Search Results (90)

Background: Gastroesophageal reflux disease (GERD) is a chronic condition that causes an abrupt decrease in salivary pH in the oral cavity, which can lead to demineralization, erosion, hypersensitivity, functional impairment, and possibly fracture of dental elements. The aim of this clinical study is to compare two types of treatment in patients with dental erosion diagnosed with gastroesophageal reflux. Methods: Thirty patients were enrolled in this randomized clinical trial. Each patient underwent clinical evaluation and esophageal pH measurement, in order to diagnose GERD. After an initial examination and assessment by an experienced dentist, the Trial group (15 patients) was assigned to home treatment with a zinc hydroxyapatite-based toothpaste and a hydroxyapatite-based paste, while the Control group (15 patients) was assigned to home treatment with zinc hydroxyapatite-based toothpaste only. The following indices were measured: Basic Erosive Wear Examination Index (BEWE); Schiff Air Index (SAI); Plaque Index (PI); and Bleeding Score (BS). Each index was assessed at T0 during the first visit, one month (T1), three months (T2), six months (T3), nine months (T4), and 12 months (T5). The Kolmogorov–Smirnov test was used to analyze the normality of the data, while Friedman’s test followed by Dunn’s post hoc test were used to compare the two groups (significance threshold: p < 0.05). Results: The results showed no statistically significant change in the BEWE and SAI indexes (p > 0.05). However, an improvement in dentin sensitivity and BS was observed. Plaque control also improved. Conclusions: The results of this study indicate that the additional hydroxyapatite paste did not significantly improve the outcomes of the study in respect to hydroxyapatite toothpaste alone. However, there was an improvement in the oral health of GERD patients using hydroxyapatite-based remineralizing treatment in terms of oral and periodontal indices calculated. Full article

This systematic review and network meta-analysis aimed to evaluate the bond strength of artificial caries-affected dentin (ACAD) of permanent human teeth with and without biomimetic remineralization (BR), assessed based on in vitro studies. Following PRISMA guidelines, we conducted a systematic search until June 2023, identifying 82 eligible articles for full-text analysis. We assessed the study characteristics, methodological quality, and summary results. Bond strength was examined immediately and after artificial aging using three bond strength tests. We performed meta-regressions (using OpenBUGS software) to explore the relationship between the independent variable’s adhesive application technique (Etch-and-Rinse or Self-Etch) and ACAD protocol (chemical or biological) and the dependent variable of bond strength. Additionally, we conducted random-effect NMAs (using CINEMA software) to compare the effect of multiple interventions per application technique and ACAD protocol simultaneously. Among the included studies that compared various BR strategies, most studies (19 out of 22) presented a medium risk of bias. In some comparisons, the meta-regression results revealed a significant association between bond strength at 24 h and both the adhesive application technique and the ACAD protocol. Our findings indicate the potential of BR to enhance bond strength in human ACAD in in vitro settings. Full article

Background and Clinical Significance: Dental demineralization is a multifactorial process influenced by biofilm activity, diet, and systemic conditions. While gastroesophageal reflux disease (GERD) is known for its role in enamel erosion, its contribution to cariogenic processes remains underexplored. Additionally, Brugada syndrome, a genetic arrhythmia disorder, may indirectly affect oral health due to medical complexities and reduced motivation for dental care. This case highlights the management of extensive mineral loss in a patient with GERD and Brugada syndrome, emphasizing the importance of personalized remineralization strategies and interdisciplinary collaboration. Case Presentation: A 27-year-old male with Brugada syndrome, treated with a subcutaneous implantable cardioverter defibrillator (S-ICD), presented with widespread enamel demineralization, multiple active carious lesions, and gingival inflammation. Clinical evaluation revealed a high DMFT index (15), significant plaque accumulation, and an oral pH of 5.8, indicating an elevated risk of mineral loss. Poor hygiene habits, frequent sugar intake, and GERD-related acid exposure contributed to his condition. The therapeutic approach included patient education, fluoride-functionalized hydroxyapatite toothpaste and mousse, dietary modifications, and restorative procedures. After 120 days, improvements included enhanced enamel integrity, a reduction in plaque index (from 50% to 25%), and the resolution of gingival inflammation (BOP: 38% to 12%). Conclusions: This case underscores the importance of an integrated approach to managing dental demineralization in patients with systemic conditions. The combination of remineralization therapy, behavioral modifications, and structured follow-up yielded significant clinical benefits. Further research is needed to develop standardized protocols for individuals at high risk due to systemic factors affecting oral health. Full article

Dental caries is a prevalent global health issue characterized by the progressive demineralization of dental tissues, which occurs when the balance between demineralization and remineralization processes is disrupted at the tooth level. Silver diamine fluoride (SDF) has gained recognition for its ability to arrest caries. However, its interaction with mineralized tissues remains incompletely understood. This study aimed to investigate the chemical interactions between SDF and mineralized bioceramics, using hydroxyapatite (HA) and beta-tricalcium phosphate (β-TCP) as analogs for enamel and dentin. Fourier transform infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopy (XPS) were employed to identify functional groups and quantify elemental compositions at varying depths. FTIR analysis revealed structural modifications in HA and β-TCP. XPS demonstrated high retention of fluoride, with limited penetration into deeper layers, while silver exhibited deeper penetration. These findings suggest that SDF primarily acts on superficial layers, forming calcium fluoride and silver phosphate as key reaction products. These findings highlight the potential of SDF in managing deep carious lesions by demonstrating its ability to form a protective CaF₂ layer at the surface while allowing deeper penetration of silver ions into mineralized tissues. This dual mechanism may contribute to SDF’s clinical efficacy in arresting caries and preventing further demineralization. Full article

Peptide-based biomimetic treatments have gained increased attention in the dental field due to their biocompatibility and minimally invasive qualities. These biomimetic approaches can replicate the native architecture of dental tissues, thus contributing to higher success rates and improved longevity of restorations. The aim of this study was first to examine the biocompatibility and stability of an amelogenin peptide-based chitosan hydrogel (P26-CS) against salivary enzymes. Second, we aimed to evaluate its efficacy in biomimetically repairing human dental lesions in situ. White spot lesions (WSLs) in enamel and non-carious cervical lesions (NCCLs) in dentin were artificially created. Chitosan (CS) improved peptide stability, while remineralization of enamel sections with P26-CS was not impeded by salivary enzymes. The peptide was not cytotoxic, irritating, or sensitizing. Fluorescently labeled P26-CS penetrated ~300 μm into the enamel of WSLs and ~100 μm into the dentin of NCCLs. After peptide treatment, quantitative light-induced fluorescence (QLF) and microcomputed tomography (μCT) indicated a gain in mineral density of WSLs. In NCCLs, scanning electron microscopy showed that the dentin was covered by a mineral layer of needle-shaped crystals. Our results show that the repair of artificial WSLs and NCCLs was achieved by P26 peptide-guided remineralization and demonstrate its potential to repair dental lesions. Full article

To overcome limitations of dentin bonding due to collagen degradation at a bonded interface, incorporating bioactive glass (BAG) into dentin adhesives has been proposed to enhance remineralization and improve bonding durability. This study evaluated sol–gel-derived BAGs (BAG79, BAG87, BAG91, and BAG79F) and conventional melt-quenched BAG (BAG45) incorporated into dentin adhesive to assess their remineralization and mechanical properties. The BAGs were characterized by using field-emission scanning electron microscopy (FE-SEM) and transmission electron microscopy for surface morphology. The surface area was measured by the Brunauer–Emmett–Teller method. X-ray diffraction (XRD) analysis was performed to determine the crystalline structure of the BAGs. Adhesive surface analysis was performed after approximating each experimental dentin adhesive and demineralized dentin by using FE-SEM. The elastic modulus of the treated dentin was measured after BAG-containing dentin adhesive application. The sol–gel-derived BAGs exhibited larger surface areas (by 400–600 times) than conventional BAG, with BAG87 displaying the largest surface area. XRD analysis indicated more pronounced and rapid formation of hydroxyapatite in the sol–gel BAGs. Dentin with BAG87-containing adhesive exhibited the highest elastic modulus. The incorporation of sol–gel-derived BAGs, especially BAG87, into dentin adhesives enhances the remineralization and mechanical properties of adhesive–dentin interfaces. Full article

In recent decades, there has been significant growth in research focused on biocompatible materials, particularly in the field of materials science and engineering. The primary advantages of these materials are their biocompatibility, bioactivity, and antibacterial properties. Consequently, there has been a growing utilization of bioceramic sealers in the field of endodontics. This study investigated the amounts of bioactive elements in dentin in contact with the AH Plus^® Bioceramic Sealer (Dentsply, Konstanz, Germany). The results were qualitatively evaluated by examining scanning electron microscopy (SEM) images and elemental mapping and quantitatively by determining element weight (wt%) and atomic (at%) percentages obtained from EDX analysis. The AH Plus^® Bioceramic Sealer demonstrated notable bioactivity through its dynamic contact with dentin at the root level. Full article

This in vitro study evaluated the protective effect of an Si-containing toothpaste associated with different fluoride concentrations by reducing the depth of the demineralized lesions in dentin after cariogenic pH cycling. Methods: Sixty bovine dentin blocks (4 × 4 × 2 mm) were randomly assigned into five groups (n = twelve/group): RGS₁ (Si toothpaste with 1450 ppm F), RGS₂ (Si toothpaste with 1100 ppm F), RGS₃ (fluoride-free Si toothpaste), negative control (NC) (fluoride-free toothpaste), and positive control (PC) (1450 ppm F toothpaste). The specimens underwent a three-day pH cycling model simulating the oral environment with twice-daily brushing. The mineral loss (ΔF) and lesion depth (ΔF_max) were assessed using quantitative light-induced fluorescence (QLF), and scanning electron microscopy (SEM) provided a morphological analysis. Elemental analyses were performed with an energy-dispersive X-ray spectrometer (EDS). ANOVA and Tukey’s test were used for the data analysis (α = 5%). Results: EDS confirmed the Si in the toothpaste formulations. The groups treated with fluoride silicon toothpastes (RGS₁, RGS₂) had significantly reduced mineral loss and lesion depth compared to the PC group. The NC group exhibited the greatest mineral loss and lesion depth. SEM images revealed occluded superficial dentin tubules and a protective mineral layer in the groups treated with Si toothpaste, whereas no deposition (NC group) or limited mineral deposition (PC group) was observed in the control groups. Conclusions: The findings suggest that the Si toothpastes favored protection against dentin demineralization, even at a lower concentration or free of fluoride, with dentin tubule occlusion, thus representing a promising oral care product over traditional fluoride toothpastes. Full article

Background: Molar–incisor hypomineralization (MIH) is an enamel defect affecting molars and incisors, often leading to hypersensitivity, enamel breakdown, and increased caries risk. Non-invasive treatments, such as casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) and fluoride varnish, show potential in remineralizing affected enamel and reducing sensitivity, but their efficacy is still debated. This study systematically reviews and analyzes the effectiveness of CPP-ACP and other non-invasive agents in improving remineralization and reducing hypersensitivity in MIH-affected teeth. Methods: A systematic search was conducted on PubMed, Embase, and Central in July 2024, including interventional and observational studies on remineralization and hypersensitivity in pediatric MIH patients (<18 years). A total of 1566 studies were found, with 15 included in the meta-analysis. A random-effects model was applied, including subgroup analysis by lesion severity. Results: CPP-ACP showed no statistically significant advantage over fluoride in remineralization (MD −3.80, 95% CI: −8.57; 0.98), but it significantly reduced hypersensitivity compared to fluoride varnish (MD −2.36, 95% CI: −3.83; −0.89). Although this reduction in hypersensitivity may be clinically relevant, the high heterogeneity (I² = 83%) and wide confidence intervals limit the reliability of these findings. Conclusions: CPP-ACP has a moderate effect in reducing hypersensitivity but does not outperform fluoride in remineralization. Other agents, such as calcium glycerophosphate and silver diamine fluoride, showed mild benefits. The current evidence base is limited and heterogeneous, highlighting the need for high-quality, long-term studies to confirm these findings and guide MIH management. Full article

It is challenging to deliver therapeutics in the oral environment due to the wet surfaces, the nature of the mucosa and the potential for saliva washout. In this study, the development of a mucoadhesive dimethicone-based oral carrier system for adhesion to the hard tissue and mucosa in the mouth was examined. This study reports the viscosity and mucoadhesion of dimethicone based polymer blends. The viscosity of the materials was measured using a rheometer. The mucoadhesion of these materials was determined as the work of adhesion and peak tack force using the tensile test method with a texture analyzer. Materials were prepared with either calcium and phosphate salts or sodium fluoride as potential therapeutics for promoting remineralization and treating dentin hypersensitivity by mechanical occlusion. Scanning electron microscopy was used to look at mineral deposition on the surface of dental hard tissue after the application of the dimethicone-based formulations. The results of this study confirm the potential for using these dimethicone-based materials as mucoadhesive therapeutic delivery systems in the oral environment. Full article

The ability of the cement to release calcium ions, which participate in the remineralization of dentin by forming apatite which improves root canal sealing with time, is of particular importance. Five recently introduced calcium-silicate commercial dental cements were investigated with a view to the influence of the physicochemical characteristics on the possibility of releasing calcium ions in an aqueous medium. Two hybrid calcium-silicate cements in the form of a paste-like ready mix (BioCal^® Cap and TheraCal LC) and three calcium-silicate cements consisting of two components—powder and liquid (Harvard MTA Universal, Rootdent, and BioFactor) were subjected to powder XRD, SEM, and EDS for detailed examination. The cements were immersed in water for 28 days and the phase composition and morphology of the cements before and after soaking were studied. The total calcium release for each cement was determined by ICP-OES. BioFactor and BioCal^® Cap release the highest amount of calcium ions, while the lowest release is registered with Rootdent and TheraCal LC. The PDT treatment of BioFactor does not influence substantially the calcium release. The impact of the elemental and phase composition on the calcium release and calcium carbonate formation was discussed. A reciprocal relation between the aluminum content and the quantity of the released calcium has been found. Full article

When dentin is directly exposed to the oral cavity for various reasons, such as a lack of enamel on the tooth surface, external stimuli to the dentin often cause transient discomfort known as dentin hypersensitivity. In order to block the incoming stimulus signal, an ideal treatment is to induce the production of minerals to block the dentinal tubules. In this work, a dentin-desensitizing plugging material was prepared by modifying mesoporous bioactive glass with gelatin, the mineralization and desensitization effects of which were compared with Gluma in in vitro experiments. These experiments confirmed that gelatin-modified bioactive glass (MBG@PDA@Gel) is more effective than traditional desensitizing agents at blocking dentin tubules. Following the successful synthesis of MBG@PDA@Gel, as confirmed by scanning electron microscopy, transmission electron microscopy, and other tests, the treatment of demineralized dentin with MBG@PDA@Gel demonstrated that the dentinal tubules were tightly blocked under scanning electron microscopy. MBG@PDA@Gel induces minerals in deeper layers of dentinal tubules, promoting remineralization and forming a unified structure with the tubule blockage. Animal studies showed that MBG@PDA@Gel can remineralize demineralized dentin, and it is stable in the oral cavity and does not fall out. MBG@PDA@Gel not only enhances the biocompatibility of the nanoparticle but also results in an overall uniform and rapid remineralization of the demineralized dentin. Full article

As dental pulp contains the stem cells necessary for regeneration, the tooth should hold the intrinsic capacity for self-repair. A triphasic hybrid dental biocomposite (3HB) composed of biocompatible biopolymers to provide strength, antibacterial properties and protein-based cell support could provide a conducive microenvironment for the regeneration of dental structures. 3HB was incorporated into Mineral Trioxide Aggregate (ProRoot MTA) to construct a malleable injectable implant. Human tooth pulp cells (hDPCs) significantly increased proliferation in the presence of 3HB+MTA compared to 3HB or MTA alone. Cell viability decreased with MTA alone but increased with 3HB and 3HB+MTA. 3HB+MTA was implanted into the residual tooth of drilled Wistar rat M2 molars for up to 45 days. Stereological analysis from micro-CT images showed the volume of the tooth remaining. Histologically, regenerative pulpal architecture was seen invading 3HB. A continuous odontoblastic profile lined a deposit of dentin-like material suggesting reparative dentinogenesis. Overall, no infection or encapsulation was seen. Immunohistochemically, odontoblasts were seen along the margins of the wounded tooth undergoing repair. Mesenchymal cells (MSCs) were seen at the base of the drilled tooth and by 21 days had translocated into the implant itself. Cells stimulating remineralization were highly expressed in the tooth undergoing repair. CD146-positive MSCs were seen in the center of the implant, possibly stimulating remineralization. In conclusion, behavior of 3HB⁺ in vitro and in vivo provided a promising start as 3HB+MTA may serve as a viable regenerative scaffold for pulp regeneration; however, this should be further studied before clinical use can be considered. Full article

Objective: The purpose of this scoping review was to identify gaps in the literature and summarize findings from studies examining the use of silicon-, silica-, and silicate-based toothpastes for the remineralization and repair of mineralized tooth tissues. Methods: A 10-year literature search was conducted using PubMed and Scopus, adhering to PRISMA 2020 guidelines. A total of 331 studies were initially identified, with 56 full-text review articles. After selecting the manuscripts, 27 studies were qualitatively analyzed by four reviewers, focusing on the results of both in vivo and in vitro methods. Results: The findings suggest that toothpastes containing silicon, silica, and silicate demonstrate promising results for remineralization and enamel repair, with evidence of mineral layer formation and/or deep enamel surface remineralization under various conditions. Additionally, the use of these toothpastes can lead to the obliteration of dentinal tubules within a few days. The results collectively support the efficacy of these toothpastes in enamel repair. Most of the clinical studies focused on dentine hypersensitivity, followed by white spot lesions. Conclusions: Silicon-, silica-, and silicate-based toothpastes (bioactive Si-toothpastes) can be considered effective based mostly on laboratory studies. There remains a need for more in vivo research studies on enamel and dentin mineral repair. Existing studies provide strong evidence that these technologies can reduce dentin hypersensitivity and promote enamel–dentin repair. Full article

This study aimed to assess the antibiofilm effects of dentin desensitizers using a modified Robbins device flow cell system. The test desensitizers were Saforide, Caredyne Shield, and Clinpro White Varnish. Standardized dentin specimens were prepared from human single-rooted premolars, treated with one of the materials, and mounted on the modified Robbins device flow cell system. Streptococcus mutans biofilms were developed for 24 h at 37 °C under anaerobic conditions. Scanning electron microscopy, fluorescence confocal laser scanning microscopy, viable and total cell counts, acid production, and gene expression analyses were performed. A wavelength-dispersive X-ray spectroscopy electron probe microanalyzer was used to analyze the ion incorporations. Clinpro White Varnish showed the greatest inhibition, suggesting its suppression of bacterial adherence and transcription of genes related to biofilm formation. Saforide reduced only the number of viable bacteria, but other results showed no significant difference. The antibiofilm effects of Caredyne Shield were limited. The uptake of ions released from a material into dentin varies depending on the element. Clinpro White Varnish is effective for the short-term treatment of tooth sensitivity due to dentin demineralization. It prioritizes remineralization by supplying calcium and fluoride ions while resisting biofilm formation. Full article