Mineral density of hypomineralised enamel

Objectives

To characterize molar–incisor hypomineralisation (MIH) defects of different severities quantitatively and qualitatively using X-ray microtomography (XMT) and to measure the range of reduction in mineral density (MD) of MIH enamel compared with the normal range.

Methods

Ten sound teeth and ten MIH teeth were scanned using a commercial XMT system. Four hydroxyapatite phantoms of different densities were used as calibration standards with each scan. A calibration equation derived from the phantoms with each tooth was used for MD calibration. MD was traced from the cementum–enamel junction (CEJ) to the cusp tip and from the dentine–enamel junction (DEJ) to the outer enamel surface.

Results

In sound teeth, MD increased from CEJ to cusp/incisal tip, while in MIH teeth MD dropped from the CEJ to the occlusal region, then increased again at the cusp tip. MD was highest midway between DEJ and outer enamel in sound teeth. In MIH, enamel showed normal thickness and MD was highest near the DEJ and then decreased towards the outer enamel. MD of MIH enamel was on average about 19% lower than sound enamel. The MIH defects seemed to follow the incremental lines of enamel formation.

Conclusions

MIH defects are hypomineralised defects of different severities that follow the natural incremental lines of enamel formation. Cuspal areas are usually only mildly affected and cervical enamel always appears to be sound.     

X-ray microtomographic study of mineral concentration distribution in deciduous enamel

OBJECTIVE: To determine the mineral concentration distribution in deciduous enamel by quantitative X-ray microtomography (XMT). DESIGN: Tooth rods ( approximately 2 mm x 2 mm) were removed from the mid-buccal region of 11 deciduous molars. Three XMT slices were taken at 1.5, 2.0 and 2.5 mm from the amelocemental junction. The distribution and variation in mineral concentration of enamel were studied from the XMT images. RESULTS: The mean mineral concentration for all the teeth was 2.81 (S.D. = 0.065) g cm(-3). There was no notable difference in the mean mineral concentration values between the three XMT slices of each tooth. However, there was up to 8% variation between different teeth (2.69-2.92 g cm(-3)). Gradients of increasing mineral concentration from the amelodentinal junction (ADJ) to the external surface were found, ranging from 0.08 to 0.60 mg cm(-3) microm(-1) with a mean of 0.366 mg cm(-3) microm(-1). The mineral concentration gradients in the occlusal slices were steeper than those in the cervical slices. The difference in mineral concentration between the inner and outer enamel ranged from 1.5 to 8.7%. CONCLUSION: In view of the large variation in both the means and the gradients of mineral concentration in deciduous molars, the mineral distribution of each experimental tooth should be measured as baseline data in studies of caries progression.     

Camouflage effects following resin infiltration of postorthodontic white-spot lesions in vivo: One-year follow-up

Objective:To assess camouflage effects by concealment of postorthodontic white-spot lesions (WSLs) to sound adjacent enamel (SAE) achieved over 12 months with resin infiltration (Icon, DMG, Hamburg, Germany).Methods: Twenty subjects (trial teeth n_teeth = 111) who had received resin infiltration treatment of noncavitated postorthodontic WSLs were contacted for a 1-year follow-up assessment of CIE-L*a*b* colors (T12). Color and lightness (CIE-L*a*b*) data for WSLs and SAE were compared to baseline data assessed before infiltration (T0) and those assessed after 6 months (T6), using a spectrophotometer. The target parameter was the difference between the summarized color and lightness values (ΔE_WSL/SAE). Intergroup (WSL, SAE) and intertime comparisons (T0 vs T6, T12) were performed using paired t-tests at a significance level of α = 5%.Results:Nine subjects (trial teeth n_teeth = 49; male/female ratio 5/4; age range 13–19 years) were available at T12. After the highly significant reduction of ΔE_WSL/SAE discrepancies between T0 and T6, analysis of 12-month records revealed color and lightness discrepancy of WSL vs SAE that was significantly decreased compared with baseline, indicating an assimilation of WSL color to SAE appearance after infiltration, while an additional reduction of discrepancies between T6 and T12 was not significant.Conclusion:As color and lightness characteristics of the Icon infiltrant as well as the esthetic camouflage effects achieved by WSL infiltration were not altered significantly or clinically relevant after 12 months, the method of resin infiltration can be recommended for an enduring esthetic improvement of postorthodontic WSL. (Angle Orthod. 2015;85:374–380.)     

Association of amoxicillin use and molar incisor hypomineralization in piglets: Visual and mineral density evaluation

AimThe aim of the present study was to determine the prevalence of MIH both visually and quantitatively, and describes the range of mineral densities of enamel specimens from three groups of piglets where two groups were given different doses of amoxicillin in infancy.MethodsIn this blind randomized clinical study, 20 piglets were randomly divided into three groups. Group A received a standard dose (50 mg/kg/day) and Group B received a high dose (90 mg/kg/day) of amoxicillin in selected days of the month (20 working days) they were born. Group K did not receive any medication and served as control. Thirteen right mandibular permanent first molars (PFMs) were randomly collected from 3 groups of piglets at age 10 months for evaluation under X-ray micro-tomography. Tomographic data were obtained using a Skyscan 1174 compact micro-CT in the Department of Anatomy.ResultsPrevalence of MIH was 0% in all groups. MD values were quantified after enamel grey level (0–255) measurements on horizontal cross-sectional slices. After MD measurements, the effects of amoxicillin use on MIH are presented.ConclusionsWhile MIH is a multifactorial disturbance, the present study attempted to highlight the clinical findings of a possible relationship between amoxicillin use and MIH with the aid of X-ray micro-tomography.     

In-vitro subsurface remineralisation of artificial enamel white spot lesions pre-treated with chitosan

Objective

To test the null hypothesis that chitosan application has no impact on the remineralisation of artificial incipient enamel white spot lesions (WSLs).

Synchrotron radiation microbeam X-ray fluorescence analysis of zinc concentration in remineralized enamel in situ

Objective

Remineralization is an indispensable phenomenon during the natural healing process of enamel decay. The incorporation of zinc (Zn) into enamel crystal could accelerate this remineralization. The present study was designed to investigate the concentration and distribution of Zn in remineralized enamel after gum chewing.

Methods

The experiment was performed at the Photon Factory. Synchrotron radiation was monochromatized and X-rays were focused into a small beam spot. The X-ray fluorescence (XRF) from the sample was detected with a silicon (Si) (lithium (Li)) detector. X-ray beam energy was tuned to detect Zn. The examined samples were small enamel fragments remineralized after chewing calcium phosphate-containing gum in situ. The incorporation of Zn atom into hydroxyapatite (OHAP), the main component of enamel, was measured using Zn K-edge extended X-ray absorption fine structure (EXAFS) with fluorescence mode at the SPring-8.

Results

A high concentration of Zn was detected in a superficial area 10-μm deep of the sectioned enamel after gum chewing. This concentration increased over that in the intact enamel. The atomic distance between Zn and O in the enamel was calculated using the EXAFS data. The analyzed atomic distances between Zn and O in two sections were 0.237 and 0.240 nm.

Conclusion

The present experiments suggest that Zn is effectively incorporated into remineralized enamel through the physiological processes of mineral deposition in the oral cavity through gum-chewing and that Zn substitution probably occurred at the calcium position in enamel hydroxyapatite.     

Prevalence of white spot lesion formation during orthodontic treatment

Purpose:To quantify the prevalence of white spot lesions (WSLs) on the anterior teeth and, secondarily, to evaluate risk factors and predictors.Materials and Methods:Digital photographs and records of 885 randomly chosen patients were evaluated before and after treatment. Chart information included gender, age, as well as banding and debanding dates. Fluorosis and oral hygiene before and after treatment were also evaluated. Preexisting and posttreatment WSLs were recorded and compared for all 12 anterior teeth. Risk ratios (RR) and absolute risk (AR) were calculated to determine the likelihood and risk of WSL formation.Results:Overall, 23.4% of the patients developed at least one WSL during their course of treatment. Maxillary anterior teeth were affected more than mandibular teeth. The maxillary laterals and canines and the mandibular canines were the most susceptible. There was no significant difference in WSLs between genders. Fluorosis, treatment time in excess of 36 months, poor pretreatment hygiene, hygiene changes during treatment, and preexisting WSLs were all significantly (P < .05) related to the development of WSLs. The highest risk of developing WSLs was associated with preexisting WSLs (RR = 3.40), followed by declines in oral hygiene during treatment (RR = 3.12) and poor pretreatment oral hygiene (RR = 2.83).Conclusions:Nearly 25% of the patients developed WSLs while in treatment, depending on fluorosis, treatment time, preexisting WSLs, and oral hygiene. Orthodontists need to be mindful of these risk factors when making treatment decisions.     

Prevention of orthodontic enamel demineralization: A systematic review with meta‐analyses

Aim of this systematic review was to assess the efficacy of preventive interventions against the development of white spot lesions (WSLs) during fixed appliance orthodontic treatment. Nine databases were searched without limitations in September 2018 for randomized trials. Study selection, data extraction and risk of bias assessment were done independently in duplicate. Random‐effects meta‐analyses of mean differences (MDs) or relative risks (RRs) with their 95% confidence intervals (CIs) were conducted, followed by sensitivity analyses, and the GRADE analysis of the evidence quality. A total of 24 papers (23 trials) were included, assessing preventive measures applied either around orthodontic brackets (21 trials; 1427 patients; mean age 14.4 years) or molar bands (2 trials; 46 patients; age/sex not reported). Active patient reminders were associated with reduced WSL incidence on patient level compared to no reminder (3 trials; 190 patients; RR: 0.4; 95% CI: 0.31‐0.64; Number Needed to Treat [NNT]: 3 patients), flat surface sealants were associated with reduced WSL incidence on tooth level than no sealant (5 trials; 2784 teeth; RR: 0.8; 95% CI: 0.63‐0.95; NNT: 33 teeth), and fluoride varnish was associated with reduced WSL severity on tooth level (2 trials; 1160 teeth; MD: ?0.32 points; 95% CI: ?0.44 to ?0.21 points). However, the quality of evidence was low according to GRADE, due to risk of bias. Some evidence indicates that active patient reminders and flat surface sealants or fluoride varnish around orthodontic brackets might be associated with reduced WSL burden, but further research is needed.     

Enamel white spot lesions can remineralise using bio-active glass and polyacrylic acid-modified bio-active glass powders

Objective

To evaluate the potential of bio-active glass (BAG) powder and BAG containing polyacrylic acid (PAA-BAG) to remineralise enamel white spot lesions (WSL).

Methods

32 human enamel samples with artificial WSLs were assigned to 4 experimental groups (n = 8); (a) BAG slurry, (b) PAA-BAG slurry, (c) “standardised” remineralisation solution (positive control) and (d) de-ionised water (negative control). Mechanical properties of enamel were assessed using surface and cross-section Knoop microhardness. Micro-Raman spectroscopy in StreamLine™ scan mode was used to scan lesion cross-sections. The intensity of the Raman phosphate peak at 959 cm⁻¹ was fitted and measured producing depth profiles analysed using a double-step fitting function. A further 20 samples (n = 5) were used to obtain 3D images of surfaces using non-contact white light profilometry permitting measurement of lesion step height in relation to the sound enamel reference level, and to scan the lesion surface using scanning electron microscopy (SEM). Data were analysed statistically using one-way ANOVA with Tukey's HSD post-hoc tests.

Results

BAG, PAA-BAG and the remineralisation solution exhibited statistically significantly higher surface and cross-section Knoop microhardness compared to the negative control. Micro-Raman spectroscopy detected significantly higher phosphate content within the treated groups compared to the negative control group. Lesions’ depth was not significantly reduced. SEM images revealed mineral depositions, with different sizes and shapes, within BAG, PAA-BAG and the positive control groups.

Conclusion

BAG and PAA-BAG surface treatments enhance enamel WSL remineralisation, assessed by the resultant improved mechanical properties, higher phosphate content and morphological changes within the artificial lesions.     

Treatment of white spot lesions with ACP paste and microabrasion

Abstract Objective: To examine the effects of application of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) paste and microabrasion treatment on the regression of white spot lesions (WSLs). Materials and Methods: Artificially-induced WSLs in bovine enamel were randomly assigned to one of four treatment groups: CPP-ACP paste only, microabrasion only, microabrasion and CPP-ACP, and a control. Samples were treated with each regimen twice daily for 2?weeks and stored in remineralizing solution between the treatments. Quantitative light-induced fluorescence was used to measure changes in fluorescence, which indicate changes in mineral content of WSLs immediately before (T1) and 2?weeks after treatment (T2). A two-within-subject factor analysis of variance was used to analyze the significance of any changes in mineral content of the lesions from T1 to T2. Results: There was a statistically significant (P < .05) gain in fluorescence associated with the microabrasion only, as well as the microabrasion and CPP-ACP treatments. The changes in fluorescence for the CPP-ACP treatment alone were not statistically significant (P = .40). Conclusions: CPP-ACP paste alone does not significantly improve the fluorescence value (ie, the mineral content) of WSLs. Within the limitations of this in vitro study, microabrasion treatment with or without CPP-ACP improved the fluorescence and thus reduced WSLs.     

Synchrotron x-ray microtomographic investigation of mineral concentrations at micrometre scale in sound and carious enamel

Synchrotron X-ray microtomography (XMT) was used to measure the linear attenuation coefficient (LAC) for 1.9-microm sidelength voxels within approximal brown spot lesions and sound human enamel. XMT demonstrated three-dimensional features, notably sheets with approximately 30 microm periodicity having low LAC, identified as regions of demineralization corresponding to Retzius lines. Quantitative three-dimensional measurements of mineral concentration, derived from LAC with assumption of a single model composition, were consistent with previous measurements of sound and carious enamel from microradiographic projections. The uncertainty in measurements of mineral concentration and mineral fraction volume was investigated by modelling enamel with a range of composition and component densities. This analysis showed that, although mineral concentration can be determined from LAC with an error of <0.2 g cm(-3), the variation in pore fraction volume within caries lesions cannot be reliably determined from X-ray attenuation measurements alone.     

Mineral concentration of natural human teeth by a commercial micro-CT

This study aimed to evaluate a commercial micro-CT system (microCT 20) for quantitative analysis of mineral concentration in human enamel and dentin using different methodologies, and thereby compare the obtained results with established data from published literature. A micro-CT device set at 50 kVp (160 microA) was used to scan five whole molars (G1) and five molars ground to 6-mm thickness (G2), as well as evaluate the mineral concentration of the samples. Mean mineral contents for enamel and dentin were 2.57 (+/- 0.12) and 1.53 (+/- 0.12) g/cm3 for G1, and 2.76 (+/- 0.03) and 1.45 (+/- 0.02) g/cm3 for G2. Difference between the groups was significant for enamel. For dentin, there was a clear although not significant tendency towards higher values with G1. The equipment could identify and differentiate a higher mineral content of the tooth enamel and dentin from the external to the inner tissue. Further, the absolute mean values of mineral concentration were lower in whole tooth samples than in sectioned samples due to beam hardening. In conclusion, the equipment is well suited for quantifying the mineral content of teeth. However, it is necessary to consider the limited acceleration voltage of the microCT 20 system and to limit sample evaluation to 6-mm thickness.     

Thirty-five percent carbamide peroxide application causes in vitro demineralization of enamel.

OBJECTIVES: The objective of this in vitro study was to investigate whether a high concentration 'in-office' bleaching agent affected the mineral content of enamel and dentin. METHODS: A commercially available 35% carbamide peroxide bleaching agent was applied for 2h to sectioned teeth (n=11). Specimens were then immersed in artificial saliva at 37 degrees C for a further 24h to simulate the oral environment. Tomographic images of these sections were obtained (micro-CT 80, Scanco, Switzerland) prior to and post-bleach application. Eight three-dimensional regions of interest (ROI), starting from the enamel surface extending to the dentinoenamel junction, were selected for each section. The hydroxyapatite equivalent mineral concentrations (g/cm(3)) of the ROIs were calculated. Any changes in mineral content as a consequence of the bleaching procedure were calculated in relation to each ROI. RESULTS: There was a significant reduction in the mineral content of enamel specimens post-bleach application extending to a depth of 250microm (paired t-test, p<0.05); this reduction in mineral content was greatest in the ROI's closest to the tooth surface. There was, however, no significant difference in the mineral content of dentin as a consequence of bleaching. SIGNIFICANCE: This in vitro study has shown that significant demineralization of enamel occurred following bleaching with 35% carbamide peroxide. The concept that 'in-office' bleaching is a non-destructive cosmetic procedure should be reconsidered.     

Enamel remineralization therapies for treating postorthodontic white-spot lesions: A systematic review

Background

One of the adverse effects of orthodontic treatment is the appearance of white-spot lesions (WSLs) resulting from enamel demineralization. The objective of this systematic review was to investigate the effectiveness of remineralization therapies on WSLs after orthodontic treatment.

Comparison of bleaching effects when applied to white-spot lesions before or after resin infiltration: An in vitro study

BackgroundThe purpose of this study was to compare color alterations (ΔE) of white-spot lesions (WSLs) bleached before versus after resin infiltration (RI).MethodsUsing the facial surfaces of bovine maxillary incisors, WSLs were created and the teeth were allocated into 2 groups (n = 45/group): bleach then RI (B-RI group) and RI then bleach (RI-B group). To determine ΔE, Commission Internationale de l’Eclairage L1 a1 b1 (L1 represents lightness, ranging from black to white [0-100]; a1 represents green to red chromaticity [–150-+100]; and b1 represents blue to yellow chromaticity [–100-+150]) measurements were obtained at baseline, after WSL formation, and after RI and bleaching. Representative specimens were evaluated by means of scanning electron microscopy. Statistical analyses included the Mann-Whitney U and Wilcoxon signed rank tests (P ≤ .0016) and repeated measures analysis of variance (P ≤ .05).ResultsNo differences in ΔE were found comparing B-RI with RI-B groups or when the B-RI group was compared with bleached enamel. A statistically significant difference was found when the RI-B group was compared with bleached enamel (ΔE, 0.81; P < .001), but the difference was deemed not clinically significant. Scanning electron microscopy revealed that bleaching after RI increased surface roughness of the resin.ConclusionsThere were no clinically significant differences in ΔE of WSLs when bleach was applied before or after RI; however, applying bleaching agent after RI roughened the surface of the resin material.Practical ImplicationsResults indicate that ΔE were not clinically significantly different between WSLs bleached before versus after RI, although it is best to sequence bleaching before RI therapy, as bleaching after RI roughened the restoration’s surface.     

Role of taste perception in white spot lesion formation during orthodontic treatment

Objectives:To investigate the role of individual''s taste sensitivity using 6-n-propylthiouracil (PROP) in the development of white spot lesions (WSLs) in adolescent orthodontic patients.Materials and Methods:44 healthy adolescents, aged 12 to 16 years old, who were in fixed-appliance orthodontic treatment for at least 6 months, consented to participate in this cross-sectional study. Data regarding participants'' demographic information, oral hygiene practices, and dietary habits were obtained by a questionnaire. An oral clinical examination was performed to determine the oral hygiene status, the presence of WSLs and dental caries experience. The taste phenotype of the participants was evaluated through PROP test and they were accordingly divided into PROP nontasters and PROP tasters.Results:The sample consisted of 24 subjects in the WSL group and 20 subjects in the WSL-free group. The WSL group demonstrated higher mean plaque score (48.2), mean decayed, missing, and filled surfaces (2.38), and mean decayed, missing, and filled teeth (1.96) scores compared to the WSL-free group (38.7, 0.85, and 0.55, respectively), but no significant differences were found. Most subjects in the WSL group were PROP nontasters (66.6%) whereas most subjects in the WSL-free group were PROP tasters (75%); a significant difference was observed between the groups (P = .006).Conclusions:The prevalence of white spot lesions was significantly higher in adolescent orthodontic patients who were PROP nontasters compared to PROP tasters. A PROP taste perception could be a potential risk factor for the formation of WSLs during fixed orthodontic treatment that warrants further attention.     

Chemical and structural challenges in remineralization of dental enamel lesions

The aim of the present paper was to identify some chemical and structural factors which may prevent a full remineralization of caries lesions and to study whether it is possible to overcome such obstacles. Samples of powdered enamel apatite were equilibrated with solutions metastably supersaturated with respect to enamel hydroxyapatite and fluorapatite. After 10 min and 60 min of equilibration at 20 degrees C the suspensions were centrifuged and the calcium and phosphate concentrations and the pH were determined in the supernatant. In parallel studies, 50 75-microns-thick sections of 27 fluorotic teeth of a severity of 5-7 according to Thylstrup and Fejerskov's classification were examined by microradiography and in polarized light using distilled water, and Thoulett's media or seen dry in air. Five obstacles inhibiting remineralization were identified: 1) Although remineralizing solutions or saliva are supersaturated with respect to enamel apatite the total amount of calcium and phosphate dissolved in it is small, so that after precipitation of the dissolved mineral only 1/20,000-1/30,000 of the volume of the mineralizing solution is occupied by mineral. 2) The concentration gradients from the mineralizing solution into the enamel is small, which indicates a slow diffusion into and out of the lesion. 3) The uptake of calcium and phosphate by the enamel apatite crystals is so rapid that the aqueous phase within the pores can be presumed to be only marginally supersaturated in the deeper parts of the lesion. 4) The surface layer of the enamel lesions was found to be a serious obstacle to remineralization so that a subsurface area remains hypomineralized after exposure to salivary remineralization even for a lifetime. 5) Nucleation of new apatite crystals to substitute lost crystals is an unsolved problem.     

Quantitative study of fluoride transport during subsurface dissolution of dental enamel

Previous studies using bovine dental enamel as a model have shown that surface and subsurface dissolution of enamel may be governed by micro-environmental solution conditions. We have now investigated the demineralization phenomenon more rigorously with the primary objective of developing a method for deducing solution species concentration profiles as a function of time from appropriate experimental data. More specifically, in this report, a model-independent method is described for determination of the pore solution fluoride gradients in bovine enamel during subsurface demineralization. Microradiography was used to determine the mineral density profiles, and an electron microprobe technique to determine total fluoride (F) profiles associated with the enamel. In each case, matched sections of bovine enamel were exposed to partially saturated acetate buffers at pH = 4.5 containing 0.5 ppm F for various periods of time (from six to 24 hours). The treated enamel was found to have an intact surface layer and subsurface demineralization. The extent of the demineralization and the depths of the lesions increased with time in all cases. The data were first used to calculate (a) the total F gradients in the enamel at various times, and (b) the local uptake rate of F as a function of time and position. Then, by manipulation of the equations describing the uptake and transport of F, we calculated the pore diffusion rate of F and the micro-environmental solution F concentration in the aqueous pores as a function of time and of distance from the enamel surface. It was also possible to calculate an intrinsic F diffusion coefficient in the pores, which was about 1.0 X 10(-5) cm2/sec, in good agreement with reported values. 14C-sucrose uptake and release experiments with identically prepared demineralized enamel sections were also conducted to provide an independent check on the assumed dependence of porosity on mineral density. The results of this investigation, especially the outcomes relative to this new method for determination of pore solution F gradients during acid attack of the dental enamel, should be valuable in future studies of the mechanism(s) of the action of F in inhibiting dental enamel demineralization.     

Effects of fluoride on matrix proteins and their properties in rat secretory enamel

This publication concerns the selective adsorption of rat enamel proteins onto hydroxyapatite, their solubility in aqueous solutions, and the effect that systemic fluoride has on these properties. The enamel proteins used as adsorbates were extracted in 0.5 mol/L acetic acid from the secretory enamel of the upper and lower incisors of SD rats (females, 200-220 g body weight). Equilibration of the proteins with hydroxyapatite was performed in two solutions: (i) 50 mmol/L acetate buffer at pH 6.0 and 0 degrees C, and (ii) 50 mmol/L Tris buffer containing 4 mol/L guanidine at pH 7.4 and room temperature. Enamel was dissected from animals, which were given either de-ionized water (control group) or water containing 25, 50, 75, or 100 ppm fluoride as NaF for four weeks. From these enamel samples, the proteins were extracted in sequence with 160 mmol/L NaCl and 3 mmol/L phosphate (pH 7.3), 50 mmol/L carbonate buffer (pH 10.8), and finally, with 0.5 mol/L acetic acid for dissolution of the enamel mineral. The F, Ca, and P contents of the various enamel samples were determined.(ABSTRACT TRUNCATED AT 250 WORDS)     

Remineralization capacity of carious and non-carious white spot lesions: clinical evaluation using ICDAS and SS-OCT

Objectives

To assess the remineralization capacity of carious, non-carious, and combined white spot lesions (WSLs) using the ICDAS and SS-OCT.

Materials and methods

This clinical trial was based on a quasi-experimental design. Forty-two healthy subjects (median age 26.6 years), who visited university hospital and had at least one WSL with an ICDAS score of 2 or 1, were recruited. The subjects chewed a non-blind sugar-free gum containing bioavailable calcium and fluoride for 3 months. The remineralization capacities of carious and non-carious 121 WSLs were assessed using ICDAS by two calibrated non-blind examiners and optical boundary depth (BD) by SS-OCT at a monthly recall. The outcome variables, transitions of ICDAS score, mean BD, and mean BD recovery rate (RR%), were statistically analyzed using the chi-square test, two way-repeated measures ANOVA, and Wilcoxon rank sum test, respectively (alpha = 0.05).

Results

Based on the visual inspection, OCT images at the baseline, 72 WSLs were purely carious, 20 were non-carious (developmental) lesions, while 29 were combined (carious-developmental). The responses of WSLs over time showed to be highly variable. There was a significant difference in transitions of ICDAS scores after 3 months between carious and non-carious WSLs (p < 0.05) and non-carious and combined WSLs (p < 0.05). Carious and combined WSLs underwent significant changes in the mean BD between baseline (161.8 ± 56.8 μm) and 2 months (130.7 ± 57.4 μm) or 3 months (119.1 ± 57.5 μm) (p < 0.05), while there was no significant difference between baseline (132.2 ± 26.2 μm) and 2 months (122.8 ± 24.1 μm) or 3 months (119.8 ± 22.6 μm) in non-carious WSLs (p > 0.05). There was a significant difference in mean RR% after 2 and 3 months between carious and non-carious WSLs (p < 0.05).

Conclusions

The remineralization capacity of WSL was variable among the cases and subjects, and depended on the WSLs history, etiology (carious, non-carious, or combined lesion) and structure (histological pattern).

Clinical relevance

Carious WSLs showed the highest remineralization potential.