Prevention of dentine erosion by brushing with anti-erosive toothpastes

Objective

This in vitro study aimed to investigate the preventive effect of brushing with anti-erosive toothpastes compared to a conventional fluoride toothpaste on dentine erosion.

Materials and methods

Bovine dentine specimens (n = 12 per subgroup) were eroded in an artificial mouth (6 days, 6 × 30 s/day) using either citric acid (pH:2.5) or a hydrochloric acid/pepsin solution (pH:1.6), simulating extrinsic or intrinsic erosive conditions, respectively. In between, the specimens were rinsed with artificial saliva. Twice daily, the specimens were brushed for 15 s in an automatic brushing machine at 2.5 N with a conventional fluoride toothpaste slurry (elmex, AmF) or toothpaste slurries with anti-erosive formulations: Apacare (NaF/1% nHAP), Biorepair (ZnCO₃-HAP), Chitodent (Chitosan), elmex Erosionsschutz (NaF/AmF/SnCl₂/Chitosan), mirasensitive hap (NaF/30% HAP), Sensodyne Proschmelz (NaF/KNO₃). Unbrushed specimens served as control. Dentine loss was measured profilometrically and statistically analysed using two-way and one-way ANOVA followed by Scheffe‘s post hoc tests. RDA-values of all toothpastes were determined, and linear mixed models were applied to analyse the influence of toothpaste abrasivity on dentine wear (p < 0.05).

Results

Dentine erosion of unbrushed specimens amounted to 5.1 ± 1.0 μm (extrinsic conditions) and 12.9 ± 1.4 μm (intrinsic conditions). All toothpastes significantly reduced dentine erosion by 24–67% (extrinsic conditions) and 21–40% (intrinsic conditions). Biorepair was least effective, while all other toothpastes were not significantly different from each other. Linear mixed models did not show a significant effect of the RDA-value of the respective toothpaste on dentine loss.

Conclusion

Toothpastes with anti-erosive formulations reduced dentine erosion, especially under simulated extrinsic erosive conditions, but were not superior to a conventional fluoride toothpaste.     

Efficacy of the stannous ion and a biopolymer in toothpastes on enamel erosion/abrasion

Objectives

Sn²⁺ has promising erosion-inhibiting properties in solutions, but little is known about respective effects in toothpastes. In addition, biopolymers might have protecting potential. Aim of this study was to investigate the effects of Sn²⁺ in toothpastes and of a biopolymer (chitosan) added to a Sn²⁺ formulation on erosion/abrasion.

Methods

Enamel samples were subjected to cyclic erosion procedures (10 days; 0.50% citric acid, pH 2.5; 6× 2 min/day), and brushing (2× 15 s/day, load 200 g) during immersion in slurries (2 min). The toothpastes were NaF formulations (NaF/1, NaF/2, NaF/3) and Sn²⁺ formulations (NaF/SnCl₂, AmF/SnF₂, AmF/NaF/SnCl₂) and AmF/NaF/SnCl₂ + 0.5% chitosan.Declared concentrations of active ingredients in toothpastes were 1400–1450 μg/g F⁻ and 3280–3500 μg/g Sn²⁺. Negative controls were erosion only and placebo, positive control was a SnF₂ gel. Tissue loss was quantified profilometrically, Sn on enamel surfaces was measured by energy dispersive X-ray spectroscopy.

Results

Loss values (μm) for erosion only and placebo were 14.4 ± 4.5 and 20.2 ± 3.8, respectively, and 4.6 ± 1.9 for the positive control (p ≤ 0.001 each compared to erosion only). The other loss values were: NaF/1 16.5 ± 3.0, NaF/2 14.0 ± 2.7, NaF/3 12.6 ± 3.9, NaF/SnCl₂ 14.7 ± 5.1, AmF/SnF₂ 13.5 ± 4.8, AmF/NaF/SnCl₂ 12.4 ± 4.2, AmF/NaF/SnCl₂ + chitosan 6.6 ± 3.5 (except NaF/1 all p ≤ 0.01 compared to placebo). AmF/NaF/SnCl₂/chitosan was more effective than all other toothpastes (p ≤ 0.01 each). Sn on the enamel surface ranged between 1.3 ± 0.3 and 2.8 ± 0.04 wt.% with no obvious relationship with efficacy.

Conclusions

The NaF and Sn²⁺ toothpastes without chitosan exhibited similar anti-erosion and abrasion-prevention effects. The experimental Sn²⁺ formulation with chitosan revealed promising results similar to those of the positive control.

Clinical significance

NaF toothpastes offer a degree of protection against erosion/abrasion, which is likely sufficient for most subjects with average acid exposures. For patients with initial erosive lesions, however, more effective toothpaste is desirable. The combination of Sn²⁺ and a biopolymer appears promising in this context.     

Inhibition of tooth erosion by milk containing different fluoride concentrations: An in vitro study

Objectives

This in vitro study assessed the effect of milk containing different fluoride concentrations on tooth erosion.

Methods

Bovine enamel and root dentine specimens were treated with: (1) bovine whole milk with 0 ppm F; (2) 2.5 ppm F; (3) 5 ppm F; (4) 10 ppm F (all after erosion); (5) whole milk with 0 ppm F (before erosion); (6) NaF (0.05% F, positive control, after erosion) or (7) 0.9% NaCl (negative control, after erosion). The specimens were submitted to pH cycles (4× 90 s in soft drink) and treatments for 5 days. The specimens were immersed in the treatment solutions for 1 min (only at the first cycle each day) with further exposition to 1:1 milk:saliva slurry for 10 min. The tooth loss was measured using a contact profilometer and statistically analysed (p < 0.05).

Results

Rinsing with milk before erosive challenge significantly reduced tooth loss compared to negative control (67% and 24% reduction in dentine and enamel loss, respectively) and to milk after erosive challenge, only for dentine. The addition of fluoride to milk also reduced tooth loss compared to negative control, but with no significant differences among fluoride concentrations for enamel and dentine (μm), respectively: 0 ppm (3.63 ± 0.04 and 2.51 ± 0.53), 2.5 ppm F (2.86 ± 0.42 and 1.96 ± 0.47), 5 ppm F (2.81 ± 0.27 and 1.77 ± 0.44), 10 ppm F (2.03 ± 0.49 and 1.68 ± 0.59). There was a negative and significant correlation between [F] and the tooth loss.

Conclusions

Daily rinse with milk containing F is able to reduce both enamel and dentine erosion in vitro.

Clinical significance

Since the prevalence of dental erosion is steadily increasing, rinse with milk or its derivate might be an important strategy to reduce the progression of tooth erosion.     

The effect of increasing sodium fluoride concentrations on erosion and attrition of enamel and dentine in vitro

Objectives

To investigate the effect of an aqueous sodium fluoride solution of increasing concentration on erosion and attrition of enamel and dentine in vitro.

Methods

Enamel and dentine sections from caries-free human third molars were polished flat and taped (exposing a 3 mm × 3 mm area) before being randomly allocated to 1 of 5 groups per substrate (n = 10/gp): G1 (distilled water control); G2 (225 ppm NaF); G3 (1450 ppm NaF); G4 (5000 ppm NaF); G5 (19,000 ppm NaF). All specimens were subjected to 5, 10 and 15 cycles of experimental wear [1 cycle = artificial saliva (2 h, pH 7.0) + erosion (0.3% citric acid, pH 3.2, 5 min) + fluoride/control (5 min) + attrition (60 linear strokes in artificial saliva from enamel antagonists loaded to 300 g)]. Following tape removal, step height (SH) in μm was measured using optical profilometry.

Results

When the number of cycles increased the amount of tooth surface loss increased significantly in enamel and dentine after attrition and erosion and for dentine after attrition. Attrition and erosion resulted in greater surface loss than attrition alone after 15 cycles of experimental wear of enamel. 5000 ppm and 19,000 ppm sodium fluoride solutions had a protective effect on erosive and attritional enamel tooth wear in vitro, however no other groups showed significant differences.

Conclusions

The more intensive the fluoride regime the more protection was afforded to enamel from attrition and erosion. However, in this study no such protective effect was demonstrated for dentine.     

Inhibitory effect of silver diamine fluoride on dentine demineralisation and collagen degradation

Objective

To investigate the inhibitory effects of 38% silver diamine fluoride (SDF) on demineralised dentine.

Methods

Human dentine blocks were demineralised and allocated to four groups: SF, F, S and W. The blocks in group SF received a topical application of 38% SDF solution (253,900 ppm Ag, 44,800 ppm F), group F received a 10% sodium fluoride solution (44,800 ppm F), group S received a 42% silver nitrate solution (253,900 ppm Ag) and group W received deionised water (control). They were subjected to pH cycling using demineralisation solution (pH 5) and remineralisation solution (pH 7) for 8 days. The surface morphology, crystal characteristics, lesion depth and collagen matrix degradation of the specimens were investigated by scanning electron microscopy (SEM), X-ray diffraction (XRD), micro-CT testing and spectrophotometry with a hydroxyproline assay.

Results

The surface morphology under SEM showed evident demineralisation with exposed collagen in groups S and W, but not in group SF. Clusters of granular spherical grains were observed in the cross-sections of specimens in groups SF and F. XRD revealed precipitates of silver chloride in groups SF and S. The mean lesion depths (±SD) of groups SF, F, S and W were 182 ± 32 μm, 204 ± 26 μm, 259 ± 42 μm and 265 ± 40 μm, respectively (SDF, F < S, W; p < 0.01). Groups SF and S had significantly less hydroxyproline liberated from the dentine matrix than groups F and W (p < 0.01).

Conclusion

The use of 38% SDF inhibited demineralisation and preserved collagen from degradation in demineralised dentine.

Clinical significance

SDF application positively influences dentine remineralization.     

The effect of casein phosphopeptide–amorphous calcium phosphate on erosive enamel and dentine wear by toothbrush abrasion

Objective

In addition to its role as a remineralizing agent in preventing dental caries, calcium product (CPP–ACP) delivered as a mousse (Tooth Mousse^®, TM) can reduce erosion of enamel and dentine. The aim of this study was to determine whether CPP–ACP could also reduce erosive tooth wear involving toothbrush abrasion.

Methods

Flat, polished enamel and dentine specimens (n = 72) were subjected to 10 wear regimes, with each regime involving erosion in 0.3% citric acid (pH 3.2) for 10 min followed by toothbrush abrasion in a slurry of fluoride-free toothpaste and artificial saliva (1:3 ratio by weight) under a load of 2N for 200 cycles. The specimens were immersed in artificial saliva for 2 h between wear regimes. In the experimental group 1, TM (containing CPP–ACP) was applied at the beginning of each wear episode for 5 min whereas TM− (without CPP–ACP) was applied in the experimental group 2. No mousse was applied in the control group.

Results

TM significantly reduced enamel wear (mean ± S.E., 1.26 ± 0.33 μm in the experimental group 1 vs 3.48 ± 0.43 μm in the control group) and dentine wear (2.16 ± 0.89 μm in the experimental group 1 vs 10.29 ± 1.64 μm in the control group), and dentine wear was significantly less in the experimental group 1 than in the experimental group 2 (5.75 ± 0.98 μm).

Conclusion

The finding that TM reduced erosive tooth wear involving toothbrush abrasion, probably by remineralizing and lubricating eroded tooth surfaces, may have implications in the management of tooth wear.     

Sodium fluoride mouthrinse used twice daily increased incipient caries lesion remineralization in an in situ model

Objectives

To investigate the remineralizing effects of fluoride mouthrinses used at different times and frequency in addition to fluoride toothpaste.

Methods

A randomized crossover single blinded study comprised 4 experimental phases of 21 days each. Twelve orthodontic volunteers were fixed with an orthodontic bracket containing an artificial carious enamel slab, which was from the same tooth in all 4 phases, and were randomly assigned to the following groups: (1) brushing with F toothpaste 2× per day (F- brush), (2) F- brush + rinsing with 0.05% NaF (F- rinse) after lunch, (3) F- brush + F-rinse before bedtime, and (4) F- brush + F- rinse 2× per day. Mean mineral gain after each phase was determined from mineral density profiles obtained using Micro-CT.

Results

The mean mineral gain in all treatments with F- brush and F-rinse were significantly greater than those in F- brush (p < 0.05). Moreover F- rinse 2× per day increased lesion remineralization more than F- rinse once a day.

Conclusions

The twice-daily use of 0.05% NaF mouthrinse combined with twice-daily regular use of fluoride toothpaste resulted in the greatest remineralization of incipient caries. These data indicate that rinsing frequency is a factor affecting the effectiveness of fluoride mouthrinse.

Clinical significance

The rinsing frequency of NaF mouthrinse, when used with fluoride toothpaste, also affects the remineralization. This finding, if confirmed by a clinical study, would lead to a new recommendation for fluoride mouthrinse used in high caries risk patients who could benefit from using it twice a day.     

Erosion-inhibiting potential of a stannous chloride-containing fluoride solution under acid flow conditions in vitro

Objectives

This study aimed to analyse the erosion-inhibiting potential of a single application of stannous chloride-containing fluoride solution on pellicle-covered enamel and dentine under constant acid flow conditions in vitro.

Design

Bovine enamel (n = 60) and dentine (n = 60) samples were exposed 1 h to the oral cavity of 4 healthy volunteers to allow for in situ pellicle formation. Pellicle-covered samples were randomly assigned to three groups (each n = 20 enamel and n = 20 dentine samples; 5 enamel and 5 dentine samples/volunteer) and treated once with a SnCl2/AmF/NaF (800 ppm Sn(II), 500 ppm F, pH 4.5) or a NaF solution (500 ppm F, pH 4.5) for 2 min or remained untreated (controls). Samples were eroded with hydrochloric acid (pH 2.6) in a small erosion chamber at 60 μl/min for 25 min. Calcium release into the acid was monitored in consecutive 30 s intervals for 5 min, then at 1 min intervals up to a total erosion time of 25 min using the Arsenazo III procedure. Data were statistically analysed by random-effects linear models (p < 0.05).

Results

The stannous chloride-containing fluoride solution reduced calcium loss of enamel and dentine to up to 6 min and 3.5 min, respectively. Calcium loss (% of control) amounted from 24 ± 7 (30 s) up to 93 ± 14 (6 min) in enamel and from 38 ± 13 (30 s) to 87 ± 15 (3.5 min) in dentine. The sodium fluoride solution was unable to reduce enamel and dentine erosion at any time point.

Conclusion

A single application of a stannous chloride-containing fluoride solution reduced enamel and dentine erosion up to 6 min and 3.5 min of constant acid flow, respectively.     

Effect of low-fluoride toothpastes combined with hexametaphosphate on in vitro enamel demineralization

Objectives

The aim of this study was to evaluate the anticaries effect of low-fluoride toothpastes combined with hexametaphosphate (HMP) on enamel demineralization.

Methods

Bovine enamel blocks were subjected to pH cycling and treatment with toothpaste's slurries (15 groups; 2×/day). Toothpaste mixtures contained the following: no fluoride (F) plus HMP (from 0 to 3.0%); 250 ppm F plus HMP (from 0 to 3.0%); 500 ppm F; 1100 ppm F; and a commercial toothpaste (1100 ppm F). After pH cycling, surface and cross-sectional hardness, as well as F present in the enamel were determined. The demineralization depth was analyzed using polarized light microscopy. The variables were subjected to 1-way ANOVA, followed by Student–Newman–Keuls’ test (p < 0.05).

Results

In the absence of fluoride, 0.5% HMP promoted the lowest mineral loss and its effect was similar to that of a 250 ppm F toothpaste (p > 0.05). The combination of 0.5% HMP and 250 ppm F resulted in lower mineral loss (p < 0.05) and similar lesion depth when compared to the 1100 ppm F toothpaste (p > 0.05).

Conclusion

To conclude, the combination of 0.5% HMP and 250 ppm fluoride in a toothpaste has a similar inhibitory effect on enamel demineralization in vitro when compared to a toothpaste containing 1100 ppm F.

Clinical significance

The anticaries effect of toothpaste containing 250 ppm F combined with 0.5% HMP was similar to that of a 1100 ppm F toothpaste, despite the 4-fold difference in F concentration. Although such effects still need to be demonstrated in clinical studies, it may be a viable alternative for preschool children.     

Shear bond strength of porcelain laminate veneers to enamel,dentine and enamel–dentine complex bonded with different adhesive luting systems

Objectives

The aim of this study was to evaluate the shear bond strength of porcelain laminate veneers to 3 different surfaces by means of enamel, dentine, and enamel–dentine complex.

Methods

One hundred thirty-five extracted human maxillary central teeth were used, and the teeth were randomly divided into 9 groups (n = 15). The teeth were prepared with 3 different levels for bonding surfaces of enamel (E), dentine (D), and enamel–dentine complex (E–D). Porcelain discs (IPS e.max Press, Ivoclar Vivadent) of 2 mm in thickness and 4 mm in diameter were luted to the tooth surfaces by using 2 light-curing (RelyX Veneer [RV], 3M ESPE; Variolink Veneer [VV], Ivoclar Vivadent) and a dual-curing (Variolink II [V2], Ivoclar Vivadent) adhesive systems according to the manufacturers’ instructions. Shear bond strength test was performed in a universal testing machine at 0.5 mm/min until bonding failure. Failure modes were determined under a stereomicroscope, and fracture surfaces were evaluated with a scanning electron microscope. The data were statistically analysed (SPSS 17.0) (p = 0.05).

Results

Group RV-D exhibited the lowest bond strength value (5.42 ± 6.6 MPa). There was statistically no difference among RV-D, V2-D (13.78 ± 8.8 MPa) and VV-D (13.84 ± 6.2 MPa) groups (p > 0.05). Group VV-E exhibited the highest bond strength value (24.76 ± 8.8 MPa).

Conclusions

The type of tooth structure affected the shear bond strength of the porcelain laminate veneers to the 3 different types of tooth structures (enamel, dentine, and enamel–dentine complex).

Clinical significance

When dentine exposure is necessary during preparation, enough sound enamel must be protected as much as possible to maintain a good bonding; to obtain maximum bond strength, preparation margins should be on sound enamel.     

Effect of open-sandwich vs. adhesive restorative techniques on enamel and dentine demineralization: An in situ study

Objectives

To assess in situ the effect of different restorative techniques used with fluoride-releasing materials on enamel and dentine demineralization in the presence of a cariogenic challenge.

Methods

Thirty human molars were prepared for 60 Class V cavities, with enamel and dentine margins. The teeth were divided into four groups (n = 15): L1 – open sandwich technique with a conventional glass ionomer cement (GIC), L2 – open sandwich technique with a resin-modified GIC, A1 – total-etch bonding with a fluoride-containing adhesive, A2 – total-etch bonding with a nonfluoride-containing adhesive. All the cavities were restored with a nanofilled composite. Fifteen volunteers used appliances containing one specimen from each group. The cariogenic challenge was carried out with a 20% sucrose solution 8×/day for 7 days. The specimens were sectioned for microhardness test and EDS analysis at different depths below the enamel and dentine margins (25, 50 and 100 μm) and distances from the tooth-restoration interfaces (25 and 75 μm). The data were analyzed by ANOVA and Games–Howell test (α = 5%).

Results

Both GICs produced higher hardness in enamel at all depth-and-distance combinations, but only L1 produced higher hardness in dentine (p < 0.05). L2 and A1 exhibited similar dentine hardness at 25 μm distance for all depths (p > 0.05). L1 demonstrated significantly higher amounts of calcium in dentine than the other groups, but had similar amounts in enamel to L2 and A1.

Conclusions

The open sandwich technique using conventional GIC proved more effective in reducing enamel and dentine demineralization at depths of up to 100 μm under a cariogenic challenge.

Clinical significance

Conventional GICs should be considered the materials of choice for lining of cavities not having all margins in enamel, particularly using the open sandwich technique.     

Effects of CPP-ACP with sodium fluoride on inhibition of bovine enamel demineralization: a quantitative assessment using micro-computed tomography

Objectives

The present study evaluated the effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and CPP-ACP with 900 ppm fluoride (CPP-ACPF) pastes on inhibition of enamel demineralization over time, using polychromatic micro-computed tomography (micro-CT).

Methods

Enamel blocks were prepared from bovine teeth. The specimens were each treated by one of the following agents, 30 min daily for 7 days: deionized water (negative control); CPP-ACP paste; CPP-ACPF paste; and NaF solutions (positive controls) (90, 900, and 9000 ppm F). After treatment, the specimens were immersed in a demineralizing solution (pH 4.5) for 24, 72, and 120 h. Mean mineral loss (ML) and lesion depth (LD) after each period were determined from mineral density profiles obtained using micro-CT.

Results

ML values in all the treatment groups were significantly smaller than those in the control group after 72 and 120 h of demineralization (p < 0.05, two-way ANOVA and t-test with Bonferroni correction). ML values in CPP-ACPF and NaF solution groups were significantly smaller compared to CPP-ACP group after 72 h (p < 0.05). LD values in the CPP-ACPF and all the NaF solutions groups were significantly smaller compared to the control group after 120 h (p < 0.05). The 9000 ppm F group showed the lowest nominal ML and LD values.

Conclusions

The application of CPP-ACP or CPP-ACPF pastes to sound enamel surfaces resulted in inhibition of enamel demineralization, and a better effect was noted for the latter paste. Quantitative assessment using polychromatic micro-CT demonstrated to be useful for detecting mineral density changes.     

The preventive effect of grape seed extract on artificial enamel caries progression in a microbial biofilm-induced caries model

Objectives

The aim of this study was to evaluate the effect of grape seed extract (GSE) on enamel caries lesion formation in an in vitro Streptococcus mutans biofilm model.

Methods

Enamel fragments were prepared from bovine incisors and divided into six treatment groups (n = 12): inoculated Brain Heart Infusion with 1% sucrose (BHIS), 1 mg/mL GSE, 2 mg/mL GSE, 3 mg/mL GSE, 10 ppm fluoride as NaF, and uninoculated BHIS. For biofilm formation, tooth fragments were incubated anaerobically in polystyrene 6-well tissue culture plates containing BHIS, the respective agents, and S. mutans (1 × 10⁵ CFU/mL) for 24 h at 37 °C. Culture medium was replaced with fresh BHIS and respective agents daily over a 7-day period. Following caries lesion formation, lesion depth (LD) and relative optical density (ROD) were determined by polarized light microscopy (PLM) and confocal laser scanning microscopy (CLSM), respectively, to evaluate lesion progression.

Results

LDs of the 2 mg/mL GSE group (122.86 ± 13.41 μm) and the 3 mg/mL GSE group (111.92 ± 11.39 μm) were significantly smaller than those of the 1 mg/mL GSE (198.33 ± 17.70 μm) and control groups (210.86 ± 15.50 μm) (p < 0.05). Compared with the 2 mg/mL and 3 mg/mL groups, the control and 1 mg/mL GSE groups showed significantly lower ROD values when depth was less than 200 μm, indicating greater mineral loss.

Conclusions

Dose-dependent GSE inhibits in vitro enamel caries formation due to its ability to suppress growth of S. mutans and the formation of bio?lm.

Clinical signi?cance

Grape seed extract may be a novel virulence-targeted natural antimicrobial agent for caries prevention.     

Comparison of the remineralization potential of CPP-ACP and CPP-ACP with 900 ppm fluoride on eroded human enamel: An in situ study

Objective

The aim of this in situ study was to compare the remineralization potential of pastes containing CPP-ACP and CPP-ACP with 900 ppm fluoride on human enamel softened by a cola drink.

Design

Forty-five enamel specimens obtained from human third molar teeth were eroded in a cola drink for 8 min and then attached to intra-oral devices worn by five volunteers. The specimens were subjected to three different in situ remineralization protocols using: (1) CPP-ACP (Group I), (2) CPP-ACP with 900 ppm fluoride (Group II), and (3) saliva (Group III, control). Vickers microhardness measurements were obtained at baseline followed by demineralization and remineralization stages.

Results

The CPP-ACP, CPP-ACP with 900 ppm fluoride and saliva controls resulted in 46.24%, 64.25% and 2.98% increase in post-erosion microhardness values, respectively. One-way ANOVA revealed statistically significant differences in the mean microhardness values between pastes containing CPP-ACP and CPP-ACP with 900 ppm fluoride.

Conclusions

Both CPP-ACP and CPP-ACP with 900 ppm fluoride substantially remineralized the softened enamel, with the CPP-ACP and fluoride combination showing higher remineralization potential than CPP-ACP. This study confirmed the synergistic effect of fluoride with CPP-ACP on remineralization of eroded enamel.     

Effect of TiF4, ZrF4, HfF4 and AmF on erosion and erosion/abrasion of enamel and dentin in situ

Objective

This in situ study aimed to analyse the impact of different tetrafluorides (TiF₄, ZrF₄ and HfF₄) and AmF on erosion and erosion plus abrasion of enamel and dentin.

Design

Ten volunteers took part in this crossover and double-blind study performed in 8 phases of each 3 days. In each phase, 2 bovine enamel and 2 dentin specimens were fixed in intraoral appliances. One enamel and one dentin sample were pretreated once with TiF₄, ZrF₄, HfF₄ or AmF (all 0.5 M F) for 60 s, while the other samples remained unfluoridated and served as control. Then, all samples were subjected to either erosion only (4 times/day, 90 s) or to erosion and abrasion (2 times/day, 30 s/sample). Toothbrushing abrasion was performed 90 min after the first and last erosion with an electrical toothbrush and fluoridated toothpaste at 1.2 N. After 3 days, enamel and dentin loss was assessed by profilometry (μm) and analysed by repeated measures ANOVA and paired t-test (p < 0.05).

Results

All fluoride solutions reduced enamel and dentin loss significantly compared to the controls. Generally, eroded samples showed less wear than eroded and abraded samples. The protective potential of the fluorides was not significantly different and was only slightly, but mostly not significantly, decreased by abrasion. The protective effect of the fluoride solutions was similar in enamel and dentin.

Conclusion

Tetrafluorides and AmF are able to reduce erosion and erosion plus abrasion in situ and are almost equally effective.     

Biomimetic mineralisation of phosphorylated dentine by CPP-ACP

Objectives

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has the potential to induce the biomimetic mineralisation of dentine collagen fibrils. This study aimed to demonstrate in vitro the ability of CPP-ACP to form apatite crystals on phosphorylated dentine collagen fibrils.

Methods

Dentine slices with a 2-mm thickness were prepared from sound human third molars. The slices were etched with phosphoric acid to expose the collagen fibres. Sodium trimetaphosphate was then used to phosphorylate the exposed collagen fibres. CPP-ACP paste was topically applied to the surface of the phosphorylated slices, which were then immersed in a metastable calcium phosphate remineralising solution and incubated at 37 °C for 10 days. The CPP-ACP paste and the remineralising solution were replaced every two days. Phosphorylated dentine slices without a CPP-ACP application and non-phosphorylated dentine slices with a CPP-ACP application were prepared and used for comparison. The slices were examined using scanning electron microscope (SEM), diffuse reflectance-Fourier transform infrared spectroscopy (DR-FTIR) and X-ray diffraction (XRD).

Results

The SEM results revealed the presence of intrafibrillar and interfibrillar crystal nucleation and growth along the phosphorylated dentine collagen fibres. The DR-FTIR and XRD confirmed that the crystals were hydroxyapatite. No apatite crystal nucleation and growth were observed in either the slices that had no non-phosphorylation or those without CPP-ACP application.

Conclusions

CPP-ACP can induce the biomimetic mineralisation of dentine through apatite formation along and between the phosphorylated dentine collagen fibres.

Clinical significance

The in vitro study imitated the application of CPP-ACP to exposed dentine tooth surfaces in the mouth. This could lead to the development of a new therapeutic technique for the treatment of tooth hypersensitivity.     

Fracture resistance and cuspal deflection of incompletely excavated teeth

Objectives

Incomplete excavation reduces the risk of pulpal complications, but doubts remain regarding the mechanical properties of incompletely excavated teeth. Remaining carious dentine is suspected to not sufficiently support the restoration and to reduce bond strengths between the tooth and the restoration, with effects possibly varying depending on the depth of the remaining caries lesion. This study investigated fracture resistance (FR) and cuspal deflection (CD) of premolars after leaving or removing demineralized dentine in vitro.

Methods

In 48 premolars, shallow and deep artificial lesions (depths [mean ± SD] of 64 ± 18 μm and 771 ± 176 μm) were created on pulpo-axial walls of standardised mesial-distal-occlusal cavities. Demineralized dentine was either removed or left before adhesively restoring the tooth (n = 12/group). Restored teeth were submitted to thermo-mechanical cycling. CD was subsequently measured at loads of 200 N and 400 N, and teeth submitted to occlusal-perpendicular loading until fracturing occurred.

Results

FR was not significantly different between teeth with or without remaining demineralized dentine regardless of the lesion depth (p > 0.30, t-test). Irrespective of the removal technique, teeth with deep lesions showed significantly decreased FR (p ≤ 0.001). In contrast, CD was significantly increased in teeth with remaining demineralized dentine compared with completely excavated teeth (p ≤ 0.05; Mann–Whitney test).

Conclusions

Remaining demineralized dentine did not significantly decrease the fracture resistance of premolars in vitro. Effects of increased cuspal deflection on restoration margins should be assessed. This study showed no indication that incomplete excavation increases the risk of non-pulpal complications.

Clinical significance

Incomplete caries removal seems suitable to treat especially deep lesions. Leaving demineralized dentine does not seem to affect the fracture resistance of incompletely excavated teeth regardless of the lesion depth.     

Effect of sodium,amine and stannous fluoride at the same concentration and different pH on in vitro erosion

Objective

This study aimed to compare the effects 0.5% and 1% sodium, amine and stannous fluoride at different pH on enamel erosion in vitro.

Methods

Bovine enamel samples were submitted to a cyclic de- and remineralisation for 3 days. Each day, the samples were exposed for 120 min to pooled human saliva and subsequently treated with one of the fluoride solutions for 3 min: amine fluoride (AmF, 0.5% and 1% F⁻), sodium fluoride (NaF, 0.5% and 1% F⁻), each at pH 3.9 and 7.0, and stannous fluoride (SnF₂, 0.5% and 1% F⁻), at pH: 3.9. Additionally, two groups were treated with fluoride-free placebo solutions (pH: 3.9 and 7.0) and one group served as control (no fluoridation). Ten specimens each group were inserted in a so-called artificial mouth and eroded six times daily with hydrochloric acid (pH 2.6) for 90 s each intermitted by exposure to artificial saliva (1 h). After 3 days, enamel loss was analyzed profilometrically and evaluated statistically by ANOVA.

Results

Only the acidic 0.5% and 1% SnF₂ and 1% AmF solutions were able to reduce erosive enamel loss significantly, while all other solutions and placebos did not differ significantly from the control. Between the acidic SnF₂ and the 1% AmF solutions no significant differences could be detected.

Conclusion

At the same concentrations, acidic SnF₂ and AmF may be more effective than NaF to protect enamel against erosion.     

Cuspal deflection,strain and microleakage of endodontically treated premolar teeth restored with direct resin composites

Objectives

To measure cuspal deflection and tooth strain, plus marginal leakage and gap formation caused by polymerization shrinkage during direct resin composite restoration of root-filled premolars.

Methods

Thirty-two first and second maxillary premolars were divided into four groups (n = 8). Group 1 had standardised mesio-occlusal-distal (MOD) cavities and served as the control group. Group 2 had endodontic access and root canal treatment through the occlusal floor of the MOD cavity, leaving the axial dentine intact. Group 3 had endodontic access and root canal treatment with the mesial and distal axial dentine removed. Group 4 had endodontic access and root canal treatment with axial dentine removed and a glass ionomer base (GIC). All groups were restored incrementally using a low shrink resin composite. Cuspal deflection was measured using direct current differential transformers (DCDTs), and buccal and palatal strain was measured using strain gauges. Teeth were immersed in 2% methylene blue for 24 h, sectioned and scored for leakage and gap formation under light and scanning electron microscopy.

Results

Total cuspal deflection was 4.9 ± 1.3 μm for the MOD cavity (group 1), 7.8 ± 3.3 μm for endodontic access with intact axial dentine (group 2), 12.2 ± 2.6 μm for endodontic access without axial dentine (group 3), and 11.1 ± 3.8 μm for endodontic access with a GIC base (group 4). Maximum buccal strain was 134 ± 56, 139 ± 61, 251 ± 125, and 183 ± 63 μstrain for groups 1–4 respectively, while the maximum palatal strain was 256 ± 215, 184 ± 149, 561 ± 123, 264 ± 87 μstrain respectively. All groups showed marginal leakage; however placement of GIC base significantly improved the seal (p = 0.007).

Conclusion

Cusp deflection and strain increased significantly when axial dentine was removed as part of the endodontic access. Placement of a glass ionomer base significantly reduced tooth strain and marginal leakage. Therefore, a conservative endodontic access and placement of a glass ionomer base are recommended if endodontically treated teeth undergo direct restoration with resin composite.     

Remineralizzazione dello smalto esposto all’azione erosiva delle bevande acide

Objectives

Aim of this in vitro study was to evaluate the effect of a calcium-phosphate based (CPP-ACP) paste in remineralisation of enamel surfaces eroded by acid soft drinks by atomic force microscopy (AFM).

Materials and methods

Twenty-four human caries-free central incisors were randomly and equally divided into four groups; teeth were exposed to the erosive action of two different acid soft drinks (Coca Cola and Gatorade) for 10 minutes twice a day for two weeks. After the second exposure, the teeth of two groups were covered with CPP-ACP paste for 10 minutes every day. Then, the samples were observed under AFM.

Results

All samples revealed increased values of surface roughness after exposure to acid soft drinks. Samples treated with CPP-ACP paste showed a significative reduction of roughness values (p < 0,01).

Conclusions

This study showed that acid soft drinks could erode tooth enamel surface; the use of CPP-ACP paste can enhance enamel remineralization.