Application of digital technology in the repair of functional and aesthetic defects in patients with acid erosion and severe attrition: a case report.

Noncarious lesions, a multifactorial condition encompassing tooth attrition, abrasion, and erosion, have a surge in prevalence and required increased attention in clinical practice. These nonbacterial-associated tooth defects can compromise aesthetics, phonetics, and masticatory functions. When providing full-arch fixed occlusal rehabilitation for such cases, the treatment strategy should extend beyond by restoring dentition morphology and aesthetics. This report details a complex case of erosive dental wear addressed through a fully digital, full-arch fixed occlusal rehabilitation. A 4D virtual patient was created using multiple digital data sources, including intraoral scanning, 3D facial scanning, digital facebow registration, and mandibular movement tracing. With a comprehensive understanding of the masticatory system, various types of microinvasive prostheses were customized for each tooth, including labial veneers, buccal-occlusal veneers, occlusal veneers, overlays, inlays, and full crowns, were customized for each tooth. The reported digital workflow offered a predictable diagnostic and treatment strategy, which was facilitated by virtual visualization and comprehensive quality control throughout the process.

The subsurface lesion in erosive tooth wear.

OBJECTIVES: This study compared the surface change on natural and polished enamel exposed to a joint mechanical and chemical wear regimen. METHODS: Human enamel samples were randomly assigned to natural (n = 30) or polished (n = 30) groups, subjected to erosion (n = 10, 0.3% citric acid, 5 min), abrasion (n = 10, 30 s), or a combination (n = 10). Wear in the form of step height was measured with a non-contact profilometer, and surface changes were inspected with SEM on selected sections. Data was normalised and underwent repeated measures MANOVA, accounting for substrate and erosive challenge as independent variables, with Bonferroni correction for significant post hoc interactions. RESULTS: After four cycles, polished samples had mean step heights of 3.08 (0.40) µm after erosion and 4.08 (0.37) µm after erosion/abrasion. For natural samples, these measurements were 1.52 (0.22) µm and 3.62 (0.39) µm, respectively. Natural surfaces displayed less wear than polished surfaces under erosion-only conditions (p<0.0001), but the difference disappeared with added abrasion. SEM revealed a shallow subsurface layer for polished surfaces and natural ones undergoing only erosion. However, natural surfaces exposed to both erosion and abrasion showed deeper subsurface changes up to 50 µm. CONCLUSION: Natural enamel, when exposed to erosion alone, showed less wear and minimal subsurface alterations. But with added abrasion, natural enamel surfaces saw increased wear and notable subsurface changes compared to polished ones. CLINICAL SIGNIFICANCE: The pronounced subsurface lesions observed on eroded/abraded natural enamel surfaces highlight how combined wear challenges may accelerate tooth tissue loss.

A Brief History of Tooth Wear.

Historical publications that have significantly improved the understanding of tooth wear mechanisms are reviewed with a focus on descriptions of the lesions, the evolution of their classification systems, and considerations addressing the main risk factors. Surprisingly, most important advances are often the oldest. Likewise, they are currently only marginally known, which requires a major dissemination effort.

The early wear susceptibility of cementum, enamel and dentine in vitro.

OBJECTIVES: To assess the differential early wear susceptibility of cementum, enamel and dentine at a micron level. METHODS: Whole human molar buccal surfaces incorporating natural enamel and cementum (n = 20) confirmed by imaging (digital microscopy: Keyence, VHX-7000 Milton Keynes, UK), were mounted, scanned (profilometry: XYRIS 4000, Taicaan, Southampton, UK), and allocated to receive erosion (citric acid, pH 2.7, 30 min (n = 10)) or erosion/abrasion challenges (3 cycles of (citric acid, pH 2.7, 10 min, 60 300 g linear abrasion strokes), n=10). Samples were polished and the experiment repeated on polished enamel, and polished coronal and radicular dentine within the same tooth. Profilometric wear data were obtained using superimposition: GeoMagic (3Dsystems, Darmstadt, Germany) and subtraction: MountainsMap (DigitalSurf, Besancon, France). Data were normal. A general linear model was used to assess differences between groups and substrates. RESULTS: The mean step height (SD) for natural enamel was 8.82 µm (2.53) for erosion and 11.48 µm (2.95) for erosion/abrasion. For natural cementum, the mean step height was 6.00 µm (2.29) for erosion and 4.67 µm (1.58) for erosion/abrasion. Dentine step heights ranged from 7.20 µm (1.53) for erosion and 9.79 µm (1.01) for erosion/abrasion with no statistical differences in dentine wear. Natural cementum surfaces had the lowest wear (p<0.001). Dentine had significantly less wear than natural enamel (p<0.02). CONCLUSIONS: Cementum surfaces demonstrated the most wear resistance, followed by dentine under erosion dominant conditions in this in vitro study. Further in-vivo investigations are needed to confirm the intraoral stability of cementum. CLINICAL SIGNIFICANCE: Cementum may be the least susceptible of dental substrates to wear and dentine does not wear at a faster rate than enamel under erosive conditions. This adds to our knowledge on the development of non-carious cervical lesions and questions whether wear rates will accelerate once dentine is exposed.

Rehardening of Eroded Enamel with CPP-ACFP Paste and CO2 Laser Treatment.

BACKGROUND: Diet and lifestyle can destroy tooth structure due to the dissolution of enamel by acidic beverages. The present study evaluated the effect of CO2 laser irradiation and CPP-ACFP (casein phosphopeptide and amorphous calcium phosphate with fluoride) paste on the remineralization of enamel eroded by carbonated soft drinks. METHODS: In the present in vitro study, 46 human sound premolar teeth were sectioned mesiodistally to achieve 84 samples. Fourteen samples were assigned to the positive control group (G1), and the remaining samples were immersed in 500 mL of cola drink for 2 minutes, followed by rinsing with distilled water for 10 seconds. This procedure was carried out three times to create erosive lesions. Then, the 60 eroded samples were randomly assigned to five groups of G2 to G6 in terms of the treatment as follows: negative control (G2), CO2 laser irradiation (G3), CPP-ACFP paste (G4), CO2 laser irradiation followed by CPP-ACFP paste application (G5), and CPP-ACFP paste application followed by CO2 laser irradiation (G6). The mean surface microhardness of the enamel surface was evaluated and determined at three points for each sample. Data were analyzed with one-way ANOVA and Tukey HSD tests (α = 0.05). RESULTS: The highest and the lowest hardness values were recorded in the G1 (314 ± 12 kg/mm2) and G2 (213.7 ± 12 kg/mm2) groups, respectively. ANOVA revealed significant differences between the study groups (P < 0.001). Two-by-two comparisons showed significant differences between the G2 group and the other groups, indicating the efficacy of all the treatment modalities in tooth remineralization and rehardening procedures (P < 0.05). Only in group G6, the enamel microhardness was not significantly different from the G1 positive control group (P > 0.05). CONCLUSION: Considering the parameters used in the present study, CO2 laser irradiation or CPP-ACFP paste application alone increased eroded enamel's surface hardness; however, their sequential application was more effective in rehardening the eroded enamel's surface to near-normal levels.

Histology and µCT reveal the unique evolution and development of multiple tooth rows in the synapsid Endothiodon.

Several amniote lineages independently evolved multiple rows of marginal teeth in response to the challenge of processing high fiber plant matter. Multiple tooth rows develop via alterations to tooth replacement in captorhinid reptiles and ornithischian dinosaurs, but the specific changes that produce this morphology differ, reflecting differences in their modes of tooth attachment. To further understand the mechanisms by which multiple tooth rows can develop, we examined this feature in Endothiodon bathystoma, a member of the only synapsid clade (Anomodontia) to evolve a multi-rowed marginal dentition. We histologically sampled Endothiodon mandibles with and without multiple tooth rows as well as single-rowed maxillae. We also segmented functional and replacement teeth in µ-CT scanned mandibles and maxillae of Endothiodon and several other anomodonts with 'postcanine' teeth to characterize tooth replacement in the clade. All anomodonts in our sample displayed a space around the tooth roots for a soft tissue attachment between tooth and jaw in life. Trails of alveolar bone indicate varying degrees of labial migration of teeth through ontogeny, often altering the spatial relationships of functional and replacement teeth in the upper and lower jaws. We present a model of multiple tooth row development in E. bathystoma in which labial migration of functional teeth was extensive enough to prevent resorption and replacement by newer generations of teeth. This model represents another mechanism by which multiple tooth rows evolved in amniotes. The multiple tooth rows of E. bathystoma may have provided more extensive contact between the teeth and a triturating surface on the palatine during chewing.

[Dental erosion in a sample of Valencian children. Prevalence and evaluation of eating habits]. / Erosión dental en una muestra de niños valencianos. Prevalencia y evaluación de los hábitos de alimentación.

INTRODUCTION: Introduction: dental erosion is the pathological, chronic, localized and painless loss of dental tissues, produced by the chemical action of acids, where the action of microorganisms is not involved. In recent years, a significant increase in the prevalence of this pathology has been observed, especially in children and adolescents. Objectives: to determine the prevalence of dental erosion in temporary dentition using the Basic Erosive Wear Examination Index (BEWE) in children between 5 and 12 years of age, and to determine the eating habits that may favor the development of these lesions. Methods: a cross-sectional study was carried out on a sample of 391 children. A survey was conducted where eating habits were analyzed and a clinical examination of the temporary teeth was performed using the BEWE index. Results: the prevalence of dental erosion in the studied sample was 19.7 %, with mild lesions being most common. Conclusions: in all, 30.62 % of the studied population had a low risk of dental erosion, and risk was seen to increase with consumption of acidic beverages (soft drinks, isotonic drinks and fruit juices) and acidic fruits such as oranges, grapes and apples.

INTRODUCCIÓN: Introducción: la erosión dental es la pérdida patológica, crónica, localizada e indolora de los tejidos dentarios, producida por la acción química de ácidos y sin la intervención de la acción de microorganismos. En los últimos años se ha observado un incremento significativo de la prevalencia de esta patología, especialmente en niños y adolescentes. Objetivos: determinar la prevalencia de la erosión dental en la dentición temporal mediante el índice Basic Erosive Wear Examination (BEWE) en niños de entre 5 y 12 años, y determinar los hábitos de alimentación que pueden favorecer en ellos el desarrollo de lesiones. Métodos: se llevó a cabo un estudio transversal en una muestra de 391 niños. Se realizó una encuesta donde se analizaron los hábitos de alimentación, y se realizó una exploración clínica de los dientes temporales empleando el índice BEWE. Resultados: la prevalencia de la erosión dental en la muestra estudiada fue del 19,7 %, presentándose con mayor frecuencia lesiones iniciales. Conclusiones: el 30,62 % de la población estudiada presentaba riesgo bajo de erosión dental, observándose un aumento del riesgo a medida que aumentaba el consumo de bebidas ácidas (bebidas gaseosas, bebidas isotónicas y zumos de frutas) y frutas ácidas, como naranjas, uvas y manzanas.

[Cup-shaped tooth wear defects: more than erosive challenges?] / Komvormige defecten in occlusale vlakken van molaren: meer dan alleen erosieve belasting?

The underlying mechanism of the development of cups and grooves on occlusal tooth surfaces is still unclear. The aim of this study was to evaluate factors contributing to in-vitro cup formation, and to elucidate the clinical process. Extracted human molar teeth were exposed to acidic aqueous solutions at pH of 4.8 and 5.5 in combination with different loading conditions: no load (0N, control), 30N or 50N. Before and after 3 months exposure, the samples were scanned using a non-contact profilometer. A statistically significant difference between a loading of 0N and 50N was found at pH 4.8 (p < 0.002). Cup shaped lesions had formed only at pH of 4.8, in the 30N and 50N groups. The study showed that a cup can arise fully in enamel and that this requires simultaneous acidic and mechanical loading.

Methods of assessment of early dentine erosion: a review.

Dentine erosion is an increasingly recognised problem, especially in aging population, and various methods have been utilised for its assessment. This narrative review was planned to summarise the methods for the assessment of the early stages of dentine erosion. Relevant original articles published in the English language from 2013 to 2017 were reviewed. Laboratory techniques and methods with in vivo potential were separately studied. It is evident that the assessment of early dentine erosion is complex and requires a combination of methods. For clinical evaluation, chemical analysis and optical methods show great potential but are in need of more validation.

Cheek tooth erosion in male babirusa (genus Babyrousa).

The wear on the occlusal surfaces of male babirusa cheek teeth was evaluated in 53 skulls of Babyrousa babyrussa from Buru and the Sula Islands and 87 skulls of B. celebensis from Sulawesi, Indonesia. Based on the comparative lengths of their continually growing maxillary canine teeth, the skulls were divided into five 'age categories' (A-E). Numerical and symbolic codes representing tooth wear were applied to each pillar (cusp region) of the mandibular and maxillary permanent third and fourth premolar teeth, and the first, second and third permanent molar teeth. There was no significant difference between the tooth wear patters of skulls in groups A and B, or in groups C and D, and so these were amalgamated. There was close correspondence in wear patterns between each side of the mouth in both species and in each age group. The wear patterns of the mandibular and maxillary teeth, although not identical, were very similar, as were the wear patterns of both species. In group A+B for both species tooth wear was relatively slight, with the M1 teeth experiencing most relative wear. There was almost no wear of the M3 teeth. In group C+D substantial wear of upper and lower M1 was evident. In group E more widespread wear of the cheek teeth was seen, with increased severity of M1 tooth wear, yet there was comparatively much less M2 and M3 tooth wear. The pattern of cheek tooth wear of the Babyrousa spp. was different from that shown by Susscrofa. Differences in diet selection and processing were highlighted as potential contributing factors. The pattern of cheek tooth wear in male babirusa was not adequate for use to monitor their age.

Analytical strategies for clinical studies on dental erosive wear.

BACKGROUND: There is a need for analytical techniques for measuring Erosive Tooth Wear (ETW) on natural surfaces in clinical studies. The purpose was to investigate the use of two instruments aimed to assess initial to more advanced stages of ETW. METHODS: Human premolar enamel samples (2x3mm) (n = 24), were polished flat and mounted in resin cylinders (4 cylinders, 6 samples in each). Part 1: Baseline analyses by White Light Interferometer (WLI), Surface Reflection Intensity (SRI: TableTop and OptiPen) and Surface Hardness (SH). Erosion (1% citric acid (pH 3.6) for 1, 2, 4, 6, 8, 10 min. SRI and SH analyses after every erosion episode and by WLI after 10 min. New indentations were made and enamel loss; was measured by change in indentation depths from toothbrush abrasion (200 g, 60 strokes, 30 s). Another series of 2 × 5 min erosion (totally15 min and 20 min) was analysed with SH and SRI after each erosion, and by WLI (on samples and impressions of samples) after 20 min. Part 2 investigated WLI performance in the interface where initial erosion increases in severity and substance loss occurs. The samples were repolished. Baseline analyses by WLI, SRI (TableTop and OptiPen) and SH. Four cylinders were etched for 1, 2, 4, 8 min respectively and analysed by SRI, SH on samples, and WLI on samples and impressions). RESULTS: Part1: SRI decreased from baseline to ~ 6 min etch and increased slightly after abrasion, the two devices correlated well (ICC 0.98 p < 0.001, Spearmans rs 0.91 p < 0.001). SH decreased nearly linearly to 10 min etch, but increased distinctly after abrasion. Mean enamel loss from abrasion alone was 0.2 µm (change in indentation depths). After 10 min etch, it was 0.27 µm (WLI) and after 20 min etch, it was 2.2 µm measured on samples vs 2.4 µm on impressions of samples (7% higher). Part 2: From baseline to 8 min etch; SRI and SH decreased whereas WLI presented increasing etch depths. CONCLUSIONS: With some adjustments, the use of SRI and WLI in combination seems to be a promising strategy for monitoring ETW in clinical studies.

Biomineralization of dentin.

A single biomineralization of demineralized dentin is significant to restore the demineralized dentin due to dental caries or erosion. In recent years, meaningful progress has been made regarding the mechanisms involved in the biomineralization of dentin collagen. Concepts changing from the classical ion-based crystallization to non-classical particle-based crystallization, inspired a different strategy to infiltrate the demineralized dentin collagen. The remarkable discovery was the report of liquid-like amorphous calcium phosphate as nanoprecursor particles to carbonated hydroxyapatite. The non-collagenous proteins and their analogues are widely investigated, for their key role in controlling mineralization during the process of crystal nucleation and growth. The in-depth studies of the gap zone provided significant improvements in our understanding of the structure of collagen and of the intrafibrillar remineralization of collagen fibrils. The collagen is not a passive substrate as previously supposed, and the active role of guiding nanoprecursor infiltration and mediating its nucleation has been demonstrated. Furthermore, recovery of mechanical properties has been evaluated to determine the effectiveness of dentin remineralization. Finally, the problems regarding the origin formation of the calcium phosphate that is deposited in the collagen, and the exact interactions between the non-collagenous proteins, amorphous calcium phosphate and collagen are still unclear. We reviewed the importance of these findings in enriching our understanding of dentin biomineralization, while addressing certain limitations that are inherent to in vitro studies.

Acquired Enamel Pellicle Modification with Casein and Mucin in Different Concentrations and its Impact on Initial Dental Erosion.

Casein and mucin have been shown to improve the erosion-protective properties of the pellicle when applied in combination. The aim of this in vitro study was to optimize the concentrations of these 2 proteins to achieve a maximum protective effect. For the 2 parts of this study, we prepared a total of 195 human enamel specimens and randomly assigned them to 13 groups, corresponding to 11 different casein-mucin concentration-combinations tested and 2 negative control groups (humid chamber). They underwent 5 cycles, consisting of pellicle formation from human whole saliva (2 h, 30°C), modification of the pellicle with casein and mucin in different concentrations (immersion in protein solutions for 2 h, 30°C), and erosion for 1 min in citric acid (0.65%, pH 3.5, 30°C). Surface microhardness (SMH), surface reflection intensity (SRI), and in the first part also calcium release were monitored during the cycling process, and analyzed with Kruskal-Wallis and post hoc Dunn's tests. The results suggest that the best concentrations to achieve the highest erosion-protective effect are 3.0% casein and 0.81% mucin, which lead to a significant protection as measured by SMH as well as SRI compared to the unmodified pellicle. For the calcium release, no significant differences were found. This concentration combination corresponds to a general raise of the protein concentrations and a change in the molar ratio of the proteins as compared to earlier studies. Casein and mucin could now be incorporated at the determined concentration as natural ingredients in oral care products designed to protect against erosion.

Self-assembly of dental surface nanofilaments and remineralisation by SnF2 and CPP-ACP nanocomplexes.

Dental caries, erosion and hypersensitivity are major public health problems. SnF2 is used widely in oral care products to help prevent/treat these conditions. Casein phosphopeptide-stabilised amorphous calcium phosphate nanocomplexes (CPP-ACP) are a biomimetic nanotechnology of salivary phosphopeptide-ACP complexes that deliver bioavailable calcium and phosphate ions to promote dental remineralisation (repair). We show here using in vitro studies and a double-blind, randomised controlled, cross-over design in situ clinical trial that SnF2 and CPP-ACP interact to form a nanofilament coating on the tooth surface and that together they are superior in their ability to promote dental remineralisation. Sn(II) by cross-linking the CPP-ACP helps to stabilise the complexes which improves delivery to the tooth surface and enhances binding and ion incorporation into tooth mineral. The combination of SnF2 and CPP-ACP in oral care products may significantly improve their efficacy in prevention/treatment of dental caries/erosion and hypersensitivity.

Effect of Er,Cr:YSGG laser associated with fluoride on the control of enamel erosion progression.

OBJECTIVE: To evaluate the effect of Er,Cr:YSGG laser associated or not with acidulated phosphate fluoride (APF) on the control of enamel erosion progression. DESIGN: Enamel slabs (4 mm × 4 mm × 2 mm) from bovine incisors were flattened, polished, and received a tape on their test surfaces, leaving a 4 mm × 1 mm area exposed. Specimens were eroded (10 min in 1% citric acid solution) and randomly assigned into 8 experimental groups (n = 10): Control (no treatment); F (APF gel, 1.23% F, pH 3.6-3.9); Er,Cr:YSGG laser irradiation (P1: 0.25 W, 20 Hz, 2.8 J/cm2, 56 W/cm2); Er,Cr:YSGG laser irradiation (P2: 0.50 W, 20 Hz, 5.7 J/cm2, 1136 W/cm2); Er,Cr:YSGG laser irradiation (P3: 0.75 W, 20 Hz, 8.5 J/cm2, 1704 W/cm2); F + Laser P1; F + Laser P2; F + Laser P3. Specimens were then subjected to erosive cycling (5 min immersion in 0.3% citric acid solution, followed by immersion in artificial saliva for 60 min; 4×/day for 5 days). At the end of cycling, surface loss (SL, in µm) was determined with optical profilometry. Selected specimens were further evaluated by environmental scanning electron microscopy (n = 3). Data were analyzed using Kruskal-Wallis and Tukey tests (α = 0.05). RESULTS: Group F + Laser P2 had the lowest SL value, differing significantly from the control; however, with no significant difference from the other groups. All groups, except F + Laser P2, showed no significant difference in SL when compared with the control. An irregular and rough surface, suggestive of a melting action of laser, was observed on enamel in Laser P2 and F + Laser P2 groups. CONCLUSIONS: Association of the Er,Cr:YSGG laser in parameter 2 with fluoride was the only treatment capable of controlling the progression of enamel erosion.

Effect of two erosive protocols using acidic beverages on the shear bond strength of orthodontic brackets to bovine enamel

Abstract Objective: To assess the short-term effect of two in vitro erosive challenge protocols on the bond strength of metal orthodontic brackets on bovine enamel. Methods: Sixty bovine incisors were selected and randomly divided into six groups: AS7 (artificial saliva - 7 days, Control Group); CC7 (Coca-Cola™ - 7 days); LJ7 (lime juice - 7 days); AS30 (artificial saliva - 30 days, Control Group); CC30 (Coca-Cola™ - 30 days); LJ30 (lime juice - 30 days). Microhardness testing was performed prior to the erosive challenge to verify the standardization of samples. Immersion was performed 4x/day for five minutes, for either 7 or 30 days. After immersions were concluded, the brackets were bonded and shear bond strength was assessed after 48 hours. The Adhesive Remnant Index (ARI) was also assessed. Data were analyzed by two-way ANOVA, followed by Tukey's post-hoc and Student's t test for paired samples, and the Kruskal-Wallis non-parametric test (α = 5%). Results: The mean and standard deviation of microhardness testing of total samples were 281.89 ± 44.51 KHN. There was no statistically significant difference in shear bond strength for the time factor (7 or 30 days; F5.54= 0.105; p = 0.901). However, there was a statistically significant difference for the solution factor (F5.54= 6.671; p = 0.003). These differences occurred among solutions of Saliva x Coca-Cola™ (p = 0.003) and Coca-Cola™ x Lime Juice (p= 0.029). The assessment of the Adhesive Remnant Index showed no significant difference between groups. Conclusions: The immersion time used in the erosion protocols did not affect the bond strength of brackets to teeth. Coca-Cola™ induced significantly higher shear bond strength values than lime juice and artificial saliva. However, the short term effects of 7/30 days in this in vitro study may not be extrapolated for in vivo ones. Clinical studies should be conducted, substantiating the laboratory results.

Resumo Objetivo: avaliar o efeito de curto prazo de dois protocolos de desafio erosivo, in vitro, na resistência adesiva de braquetes ortodônticos metálicos em esmalte bovino. Métodos: Sessenta incisivos bovinos foram selecionados e divididos aleatoriamente em seis grupos: SA7 (saliva artificial - 7 dias, Grupo Controle); CC7 (Coca-Cola® - 7 dias); SL7 (suco de limão - 7 dias); SA30 (saliva artificial - 30 dias, Grupo Controle); CC30 (Coca-Cola® - 30 dias); SL30 (suco de limão - 30 dias). Foi realizado o teste de microdureza antes do desafio erosivo, para verificar a padronização das amostras. A imersão foi realizada quatro vezes ao dia, por cinco minutos, durante 7 ou 30 dias. Finalizadas as imersões, os braquetes foram colados e, após 48 horas, foi avaliada a resistência ao cisalhamento. O Índice de Adesivo Remanescente (IAR) também foi avaliado. Para análise dos dados, foram utilizados os testes ANOVA dois fatores, seguido do post-hoc de Tukey e teste t de Student para amostras pareadas, e o teste não-paramétrico de Kruskal-Wallis (α?#8197;= 5%). Resultados: a média e o desvio-padrão do teste de microdureza das amostras totais foi igual a 281,89 ± 44,51 KHN. Não houve diferença estatisticamente significativa na resistência ao cisalhamento para o fator tempo (7 ou 30 dias; F5,54= 0,105; p= 0,901). Contudo, houve diferença estatisticamente significativa para o fator solução (F5,54=6,671; p= 0,003). Essas diferenças ocorreram entre as soluções de Saliva x Coca-Cola® (p= 0,003) e Coca-Cola® x suco de limão (p= 0,029). Ao avaliar o Índice de Adesivo Remanescente, não foi possível verificar diferença significativa entre os grupos. Conclusões: o tempo de imersão utilizado nos protocolos de erosão não afetou a resistência de união dos braquetes aos dentes. A Coca-Cola® induziu valores de resistência ao cisalhamento significativamente mais altos do que o suco de limão e a saliva artificial. No entanto, os efeitos em curto prazo de 7 e 30 dias, nesse estudo in vitro, não podem ser extrapolados para os estudos in vivo. Estudos clínicos devem ser conduzidos, fundamentando os resultados laboratoriais.

Root grooves on two adjacent anterior teeth of Australopithecus africanus.

Tooth root grooves and other ante-mortem dental tissue loss, not associated with caries found on or near the cementoenamel junction (CEJ), are commonly termed non-carious cervical lesions. Three main processes are implicated in forming these lesions: abrasion, dental erosion, and abfraction. As yet, these lesions have not been described in non-Homo hominins. In this study, South African fossil hominin collections were examined for evidence of any type of non-carious cervical lesion. Only one individual shows ante-mortem root grooves consistent with non-carious cervical lesions. Two teeth, a mandibular right permanent lateral incisor (STW 270) and canine (STW 213), belonging to the same Australopithecus africanus individual, show clear ante-mortem grooves on the labial root surface. These lesions start below the CEJ, extend over a third of the way toward the apex, and taper to a point towards the lingual side. The characteristics of these grooves suggest the predominant aetiology was erosive wear. In addition, they are extremely similar to clinical examples of dental erosion. These are the oldest hominin examples of non-carious cervical lesions and the first described in a genus other than Homo. Further, the lesions suggest that this individual regularly processed and consumed acidic food items.

In vitro evaluation of the early erosive lesion in polished and natural human enamel.

OBJECTIVE: This study evaluated the capability of profilometry, microhardness, Optical Coherence Tomography (OCT) and Tandem Scanning Confocal Microscopy (TSM) in characterising the early erosive lesion in polished and natural human enamel in vitro. METHODS: Polished (n=60) and natural (n=60) human enamel surfaces, were immersed and agitated in 0.3% citric acid erosion at 0s, 10s, 30s, 60s, 120s, and 300s (n=10). Changes in the surface were measured with 3D-step height change (µm), surface roughness (µm), surface microhardness (KHN), and images were assessed qualitatively with OCT and TSM. RESULTS: Mean (SD) 3D-step height change (µm) was measurable for polished enamel at: 60s (0.24±0.1), 120s (1.16±0.71), 300s (2.01±0.47; p<0.05); a step height change was not detectable on acid challenged natural enamel surfaces. Mean (SD) surface roughness (µm) of polished enamel was detected at 10s (0.270±0.013; p<0.05) and all erosion periods; and in natural enamel detected after 120s (0.830±0.125) and 300s (0.800±0.140; p<0.005). Polished enamel Mean (SD) microhardness (KHN) statistically significantly decreased at all time points (p<0.001); this was unmeasurable for natural enamel. Qualitative image analysis of both surface types indicated erosive change at the surface level, with progression after increasing erosion time. SIGNIFICANCE: The early erosive lesion in polished enamel could be characterised quantitatively surface roughness and microhardness and qualitatively using OCT and TSM; whilst in natural enamel only surface roughness could be utilised. Further investigation of early erosion in natural enamel is required to develop new more clinically relevant models.

The Effect of SnCl2/AmF Pretreatment on Short- and Long-Term Bond Strength to Eroded Dentin.

This study investigated the effect of SnCl2/AmF pretreatment on short- and long-term bond strength of resin composite to eroded dentin mediated by two self-etch, MDP-containing adhesive systems. 184 dentin specimens were produced from extracted human molars. Half the specimens (n = 92) were artificially eroded, and half were left untreated. For both substrates, half the specimens were pretreated with SnCl2/AmF, and half were left untreated. The specimens were treated with Clearfil SE Bond or Scotchbond Universal prior to application of resin composite. Microtensile bond strength (µTBS) was measured after 24 h or 1 year. Failure mode was detected and EDX was performed. µTBS results were statistically analyzed (α = 0.05). µTBS was significantly influenced by the dentin substrate (eroded < noneroded dentin) and storage time (24 h > 1 year; p < 0.0001) but not by pretreatment with SnCl2/AmF or adhesive system. The predominant failure mode was adhesive failure at the dentin-adhesive interface. The content of Sn was generally below detection limit. Pretreatment with SnCl2/AmF did not influence short- and long-term bond strength to eroded dentin. Bond strength was reduced after storage for one year, was lower to eroded dentin than to noneroded dentin, and was similar for the two adhesive systems.

A novel electron-microscopic method for measurement of mineral content in enamel lesions.

OBJECTIVE: To assess Scanning Electron Microscopy in Back-Scattered Emission mode (BSE-SEM) for measurement of lesion mineral content as a function of depth. Direct comparison is made with Transverse Micro-Radiography (TMR) and Surface Micro-Hardness (SMH) on carious and erosive lesions. DESIGN: Caries lesions prepared from sound bovine enamel at 37 °C and pH 4.6 in unsaturated (7d) or part-saturated (8d, 4.1 mM Ca2+, 8 mM Pi) lactic acid /methyl cellulose gel system, followed by TMR analysis. Erosive lesions prepared from sound bovine enamel (1% citric acid, pH3.8, room temperature) for 5, 10, 15 or 20 min at n = 10 per treatment group. SMH readings (Vickers diamond, 1.9 N, 20 s) were taken from acid-treated and reference areas of each sample. BSE-SEM performed on polished cross-sections of lesioned samples (Jeol JSM6490LV SEM; high vacuum, 10 keV beam voltage, magnification x500 with constant working distance of 10 mm). Under identical SEM conditions, polished standards i.e. MgF2, alumina, Mg, Al and Si provided a calibration plot of BSE-SEM signal vs. atomic number (z¯). Mineral content vs. depth plots were derived from the cross-sectional BSE-SEM data. RESULTS: Cross-sectional BSE-SEM images clearly differentiate between caries and erosive lesions. Comparison of caries lesion mineral loss from BSE-SEM with TMR data showed good correlation (R2 = 0.98). Similarly, comparison of BSE-SEM data from erosive lesions showed good correlation (R2 = 0.99) with hardness loss data from SMH. CONCLUSION: BSE-SEM provides a relatively rapid and cost-effective method for the assessment of mineral content in demineralised tooth enamel and is applicable to both caries and erosive lesions.