The aim of this literature review is to explore the treatment methods for root caries in laboratory and clinical research in the last decade. A systematic search of publications in PubMed and Web of ...Science databases was performed. The timespan was limited to the last 10 years and English language. Further retrieval was conducted using the search terms of specific therapies or treatments. Eighty‐two articles were included in this systematic review and full texts were retrieved. Types of studies included laboratory studies and clinical trials. Therapeutic approaches for root caries without risk of pulp exposure can be categorized into non‐invasive and restorative treatment. Non‐invasive treatments which targeted different causative factors of root caries have been developed in the last decade. Accordingly, several artificial caries model systems have been proposed for the study of root caries in the laboratory. Carious tissue excavation techniques and restorative materials and procedures have been modified to improve the prognosis of invasive treatment. It is of importance to determine the most appropriate therapy for root caries and further clinical trials are needed to draw firm conclusions concerning the efficacy and consistency of the various treatment methods proposed.
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BFBNIB, CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Preservation of natural tooth structure requires early detection of the carious lesion and is associated with comprehensive patient dental care. Processes aiming to detect carious lesions in the ...initial stage with optimum efficiency employ a variety of technologies such as magnifying loupes, transillumination, light and laser fluorescence (QLF® and DIAGNOdent®) and autofluorescence (Soprolife® and VistaCam®), electric current/impedance (CarieScan®), tomographic imaging and image processing. Most fluorescent caries detection tools can discriminate between healthy and carious dental tissue, demonstrating different levels of sensitivity and specificity. Based on the fluorescence principle, an LED camera (Soprolife®) was developed (Sopro‐Acteon, La Ciotat, France) which combined magnification, fluorescence, picture acquisition and an innovative therapeutic concept called light‐induced fluorescence evaluator for diagnosis and treatment (LIFEDT). This article is rounded off by a Soprolife® illustration about minimally or even non‐invasive dental techniques, distinguishing those that preserve or reinforce the enamel and enamel‐dentine structures without any preparation (MIT1– minimally invasive therapy 1) from those that require minimum preparation of the dental tissues (MIT2 – minimally invasive therapy 2) using several clinical cases as examples. MIT1 encompasses all the dental techniques aimed at disinfection, remineralizing, reversing and sealing the caries process and MIT2 involves a series of specific tools, including microburs, air abrasion devices, sonic and ultrasonic inserts and photo‐activated disinfection to achieve minimal preparation of the tooth. With respect to minimally invasive treatment and prevention, the use of lasers is discussed. Furthermore, while most practices operate under a surgical model, Caries Management by Risk Assessment (CaMBRA) encourages a medical model of disease prevention and management to control the manifestation of the disease, or keep the oral environment in a state of balance between pathological and preventive factors. Early detection and diagnosis and prediction of lesion activity are of great interest and may change traditional operative procedures substantially. Fluorescence tools with high levels of magnification and observational capacity should guide clinicians towards a more preventive and minimally invasive treatment strategy.
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Background
This study investigated the physical properties and ion release of casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP)‐modified calcium silicate‐based cements (CSCs) and compared ...the properties of a trial mineral trioxide aggregate (MTA) with two commercially available CSCs, Biodentine™ and Angelus® MTA.
Methods
The setting time, solubility, compressive strength and Vickers surface microhardness of the three CSCs incorporated with 0%, 0.5%, 1.0%, 2.0% and 3.0% (w/w) CPP‐ACP were investigated. Release of calcium (Ca2+), phosphate ions (Pi) and pH of the test cements were measured after 24, 72, 168 and 336 h of storage.
Results
The addition of up to 1.0% CPP‐ACP into Biodentine™ and 0.5% into the other cements did not adversely affect their physical properties except for the setting time. The addition of 0.5% CPP‐ACP increased Ca2+ released from Biodentine™ (after 168 and 336 h), Angelus® MTA (after 168 h) and the trial MTA (after 72 h). The addition of 1.0–3.0% CPP‐ACP increased Ca2+ and Pi released from all the cements. Biodentine™ released more Ca2+ particularly in the early stages and showed shorter setting time and higher mechanical properties than the other cements. The mechanical properties of Angelus® MTA and the trial MTA were similar. All the cements produced highly alkaline storage solutions.
Conclusions
Up to 1.0% CPP‐ACP in Biodentine™ improves Ca2+ and Pi release and 0.5% CPP‐ACP in Angelus® MTA and the trial MTA improves Ca2+ release without altering the mechanical properties and solubility. The addition of CPP‐ACP into CSCs prolonged the setting time.
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BFBNIB, CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background
The purpose of this study was to evaluate and compare the relative efficacy of a resin fissure sealant, nano‐filled self‐adhesive protective coating, resin infiltrant, glass ionomer cement ...(GIC), and GIC containing casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP) in preventing the formation of subsurface lesions of enamel (SLE) adjacent to orthodontic brackets by acting as an enamel surface sealant (ESS).
Methods
Eighty‐five enamel specimens with molar tubes bonded at their centre were randomly divided into five groups, each treated with a different material at the bracket's periphery. Specimens were stored in an acetate demineralization solution at pH 4.5 for 7 days at 37 °C then imaged using quantitative light‐induced fluorescence (QLF) to determine the difference in fluorescence (∆F) between sound‐ and acid‐exposed enamel. Lesion cross‐sections were then examined using backscattered scanning electron microscopy (SEM) to measure lesion depth.
Results
The use of GIC alone or incorporating CPP‐ACP significantly reduced ∆F compared with other materials. Backscattered SEM images showed no measurable demineralization for enamel treated with either GIC material in contrast with other groups, which showed statistically significant demineralization levels.
Conclusions
The fluoride‐releasing effects and CPP‐ACP benefits of the GIC materials show promise as an effective ESS in inhibiting enamel demineralization adjacent to orthodontic brackets.
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BFBNIB, CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background: To investigate, in vitro, the effect on enamel erosion of the addition of 0.2% w/v casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP) to four commercially‐available soft drinks, ...two of which were carbonated.
Methods: Enamel specimens (n = 27) were sectioned from sound extracted human third molar teeth and polished to a mirror finish. Exposed enamel windows of 1 mm2 were created by painting the surface with acid‐resistant nail varnish. Four citric flavoured soft drinks (pH range 2.2 to 2.4) and distilled deionized water (DDW) were tested. Each drink was tested with and without 0.2% CPP‐ACP w/v. The specimens were placed into 50 mL of solution at 37 °C for 30 minutes, rinsed and varnish removed. The samples were profiled with a white light profilometer and erosive depths recorded.
Results: All soft drinks tested caused enamel erosion but adding 0.2% w/v CPP‐ACP significantly reduced (p <0.05) erosive depth in all test solutions in comparison with the solutions without CPP‐ACP. The erosive depths for all solutions with 0.2% CPP‐ACP did not differ significantly from those of DDW.
Conclusions: Adding CPP‐ACP at 0.2% w/v significantly decreased the erosivity of all four soft drinks. The erosivity of the soft drinks with 0.2% CPP‐ACP added did not differ significantly from that of distilled water.
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Background
Dental caries and enamel defects (DDE) are prevalent amongst children. The presence of DDE, especially enamel hypomineralization, may increase caries experience. The reported prevalence of ...hypomineralized second primary molars (HSPM) is 2.7–21.8%, although the occurrence in Australian children remains unknown. These HSPM represent a potential predictive factor for molar‐incisor hypomineralization (MIH).
Methods
In total, 623 children aged 3–5 years from 30 randomly selected kindergartens participated. The HSPM were recorded using an index combining the European Academy of Paediatric Dentistry MIH Judgment Criteria and modified DDE Index. Caries was recorded using International Caries Detection and Assessment System criteria.
Results
In total, 144 HSPM were observed in 88 of the 623 (14.1%) children, a tooth‐level prevalence of 5.8%. The prevalence of dentinal carious lesions was 13.2%, and caries prevalence (d2–6mft > 0) was 36.4%. Cavitated carious lesions affected 30.7% of HSPM.
Conclusions
The relationship between an increase in HSPM lesion extent and increasing number of HSPM per child was statistically significant. A positive association between HSPM severity and extent at tooth level existed (P < 0.05). There was a positive relationship between the extent of HSPM and carious lesion severity (P < 0.05). In this population, children with HSPM did not have overall greater caries experience.
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Background: Quantitative light‐induced fluorescence (QLF) and digital photography (DP) have been proposed as clinical methods for measuring changes in enamel mineral content. The aim of this study ...was to compare the ability of QLF and DP with the in vitro gold standard transverse microradiography (TMR) to measure the remineralization of enamel subsurface lesions.
Methods: Subsurface lesions were formed in enamel (n = 40) and exposed to remineralization solutions for 10 days. Changes were analysed by DP, QLF and TMR to determine percentage changes in luminescence (%L), fluorescence (%F) and mineral content (%R), respectively and correlation between these parameters determined.
Results: The correlations between TMR and QLF (r = 0.63), TMR and DP (r = 0.59), and DP and QLF (r = 0.64) were all moderate but statistically significant (p < 0.001). The variability in %L and, to a lesser extent, %F values significantly impacted on the potential role of DP and QLF as methods by which mineral content changes produced by remineralization treatments could be accurately measured.
Conclusions: Both QLF and DP provided data that correlated moderately with TMR data. QLF images were easier to analyse, free of glare and had less variability compared with those produced using DP.
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BFBNIB, CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Orthodontic patients have an increased risk of white-spot lesion formation. A clinical trial was conducted to test whether, in a post-orthodontic population using fluoride toothpastes and receiving ...supervised fluoride mouthrinses, more lesions would regress in participants using a remineralizing cream containing casein phosphopeptide- amorphous calcium phosphate compared with a placebo. Forty-five participants (aged 12–18 yrs) with 408 white-spot lesions were recruited, with 23 participants randomized to the remineralizing cream and 22 to the placebo. Product was applied twice daily after fluoride toothpaste use for 12 weeks. Clinical assessments were performed according to ICDAS II criteria. Transitions between examinations were coded as progressing, regressing, or stable. Ninety-two percent of lesions were assessed as code 2 or 3. For these lesions, 31% more had regressed with the remineralizing cream than with the placebo (OR = 2.3, P = 0.04) at 12 weeks. Significantly more post-orthodontic white-spot lesions regressed with the remineralizing cream compared with a placebo over 12 weeks.
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CMK, NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Growing interest in the treatment and prevention of Molar/Incisor Hypomineralization (MIH) warrants investigation into the protein composition of hypomineralized enamel. Hypothesizing abnormality ...akin to amelogenesis imperfecta, we profiled proteins in hypomineralized enamel from human permanent first molars using a biochemical approach. Hypomineralized enamel was found to have from 3- to 15-fold higher protein content than normal, but a near-normal level of residual amelogenins. This distinguished MIH from hypomaturation defects with high residual amelogenins (amelogenesis imperfecta, fluorosis) and so typified it as a hypocalcification defect. Second, hypomineralized enamel was found to have accumulated various proteins from oral fluid and blood, with differential incorporation depending on integrity of the enamel surface. Pathogenically, these results point to a pre-eruptive disturbance of mineralization involving albumin and, in cases with post-eruptive breakdown, subsequent protein adsorption on the exposed hydroxyapatite matrix. These insights into the pathogenesis and properties of hypomineralized enamel hold significance for prevention and treatment of MIH.
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CMK, NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
In recent decades a desire has driven the uptake of the minimum intervention dentistry (MID) philosophy to end the destructive ‘drill and fill’ mentality prevalent amongst dental training programmes ...since the establishment of formalized dental training courses more than 100 years ago. This change in attitude has been concomitant with the decrease in caries prevalence in large sectors of the community and a better understanding of the caries process. One of the pivotal arms of MID is caries risk assessment, and early and accurate caries detection is a major part of this procedure. There is great variation between the diagnostic decisions between individual clinicians, and the development of valid detection aids may decrease this variation and improve the clinical decision making process as it relates to dental caries.
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