Search Results (109)

Background: Dental caries is a prevalent dental problem affecting primary and permanent teeth. Early demineralization of enamel lesions can be reversed through remineralization. Many studies have focused on caries prevention and disease progression arrest using silver diamine fluoride (SDF). No in vitro studies have compared the remineralization effects of different 38% SDF solutions on artificially demineralized enamel lesions. This study aimed to compare the remineralization potential of three commercial 38% silver diamine fluoride formulations on artificial enamel lesions in primary teeth using a pH cycling model. The hypothesis was as follows: different commercial SDF formulations would exhibit varying remineralization effects, as measured by surface microhardness, due to potential differences in their compositions. Materials and Methods: In this study, 75 primary molars were randomized into five groups (N = 15): I: baseline, II: SDF Riva Star Aqua^® 38%, III: Riva Star^® 38%, IV: SDF Advantage Arrest^® 38%, and V: control. Artificial caries were created by submerging teeth in 10 mL of demineralization solution (pH 4.5) for three days in a light-resistant container, ensuring distinct visual changes in the enamel as per the International Caries Detection and Assessment System (ICDAS level 2). After pH cycling, all samples underwent a standardized Vickers microhardness test (VMHT) with a 50 g load for 15 s. Data were analyzed using one-way ANOVA and Tukey’s post hoc test, with a significance level set at p ≤ 0.05. Results: The one-way ANOVA test indicated a significant difference in microhardness among the groups (SDF Riva Star Aqua, SDF Riva Star, and SDF Advantage Arrest), with an F-value of 167.73 and p < 0.001. The post hoc Scheffé test showed that SDF Riva Star Aqua and SDF Riva Star were not significantly different (p = 0.388). However, SDF Advantage Arrest had a significantly higher mean microhardness compared to both groups (p < 0.001). Overall, these results show that SDF Advantage Arrest leads to greater microhardness than SDF Riva Star Aqua or SDF Riva Star. Conclusions: SDF Advantage Arrest showed superior performance among the SDF-treated groups, significantly increasing microhardness compared to SDF Riva Star Aqua and SDF Riva Star. This suggests that SDF Advantage Arrest offers enhanced remineralization and structural strengthening, making it the most effective option for managing demineralized primary teeth. Future research should investigate the long-term performance and mechanisms of these treatments to optimize clinical protocols for preserving primary tooth integrity. Full article

Molar incisor hypomineralization (MIH) is characterized by systemic hypomineralization affecting one to four first permanent molars (FPMs), often accompanied by lesions in incisors and potentially involving other primary or permanent teeth. MIH poses clinical challenges, including hypersensitivity, susceptibility to pulp involvement, and aesthetic concerns. Optical Coherence Tomography (OCT), an advanced, non-invasive imaging modality, has gained interest as a potential diagnostic tool in dentistry. This exploratory observational case-control study aims to compare the structural characteristics of MIH-affected and healthy teeth using in vivo OCT, focusing on identifying qualitative imaging patterns associated with enamel hypomineralization. This study included 50 mild MIH-affected permanent teeth from pediatric patients and 50 healthy permanent teeth as controls. Representative OCT scans were acquired, analyzed, and compared for both groups. In OCT imaging, healthy enamel and dentin appeared as two distinct superimposed layers defined by the dentin-enamel junction. Conversely, MIH-affected teeth exhibited characteristic subsurface hyper-reflective zones, indicative of hypomineralized enamel, with deeper hypo-reflective shadowing. This first in vivo study applying OCT to MIH-affected teeth demonstrates its potential as a non-invasive technique for the real-time assessment of enamel structural anomalies, supporting its future role in monitoring remineralization therapies and improving early detection strategies in pediatric dental care. Full article

Tooth bleaching is a widely used esthetic treatment; however, bleaching agents can temporarily alter the surface morphology of enamel, increasing surface roughness and porosity, which may lead to increased susceptibility to discoloration. This in vitro study investigated the effectiveness of fluoride varnish in preventing immediate discoloration of bovine incisors after bleaching. Specimens were bleached with 35% hydrogen peroxide and treated with either Clinpro White Varnish (CW) or Enamelast Fluoride Varnish (EN), whereas control specimens received no treatment after bleaching. The samples were immersed in coffee for 24 h, and the color difference (ΔE₀₀) was calculated using the CIEDE2000 formula. The surface morphology of enamel was examined using SEM. The fluoride varnish groups showed significantly lower color difference values than the control group (p < 0.05), with ΔE₀₀ reduced by approximately two-thirds in both the CW and EN groups. SEM observations showed that the enamel surfaces in the varnish-treated groups exhibited reduced surface irregularities compared to the untreated group, suggesting remineralization. These results suggest that the immediate application of fluoride varnish after bleaching can effectively reduce short-term discoloration by providing physical protection and promoting remineralization. Fluoride varnish may serve as a simple and effective strategy to maintain whitening outcomes and minimize early discoloration. Full article

Background: Due to limitations of fluoride (F) treatment as a main caries preventive measure, it is important to consider the use of other dental caries preventive measures to reduce caries prevalence, especially in its early stages. Recently, new remineralizing agents appeared on the market, with their commercial availability in a variety of oral care products. Objectives: The purposes include providing a scoping review that represents caries remineralizing efficacies of only commercially available products and their existing adverse effects (if it is presented) and ensuring that only evidence-based approved products are included. Methods: The following databases were used in searching scientific literature on 28 October 2024: PubMed, PubMed Advanced Search, MeSH database, and PubMed Clinical Queries. The study selection criteria were as follows: for laboratory, in vitro, and/or in situ—remineralization of enamel-scanning electron microscopy, spectroscopy, microhardness test, light microscopy, profilometry, transverse microhardness microradiography, integrated mineral loss, light microscopy, photothermal radiometry; if it was a randomized controlled trial—CONSORT protocol, ICDAS system (to detect dental caries), diagnostic additional devices; antibacterial ability-colony forming units, DNA-based sequencing, scanning electron microscopy, crystal violet staining, and confocal laser scanning microscopy. Results: This review includes 98 papers: 14 of them describing the current status of caries patterns in the world, 60 studies (45 laboratory studies and 15 RCTs), and 24 systematic reviews were analyzed in order to detect whether new remineralizing agents can replace fluoride in further caries prevention. Conclusions: All reviewed new remineralization agents could be used without additives to treat early caries lesions, but the combination with F promotes better remineralization. Only HAP demonstrated its potential to serve as an alternative to fluoride in oral care products. However, further clinical studies are needed to prove its role in the remineralizing process of initial caries lesions. One also needs to ensure that both the clinical trials and in vitro lab studies use the best gold standards to validate any changes in the tooth structure, both remineralization and demineralization. Full article

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

Background/Objectives: Toothbrushing is a recommended daily practice that helps sustain oral health. However, if performed improperly, it can lead to loss of tooth structure and injury to soft tissues. We explored this topic with an extensive literature search. Methods: A literature search was performed across textbooks and journals for original research and review articles in Scopus, PubMed, PubMed Central, and Cochrane databases, published between 1967 and 2024. Results: The search result yielded 118 articles that were suitable to include in this review. Toothpaste abrasivity plays a major role in combination with toothbrush forces. Therefore, maintaining forces between 2 and 3 N may be gentler on the tissue. Electric toothbrushes are safer. Toothpastes with low RDA values are also less abrasive. Active ingredients in whitening and desensitizing toothpaste can induce tooth wear. Remineralizing agents have the potential to manage the associated lesions. Conclusions: Cervical abrasions and gingival recession occur frequently due to oral hygiene measures. Standards in oral hygiene aid to match patient needs can prevent hard and soft tissue loss. 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

Background/Objectives: Tooth wear is a progressive and multifactorial condition influenced by mechanical and chemical factors. Saliva plays a crucial role in modulating erosive wear through its buffering capacity and remineralization potential. This study aimed to assess the prevalence and severity of erosive tooth wear among dental students and explore its correlation with salivary factors such as flow rate and pH. Methods: A cross-sectional study was conducted on 96 individuals from the Egas Moniz School of Health & Science. Erosive wear was evaluated using the Basic Erosive Wear Examination (BEWE) index. Unstimulated and stimulated saliva samples were collected to measure salivary flow rate and pH. Statistical analyses included Spearman’s correlation and multinomial logistic regression. Results: All individuals were classified as no risk (BEWE Score 0–2) or low risk (BEWE Score 3–8). The most affected teeth were the lower first molars and the 4th and 6th sextants. Salivary analysis showed a mean unstimulated flow rate of 0.5 mL/min and stimulated flow of 1.7 mL/min. A significant negative correlation (rho = −0.224, p = 0.029) was found between stimulated salivary pH and BEWE score, indicating that higher acidity contributes to greater erosive wear. Conclusions: This study highlights the impact of salivary properties on erosive tooth wear, emphasizing the protective role of higher salivary pH. Regular monitoring of saliva and preventive strategies should be integrated into early diagnosis and management of erosive wear in young adults. 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

Tooth root caries account for 10.1% of all dental caries in the USA. This study developed a multifunctional resin coating with calcium (Ca) and phosphate (P) ion release and antibacterial properties to combat root caries. The effects of nano-sized amorphous calcium phosphate (NACP) and dimethylaminohexadecyl methacrylate (DMAHDM) on mechanical, physical, and antibacterial properties against Streptococcus mutans, and cytotoxicity on dental pulp stem cells and gingival fibroblasts were evaluated. A coating resin combining urethane dimethacrylate (UDMA), triethylene glycol divinylbenzyl ether (TEGDVBE), DMAHDM, and NACP was synthesized and compared with Seal&Protect and Vanish XT. Experimental groups (UV + 5% DMAHDM + 10%, 15%, and 20% NACP) showed flexural strength (70.9 ± 8.0 to 81.1 ± 6.0) MPa, significantly higher than Seal&Protect (48.2 ± 7.2) MPa (p < 0.05) and comparable to Vanish XT (70.2 ± 13.6) MPa, (p > 0.05). Elastic modulus (2.2 to 3.3) GPa was lower than Vanish XT (9.4 ± 1.1) GPa (p < 0.05). Experimental groups showed an 8 log CFU reduction, 96% reduction in metabolic activity and 87% in lactic acid production, and increased Ca (1.25 ± 0.03) mmol/L and P (0.8 ± 0.001) mmol/L release over 35 days. Cytotoxicity for experimental groups against dental pulp stem cells and human gingival fibroblast was low and matched those of commercial controls already used in clinic. The resin demonstrated potent antibacterial properties, high ion release, low cytotoxicity, and maintained physical and mechanical integrity, offering potential to prevent root caries formation and progression. Full article

Background and Objectives: Contemporary caries treatment seeks to preserve hard dental tissues as well as to promote lesion remineralization and biological tissue regeneration. While fluoride-based treatments remain the gold standard, their effectiveness has limitations, prompting interest in innovative remineralization technologies. Nano-hydroxyapatite (nano-HA) varnish and self-assembling peptide (SAP) P11-4 are promising biomimetic materials that promote enamel repair, yet long-term data on their efficacy are limited. The objectives of this study were to evaluate the effectiveness of nano-HA varnish and peptide P11-4 in restoring enamel surface hardness after artificial lesions in vitro and to compare them to a control group and fluoride varnish. Materials and Methods: Artificial enamel lesions were created on the buccal surfaces of 36 extracted human molars, which were randomly divided into four groups (n = 9): control, peptide P11-4, fluoride varnish, and nano-hydroxyapatite varnish. After applying the materials as per manufacturer instructions, specimens were stored in artificial saliva for 14 days. Enamel surface hardness was measured using the Vickers hardness test (HV) at baseline, after demineralization, and after remineralization. Statistical analysis was performed with “IBM SPSS 27.0” using non-parametric Kolmogorov–Smirnov, Kruskal–Wallis, Dunn’s, and Wilcoxon tests. Results: The mean baseline enamel hardness value was 323.95 (SD 33.47) HV. After 14 days of demineralization, the mean surface hardness of artificial enamel lesions significantly plummeted to 172.17 (SD 35.96) HV (p = 0.000). After 14 days of remineralization, the mean value significantly increased to 213.21 (SD 50.58) HV (p = 0.001). The results of the study revealed statistically significant enamel remineralization of the peptide P11-4 group in regard to the demineralized enamel (p < 0.05). In contrast, there were no significant results in other treatment groups (p > 0.05). Remineralization of enamel was the highest in samples from the P11-4 group (54.1%), followed by the nano-HA group (35.4%), FV group (17.8%), and control group (11.2%). There was a significant difference (p < 0.05) in the remineralizing ability between the peptide P11-4 and all other treatment groups. Conclusions: Self-assembling peptide P11-4 effectively remineralized artificial enamel lesions and proved to be significantly more effective compared to fluoride varnish and nano-hydroxyapatite varnish, showcasing its superior performance as a remineralizing agent. Full article

Background: We compared the camouflage effect of three white spot lesion (WSL) treatments (infiltration, nano-hydroxyapatite (nHAP) remineralization, and microabrasion) and color stability of the treated surfaces. Methods: Fifty sound extracted teeth were used in the study. WSLs were created on 40 buccal dento-enamel specimens through the use of acidic methylcellulose gel. These specimens were randomly assigned to treatment groups (n = 10 per group): negative controls, nano-hydroxyapatite (nHAP), resin infiltration, and microabrasion. After the treatment, all 50 specimens were immersed in coffee for 7 days. Color measurements were performed four times: at baseline (T0), after the demineralization procedure (T1), after the treatments (T2), and after immersion in coffee (T3). Results: No restoration of the initial enamel color was observed in any of the groups. The ICON and MA groups exhibited the highest masking effect, with the mean ΔE_T0-T2 = 7.46, although the differences among the study groups were insignificant. All three treatments increased the resistance of WSLs to discoloration in coffee compared to the negative control group; however, infiltration (∆E_T2-T3 = 4.13) and microabrasion (∆E_T2-T3 = 3.49) showed a better color stability tendency than nHAP remineralization (∆E_T2-T3 = 7.26). Conclusions: Despite its well-known remineralizing and desensitizing effects, nHAP showed the least masking effect for WSLs and lower color stability compared to resin infiltration and microabrasion. However, none of the methods allowed for complete restoration of the original color. After the discoloration procedure, the color changes in the white spots treated with microabrasion and infiltration were comparable to those of the sound enamel. Full article

The aim of this study is to evaluate the shear bond strength of different universal adhesives applied to intact, demineralized, and remineralized enamel surfaces with total-etch and self-etch modes and to examine the effect of universal adhesives on the Ca/P mineral atomic and mass ratios of these enamel with FE-SEM/EDX (Field Emission Scanning Electron Microscopy with Energy Dispersive X-Ray Spectroscopy) analysis. For this study, 264 bovine incisors were used. Samples in the demineralized and remineralized groups were kept in demineralization solution at 37 °C for 96 h to make an artificial initial carious lesion. After demineralization, half of the demineralized samples were remineralized with MI Paste Plus. For shear bond strength (n = 144) and FE-SEM/EDX analysis (n = 120), G-Premio Bond and Clearfil S³ Bond Universal were applied on enamel surfaces with total-etch and self-etch modes, and bond strength samples were restored with resin composite. All samples were tested. The results were evaluated statistically by a three-way ANOVA test. The shear bond strength of the remineralized enamel showed high bond strength values comparable to intact enamel for universal adhesive systems. The Ca/P mineral atomic and mass ratios in remineralized enamel showed higher values than demineralized enamel, similar to intact enamel for universal adhesive systems. Initial carious lesion surfaces are unsuitable enamel surfaces for restoration. The remineralization of this surface layer before adhesive procedures may positively affect bond strength. Full article

Research with nanoparticles for the treatment and prevention of dental caries is of special interest given the high prevalence of the disease worldwide. Several studies support the use of nanoparticles associated with materials given their antimicrobial properties and potential demineralization reduction. This study aimed to evaluate the impact of the application of silver nanoparticles (AgNPs) and chitosan gel in combination with commercial fluoride varnish on the remineralization of dental enamel. Ninety-six tooth blocks were macroscopically evaluated via stereomicroscopy, ICDAS II, and laser fluorescence. Enamel blocks were subjected to artificial demineralization and divided into four exposure groups (24, 48, 120, and 168 h), and five different remineralizing agents were applied, namely, FV (fluoride varnish), FV + CG (fluoride varnish + chitosan gel), FV + AgNPs (fluoride varnish + AgNPs), FV + AgNPs + CG (fluoride varnish + AgNPs + chitosan gel), and AgNPs + CG (AgNPs + chitosan gel). Enamel surface changes were evaluated via laser fluorescence, X-ray diffraction, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Laser fluorescence results obtained from demineralized blocks and subsequently exposed to remineralizing treatment indicate significant differences. After exposure to remineralizing agents, hydroxyapatite and modified apatite phases were identified mainly in the samples treated with FV + AgNPs + CG in the groups exposed for 24, 48, and 120 h. The FV + AgNPs + CG and AgNPs + CG indicate good performance in terms of the Ca/P ratio in in vitro demineralization compared to the group treated with fluorine varnish. Full article