Biomedical subjects
Publications and source records attributed to A Lussi.
The in-vitro binding of fluoride to isolated organic matrix of secretory bovine enamel was studied by direct fluoride measurement and equilibrium dialysis. Over a wide range of protein and fluoride concentrations there was no indication of fluoride binding by the matrix in contrast to earlier reports.
Highly phosphorylated rat incisor phosphoprotein (PP-H) was purified and covalently attached to agarose beads. The beads were incubated for 24 h in solutions having an ionic strength of 0.165, a molar Ca/P ratio of 1.67, and a pH of 7.4. The calcium-phosphate concentration products [( Ca][P]) in the stable incubation solutions ranged from 1.0 to 1.8 mM2, from which no spontaneous precipitation occurred. In a timed series mineral formation was monitored by SEM and X-ray diffraction. The inhibitory capacity of PP-H, free solution, was also studied. The first mineral appeared after 10 min at a [Ca][P] product as low as 1.2 mM2; X-ray diffraction showed that the mineral was (hydroxy)apatite. Thus small amounts of PP-H attached to a surface are capable of inducing mineral formation in vitro at comparatively low supersaturation, whereas PP-H is a mineral inhibitor when free in solution.
The objectives of this study were to determine the specific surface area of secretory-stage and of maturation-stage enamel, to compare the fluoride uptake by isolated enamel at these two stages on a surface-area basis, and to examine the effect of the organic matrix on the fluoride uptake by whole enamel. Fetal bovine secretory and maturation stage enamel samples were collected, and a portion of the enamel at each developmental stage was treated with hydrazine for removal of the organic matrix. The specific surface areas of the enamel mineral, as determined by the multi-point BET method, were 59.3 m2/g in the secretory stage and 37.9 m2/g in the maturation stage. Whole and deproteinated enamel samples were equilibrated in buffered solutions containing 10(-5) to 10(-3) mol/L fluoride, and the uptake was measured with a fluoride specific electrode. The results indicate that the in vitro fluoride uptake was controlled solely by the surface area of the apatitic mineral and that the organic matrix did not contribute to the fluoride uptake.
Minicavities were prepared in 26 caries-free teeth. Cavity preparation and the finishing of the occlusal area and the gingival floor was done with diamond burs (diameter 1 mm, grain sizes 90 micron and 15 micron, respectively). For the finishing of the axial box margin and the proximo-cervical curved border, a new set was developed: It is composed of an EVA-system with the total amplitude reduced to 0.34 mm, and a highly flexible file (Cavishape, grain 15 micron). The shape of this file had to be modified in order to follow the proximo-cervical curvature. The efficiency of the new device was compared with the axial margin trimmer by means of scanning electron microscopy and a score system. The new device allowed a significantly better finishing of the proximo-cervical curvature and of the axial box margin.
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OBJECTIVES: Cutting and finishing approximal preparations with conventional instrumentation and methods may produce iatrogenic damage in adjacent tooth surfaces which subsequently requires restoration. The objective of this investigation was to determine the occurrence of iatrogenic damage and whether, under everyday working conditions in dental practice, such damage could be reduced significantly by using an alternative method and instrumentation designed especially for the purpose. METHODS: Dental practitioners were asked to take impressions of teeth scheduled for Class II amalgam restorations. One group (control) prepared the teeth with conventional rotary instrumentation (n = 71), while the test group used a new method and instrumentation (n = 63). These comprised a set of files, a right-angle handpiece with reduced stroke, 36 fixed (rotation-locked) positions for the files and a cylindrical bur with a recessed front-end cutting surface. Damage to the adjacent teeth was assessed under a stereomicroscope. RESULTS: Using conventional methods, all adjacent tooth surfaces showed damage, often exposing deep layers of dental tissues. There was a clinical and statistically significant reduction of incidence and severity of iatrogenic preparation trauma in the test group. CONCLUSION: It appears that conventional approximal box preparation results in significant damage to adjacent tooth surfaces. With the system tested, damage to adjacent tooth surfaces during preparation of proximal boxes can be significantly reduced. This should have an impact on the subsequent rate of restoration for the adjacent surfaces.
OBJECTIVE: Besides DNA, dental radiographs play a major role in the identification of victims in mass casualties or in corpses with major postmortem alterations. Computed tomography (CT) is increasingly applied in forensic investigations and is used to scan the dentition of deceased persons within minutes. We investigated different restoration materials concerning their radiopacity in CT for dental identification purposes. METHODS: Extracted teeth with different filling materials (composite, amalgam, ceramic, temporary fillings) were CT scanned. Radiopacities of the filling materials were analyzed in extended CT scale images. RESULTS: Radiopacity values ranged from 6000-8500HU (temporary fillings), 4500-17000HU (composite fillings) and >30710HU (Amalgam and Gold). The values were used to define presets for a 3D colored volume rendering software. CONCLUSIONS: The effects of filling material caused streak artifacts could be distinctively reduced for the assessment of the dental status and a postprocessing algorithm was introduced that allows for 3D color encoded visualization and discrimination of different dental restorations based on postmortem CT data.
The diagnosis of occlusal caries at non-cavitated sites remains problematic, especially since clinical visual detection has limited sensitivity. Electrical methods of detection show considerable promise, but specificity is reduced. The aims of this in vitro study were: (1) to assess the validity of a new laser fluorescence device--the DIAGNOdent--(and compare the values with those of a fixed-frequency electrical device); (2) to determine the optimum cut-off points of the new device for different stages of the caries process, and (3) to assess the reproducibility of the new laser device. For validity and determination of optimum cut-off points, 105 extracted teeth with macroscopically intact occlusal surfaces were measured by a single examiner, using both the laser fluorescence device (on both moist and dried teeth) and an Electronic Caries Monitor. The teeth were subsequently examined histologically to determine the specificity, sensitivity and likelihood ratio at the D2 (caries extending through more than half of the enamel thickness) and D3 (caries involving dentin) levels. The values obtained for the laser device ranged from 0.72 to 0.87 (specificity), 0.76 to 0.87 (sensitivity) and 3.0 to 5.6 (likelihood ratio). Those for the ECM ranged from 0.64 to 0.78 (specificity), 0. 87 to 0.92 (sensitivity) and 2.4 to 4.1 (likelihood ratio). To determine intra- and interexaminer reproducibility of the DIAGNOdent, 11 dentists recorded two different measurements at the same site on a separate set of 83 extracted molar teeth, and these were compared using Cohen's kappa (at D2 and D3 levels) and Spearman's correlation coefficient. The average intra-examiner kappa scores were 0.88 (D2) and 0.90 (D3), with a Spearman correlation of 0.97. For interexaminer reproducibility, the average kappa values were 0.65 (D2) and 0.73 (D3), with a Spearman correlation of 0.84. It is concluded that for occlusal caries (1) the new laser device has a higher diagnostic validity than the ECM, and (2) in vitro, measurements using the device are highly reproducible. Thus, the laser device could be a valuable tool for the longitudinal monitoring of caries and for assessing the outcome of preventive interventions.
The aim of this in situ study was to test the effect of toothbrush abrasion on enamel previously exposed to a standardized artificial erosive agent. To generate moderate erosive lesions, slabs of the buccal surface of human premolars were immersed in a solution of citric acid for 3 min. Then they were attached to intraoral appliances and each one was exposed for 0 min (= toothbrushing immediately after intraoral exposure), 30 or 60 min to the oral milieu of 1 of 7 female subjects with a mean age of 22 years. Immediately thereafter the volunteers brushed the slabs for 30 s with toothpaste using their preferred brushing technique. For each test person the secretion rate of resting and paraffin-stimulated saliva, buffering capacity and pH were measured. The following mean losses of substance at the surface were registered: 0.258+/-0.141 microm (toothbrushing immediately after intraoral exposure), 0. 224+/-0.087 microm (toothbrushing after intraoral exposure of 30 min) and 0.195+/-0.075 microm (toothbrushing after intraoral exposure of 60 min). Toothbrush abrasion in situ was significantly lower after 60-min exposure to the oral environment than after 0-min (p<0.001). Also, the 30- and 60-min values were significantly different from each other (p<0.001). Multiple linear regression analyses revealed that in this model toothbrush abrasion was associated with the intraoral exposure to saliva (p = 0.026), the severity of the erosive attack (p<0.001) and the secretion rate of resting saliva (p = 0.029). If no other preventive measures are taken we suggest that individuals at risk for erosive tooth wear wait at least 1 h before brushing their teeth after consuming erosive foodstuffs or beverages.
It has been shown that dental erosion is not a very rare condition. Careful observation and clinical experience led us to hypothesize a progression of these lesions with time despite dietary counselling and oral hygiene instruction. The purpose of this study was to determine the progression rate and risk factors of dental erosion and wedge-shaped defects over a 6-year period. In the year 1987, 204 randomly selected persons living in Bern from two age groups (26-30 and 46-50 years) were examined for frequency and severity of dental erosion and wedge-shaped defects. In the year 1993, 55 persons could be re-examined by the same dentist using the same indices. Further, detailed case histories of the patients were recorded and the flow rate and buffering capacity of the saliva were determined. The results indicated a distinct progression of erosion on facial and occlusal surfaces and wedge-shaped defects over the 6-year period. The increase in the defects was more marked in the older age group. Surprisingly, nutritional habits did not change despite thorough informative discussion about erosive foodstuff with every patient during the first session. Multiple linear regression analysis revealed consumption of nutritional acids and age as significant risk factors explaining 28% of the variability of the progression of erosions. The significant factors for the progression of wedge-shaped defects were identified to be frequency of tooth brushing and age, explaining 21% of the variability of the progression of wedge-shaped defects. In summary, there was a definite statistically significant progression of non-carious dental hard tissue defects in our sample. This progression was correlated with age (erosion and wedge-shaped defects), consumption of dietary acids (erosion) and frequency of toothbrushing (wedge-shaped defects).
The aim of this study was to compare, in vitro, the performance of different conventional diagnostic techniques with the laser-based device, DIAGNOdent, for diagnosis of occlusal caries in deciduous teeth. 95 deciduous teeth with macroscopically intact occlusal surfaces were selected. All teeth were assessed by the following techniques: visual inspection (VI), visual inspection with magnification (VIM), visual inspection combined with light pressure probing (VIP), bitewing radiography (BW) and the DIAGNOdent (DD). Caries extension was assessed by histology. DIAGNOdent showed, in comparison with the conventional clinical methods, a significantly improved ability (p < 0.05) to detect dentinal lesions (D(3) or D(4)) in deciduous teeth and an overall performance similar to that obtained in previous studies on permanent teeth. There was no statistically significant difference between VIM and DD in detecting caries confined to enamel (D(2)). DD performed better at D(2) level than the other methods. The intraexaminer kappa scores for DIAGNOdent were 0.76-0.86 (D(2)) and 0.77-0.85 (D(3)), respectively. It was concluded that DIAGNOdent could be used as an additional tool in the detection of occlusal caries in deciduous teeth and its good reproducibility should enable the laser device to monitor the caries process over time.
The aim of this study was to test the effect of fluoride rinsing on the prevention of toothbrush abrasion of softened enamel in situ. For softening, the samples were immersed in 0.1 M citric acid (pH 3.5) for 3 min. Eight test subjects had to make 5 runs in which 4 slabs per run were attached to intraoral appliances. They were as follows: (1) no softening, no fluoride rinsing (control 1); (2) softening, no fluoride rinsing (control 2); (3) softening, rinsing in situ with a sodium/amine fluoride rinsing solution (250 ppm F) for 30 s; (4) rinsing in situ with the sodium/amine fluoride rinsing solution (250 ppm F) for 30 s, softening; (5) softening, rinsing in situ with an experimental amine fluoride-containing rinsing solution (250 ppm F) for 30 s. After exposure for 60 min to the oral milieu, the volunteers brushed the samples for 30 s with toothpaste and the loss of tooth substance was determined. For each test person, the secretion rate of resting and paraffin-stimulated saliva, buffering capacity and pH were measured. Toothbrush abrasion in situ was not significantly lower using the fluoride rinsing solutions before or after softening the enamel compared to no rinsing (p > 0.05). Multiple linear regression analyses revealed that 57% of the variation in toothbrush abrasion could be attributed to the severity of softening (p < 0.001) and the pH of stimulated saliva (p < 0.001). It was concluded that a single rinse for 30 s had no statistically significant effect on the prevention of toothbrush abrasion of softened enamel.
The study is a comparison of methods for the quantitative measurement of erosive mineral loss including longitudinal microradiography (LMR), profilometry (PM), and analysis of calcium (CA) and phosphorus (PA) in the erosion solution. Polished human enamel samples were taped, covered with nail varnish and the edges of the resulting enamel window marked with drilled holes as a reference. All samples were subjected to baseline LMR. Sixty samples each were eroded with citric acid (0.05 M; pH 2.3; 10 ml per sample) for 30, 60, 90, or 120 min. Erosive loss of each sample was estimated by the four methods. All methods revealed a linear erosive loss over time and showed good linear correlation. Values calculated from PM and LMR were both approximately 20% lower than those from CA and PA. After 30 min erosion, LMR showed no significant correlation with the other three methods. With LMR, erosive loss below 20 microm should be interpreted with care.
Three dentists recorded laser fluorescence (LF) values on 117 teeth in 70 patients, in the sequence: (1) moist, uncleaned; (2) dried, uncleaned; (3) moist, cleaned; (4) dried, cleaned. LF values varied significantly with surface status (p < 0.01). The optimal cutoffs were up to 5 units lower on uncleaned, moist surfaces compared to the other states. Drying uncleaned surfaces significantly increased LF readings for dentinal caries (p < 0.01). It was concluded that occlusal surfaces should be clean and dry, for precise longitudinal monitoring of caries with LF as well as for detailed visual inspection, which should precede LF measurements.
PURPOSE: The purpose of this study was to evaluate the microleakage and penetration ability of sealing materials applied under different conditions of contamination. METHODS: One hundred twenty extracted human molar teeth were randomly assigned to 12 groups. The treatment groups were defined by the combination of sealing materials (Concise; Optibond system; Optibond system plus Concise) and 4 surface conditions (no moisture and no saliva contamination; moisture contamination; dried saliva contamination; wet saliva contamination). Each tooth was subjected to thermal cycling (5,000 cycles at 5 degrees C-55 degrees C) with a dwell time of 30 seconds and dye immersion (5% methylene blue for 24 hours). Microleakage, penetration ability, and fissure types were examined after sectioning. Multiple regression analyses and the Tukey test were used for statistical analysis. RESULTS: Concise showed significantly less microleakage than the Optibond system (P<.031) when the procedures were performed under no contamination or moisture contamination. However, when Concise was applied on the wet saliva-contaminated surfaces, considerably higher microleakage and unfilled areas were found compared to the use of Optibond alone or Optibond with Concise (P<.001). CONCLUSIONS: When there is saliva contamination, the use of Optibond alone or with Concise is beneficial for decreasing microleakage and increasing the penetration ability of sealants.