Confocal laser scanning reflection microscopy applied to the remineralization studies in incipient caries lesions

To evaluate through roughness parameters measurement the penetration of calcium phosphate stabilized by casein phosphopeptides (CPP-ACP) in the subsurface zone of the incipient caries lesions known in dentistry as white spot lesion (WSL). To our knowledge, there is no data about roughness parameters to evaluate the demineralization-remineralization process in the body of the lesion. WSL was generated in vitro in 10 dental samples and sectioned in half of them (longitudinal section). CPP-ACP was applied on the WSL (3 minutes daily for 60 days). Roughness parameters (Rp and Ra) were measured on the longitudinal section with a laser scanning confocal microscope in the reflection acquisition mode (CLSRM), either in the WSL or sound enamel, before and after applying CPP-ACP. CLSRM is a non-contact method able to detect small irregularities more precisely due to the small spot of laser illumination (0.5 μm). Mixed linear models were carried out, using the treatment as a fixed factor and the tooth as a random factor (significance level 5%). Rp and Ra values in WSL area before applying the remineralization protocol (WSL pre) were significantly higher than in the sound enamel of the same samples. After applying CPP-ACP, Rp and Ra values decreased significantly with respect to the WSL pre and were similar to the values of these parameters in sound enamel. roughness parameters were used as an indirect way to measure the porosity of WSL at subsurface level. The decrease of these parameters could be interpreted as the remineralization of WSL by the ability of CPP-ACP to penetrate the body of the lesion. Clinical significance: WSL is characterized by the loss of minerals from the enamel and an increase in porosity at the subsurface level. The effectiveness of remineralizing substances would be determined by their ability to penetrate the body of the lesion and reduce porosity.

Conservative treatment of interproximal incipient caries lesions by resin infiltration

Minimally invasive dentistry is based on conservative techniques for the treatment of initial caries lesions, the so-called white spot lesions. One of the conservative maneuvers includes the use of enamel resin infiltrant: a low viscosity material that penetrates the enamel pores to stop lesion progression. Aim: Therefore, this case report aimed to describe the clinical case of a 28-year-old female patient under routine consultation, in which a radiographic examination showed the presence of two incipient caries lesions in the left upper premolars. Methods: The application of a resin infiltrating agent (Icon®, DMG – Hamburg, Germany) was chosen as treatment to stop caries lesions progression. Conclusion: The use of this conservative technique can be considered a promising approach for the prevention of dental tissue wear, and the resin infiltrant is considered an effective material.

The Evaluation of Different Treatments of Incipient Caries Lesions: An in Situ Study of Progression Using Fluorescence-based Methods

Clinical Relevance Effective methods to control incipient caries lesions are needed. In this investigation, several methods provide encouraging results. SUMMARY This study aimed to evaluate in situ the inhibition of incipient caries lesion progression using different treatment protocols and to evaluate the effectiveness of fluorescence-based methods (DIAGNOdent, DIAGNOdent pen, and VistaProof fluorescence camera [FC]) in monitoring this process. The research was conducted in four phases: (1) at baseline, (2) after a first cariogenic challenge, (3) after treatment modalities, and (4) after a second cariogenic challenge. Sixteen volunteers used intraoral acrylic palatal appliances, each containing six enamel blocks (n=96). The cariogenic challenge was performed using a 20% sucrose solution over a 14-day period. The appliances were removed eight times a day and, upon removal, two drops of the solution were placed onto each enamel block. The enamel blocks were randomly assigned to three treatment groups: fluoride varnish ([FV] Duraphat; n=32), resin infiltrant ([RI] Icon; n=32), and adhesive system ([AS] Scotchbond; n=32). At the end of each phase, the surface microhardness (SMH) was measured, and two trained examiners evaluated the specimens using fluorescence-based methods. In addition, integrated mineral loss (ΔΔZ; vol%.min x μm) and lesion depth (ΔLD; μm) were evaluated using transverse microradiography. A two-way analysis of variance and a Tukey post hoc test were calculated (α=5%). Significant differences in SMH were observed according to the treatment, phases, and interaction of factors (p<0.001). Treatment with FV resulted in significantly higher SMH values in phases 3 and 4 compared to RI and AS, with the last two treatments resulting in similar values (p>0.05). The ΔΔZ value was similar for FV and AS but significantly higher for RI (p=0.016). ΔLD was not significantly different among the groups (p=0.126). Significant differences in the measurement of fluorescence for each fluorescence-based method were observed between each phase of the study (p<0.05). It can be concluded that all treatments were effective in inhibiting the in situ progression of incipient lesions, although to different degrees, with minor mineral loss changes observed for the AS and FV. Besides, all fluorescence-based methods tested, except for that using the FC device, were effective in monitoring caries lesion progression.

Evaluation of Some Exogenous Colorants Effects on Resin Based Materials Used in Incipient Caries Lesions Therapy

The aim of this study was to evaluate the potential of coloring of two commercial beverages: coffee and wine, and cigarette smoke, on three materials (ICON infiltration resin, MI Varnish Recaldent, and a sealant based on composite resin) currently used in incipient caries therapy. The study group included 75 extracted teeth that were divided into 3 groups corresponding to each material used. The groups were divided into 5 subgroups that corresponded to each colorant (A. red wine, B. coffee, C. cigarette smoke, D. association of the three colorants, E. control group). The coloration degree of the samples was measured both after the moment of coloring (M3) and after polishing (M4). The results showed a significant increase of the coloring degree for the samples subjected to the combined action of the three colorants (M3), for all the three materials used (DE1*: Id = 23.56, IId = 25.87, IIId = 19.87), and in terms of the coloring degree after the polishing procedure (M4), a decrease of the values was observed (DE2*: Id = 17.56, IId = 21.67, IIId = 16.78). In conclusion, both exposure to the two beverages used in the study and cigarette smoke (C) leads to the appearance of color changes, but the most significant changes were obtained by combining the three colorants (D). Also, the polishing procedure leaded to an improvement of the color variation for all three materials.

Assessment of the Remineralisation Products Efficiency in Incipient Caries Lesions Adjacent to the Fixed Orthodontic Appliances

The aim of the study is to asses, by using microhardness technique, the remineralization effect of some products used in the treatment of early dental caries adjacent to fixed orthodontic appliances. The study was performed on a group of 32 patients receiving fixed orthodontic therapy. The patients were randomly divided in two groups, accordingly to the administered preventive protocol: in group 1 (control) toothpaste Splat Professional Biocalcium (without fluoride) was applied twice a day; in group 2 (study group) toothpaste and mouthwash Vitis anticaries with natrium monofluorophosphate 1450 ppm F, respectively 226 ppm F, twice a day were used. After 60 days, the extraction of premolars was made and the preparation of the samples was done. The microhardness analysis was performed using the device CV 400 DAT (Namicon). The analysis of the results found lower microhardness for the samples submitted to brushing with fluoridated toothpaste and rinsing with fluoridated mouthwash solution, comparing to control (samples submitted only to brushing with non-fluoridated toothpaste). The conclusions of this study confirm the effectiveness of a proper prophylactic protocol (toothbrushing with fluoridated toothpaste, mouth rinsing with fluoridated mouthwashes) associated to the fixed orthodontics therapy, in the prevention of the early enamel demineralization onset adjacent to brackets.

Clinical Evaluation of Two Different Prevention Programs in Adults Depending on Their Caries Risk Profile: One-year Results

SUMMARYThe aim of this study was to investigate the management of incipient caries lesions in adults with two preventive protocols. A total of 44 adult patients with high, moderate and low caries risk with 516 incipient caries took part in the study. These patients were assessed for caries with International Caries Detection and Assessment System (ICDAS) criteria and were then divided into three groups depending on their caries risk profile: a high-risk group (group A), a moderate-risk group (group B), and a low-risk group (group C). Participants in each group were further divided randomly into two subgroups. In subgroups A1, B1, and C1, an intensive preventive protocol was applied, while in subgroups A2, B2, and C2, the protocol consisted only of instructions in oral hygiene. The invasive-intensive protocol included the topical application of fluoride, brushing with 5000-ppm fluoride toothpaste, use of amorphous calcium phosphate-casein phosphopeptide, applications of sealants for occlusal lesions (ICDAS code 2), and minimal resin restorations for occlusal lesions (ICDAS code 3). There was no statistically significant difference in the number of lesions (baseline and after one year) in the high-risk and moderate-risk groups that received the intensive protocol (groups A1 and B1), while the control groups were statistically significant different (groups A2 and B2). In the low-risk group, there was no statistically significant difference in the number of lesions (groups C1 and C2). The two different preventive protocols in the high- and moderate-risk groups presented differences in effectiveness, while in the low-risk group, no significant difference was demonstrated.