometers). The data were analyzed using a 2-way ANOVA test followed by a Bonferroni correction (p < 0.05). In in vitro conditions, the 5,000 microg F/g and 500 microg F/g plus 3% TMP dentifrices had a greater protective effect when compared with the 1,100 microg F/g dentifrice, under both ERO and ERO + ABR conditions. The results suggest that dentifrices alone are not capable of completely inhibiting tooth wear.

Evaluación del desgaste por cepillado, in vitro, de una resina compuesta, fotopolimerizada por lámpara halógena: en dos tiempos diferentes / Wear evaluation of the in vitro toothbrushing of a composite resin cured by halogent light curing: in two different times

El objetivo de este trabajo fue evaluar el desgaste abrasivo por cepillado in vitro de la resina compuesta 4Seasons, de dos colores diferentes (A3 y C4) y polimerizadas por dos diferentes tiempos (20 e 40 s), utilizando cepillo dental y dentífrico; también se uso como material de referencia, el PMMA. Fueron confeccionados 10 especímenes, para cada uno de los 5 grupos (PMMA, A3 20s, A3 40s, C4 20s, C4 40s). Después de su confección, cada espécimen era almacenado en agua desmineralizada a 37 ± 2 ºC, por 24 horas, regularizados con lija; después del lavado en ultrasonido, volvían a ser almacenados en las mismas condiciones por 7 días. El cepillado fue realizado en una máquina para desgaste por cepillado, aplicándose una carga de 3N, con frecuencia de 4,5 ciclos/seg; el período de cepillado de un espécimen comprendía 150,000 ciclos. Fueron realizados 5 lotes de cepillado, de modo que un espécimen de cada material de cada grupo fuese sometido a cada una de las posiciones ocupadas por los 10 cepillos. La cantidad de masa pérdida fue calculada por pesaje (pre y post cepillado). Este trabajo también fue ilustrado con gráficos de rugosidad y MEB. La tasa media de desgaste fue de 2,8 mg para PMMA, de 5,5 mg para A3-20s, 4,7 mg para A3-40 s, 5,4 para C4-20s y 4,2 mg para C4-40s. ANOVA mostro que no hubo diferencia significante entre los grupos, para p=0,166. Concluyéndose que no existió diferencia de resistencia al desgaste abrasivo entre los grupos

To evaluate abrasive wear, by weight changes, of a resin composite to in vitro toothbrushing, of two different colors (A3 and C4), cured by two times (20 and 40 s). Resin composite 4Seasons was material studied and PMMA was used as reference material. Ten cylindric samples had been prepared for each one of the five evaluated groups (PMMA, A3 20s, A3 40s, C4 20s, C4 40s). After confection, samples were immersed in deionized water, at 37± ºC, for 24 h, and then regularized by abrasive gritting with sandpaper, after that, were cleaned in ultrasound bath, and restored to the same described conditions, for 7 days. The toothbrushing was then conducted in a proper machine that holds 10 specimens, with 3 N load of each toothbrush on the respective sample using dentifrice and water. 150.000 cycles were applied per group. Five lots of toothbrushing had been performed; in a way that one sample of each group had been submitted to the brushing action at one position in the machine. The amount of weight loss for each sample was calculated by means of weighting. Roughness and MEV were also evaluated. Data were analyzed with one-way ANOVA. The average rate of wear was of 2.8 mg for PMMA, 5.5 mg for A3-20s, 4.7 mg for A3-40 s, 5.4 for C4-20s, and 4,2 mg for C4-40s. One-way ANOVA showed no significant difference between groups (p=0.166). It was possible to conclude that difference of the resistance to the abrasive wear between the studied groups did not exist

Techniques for restoring worn anterior teeth with direct composite resin.

UNLABELLED: Toothwear is increasing in prevalence. Traditional treatment methods for moderate or advanced toothwear, such as indirect restorations and crown lengthening surgery, are invasive and destructive of remaining tissues. The 'Dahl technique' has been used to obtain space for anterior restorations and has been modified such that direct composite restorations are placed at increased occlusal vertical dimension. These restorations have proved durable and aesthetic, protect tooth structure and posterior occlusal contact is predictably re-established. The authors describe and compare two techniques using composite resin to treat localized anterior toothwear in a general practice setting. CLINICAL RELEVANCE: Toothwear is a significant clinical problem and general dental practitioners and specialists alike must be familiar with the available conservative treatment options.

Scanning electron microscopic study of the in situ effect of salivary stimulation on erosion and abrasion in human and bovine enamel

This in situ study investigated, using scanning electron microscopy, the effect of stimulated saliva on the enamel surface of bovine and human substrates submitted to erosion followed by brushing abrasion immediately or after one hour. During 2 experimental 7-day crossover phases, 9 previously selected volunteers wore intraoral palatal devices, with 12 enamel specimens (6 human and 6 bovine). In the first phase, the volunteers immersed the device for 5 minutes in 150 ml of a cola drink, 4 times a day (8h00, 12h00, 16h00 and 20h00). Immediately after the immersions, no treatment was performed in 4 specimens (ERO), 4 other specimens were immediately brushed (0 min) using a fluoride dentifrice and the device was replaced into the mouth. After 60 min, the other 4 specimens were brushed. In the second phase, the procedures were repeated but, after the immersions, the volunteers stimulated the salivary flow rate by chewing a sugar-free gum for 30 min. Enamel superficial alterations of all specimens were then evaluated using a scanning electron microscope. Enamel prism core dissolution was seen on the surfaces submitted to erosion, while on those submitted to erosion and to abrasion (both at 0 and 60 min) a more homogeneous enamel surface was observed, probably due to the removal of the altered superficial prism layer. For all the other variables - enamel substrate and salivary stimulation -, the microscopic pattern of the enamel specimens was similar.

Abfracción. La lección dental del futuro. Parte I: etiopatogenia y características clínicas / Abfraction. The dental lesion of the future. Part I: etiopathogenesis and clinical features

Se denomina abfracción a la lesión en forma de cuña en el límite amelocementario (LAC) causada por fuerzas oclusales excéntricas que llevan a la flexión dental provocando la ruptura de prismas de esmalte, cemento y dentina. Los objetivos de este trabajo son: 1) comprender los mecanismos que generan la abfracción, su etiología, desarrollo y patología generada; 2) cuáles trabajos de investigación fundamentan la etiopatogenia de estas lesiones; 3) describir las características clínica; 4) valorar la abfracción y su importancia en el futuro como lesión en las próximas generaciones; 5) establecer las situaciones en que estas lesiones cervicales deben ser restauradas.

[Tooth wear in Hindu betel nut chewers]. / Starcie zebów w wybranej populacji hinduskiej zujacej betel.

Literature data describe the impact of certain factors on oral health. Very well known is habitual chewing of different plant products, including tobacco, which depending on the geographical area and the substances used, have various names. It has been estimated that approximately 200 million residents of the West Pacific Rim and South-East Asia indulge in betel chewing. Betel is composed of a leaf of the betel pepper, lime, tobacco and the nut of the areca palm. This study aimed to assess the degree of abrasive changes in residents of the Korunalaya Leprosy Care Center. The examinations were carried out on 85 patients (45 females and 40 males), aged 35-95 years, at the local dental surgery. Patients had their teeth assessed and they were further interviewed as to the duration of their habit with regard to their sex and age (35-44; 45-64 and > or = 65 years). The abrasive changes were evaluated using Gerasimov's 7-degree scale. Interview data indicate that 71.76% of the patients were habitual betel chewers. Among female patients, third-degree abrasion was the most frequent change while among males--fifth degree (53.3% and 45.0%, respectively). The abrasive changes, increasing with age, can be attributed to the duration of betel chewing. It is worth noticing that a vegetarian diet can be a contributing factor to abrasion as most of the food consumed by Hindus are plants.

Accuracy of ultrasound measurement of progressive change in occlusal enamel thickness.

OBJECTIVE: To evaluate the effectiveness of ultrasound on measuring the thickness of enamel in abrasion. STUDY DESIGN: Flat areas on occlusal surfaces of 20 premolar teeth were marked. Two initial ultrasonic measurements on marked areas were obtained by the first researcher. Then the tooth was measured in the axial direction with a compass. The cusp tips were abraded by an abrasive paper, then the second and third ultrasonic measurements were taken. The second researcher repeated the third ultrasonic measurement to evaluate the interobserver variation. All specimens were sectioned and the remaining enamel thickness was measured under polarized light microscope. RESULTS: Pearson's correlation analysis showed a high level of intraobserver agreement for the ultrasonic measurements of the first researcher (r = .891, P < .000 initial; r = .690, P < .001 first abrasion; r = .885, P < .000 second abrasion). Third ultrasonic measurements of the first and second researchers were positively and significantly correlated with histological readings (r = .966, P < .000; r = .466, P = .039). CONCLUSIONS: The ultrasonic system used in this study was reliable in measuring enamel thickness.

The effect of miswak and tooth brush filaments end-surface texture on enamel. A SEM pilot study.

OBJECTIVE: The aim of the study was to compare the abrasive effect of miswak and toothbrush filaments on enamel tooth surface. MATERIAL AND METHODS: Ten maxillary central incisors were obtained from Division of Maxillofacial Surgery, King Saud University, College of Dentistry. Twenty specimen were prepared, they were divided into 4 groups (1) Butler toothbrush; (2) Aquafresh toothbrush; (3) Miswak; (4) Control group. Miswak, Aquafresh 311 and Butler 311 tooth brush were used with light pressure in one direction motion for 60 seconds on enamel surface. The specimens were prepared for Scanning Electron Microscopy (SEM) examination. The middle filament from toothbrushes and miswak were also prepared for SEM. RESULTS: Showed that filaments end-surface texture play a major role in abrasive active activity and enamel tooth surface loss. CONCLUSION: The Butler 311 toothbrush and miswak showed lesser effect on enamel as compared to Aquafresh 311 toothbrush.

Associated postmortem dental findings as an aid to personal identification.

The use of the unique features of the human dentition to aid in personal identification is well accepted within the forensic field. Indeed, despite advances in DNA and other identification methodologies, comparative dental identifications still play a major role in identifying the victims of violence, disaster or other misfortune. The classic comparative dental identification employs the use of postmortem and antemortem dental records (principally written notes and radiographs) to determine similarities and exclude discrepancies. In many cases the tentative identification of the individual is unknown and therefore antemortem records cannot be located. In such a situation a dental profile of the individual is developed to aid the search for the individual's identity. With such a profile a forensic odontologist can identify and report indicators for age at time of death, race (within the four major ethnic groups) and sex. In addition to these parameters the forensic dentist may be able to give more insight into the individual. This paper outlines, for the non-expert, some of the additional personal information that can be derived from the teeth of the deceased, and which may assist in their ultimate identification.

Lesiones cervicales no cariosas y su tratamiento / Non-carious cervical lesions and their treatment

El objetivo de este trabajo consiste en describir las distintas lesiones cervicales no cariosas, la abrasión, la erosión y la abfracción. Se desarrollarán en detalle: su etiología, localización y características clínicas. Siendo la abfracción considerada la más asociada a la hipersensibilidad, se plantearán diferentes formas de tratamiento de la misma. Se mencionarán los diferentes procedimientos a realizar para su prevención y los materiales a utilizar para su restauración

Spatial resolution in radiometric analysis of enamel loss. A pilot study.

This pilot study was undertaken to determine whether spatial resolution affects radiometric analyses aimed at detecting progressive enamel loss. Four teeth were weighed, attached to a positioning device, and evaluated with radiography. A 1 mm strip of enamel was removed from each tooth, and the teeth were weighted again and reexamined by radiography. This process was repeated five times until 1/2 mm of dentin was removed. The radiographs were digitized twice with 59 and 200 microns pixels at 8 bits, providing two series of images with the optical densities converted into 256 gray levels. Each series of images was adjusted for contrast variation. Regions of interest were drawn on the crowns, and cumulative percent histograms (CPHs) were calculated. Within a series of CPHs enamel reduction resulted in shifts in the CPHs that were directly proportional to the amount of enamel removed. CPH shifts associated with the smaller 59 microns pixels accounted for 68% of the variation in weights caused by enamel reduction, whereas the shifts associated with the larger 200 microns pixels accounted for 50%. The results indicate that pixel size does affect radiometric determinations of enamel reduction.

Smokeless tobacco use: how it affects the performance of major league baseball players.

The authors examined the effect of smokeless tobacco use on the athletic performance of major league baseball players during the 1988 season. They evaluated performance records of 158 players on seven major league teams who played or pitched at least 10 games or innings during the 1988 season. ST use, they concluded, is not related to player performance in major league baseball but does place players at significantly increased risk for mucosal lesions and other oral pathology.

Surface morphology and chemical characterization of abrasion/erosion lesions.

PURPOSE: To describe the dentin surface morphology of abrasion/erosion lesions and to chemically characterize in vivo samples of sclerotic dentin. MATERIALS AND METHODS: Baseline polyvinylsiloxane impressions of eight in vivo caries-free lesions were taken. Dentin was collected from retention grooves for FTIR photoacoustic spectroscopic analysis. The cavity preparation was etched for 30 seconds with 37% phosphoric acid, rinsed, and dried. Impressions were taken of the etched surfaces. Epoxy resin dies were made of baseline and etched impressions, sputter-coated and examined at x1000 with the SEM. RESULTS: Lateral dentin tubule orientation was observed at gingival margins and on occlusal walls. Open cross-sectional tubules were seen at the depth of the groove. The mineral/protein ratio in the FTIR/PAS spectra of in vivo unetched sclerotic dentin samples suggested an increased mineral content.