Search Results (83)

White spot lesions (WSLs) are early clinical stages of enamel demineralization, often related to orthodontic treatment or poor oral hygiene. The use of gels such as fluoride for topical application inhibits demineralization and promotes remineralization of dental tissues through various mechanisms. A variety of therapeutic approaches are available; however, recent research indicates that combined treatment strategies may yield superior clinical outcomes compared to monotherapy. The aim of this study was to critically compare the efficacy of combining multiple treatment techniques for WSLs compared to using these techniques alone. A systematic search was conducted in PubMed, Scopus, and Cochrane databases according to PRISMA guidelines. The PICO strategy was used to formulate the research question: Which clinical approaches combined or isolated (C) influence the treatment and prevention effectiveness (O) of white spot lesions (I) in humans (P) in the last ten years (T)? Inclusion criteria focused on clinical studies from the last ten years evaluating the combined use of at least two treatment techniques for WSL, resulting in a total of 8 randomized controlled trials selected from an initial pool of 1185 articles. Our results suggest that combined treatment strategies, including resin infiltration with fluoride varnish and ozone therapy combined with fluoride application, demonstrated enhanced efficacy in lesion masking and remineralization compared to single-treatment approaches. CPP-ACP and hydroxyapatite-based creams improved aesthetics, particularly when used alongside fluoride varnish. Our study concluded that the combination of remineralization agents like fluoride gel, infiltrative resins, and antimicrobial treatments offers superior outcomes on white spot lesion treatment than using these techniques alone. However, long-term clinical studies are needed to standardize treatment protocols and confirm durability. Full article

(1) Background: White spot lesions (WSLs) on enamel result from demineralization and are an early sign of dental caries. Glass ionomer cement (GIC) has been widely used for its remineralization potential, and zinc-containing GIC (zGIC) has been introduced to enhance this effect. However, its efficacy compared to conventional GIC (cGIC) remains unclear. This study aimed to evaluate and compare the remineralization effects of cGIC and zGIC on WSLs. (2) Methods: Thirty-six bovine enamel specimens were prepared, demineralized for four days, and divided into three groups: control, cGIC, and zGIC. Half of each specimen’s treated window was covered with varnish, and a two-week pH cycling protocol was conducted. Mineral density (MD) changes were assessed using microcomputed tomography (Micro-CT) at five time points: pre-demineralization, after demineralization, immediately after treatment, and 1- and 2-weeks post-treatment. Scanning electron microscopy (SEM) was also performed. (3) Results: MD values in the zGIC and cGIC groups were significantly higher than in the control group throughout every post-treatment assessment (p < 0.05). zGIC demonstrated significantly higher MD than cGIC (p < 0.05), and SEM images revealed inferior mineral deposition. (4) Conclusions: These findings suggest that zGIC is more effective in remineralizing WSLs than cGIC over two weeks. 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

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

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

Peptide-based biomimetic treatments have gained increased attention in the dental field due to their biocompatibility and minimally invasive qualities. These biomimetic approaches can replicate the native architecture of dental tissues, thus contributing to higher success rates and improved longevity of restorations. The aim of this study was first to examine the biocompatibility and stability of an amelogenin peptide-based chitosan hydrogel (P26-CS) against salivary enzymes. Second, we aimed to evaluate its efficacy in biomimetically repairing human dental lesions in situ. White spot lesions (WSLs) in enamel and non-carious cervical lesions (NCCLs) in dentin were artificially created. Chitosan (CS) improved peptide stability, while remineralization of enamel sections with P26-CS was not impeded by salivary enzymes. The peptide was not cytotoxic, irritating, or sensitizing. Fluorescently labeled P26-CS penetrated ~300 μm into the enamel of WSLs and ~100 μm into the dentin of NCCLs. After peptide treatment, quantitative light-induced fluorescence (QLF) and microcomputed tomography (μCT) indicated a gain in mineral density of WSLs. In NCCLs, scanning electron microscopy showed that the dentin was covered by a mineral layer of needle-shaped crystals. Our results show that the repair of artificial WSLs and NCCLs was achieved by P26 peptide-guided remineralization and demonstrate its potential to repair dental lesions. Full article

Background: Orthodontic appliances increase biofilm accumulation by expanding plaque retention sites. Enamel demineralization and periodontal inflammation are considered to be the most prevalent consequences of biofilm formation in orthodontic patients, with reported prevalence rates of up to 50%. To date, there are different procedures and indications that have been used for the treatment of these conditions. Therefore, professionals may use different technologies and protocols to control bacterial biofilm. The aim of this study was to investigate the protocols and technologies used by Italian dental professionals to maintain good oral health in orthodontic patients before, during and after treatment. Methods: A total of 155 dental professionals, dentists, dental hygienist students and dental hygienists, attending the Italian Academy of Advanced Technologies in Oral Hygiene Sciences (A.T.A.S.I.O.) congress, completed a questionnaire to identify prevention technologies and protocols before, during and after orthodontic treatment. Results: The results show equivalent responses between dentists and dental hygienists, with most dental hygienists more likely to personalize treatment. Remineralization technologies and protocols are selected based on patient characteristics. During professional oral hygiene sessions, the most commonly used technologies before, during and after therapy are ultrasonic scaler and airflow with powders. Mouthwashes and toothpastes are customized and shared with the patient, with remineralizing technologies predominant in toothpastes. After treatment, aesthetics is evaluated and the whitening protocol is selected based on the patient’s characteristics. Conclusions: There is not a specific prevention program associated with each orthodontic therapy in the literature, so it is necessary to tailor the treatment to best manage the risks of orthodontic therapy and maintain healthy tissues. Full article

Dental caries is a widespread issue impacting global oral health. White spot lesions, the earliest stage of caries, compromise enamel’s esthetics and integrity. Remineralization therapies, both fluoride and non-fluoride based, aim to restore enamel, but limited comparative data exist on their effects on lesion depth and microhardness. Thus, the aim of this systematic review was to evaluate the efficacy of remineralizing agents on lesion depth and microhardness of human teeth. The literature search included the following five databases: PubMed, Web of Science, Scielo, SCOPUS, and EMBASE from the period 2012 to October 2022. Studies evaluating lesion depth and microhardness in human teeth after the application of a remineralizing agent were considered for review. The meta-analysis was performed using RevMan 5.4 (The Cochrane Collaboration, Copenhagen, Denmark). A random effect model was used to pool estimate of effect and its 95% confidence intervals (CIs) for surface microhardness and depth lesion. Subgroup analyses were performed considering the presence of fluoride or not in the remineralization agent. Thirty-three studies were included in the qualitative review. Of these, twenty-six studies were included in the meta-analysis. The main risks of bias associated with the studies included a lack of blinding of the test operator and failure to obtain sample size. To conclude, fluorinated agents are more effective in remineralizing artificially induced white spot lesion than non-fluoride remineralizing agents. 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

This study investigates the microstructure of dental enamel following demineralization and re-mineralization processes, using DIAGNOdent scores and images obtained via scanning electron microscopy (SEM), atomic force microscopy (AFM), and microhardness (Vickers). The research evaluates the effects of two experimental hydrogels, Anti-Amelogenin isoform X (ABT260, S1) and Anti-Kallikrein L1 (K3014, S2), applied to demineralized enamel surfaces over periods of 14 and 21 days. The study involved 60 extracted teeth, free from cavities or other lesions, divided into four groups: a positive group (+), a negative group (−) and groups S1 and S2. The last three groups underwent demineralization with 37% phosphoric acid for 20 min. The negative group (−) was without remineralization treatment. The DIAGNOdent scores indicate that the S1 group treated with Anti-Amelogenin is more effective in remineralizing the enamel surface compared to the S2 group treated with Anti-Kallikrein. These findings were corroborated by SEM and AFM images, which revealed elongated hydroxyapatite (HAP) nanoparticles integrated into the demineralized structures. Demineralization reduced enamel microhardness to about 1/3 of a healthy one. Both tested hydrogels restored enamel hardness, with S1 being more effective than S2. Both peptides facilitated the interaction between the newly added minerals and residual protein binders on the enamel surface, thereby contributing to effective enamel restoration. Full article

This study aimed to investigate the remineralization processes of dental enamel via scanning electron microscopy and observe the changes induced in the microstructure by oral hygiene products. More specifically, the effectiveness of Mentadent Professional Resilience was analyzed for its ability to demineralize erosion-affected enamel surfaces. This involved the sectioning of some teeth to preserve enamel integrity, followed by dehydration and preparation for SEM analysis. SEM observations were made at various magnifications to detect differences in enamel morphology after treatment with the product. These observations provide valuable insights into the mechanisms of action of dental care products and their potential to protect enamel. The study makes a contribution to our understanding of remineralization processes and describes the importance of microscopic analysis for evaluating and developing effective dental products. Full article

This study aimed to clarify the effects of high-concentration fluoride varnish application on the inhibition of the progression of initial enamel caries. Remineralization capacity and acid resistance following high-concentration fluoride varnish application were compared with untreated models and models treated with fluoride mouthwash. Bovine enamel was used to create a model of initial enamel caries. The high-concentration fluoride varnishes Enamelast and Clinpro White Varnish and the fluoride mouthwash Miranol were used. Specimens were evaluated using Contact Microradiography (CMR) and an Electron Probe Micro-Analyzer (EPMA). While a single application of high-concentration fluoride varnish and short-term fluoride mouthwash use did not appear to cause remineralization in the subsurface demineralized layer, improvements in acid resistance were observed, leading to reduced demineralization under subsequent acidic challenges. Full article

Background: Molar–incisor hypomineralization (MIH) is an enamel defect affecting molars and incisors, often leading to hypersensitivity, enamel breakdown, and increased caries risk. Non-invasive treatments, such as casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) and fluoride varnish, show potential in remineralizing affected enamel and reducing sensitivity, but their efficacy is still debated. This study systematically reviews and analyzes the effectiveness of CPP-ACP and other non-invasive agents in improving remineralization and reducing hypersensitivity in MIH-affected teeth. Methods: A systematic search was conducted on PubMed, Embase, and Central in July 2024, including interventional and observational studies on remineralization and hypersensitivity in pediatric MIH patients (<18 years). A total of 1566 studies were found, with 15 included in the meta-analysis. A random-effects model was applied, including subgroup analysis by lesion severity. Results: CPP-ACP showed no statistically significant advantage over fluoride in remineralization (MD −3.80, 95% CI: −8.57; 0.98), but it significantly reduced hypersensitivity compared to fluoride varnish (MD −2.36, 95% CI: −3.83; −0.89). Although this reduction in hypersensitivity may be clinically relevant, the high heterogeneity (I² = 83%) and wide confidence intervals limit the reliability of these findings. Conclusions: CPP-ACP has a moderate effect in reducing hypersensitivity but does not outperform fluoride in remineralization. Other agents, such as calcium glycerophosphate and silver diamine fluoride, showed mild benefits. The current evidence base is limited and heterogeneous, highlighting the need for high-quality, long-term studies to confirm these findings and guide MIH management. Full article

This concise review provides an update on the use of calcium-based materials for the prevention of dental caries. Some calcium-based materials promote remineralization and neutralize bacterial acids, disrupting cariogenic biofilms and inhibiting bacterial growth. Medical Subject Headings of [Dental Caries] and [Calcium] were adopted to search publications. Information related to the aim of this review was extracted and summarized. Common calcium-based materials are calcium phosphate, hydroxyapatite, calcium carbonate, calcium fluoride and casein phosphopeptide–amorphous calcium phosphate (CPP-ACP). Calcium phosphate is commonly used in toothpaste. It provides calcium and phosphate ions, enhances the incorporation of fluoride into caries lesions and increases mineral density. Hydroxyapatite is a form of calcium phosphate that is chemically similar to the mineral found in teeth. It can be applied on teeth to prevent caries. Calcium carbonate can be found in toothpastes. It neutralizes bacterial acids and acts as a calcium reservoir during remineralization. Calcium fluoride is found in dental products and promotes remineralization as a source of fluoride, which can be incorporated into tooth enamel, forming fluorapatite and increasing resistance to caries. CPP-ACP is derived from milk proteins. It contains calcium and phosphate, which help to remineralize tooth enamel. CPP-ACP inhibits cariogenic bacteria. It also interacts with bacterial biofilms and disrupts their formation. These calcium-based materials can be used to boost the preventive effect of fluorides or, alternatively, as a therapy for caries prevention. Full article