Combined use of stannous fluoride-containing mouth rinse and toothpaste prevents enamel erosion in vitro.

OBJECTIVE: To compare the protective effect of commercial stannous-containing mouth rinses on enamel erosion in a simulated 5-day in vitro cycling model. MATERIALS AND METHODS: 81 human enamel specimens were embedded in resin blocks and divided into nine groups as follows; group 1: stannous fluoride (1000SnF2) toothpaste; groups 2,3, and 4 were the same as group 1 plus Elmex®, PerioMed™, and Meridol®, respectively, group 5: stannous fluoride (1450SnF2) toothpaste, groups 6, 7, and 8 were the same as group 5 plus Elmex®, PerioMed™, and Meridol®, respectively, group 9: negative control. An erosive challenge was induced with a 1 min hydrochloric acid (0.01 M, pH 2.2) treatment 3 times per day. Each cycle included immersing in the toothpaste slurry twice for two minutes and a one-minute rinse. The enamel slabs were immersed in artificial saliva between each erosive cycle and incubated overnight at 37 °C. Surface hardness loss and enamel loss were determined by Knoop surface hardness and non-contact profilometry, respectively. Finally, enamel surfaces were analyzed by scanning electron microscopy and X-ray energy dispersive spectroscopy (SEM/EDS). RESULTS: All three mouth rinses had similar protective effects against erosion when using adjunct with 1000 SnF2 toothpaste (p > 0.05). With 1450 SnF2 toothpaste, Elmex® presented significantly lower surface hardness loss than Meridol® (p < 0.05). The combined use of Elmex® or PerioMed™ with toothpaste provided significantly better erosion protection than toothpaste alone, either 1000 or 1450 SnF2. In addition, 1000SnF2 toothpaste adjunct with mouth rinse is comparable to 1450 SnF2 toothpaste alone in preventing enamel erosion. CONCLUSION: All three mouth rinses reduced enamel erosion. The additional use of a high concentration stannous containing mouth rinse with 1450 SnF2 toothpaste increases the protective effect against enamel erosion in vitro. CLINICAL SIGNIFICANCE: To date, no standard protocol for preventing dental erosion is available. There are three stannous-containing mouth rinses on the market; however, no study compared their efficacy or indicated whether using adjuncts with anti-erosion toothpaste provides additional benefits. This study found that adding stannous mouth rinse to twice-daily toothpaste increases erosion protection.

Preventive effect of chitosan gel containing CaneCPI-5 against enamel erosive wear in situ.

OBJECTIVE: This study evaluated the preventive effect of a chitosan gel containing CaneCPI-5 against enamel erosion and erosion + abrasion in situ. METHODS: Sixteen volunteers participated in a crossover, double-blind protocol, comprising 4 phases: (1) no treatment (Nt); (2) chitosan gel (Cg); (3) chitosan gel + 12,300 ppm NaF (Cg + NaF); and (4) chitosan gel + 0.1 mg/mL CaneCPI-5 (Cg + Cane). Volunteers wore an appliance containing 4 specimens. Once/day, they applied the gel (except for Nt) (4 min/specimen). Erosive challenges were performed extra-orally (0.1% citric acid, 90 s, 4 × /day; ERO). Specimens were also abraded (toothbrush, 15 s/specimen, 2 × /day; ERO + ABR). Enamel wear was assessed by profilometry and relative surface reflection intensity (%SRI). Two-way RM-ANOVA/Sidak's tests and Spearman's correlation were used (p < 0.05). RESULTS: For profilometry, ERO + ABR promoted significantly greater wear when compared with ERO. There was a significant difference among all treatments. The lowest enamel loss occurred for Cg + Cane, followed by Cg + NaF, Cg, and Nt (p < 0.05). The %SRI was significantly lower for ERO + ABR when compared to ERO, only for the Nt group. The greatest %SRI was found for the Cg + NaF and Cg + Cane groups, which did not differ significantly, regardless of the conditions. The lowest %SRI was found for the Nt and Cg groups, which did not differ from each other, regardless of the conditions. The Nt group did not differ significantly from the Cg + NaF (ERO). There was a significant correlation between both analyses. CONCLUSION: The incorporation of CaneCPI-5 in the chitosan gel prevented erosive wear in situ. CLINICAL RELEVANCE: These results open a new perspective for the use of CaneCPI-5 in other application vehicles, such as chitosan gel.

Nanoencapsulated fluoride as a remineralization option for dental erosion: an in vitro study.

OBJECTIVE: To compare the in vitro performance of different dentifrices indicated for dental erosion and a new dentifrice with controlled fluoride release system (NanoF) in terms of surface microhardness remineralization in enamel erosion lesions. MATERIALS AND METHODS: 72 human enamel specimens were divided into 6 groups (n = 12): PC (100% NaF - positive control); NC (Placebo - negative control); 50%nF (50% NanoF + 50% free NaF), 100%nF (100% NanoF); PN (Sensodyne® ProNamel™) and AG (Colgate® Sensitive Pro-Relief™). A surface microhardness analysis was performed before (SH0) and after (SH1) the erosion lesion formation. The blocks were submitted to a 5-day de-remineralization cycling model, consisting of 90 s immersion on 0.1% citric acid (4x/day) and 1 min treatment with dentifrice slurries along with 1 mL/block of human saliva (2x/day). Lastly, the final surface microhardness analysis (SH2) was measured and the percentage of surface microhardness remineralization (%SMHR) was calculated. Data were analysed with 2-way ANOVA and Tukey's test (p < .05). RESULTS: Statistically significant differences were observed for SH2 and %SMHR between NC and AG with the other groups (p < .05). The best %SMHR from the experimental groups was found in 100%nF and PN. CONCLUSION: Dentifrices with NanoF exhibited a surface microhardness remineralization similar to sodium fluoride (PC). Therefore, NanoF dentifrice can be an alternative to prevent and treat patients with dental erosion.

Er,Cr:YSGG laser associated with acidulated phosphate fluoride gel (1.23% F) for prevention and control of dentin erosion progression.

To evaluate the effect of Er,Cr:YSGG laser, associated with fluoride application, on the prevention/control of dentin erosion. Dentin slabs were embedded in acrylic resin, flattened, and polished. Half of the specimens were previously eroded (10 min immersion in 1% citric acid solution) and half were kept sound. The specimens (n = 10 each substrate) were randomly allocated into the experimental groups, according to the following treatments: control (no treatment); APF gel (1.23% F, 1 min); Er,Cr:YSGG laser irradiation (P1: 0.25 W, 20 Hz, 2.8 J/cm2, tip S75, beam diameter of 750 µm, 1 mm away from the surface); Er,Cr:YSGG laser irradiation (P2: 0.50 W, 20 Hz, 5.7 J/cm2, tip S75, beam diameter of 750 µm, 1 mm away from the surface); APF gel + Er,Cr:YSGG laser P1 and; APF gel + Er,Cr:YSGG laser P2. Afterwards, the specimens underwent an erosion-remineralization cycling, consisting of a 5-min immersion into 0.3% citric acid, followed by 60-min exposure to artificial saliva. This procedure was repeated 4×/day, for 5 days. Surface loss (SL, in µm) was determined by optical profilometry. Specimens from each group were analyzed by environmental scanning electron microscopy (n = 3). Data were statistically analyzed (α = 0.05). For the eroded specimens, APF gel presented the lowest SL, being different from the control. For the sound specimens, none of the groups differed from the control, except for Er,Cr:YSGG laser P2, which presented the highest SL. When substrates were compared, only the eroded specimens of the control and APF + Er,Cr:YSGG laser P1 Groups showed higher SL. Selective structure removal was observed for the laser-treated groups. None of the Er,Cr:YSGG laser parameters were effective in the prevention/control dentin erosion. The laser was also unable to enhance the protection of fluoride against dentin erosion.

Zinc and silica are active components to efficiently treat in vitro simulated eroded dentin.

OBJECTIVES: Biomaterials for treating dentin hypersensitivity and dentin wear were evaluated to efficiently occlude the dentinal tubules and to increase dentin resistance to abrasion. MATERIALS AND METHODS: Twenty-four dentin surfaces were treated with EDTA to expose dentinal tubules and were (1) non-brushed, (2) brushed with distilled water, or with pastes containing (3) monetite, (4) brushite, (5) Zn-monetite, (6) Zn-brushite, (7) Silica-brushite, and (8) NovaMin®. Topographical, nanomechanical, and chemical analysis were assessed on dentin surfaces (n = 3) after artificial saliva immersion for 24 h, and after citric acid challenge. Twenty-one further dentin specimens were created to evaluate dentin permeability after brushing, saliva storage, and acid application (n = 3). ANOVA, Student-Newman-Keuls (p < 0.05), and Student t test (p < 0.001) were used. RESULTS: Particles containing major proportion of silica attained intratubular occlusion by carbonate crystals (Raman carbonate peak heights 15.17 and 19.24 au; complex modulus 110 and 140 GPa, at intratubular dentin). When brushing with pastes containing higher proportion of silica or zinc, phosphate calcium compounds were encountered into tubules and over dentin surfaces (Raman intratubular phosphate peak heights 49 to 70 au, and at the intertubular dentin 78 to 92). The formed carbonated apatite and calcium phosphate layer were resistant to citric acid application. Zinc compounds drastically increased tubule occlusion, decreased dentin permeability (up to 30%), and augmented mechanical properties at the intertubular dentin (90-130 GPa); it was maintained after acid challenging. CONCLUSIONS: Zinc-containing pastes occluded dentinal tubules and improved dentin mechanical properties. CLINICAL RELEVANCE: Using zinc as an active component to treat eroded dentin is encouraged.

Progression of erosive lesions after Nd:YAG laser and fluoride using optical coherence tomography.

This study aimed to use optical coherence tomography (OCT) to assess the progression of erosive lesions after irradiation with Nd:YAG laser and application of topical fluoride. One-hundred and twenty dentin samples (4 × 4 × 2 mm) obtained from bovine incisors were used. Samples were protected with acid-resistant nail varnish, with exception of a central circular area 2 mm in diameter. All samples were submitted to erosive cycles with citric acid solution 0.05 M (citric acid monohydrate-C6H8O7·H2O); M = 210.14 g/mol) pH 2.3, at room temperature, for 20 min, 2×/day, throughout 20 days. After 10 days of acid challenges, lesions became visible, and each group received a different treatment (n = 15): control (without treatment), topical application of sodium fluoride 2 % for 4 min; Nd:YAG laser with different irradiation parameters (1, 0.7, and 0.5 W); and the association of fluoride with the laser parameters. OCT readouts were performed on day 01 (before the first acid challenge-OCT1), on day 05 (OCT2), day 10 (OCT3-after treatment), day 15 (OCT4), day 17 (OCT5), and day 20 (OCT6). The OCT images generated made it possible to measure the amount of tooth tissue loss over the 20 days of erosive cycle, before and after treatments, and to monitor early dentin demineralization progression. After statistical analysis, the fluoride group was observed to be the one that showed smaller loss of tissue over time. The OCT technique is promising for diagnosing and monitoring erosive lesion damage; however, further in vitro and in vivo research is needed to improve its use.

Nd:YAG laser irradiation associated with fluoridated gels containing photo absorbers in the prevention of enamel erosion.

This study evaluated the combined effect of Nd:YAG laser irradiation and fluoridated gels containing photo absorbers against enamel erosion. Enamel specimens from bovine teeth were polished, eroded (10 min, with 1% citric acid, pH = 2.6), and randomly allocated into the experimental groups (n = 8), according to the different surface treatments: fluoridated gels (F: 9047 ppm F and F + Sn: 9047 ppm F and 3000 ppm Sn), with or without photo absorbers (E: erythrosine and MB: methylene blue), and associated or not with Nd:YAG laser irradiation (in contact; 0.5 W; 50 mJ; ~41.66 J/cm2; 10 Hz; 40 s; pulse duration of 120 µs). A placebo gel (PLA) associated or not with laser was used as control. All gels had pH = 4.5 and were applied for 2 min. Laser irradiation was performed during gel application. The specimens were then submitted to a 5-day erosion-remineralization cycling model using 0.3% citric acid (pH = 2.6), 4×/day. Enamel surface loss (SL) was analyzed by optical profilometry in the end of the cycling (in µm). Data were analyzed by ANOVA and Tukey tests (α = 0.05). Means (SD) of SL for the groups were the following (different superscript letters imply significant difference among groups): PLA (21.02 ± 1.28)a, PLA + laser (19.20 ± 0.96)ab, laser (17.47 ± 1.50)b, F + Sn + E + laser (13.69 ± 0.62)c, F + E + laser (13.52 ± 1.16)c, F (13.10 ± 1.08)c, F + laser (11.94 ± 1.44)cd, F + Sn + MB + laser (11.90 ± 4.02)cd, F + MB + laser (11.42 ± 1.42)cd, F + Sn (11.12 ± 1.20)cd, and F + Sn + laser (10.35 ± 0.89)d. In conclusion, all fluoridated gels and the Nd:YAG laser irradiation reduced erosion development, but the combination of treatments did not promote further protection. The addition of photo absorbers to the fluoridated gels did not influence the anti-erosive effect of the combination of laser plus fluoridated gels.

Influence of Calcium Phosphate and Apatite Containing Products on Enamel Erosion.

For the purpose of erosion prevention the present study aimed to compare the efficacy of two biomimetic products and a fluoride solution to optimize the protective properties of the pellicle. After 1 min of in situ pellicle formation on bovine enamel slabs, 8 subjects adopted CPP-ACP (GC Tooth Mousse), a mouthwash with hydroxyapatite microclusters (Biorepair), or a fluoride based mouthwash (elmex Kariesschutz) for 1 min each. Afterwards, samples were exposed in the oral cavity for 28 min. Native enamel slabs and slabs exposed to the oral cavity for 30 min without any rinse served as controls. After oral exposure, slabs were incubated in HCl (pH values 2, 2.3, and 3) for 120 s and kinetics of calcium and phosphate release were measured photometrically; representative samples were evaluated by SEM and TEM. The physiological pellicle reduced demineralization at all pH values; the protective effect was enhanced by fluoride. The biomimetic materials also reduced ion release but their effect was less pronounced. SEM indicated no layer formation after use of the different products. However, TEM confirmed the potential accumulation of mineral components at the pellicle surface. The tested products improve the protective properties of the in situ pellicle but not as effectively as fluorides.

Combined Tin-Containing Fluoride Solution and CO2 Laser Treatment Reduces Enamel Erosion in vitro.

The aim of this in vitro study was to evaluate the effect of combined CO2 laser and tin-containing fluoride treatment on the formation and progression of enamel erosive lesions. Ninety-six human enamel samples were obtained, stored in thymol solution and, after surface polishing, randomly divided into 6 different surface treatment groups (n = 16 in each group) as follows: no treatment, control (C); one CO2 laser irradiation (L1); two CO2 laser irradiations (L2); daily application of fluoride solution (F); combined daily fluoride solution + one CO2 laser irradiation (L1F), and combined daily fluoride solution + two CO2 laser irradiations (L2F). Laser irradiation was performed at 0.3 J/cm2 (5 µs/226 Hz/10.6 µm) on day 1 (L1) and day 6 (L2). The fluoride solution contained AmF/NaF (500 ppm F), and SnCl2 (800 ppm Sn) at pH 4.5. After surface treatment the samples were submitted to an erosive cycling over 10 days, including immersion in citric acid (2 min/0.05 M/pH = 2.3) 6 times daily and storage in remineralization solution (≥1 h) between erosive attacks. At the end of each cycling day, the enamel surface loss (micrometers) was measured using a 3D laser profilometer. Data were statistically analyzed by means of a 2-level mixed effects model and linear contrasts (α = 0.05). Group F (-3.3 ± 2.0 µm) showed significantly lower enamel surface loss than groups C (-27.22 ± 4.1 µm), L1 (-18.3 ± 4.4 µm) and L2 (-16.3 ± 5.3 µm) but higher than L1F (-1.0 ± 4.4 µm) and L2F (1.4 ± 3.2 µm, p < 0.05). Under the conditions of this in vitro study, the tin-containing fluoride solution caused 88% reduction of enamel surface loss, while its combination with CO2 laser irradiation at 0.3 J/cm2 hampered erosive loss almost completely.

Effect of pretreatment with an Er:YAG laser and fluoride on the prevention of dental enamel erosion.

The aim of this study was to evaluate the effect of the Er:YAG laser and its association with fluoride (1.23% acidulate phosphate fluoride gel) on the prevention of enamel erosion. Sixty specimens were obtained from bovine enamel (4 × 4 mm), which were ground flat, polished, and randomly divided into five groups according to the preventive treatments: control-fluoride application; L--Er:YAG laser; L+F--laser + fluoride; F+L--fluoride + laser; L/F--laser/fluoride simultaneously. Half of the enamel surface was covered with nail varnish (control area), and the other half was pretreated with one of the preventive strategies to subsequently be submitted to erosive challenge. When the laser was applied, it was irradiated for 10 s with a focal length of 4 mm and 60 mJ/2 Hz. Fluoride gel was applied for 4 min. Each specimen was individually exposed to regular Coca-Cola® for 1 min, four times/day, for 5 days. Wear analysis was performed with a profilometer, and demineralization was assessed with an optical microscope. Data were analyzed using the Kruskal-Wallis test (wear)/Dunn test and ANOVA/Fisher's exact tests. The group L/F was similar to control group. The other groups showed higher wear, which did not present differences among them. In the demineralization assessment, the groups F+L and L/F showed lower demineralization in relation to the other groups. It can be concluded that none preventive method was able to inhibit dental wear. The treatments L/F and F+L showed lower enamel demineralization.

Effect of Nd:YAG laser irradiation and fluoride application in the progression of dentin erosion in vitro.

Nd:YAG laser and its association with fluoride have been proposed as an option for the prevention of dental erosion. This study evaluated the progression of existing dentin erosive lesions after treatment with different Nd:YAG laser (1064 nm) protocols, associated or not with fluoride. Erosive lesions were created with 1 % citric acid for 10 min in human dentin specimens. They were randomly assigned into eight groups (n = 15): no treatment (control), 1-min application of 2 % sodium fluoride gel (NaF), Nd:YAG1 (Nd:YAG laser irradiation 0.5 W; 50 mJ; ~41.66 J/cm(2); 10 Hz; 40 s; in contact), Nd:YAG2 (0.7 W; 70 mJ; ~62.50 J/cm(2); 10 Hz; 40 s; in contact), Nd:YAG3 (1 W; 100 mJ; ~54,16 J/cm(2); 10 Hz; 40 s; 1 mm unfocused), NaF + Nd:YAG1, NaF + Nd:YAG2, and NaF + Nd:YAG3. After treatment, the specimens were submitted to a 5-day erosion-remineralization cycling model, 6×/day. Dentin surface loss (SL) was evaluated with optical profilometry after the formation of the initial lesion; after treatment; and after days 1, 3, and 5. Data were statistically analyzed (alpha = 0.05). Significant differences were observed among the groups in all testing times (p < 0.001), except after initial lesion formation. Loss of dentin surface was observed after irradiation with all Nd:YAG laser protocols (p < 0.05). The association fluoride and laser did not differ significantly from laser alone. NaF showed the lowest values of SL and Nd:YAG2 and NaF + Nd:YAG2, the highest. Within the limitations of an in vitro study, it was concluded that laser irradiation, according to the parameters used, was not an appropriated approach to prevent dentin erosion progression, even when it was associated with fluoride.

Evaluation of a dentifrice containing 8% arginine, calcium carbonate, and sodium monofluorophosphate to prevent enamel loss after erosive challenges using an intra-oral erosion model.

OBJECTIVE: The objective of this study was to assess the ability of a dentifrice containing 8% arginine and calcium carbonate (Pro-Argin' Technology), and 1450 ppm fluoride as sodium monofluorophosphate (MFP) to prevent enamel loss from an erosive acid challenge in comparison to a silica-based dentifrice with 1450 ppm fluoride as MFP using an intra-oral erosion model. METHODS: The intra-oral clinical study used a double blind, two-treatment, crossover design. A palatal retainer was used to expose the enamel specimens to the oral environment during the five-day treatment period. The retainer was designed to house three partially demineralized bovine enamel samples. The study population was composed of 24 adults, ages 18 to 70 years. The study consisted of two treatment periods, with a washout period lasting seven (+/- three) days preceding each treatment phase. A silica-based dentifrice without fluoride was used during the washout period. The Test Dentifrice used in this study contained 8% arginine and calcium carbonate (Pro-Argin Technology), and 1450 ppm fluoride as sodium monofluorophosphate (MFP). The Control Dentifrice was silica-based and contained 1450 ppm fluoride as MFP. The treatment period lasted five days, during which the panelists wore the retainer 24 hours a day (except during meals and the ex vivo acid challenges) and brushed with their assigned product while wearing the retainer. The panelists brushed once in the morning and once in the evening each day for one minute, followed by a one-minute swish with the slurry and a rinse with 15 ml of water. The panelists brushed only their teeth and not the specimens directly. There were four ex vivo challenges with 1% citric acid dispersed throughout the day: two in the morning, one in the afternoon, and one in the evening. Mineral loss was monitored by a quantitative light fluorescence (QLF) technique. RESULTS: Twenty-three of 24 subjects successfully completed the study. The one subject who did not complete the study did so for reasons unrelated to the study or products used. The average percent mineral loss for the Test Dentifrice and Control Dentifrice was 9.74 +/- 13.23 and 18.36 +/- 14.14, respectively. The statistical analysis showed that the observed product differences were statistically significant (p < 0.001). CONCLUSION: The Test Dentifrice with 8% arginine, calcium carbonate, and 1450 ppm fluoride as MFP provided significantly better protection against erosive challenges in comparison to the Control Dentifrice with 1450 ppm fluoride as MFP.

Evaluation of a dentifrice containing 8% arginine, calcium carbonate, and sodium monofluorophosphate to repair acid-softened enamel using an intra-oral remineralization model.

OBJECTIVE: An intra-oral remineralization study was conducted to compare the ability of a dentifrice containing 8% arginine and calcium carbonate (Pro-Argin Technology), and 1450 ppm fluoride as sodium monofluorophosphate (MFP) to remineralize acid-softened bovine enamel specimens compared to a silica-based dentifrice with 1450 ppm fluoride as MFP. METHODS: The intra-oral clinical study employed a double blind, two-treatment, crossover design, and used an upper palatal retainer to expose the enamel specimens to the oral environment during product use and periods of remineralization. The retainer was designed to house three partially demineralized bovine enamel samples. The study population was comprised of 30 adults, ages 18 to 70 years. The study consisted of two treatment phases with a washout period lasting seven (+/- three) days preceding each treatment phase. A silica-based dentifrice without fluoride was used during the washout period. The Test Dentifrice used in this study contained 8% arginine, calcium carbonate, and 1450 ppm fluoride as sodium monofluorophosphate (MFP). The Control Dentifrice was silica-based and contained 1450 ppm fluoride as MFP. The treatment period consisted of a three-day lead-in period with the assigned product. The panelists brushed two times per day during the three-day lead-in period with the assigned product. On the fourth day, the panelists began brushing with the assigned product with the retainer in their mouth. The panelists brushed for one minute, followed by a one-minute swish with the slurry and a rinse with 15 ml of water in the morning, in the afternoon, and night with the retainer in the mouth. The panelists brushed only their teeth and not the specimens directly. Changes in mineral content before and after treatment were measured using a Knoop microhardness tester. RESULTS: The results of the study showed that percent remineralization values for the Test Dentifrice and Control Dentifrice were 14.99% and 8.66%, respectively. A statistical analysis showed that the Test Dentifrice was statistically significantly more effective at remineralizing acid-softened enamel in comparison to the Control Dentifrice (p < 0.05). CONCLUSION: This study demonstrated that the Test Dentifrice with 8% arginine, calcium carbonate, and 1450 ppm fluoride as MFP is highly effective treatment for promoting remineralization of enamel that has been softened by an erosive challenge.

Pilot clinical study to evaluate the efficacy of a professionally delivered high fluoride varnish on erosive tooth wear in an in-situ model.

OBJECTIVES: The aim for this pilot study was to investigate the effect of a sodium fluoride varnish on step height measured by a profilometer from human enamel worn by healthy volunteers with a novel in situ/ex vivo erosion design. METHOD: Healthy volunteers aged 18-70 years wore a palatal splint containing 8 human enamel samples and underwent two 3-day treatment periods for 6 h a day with a varnish containing sodium fluoride at 22,600 ppm and the control with the same ingredients but without fluoride. Each splint contained 4 polished and 4 unpolished samples. The interventions were applied to the surface of the enamel samples in randomised order, removed after 6 h, then immersed ex-vivo in 1 %, pH 2.7 citric acid for 2 min, repeated 4 times a day, over 2 days. Measurements of enamel were assessed blindly by microhardness on day 2 and by non-contact laser profilometry on day 3 for the two treatments. RESULTS: 24 volunteers, 2 males and 22 females aged 27-54 years, were screened and recruited. The delta microhardness, from polished samples removed at the end of day 2, for the control and fluoride treatment was 95.7 (22.9) kgf/mm2 and 123.7 (28.9) kgf/mm2, respectively (p < .005). The mean (SD) step height for the control polished enamel surfaces was 3.67 (2.07) µm and for the fluoride varnish was 1.79 (1.01) µm (p < .0005). The control unpolished enamel surfaces had a mean 2.09 (1.53) µm and the fluoride varnish was 2.11 (1.53) µm but no statistical difference was detected. CONCLUSIONS: The results from this pilot study, utilizing an in-situ model where enamel was exposed to acid over the course of 2 days, demonstrated that a high fluoride varnish containing sodium fluoride at 22,600 ppm prevented erosive wear compared to a control on the polished enamel surfaces. CLINICAL SIGNIFICANCE: Intra-oral study demonstrated that a high fluoride varnish containing sodium fluoride at 22,600 ppm reduced erosive tooth wear.

Permeability of eroded enamel following application of different fluoride gels and CO2 laser.

This study evaluated the combined effect of fluoride compounds and CO(2) laser in controlling the permeability of eroded enamel. Bovine enamel slabs (3 × 2 mm) were cycled twice through an alternating erosion and remineralization regimen. Slabs were immersed in 20 ml of orange juice (pH 3.84) for 5 min under agitation, rinsed with deionized water, and stored in artificial saliva for 4 h to form erosive lesions. Specimens were then divided into four groups (n = 10), which were treated for 1 min with either a control or with one of the following gels: amine fluoride (AmF), titanium tetrafluoride (TiF(4)), or sodium fluoride (NaF). Half of the specimens were irradiated with a CO(2) laser (λ = 10.6 µm; 2.0 W). Specimens were cycled two more times through the aforementioned erosion-remineralization regimen and were subjected to permeability assessment. ANOVA demonstrated a significant interaction between fluoride and laser treatment (p = 0.0152). Tukey's test showed that when fluoride was applied alone, TiF(4) resulted in lower enamel permeability than that observed after application of the placebo gel. Intermediate permeability values were noted after NaF and AmF had been used. A significant reduction in enamel permeability was obtained when fluoride was combined with CO(2) laser treatment, with no difference between fluoride gels. Permeability of eroded enamel may be reduced by combining the application of fluoride gels with CO(2) laser irradiation.

[Infiltration of enamel erosions as a part of combined dental care in gastroesophageal reflux disease].

The paper presents the results of evaluation of clinical efficacy of the Icon infiltration method for the treatment of tooth enamel erosion associated with gastroesophageal reflux disease (GERD). The study was performed in 10 volunteers. Twenty-seven teeth were treated, and the degree of dental hard tissues hyperesthesia reduction as well as the dynamics of erosions size was estimated. It was proved that in most part of cases hyperesthesia deceased significantly and there were no increase in the erosions area during the follow-up period.

Gels containing statherin-derived peptide protect against enamel and dentin erosive tooth wear in vitro.

The effect of gels containing a statherin-derived peptide (Stn) on the protection against enamel and dentin erosive tooth wear (ETW) in vitro was evaluated. Bovine enamel and dentin specimens were divided into 2 groups (n = 15 and 18/group for enamel and dentin, respectively) that were treated with Chitosan or Carboxymethylcellulose (CMC) gels containing Stn15pSpS at 1.88 × 10-5 M or 3.76 × 10-5 M. Chitosan or CMC gels without active ingredients served as negative controls, while chitosan gel containing 1.23% F (as NaF) and acidulated phosphate fluoride gel (1.23% F) served as positive controls. The gels were applied on the specimens for 4 min. Stimulated saliva was collected from 3 donors and used to form a 2-h acquired pellicle on the specimens. Then, the specimens were submitted to an erosive pH cycling protocol 4 times/day for 7 days (0.01 M HCl pH 2.0/45 s, artificial saliva/2 h, and artificial saliva overnight). The gels were applied again during pH cycling, 2 times/day for 4 min after the first and last erosive challenges. Enamel and dentin loss (µm) were assessed by contact profilometry. Scanning electron microscopy (SEM) was analyzed using a cold field emission. Data were analyzed by two-way ANOVA (for chitosan and CMC gels, separately) and Tukey's multiple comparison test. SEM images showed changes to enamel topography after application oft the gels containing Stn or F. Regarding CMC-based gels, for enamel, none of the treatments significantly reduced ETW in comparison with placebo; for dentin, however, gels containing Stn, regardless the concentration, significantly reduced the ETW. Moreover, Chitosan-based gels, regardless the Stn concentration, were able to protect enamel and dentin against ETW. Gels containing Stn might be a new approach to protect against ETW.

Erosion-inhibiting potential of the stannous fluoride-enriched CPP-ACP complex in vitro.

Currently available anti-erosive agents only provide partial protection, emphasizing the need to enhance their performance. By characterizing erosive enamel wear at the nanoscale, the aim of this in vitro study was to assess the anti-erosive effects of SnF2 and CPP-ACP both individually and synergistically. Erosion depths were assessed longitudinally on 40 polished human enamel specimens after 1, 5, and 10 erosion cycles. Each cycle comprised one-min erosion in citric acid (pH 3.0) and one-min treatment in whole saliva (control group) or a slurry of one of the three anti-erosive pastes (10% CPP-ACP; 0.45% SnF2 (1100 ppm F); or SnF2/CPP-ACP (10% CPP-ACP + 0.45% SnF2)) (n = 10 per group). Scratch depths were assessed longitudinally in separate experiments using a similar protocol after 1, 5, and 10 cycles. Compared with the control groups, all slurries reduced erosion depths after 1 cycle (p ≤ 0.004) and scratch depths after 5 cycles (p ≤ 0.012). The order of anti-erosive potential was SnF2/CPP-ACP > SnF2 > CPP-ACP > control for erosion depth analysis, and SnF2/CPP-ACP > (SnF2 = CPP-ACP) > control for scratch depth analysis. These data provide 'proof of concept' evidence that SnF2/CPP-ACP has superior anti-erosive potential compared to SnF2 or CPP-ACP alone.

Influence of extra- and intra-oral application of CPP-ACP and fluoride on re-hardening of eroded enamel.

OBJECTIVES: This in-situ study aimed to investigate the potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) crème and fluoride mouth rinse to re-harden erosively softened enamel and to evaluate the influence of an intra-oral or extra-oral application. METHODS: Ten volunteers performed five experimental series. Per series, four bovine enamel samples were extra-orally softened by immersion in Sprite light(®) (2 min) and subsequently worn intra-orally for 5 min in intra-oral appliances. Thereafter, samples were treated (3 min) with either 250 ppm AmF/SnF(2) solution (Meridol) (series 1 and 3) or CPP-ACP crème (Tooth Mousse) (series 2 and 4). Application of the substances was performed extra-orally (series 1 and 2) or intra-orally (series 3 and 4). Untreated specimens served as control (series 5). The appliances were worn for 4 h afterwards. Knoop microhardness (KHN) measurement was performed at baseline, after softening and after completing of the respective run. Data were statistically analyzed by ANOVA and Bonferroni/Dunn post-hoc test. RESULTS: No significant difference in baseline microhardness was observed, while immersion in Sprite light reduced the microhardness significantly. Significant re-hardening after intra-oral exposure occurred in all series, but baseline microhardness was not achieved. Microhardness in series 2 was significantly higher than that in series 1 and 5. No significant differences in KHN were detected between series 3, 4 and 5. The re-hardening ΔKHN (final microhardness - microhardness after erosion) was not significant different in all five series. CONCLUSION: Intra-oral application of CPP-ACP crème or fluoride solution provides no benefit regarding re-hardening of erosively softened enamel.

Treatment for dental erosion: a systematic review of in vitro studies.

Background: Dental erosion is a chemical loss of the mineralized dental tissue caused by exposure to nonbacterial acids. Different treatment protocols have been adopted with the use of fluoride compounds to promote the formation of a layer of mineral precipitation in eroded lesions. Aim: This systematic review aimed to evaluate the main treatments for dental erosion. Methodology: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recorded in the Open Science Framework database (OSF) under DOI 10.17605/OSF.IO/XMFNZ. The searches were conducted in six electronic databases (Pubmed, Embase, Web of Science, Cochrane, Scopus, Lilacs) and two grey literature sources (Google Scholar and OpenGrey). The eligibility criteria included in vitro studies that evaluated eroded teeth under treatment with some topical agent. Risk of bias assessment and qualitative synthesis were performed using the Cochrane collaboration's tool for assessing risk of bias modified for in vitro studies. Results: A total of 522 studies were identified, and only four studies that fulfilled our eligibility criteria were included in this review. Among these studies, three were considered to have a low risk of bias, and one to have a high risk of bias. Two studies evaluated the anti-erosion effect of fluoride toothpaste, and the other two assessed the action of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on the surface of human teeth. Among the products analyzed, CPP-ACP was the only one that promoted a significant increase in enamel microhardness and reduced tooth wear. Conclusion: Based on the in vitro studies included in this review, there was no anti-erosion effect after using different fluoride toothpaste. However, it should be considered that one of these studies presented a high risk of bias. On the other hand, studies with CPP-ACP showed anti-erosion efficacy when applied before or after erosive wear.