J. Tagami

Dentin demineralization: Effects of dentin depth, pH and different acids

OBJECTIVES This investigation sought to determine: 1) if dentin demineralization rates are proportional to acid concentration for demineralization in phosphoric acid (10% or 1.76 M, 0.025 M, 0.0001 M, with pH = 0.95, 2.0, 4.0 respectively); 2) if the etching characteristics are independent of dentin depth; and 3) if the etching characteristics for phosphoric acid were comparable to those for citric acid over a similar pH range. METHODS Highly polished dentin disks from freshly extracted, non-carious, third molars were prepared with a reference layer. Samples were prepared from either superficial or deep coronal dentin. The samples were etched for periods of up to 30 min using phosphoric acid solutions (pH = 0.95, 2.0, 4.0) in a wet cell of an atomic force microscope (AFM). Depth changes with respect to the reference layer were determined for the intertubular and peritubular dentin to quantify structural changes. The results were compared with similar studies using citric acid (pH = 1.0, 2.15 or 3.4). Etching characteristics were statistically compared using 2-way repeated measures ANOVA at p < 0.05 and the Tukeys multiple comparison test. RESULTS The relation between time and recession for peritubular dentin was initially linear. The intertubular dentin recession started rapidly but then reached a plateau within a very short interval for etching solutions at pH = 2.0 and 4.0. At the highest concentration, the recession decreased with time, but a clear plateau was not established. There was no statistical difference between peritubular etching rates of superficial and deep dentin surfaces with phosphoric acid at any concentration. There was also no difference in the intertubular dentin recession at the location of the plateau that depended on dentin depth. Etching rates increased dramatically with decreased pH for both phosphoric and citric acids, but were higher for citric acid than for phosphoric acid. SIGNIFICANCE The AFM allowed quantification of changes during etching of wet dentin. Peritubular dentin etching rates increased with decreasing pH, as expected, but changes were not linear and were different for the two acids studied over a similar pH range. Intertubular dentin surface recession was small and plateaued for low concentrations. The peritubular etching rate and intertubular dentin recession did not depend on dentin depth.

Enamel Lesion Parameter Correlations between Polychromatic Micro-CT and TMR

Transverse microradiography (TMR) is considered as the gold standard technique for the evaluation of enamel lesions. Micro-computed tomography (µCT) has the advantage of non-destructive measurements, but the beam-hardening effect with polychromatic x-rays is a major drawback. To date, no study has validated µCT against TMR. The objective of this study was to validate µCT measurements of enamel lesions under various x-ray conditions and software beam-hardening correction (BHC) against TMR. Human molars with natural white-spot lesions were scanned for 5 min by µCT at 100 kV in different conditions: 50 µA (0.5-mm Al filter), 165 µA (0.5-mm Al/0.3-mm Cu), and 200 µA (0.5-mm Al/0.4-mm Cu), with or without BHC. Grayscale values were converted into mineral density values using phantoms. Thin sections at the same positions were then prepared for TMR. Lesion depth (LD; µm) and mineral loss (ΔZ; vol%µm) were compared between µCT and TMR by Pearson’s correlations. µCT measurements correlated well with TMR under all conditions (p < 0.001, r > 0.86 for LD and ΔZ), except for 0.5-mm Al without BHC (p > 0.05). Even without BHC, combined Al/Cu filters successfully reduced the beam-hardening effect. µCT can be used as a non-destructive alternative to TMR with comparable parameters for the study of enamel lesions.

Gum Containing Calcium Fluoride Reinforces Enamel Subsurface Lesions in situ

The aim of this study was to assess the effect of chewing gum containing phosphoryl oligosaccharides of calcium (POs-Ca) and a low concentration of fluoride (F) on the hardness of enamel subsurface lesions, utilizing a double-blind, randomized, and controlled in situ model. Fifteen individuals wore removable lingual appliances with 3 bovine-enamel insets containing subsurface demineralized lesions. Three times a day for 14 days, they chewed one of the 3 chewing gums (placebo, POs-Ca, POs-Ca+F). After the treatment period, cross-sectional mineral content, nanoindentation hardness, and fluoride ion mapping by time-of-flight secondary ion mass spectrometry (TOF-SIMS) were evaluated. Although there were no statistical differences in overall mineral content and hardness recovery rates between POs-Ca and POs-Ca+F subsurface lesions (p > 0.05), nanoindentation at 1-μm distance increments from the surface showed statistical differences in hardness recovery rate between POs-Ca and POs-Ca+F in the superficial 20-μm region (p < 0.05). Fluoride mapping revealed distribution of the ion up to 20 μm from the surface in the POs-Ca+F group. Nanoindentation and TOF-SIMS results highlighted the benefits of bioavailability of fluoride ion on reinforcement of the superficial zone of subsurface lesions in situ (NCT01377493).

Microgaps and Demineralization Progress around Composite Restorations

This study investigated the influence of adhesives and marginal sealing on demineralization progress using optical coherence tomography (OCT). Cavities (4 × 2 mm) were prepared in bovine incisors and restored using Clearfil SE Protect (SP), Bond Force (BF), Scotchbond Universal (SB), or G-Bond Plus (GB), followed by Estelite Flow Quick flowable composite. The control group received no adhesive (n = 10). After 3-d incubation in artificial saliva and 10,000 thermal cycles, gaps at enamel and dentin margins were measured at 8 locations on cross-sectional images obtained from each restoration using swept-source OCT at 1310-nm wavelength. Specimens were demineralized using acidified gel (pH = 4.5) for 5 wk and scanned every week to monitor the lesion progress at the same marginal locations. Repeated-measures analysis of variance showed that demineralization period and adhesive type and their interaction had a significant effect on the lesion size in both substrates (P < 0.001). SP, BF, and SB had significantly lower enamel and dentin initial gaps than the control and GB (P < 0.05). Enamel lesion progress was slower in the fluoride-releasing adhesives SP and BF and significantly different from SB, GB, and the control (P < 0.001). SP and BF dentin lesions were significantly different from GB and the control (P < 0.001), but not from SB (P > 0.05). A significant positive correlation (P < 0.05) was found between initial gap length and formed lesion size in both substrates, which was stronger in enamel (r = 0.63) than dentin (r = 0.35). Microgaps forming at the margins of restorations depend on adhesives and significantly contribute to the progress of demineralization around the margins, while fluoride release may decrease the rate of progression.