Erik Saxegaard

Effects of Inorganic Orthophosphate and Pyrophosphate on Dissolution of Calcium Fluoride in Water

Calcium and fluoride release from excess solid calcium fluoride was monitored for 15-30 min in aqueous solutions containing various concentrations of inorganic orthophosphate and pyrophosphate. Low concentrations of these ions (1-10 μmol/L) considerably inhibited the rate of dissolution of calcium fluoride. This inhibition was pH-dependent, being reduced at pH values below 5. It is suggested that a reduced calcium fluoride dissolution rate, in the presence of phosphate, can account for the relatively slow loss of calcium fluoride from dental enamel observed in recent clinical studies. It also appears that calcium fluoride coated with phosphate may provide a pH-controlled slow release of fluoride that may be of clinical significance and a major component of the cariostatic mechanism of topically applied fluoride.

Kinetics of Acquisition and Loss of Calcium Fluoride by Enamel in vivo

Two in vivo experiments were performed, concerning (1) the kinetics of the acquisition of calcium fluoride on enamel during daily rinses with a solution of 0.023% F as sodium fluoride, and (2) the loss of calcium fluoride from enamel slabs which had been topically treated with a neutral solution containing 0.9% F as sodium fluoride. Enamel slabs were carried in the mouth by 6 volunteers for 8 days in both experiments. Sound and etched enamel were included. (1) During mouthrinses moderate amounts of fluoride were acquired by sound enamel, and more as calcium fluoride than as fluoridated apatite, whereas on etched enamel, more fluoride was deposited as fluoridated apatite. On etched enamel there was also a tendency that the deposition of calcium fluoride levelled out whereas the incorporation of firmly bound fluoride continued. This may indicate that calcium fluoride was transformed into fluoridated apatite, probably through remineralization during pH cycling in plaque covering the etched enamel. (2) After single topical application, it was found that etched enamel initially took up more calcium fluoride than sound enamel, but also lost more during the 1st day of in vivo exposure. The loss of calcium fluoride was arrested after 1-2 days, on sound enamel at 70% and on etched enamel at 40% of the original level. It is suggested that the increased amounts of firmly incorporated fluoride in enamel originated from calcium fluoride on enamel, and that calcium fluoride is an important and clinically significant source of fluoride ions on enamel.

The Effects of Acidic Fluoride Solutions on Early Enamel Erosion in vivo

Acidic fluoride solutions may reduce dental erosion. The aim of this study was to compare the effect of different acidic fluoride solutions on enamel dissolution using an established in vivo model. When possible 4 anterior teeth (255 teeth in a total of 67 subjects) were isolated and exposed to 0.01 M citric acid. The acid was collected in test tubes before (etch I) and 5 min after (etch II) application of test fluoride preparations. Acidic fluoride solutions (pH range 1.5–2.9), i.e. SnF2, TiF4 and hydrogen fluoride (HF) (all approx. 0.1 M F), HF (0.027, 0.055, 0.082 M F) and neutral NaF solution (0.1 M F) as control were applied to the labial surfaces of the teeth for 1 min (6 ml/min). Enamel dissolution was examined by chemical analysis of calcium content in the citric acid etch solutions using atom absorption spectrometry. The change in calcium concentration (ΔCa) and the percentage of mean calcium reduction were calculated from the difference in calcium loss between etch I and etch II. Statistical analysis was carried out using the Wilcoxon signed rank test and Kruskal-Wallis tests with Dunn’s multiple comparison. Results showed a mean ΔCa of 0.671 mg/l (SD 0.625) for SnF2, and ranged from 0.233 mg/l (SD 0.248) for the weakest HF solution to 0.373 mg/l (SD 0.310) for the strongest HF solution. This represented a 67% reduction in enamel dissolution for SnF2 and a 40–76% reduction for the HF solutions. No reduction was observed for TiF4 or NaF. The types of metal, pH and fluoride concentration are all important for the in vivo effect.

Effect of acidic fluoride treatments on early enamel erosion lesions—A comparison of calcium and profilometric analyses

OBJECTIVE The protective effect of fluoride solutions against acidic challenge on enamel was tested in vitro using calcium- and profilometer analyses. METHODS HF-, SnF(2)-, TiF(4)- and NaF solutions (0.1M F(-), with a pH of 2.0, 2.9, 1.5, 7.3, respectively) and H(2)O were tested on a total of 60 enamel specimens divided into 10 groups. Prior to and after F-treatment five groups were exposed for 1 min to 0.01 M citric acid, and the other five groups for 10 min to 0.1M citric acid. Enamel specimens were measured by profilometry at baseline and before and after each acidic challenge. [Ca] in the collected citric acid samples was measured by atom absorption spectroscopy (AAS). DeltaCa and Delta surface height were calculated for each specimen and the data were analysed using one-way ANOVA, Tukeys test and Pearson r correlation. RESULTS AAS showed that the acidic F-treatments significantly reduced enamel dissolution for both the 1 min and 10 min acidic challenge. Profilometry showed no significant differences between the F-solutions for the 1 min groups. Significant differences could be seen between the fluorides for the 10 min groups and there was a large correlation between the profilometric and AAS results. In conclusion, all fluoride solutions reduced enamel dissolution when specimens were exposed to citric acid. CONCLUSIONS The profilometer was not sensitive enough to measure the effects of the different fluorides against a low acidic challenge. AAS was able to show these differences and for the 10 min acidic challenge there was a good correlation between the results from the two methods.

Effect of Stannous Fluoride and Dilute Hydrofluoric Acid on Early Enamel Erosion over Time in vivo

Recent experimental in vivo studies have shown that aqueous solutions of stannous fluoride (SnF2) and hydrofluoric acid (HF) can reduce enamel solubility after 5 min. The aim of this study was to evaluate the longer-term protective effect of SnF2 (0.78%, pH 2.9) and HF (0.2%, pH 2.0) (both ∼0.1 mol/l F) using the same experimental model. Labial surfaces of healthy anterior teeth (all four surfaces when possible, otherwise a pair of surfaces) in 103 subjects (n = 399 teeth) were exposed to citric acid (0.01 mol/l, pH 2.7). The acid was applied using a peristaltic pump (5 ml, 6 ml/min) and was collected in coded test tubes (etch I). The test solutions were then applied to the same surfaces of the teeth (1 min, 6 ml/min). After either 1, 7, 14 or 28 days, citric acid was again applied to the same surfaces and subsequently collected (etch II). Enamel solubility was examined by assessment of calcium concentration in etch I and etch II solutions using atom absorption spectroscopy. Median values were calculated for all time periods and statistical analysis was carried out using the Wilcoxon signed-ranks test. Results showed that HF reduced enamel solubility by 54 and 36% after 1 and 7 days, respectively. After 14 and 28 days, there was no longer any effect. SnF2 showed no protective effect after the first day. Given these results, repeated application of HF and especially SnF2 may be necessary to improve the protective effect of these fluorides, and this requires further testing.

Treatment outcome of dental implants in the esthetic zone: a 12- to 15-year retrospective study.

In the mid-nineties, 27 patients received 31 implant-supported crowns in the anterior maxillary region, and 12 to 15 years later, 18 patients (67%) with 22 implants (67%) participated in a retrospective study evaluating implant survival, bone loss, prosthetic complications, patient satisfaction, and patient and professional evaluation of esthetics. One implant was lost because of implant fracture after 10 years. Mean marginal bone loss was 1.53 mm (standard error ± 0.17 mm). In 6 patients, 6 crowns were replaced and 1 repaired. In 3 patients, 3 crowns had minor unrepaired porcelain fractures. Implant survival was 95.5%, and, despite the high frequency of prosthetic complications, patients were generally very satisfied with the long-term treatment outcome.

In vivo and in vitro irritation testing of low concentrations of hydrofluoric acid

Objective. Acidic fluorides are proposed for the treatment of dental erosion. The aim of this study was to examine the irritation properties of dilute hydrofluoric acid (HF) solutions for potential use in the oral cavity. Material and methods. Hens egg test–chorioallantoic membrane (HET-CAM): The CAM was accessed by careful dissection through the egg shell (n=36, 6 eggs/test solution) and exposed to 300 µl of the HF solutions (0.05%, 0.10%, 0.20%, and 1.0%) under macroscope examination over the course of 5 min. Mean time-to-coagulation and average irritation score were recorded based on appearance of hemorrhage, coagulation, and lysis of the blood vessels in the membrane. Mouse skin test: 60 male mice were randomly divided into 10 groups of 6 animals each (control, 0.05%, 0.10%, 0.20%, and 1.0% HF), shaved on the back, exposed to test solution, and euthanized after 2 h or 24 h. Skin samples were evaluated by light microscopy, scoring epithelial leukocyte infiltration, vascular congestion, and edema. Results. HET-CAM: 0.05% HF was slightly irritant, 0.1% HF moderately irritant, 0.2% and 1% HF strongly irritant. 0.1–1% HF solutions were severely irritating on the eye. Mouse skin test: HF concentration was significantly correlated with tissue response, and 24-h exposure to 1% HF solution showed focal erosion of the epithelium and marked localized subepithelial leukocyte infiltration. Conclusion. The results of the studies suggest that accidental exposure of soft tissues to solutions containing more than 0.2% HF may be harmful.

Alkali solubility of calcium fluoride pre-exposed to inorganic orthophosphate at pH6.8

The dissolution behavior in 1 M KOH solution of calcium fluoride which had been pre-exposed to inorganic orthophosphate at pH 6.8 was investigated. Chemically pure calcium fluoride (50 mg) was incubated in 5 ml of 2 mmol/l sodium phosphate buffer, pH 6.8, for 24 h or 120 h and subsequently incubated in 5 ml 1 M KOH for 24h. Control samples were incubated in distilled water before KOH exposure. Pre-treatment with phosphate caused a significantly reduced dissolution rate of calcium fluoride in alkali. Longer exposure to phosphate resulted in further reduction of the dissolution rate in alkali. Calcium fluoride formed on teeth in vitro and in vivo will always be exposed to phosphate. The alkali method thus has limitations because calcium fluoride that has been exposed to phosphate will be underestimated.

Etching effect of acidic fluorides on human tooth enamel in vitro.

OBJECTIVE This in vitro study aimed to examine the etching effect of acidic fluoride solutions on enamel. MATERIALS AND METHODS 24 human teeth divided into 48 enamel-specimens were partly isolated with impression material. Specimens were exposed for 10 min to 20ml of the following solutions: 1.6% TiF4, 3.9% SnF2, 0.2% HF and 1.8% citric acid (CA). The isolation was removed and 24 specimens analysed by profilometry (Δheight: exposed/isolated enamel surfaces, surface roughness parameters). For the remaining 24 specimens [Ca(2+)] in the test solutions was analysed by atomic absorption spectroscopy. RESULTS Median Δheights (μm) after exposure were: TiF4 0.07, SnF2 -0.03, HF -0.14 and CA -5.92. TiF4-exposed surfaces showed both deposits and etched areas and exhibited statistically significant different surface roughness parameters compared to the HF- and SnF2-exposed surfaces. Median [Ca(2+)] values (ppm): TiF4 1.88, SnF2 0.11, HF 0.10 and CA 2.17. CONCLUSION At the [F] tested in this study it can be concluded that SnF2- and HF solutions had negligible erosive effects on enamel. TiF4 solution resulted in an incomplete surface deposition associated with calcium dissolution suggesting that TiF4 applied as solution may not be advisable.

On inhibition of dental erosion

Abstract Objective. To examine the erosion-inhibiting effect of different concentrations of hydrofluoric acid. Materials and methods. Thirty-six human molars were individually treated with 10 ml of 0.1 M citric acid for 30 min (Etch 1), acid was collected and stored until analysis. The teeth were randomly divided into six groups and then individually treated with 10 ml of one of six dilutions (from 0.1–1%) of hydrofluoric acid. The teeth were then again treated with citric acid (Etch 2). The individual acid samples from Etch 1 and 2 were analyzed for calcium by flame atomic absorption spectroscopy and difference in calcium loss was calculated. Results. The highest erosion inhibiting effect was obtained in groups with the highest concentrations of hydrofluoric acid, where the pH was lowest, below pKa of 3.17, thus the hydrofluoric acids being mainly in an undissociated state. Discussion. Diluted hydrofluoric acid is present in aqueous solution of SnF2 and TiF4 (which are known to inhibit dental erosion): SnF2 + 3H2O = Sn(OH)2 + 2HF + H2O and TiF4 + 5H2O = Ti(OH)4 + 4HF + H2O. It is also known that pure, diluted hydrofluoric acid can inhibit dental erosion. Teeth treated with hydrofluoric acid are covered by a layer of CaF2-like mineral. This mineral is acid resistant at pH < 3, because it was formed at this pH. Conclusion. The erosion-inhibiting effect is due to formation of an acid resistant mineral, initiated by tooth enamel treatment with hydrofluoric acid. Hydrofluoric acid is different in having fluoride as a conjugated base, which provides this acid with unique properties.