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Remineralization of caries lesions extending into dentin.

Remineralization is one aspect of the overall process of tooth decay. However, it is primarily studied in shallow lesions. The aim of this study was to explore whether caries lesions in enamel and extending into the dentin can be remineralized. A single-section model was developed for the longitudinal and non-destructive monitoring of changes in enamel and dentin. Lesions at least 200 microm into dentin were formed in undersaturated acetate buffers. Next, the lesions were divided into groups (three treatment and one control) and remineralized. The treatments were: weekly immersion in 1,000 ppm fluoride, single treatment with methanehydroxybisphosphonate, and a constant level of 1 ppm fluoride. De- and remineralization was assessed by transverse microradiography. Remineralization was observed in enamel, but also in dentin, indicating that, deep into dentin, the pores become supersaturated to apatite formation. Treatments affected remineralization only in the outer part of enamel. Both findings are explained by a relatively fast diffusion of mineral ions, with precipitation being rate-limiting. The results suggest that dentin remineralization, underneath enamel, can be achieved and could possibly be used in clinical treatment strategies.

Analysis of Variance↗

Effects of Nd:YAG laser on apical seal of teeth after apicoectomy and retrofill.

The application of Nd:YAG laser to tooth surface can change its surface permeability. The purpose of this study was to investigate the effects of Nd:YAG laser on the permeability of dentin following apicoectomy and retrofill. Sixty single-rooted teeth were randomly assigned to six groups of 10 teeth each. The six groups were arranged in three pairs, experimental and control groups. The canals of teeth in pairs 1 and 2 were cleaned, shaped, obturated, and their apical 2 mm were resected. A class I preparation was prepared and filled with amalgam in each tooth in pair 1. The apical 2 mm of each tooth in pair 3 was removed, and a class I preparation was prepared and filled with amalgam. The apical surface of resected roots in half of the samples in each pair was lased twice by using Nd:YAG laser. The duration of lasing and the number of pulses were recorded for each tooth. After application of nail polish to the unoperated surface of each tooth, the teeth were placed in 0.5% methylene blue dye for 48 h. The amount of dye penetration in sagittal sections of each tooth was measured. The amount of dye penetration was significantly lower in lased roots than in nonlased ones (p < 0.05). Based on our results, it appears that application of Nd:YAG laser reduces the permeability of resected roots.

Analysis of Variance↗

Effect of endodontic smear layer and various solvents on the calcium ion diffusion through radicular dentin--an in vitro study.

External root resorption and ankylosis remains the major cause of failure of replanted teeth. This study was conducted to explore the different ways to increase the pH of periradicular area in order to overcome the problem of root resorption and ankylosis. 60 freshly extracted permanent anteriors were used after removing the crown at CEJ. After biomechanical preparation Ca (OH)2 was injected and assays were done using EDTA, Citric and tannic acid Assays were repeated. Calcium diffusion and pH in the root exterior was measured using spectrophotometer. Results showed that dentin is permeable to calcium & hydroxyl ions and placement of Ca (OH)2 in the canal resulted in its increased recovery and alkaline pH periradicularly. Smear layer removal did not result in significant increase in Ca++ recovery or alkaline pH however combination of EDTA & NaOCl was found best than the other two.

Calcium↗

An experimental technique to repair cracked teeth using calcium phosphate, melted by a laser beam: an in vitro evaluation.

Using a neodymium: yttrium-aluminum-garnet laser beam to seal vertical root fracture lines with tricalcium phosphate paste represents an alternative treatment for cracked teeth with noted clinical results. This article describes a study of the permeability of molten crystals of hydroxyapatite in the dentin of a cracked root after crack lines have been filled with a preparation of tricalcium phosphate melted by a neodymium: yttrium-aluminum-garnet laser beam. The morphology of the sealed cracks was analyzed under a scanning electron microscope that showed a deep fusion of tricalcium phosphate along crack lines.

Calcium Phosphates↗

Scanning electron microscopy (SEM) and optical microscopy: effects of Er:YAG and Nd:YAG lasers on apical seals after apicoectomy and retrofill.

OBJECTIVE: This study evaluated the dentinal and marginal permeability of the cut surface after apicoectomy, treatment and retrocavity preparation with Er:YAG and Nd:YAG lasers. Furthermore, scanning electron microscopy (SEM) analysed the morphological alteration of dentin caused by laser irradiation through an optical fiber. BACKGROUND DATA: Numerous studies have shown the beneficial effects of laser treatment upon sealing dental apex, avoiding the changes of organic fluids, microorganisms and their by-products between the root canal system and periapex. MATERIALS AND METHODS: Twenty-four extracted and endodontically treated teeth were divided into three groups: GI, apices were resected with Er:YAG laser (350 mJ; 4 Hz) treatment of cut dentinal surface and retrocavity were lased with this same laser (120 mJ; 4 Hz; bur 2051) using the optical fiber 50/10; GII, apicoectomy was performed similar to GI, however the cut dentinal surface was treated with Nd:YAG laser through optical fiber, as well as the retrocavity preparation (100 mJ; 15 Hz; 1.5 W); and GIII (control group), high speed burs were used. RESULTS: Analysis of methylene blue dye penetration into dentin demonstrated that the specimens of the groups irradiated with laser showed to have lower infiltration indices than the control group. These results were compatible with structural and morphological injuries, evidenced by SEM. CONCLUSION: Under the conditions of the present study, apicoectomy using Er:YAG laser, followed by dentinal surface irradiation and retrocavity preparation with Nd:YAG laser, showed to be an alternative clinical tool able to reduce the dentinal permeability.

Humans↗

Permeability, morphologic and temperature changes of canal dentine walls induced by Nd: YAG, CO2 and argon lasers.

The permeability, temperature and morphologic changes of the wall of the root canal induced by Nd:YAG, CO2 and argon lasers were studied. The changes were evaluated according to the presence or absence of a smear layer. Root canals of 140 human single-rooted teeth were enlarged using a step-back technique. Permeability was evaluated by the extent of methylene blue dye penetration into the tubules. Temperature changes were measured using a thermovision system, and morphological changes were evaluated by scanning electron microscopy. Laser energy was delivered into the canal by means of a flexible optical fibre or metal tip. There were statistically significant differences in permeability between lased groups with and without a smear layer in the cervical third of the root canal following lasing. In the middle third of the root canal, all three laser types induced permeability increases in groups with a smear layer. In the apical third, statistically significantly decreases in permeability were observed among CO2 laser and Nd:YAG compared with control group (P < 0.01). Rises in temperature ranged from a minimum of +10.1 degrees C (CO2 laser) to a maximum of +54.8 degrees C (argon laser). All three laser devices appeared capable of producing a glazed-like surface and craters.

Analysis of Variance↗

Defense responses of dentin/pulp complex to experimentally induced caries in rat molars: an immunohistochemical study on kinetics of pulpal Ia antigen-expressing cells and macrophages.

Experimental caries was induced in rats that were inoculated orally with Streptococcus mutants and maintained on a cariogenic diet. During the caries process, kinetics of the pulpal la antigen-expressing cells and macrophages was monitored immunohistochemically and was correlated with caries depth and the status of reparative dentin formation. Initial pulpal response was characterized by a localized accumulation of la antigen-expressing cells beneath the dentinal tubules communicating with the superficial caries. This was followed by a caries-depth related increase of la antigen-expressing cells and macrophages in the coronal pulp. The accumulation of these cells under the dentin was most apparent when the caries had progressed into the reparative dentin. These findings suggest that the response of la antigen-expressing cells to carious irritants triggers the defense reactions of the pulp. The intensity of the defense reactions may be correlated with the permeability of carious dentin.

Animals↗

The morphology and stability of resin-modified glass-ionomer adhesive at the dentin/resin-based composite interface.

PURPOSE: To evaluate the interface with tooth structure, mode of failure and stability of Fuji Bond LC (FBLC) resin-modified glass-ionomer bonding system. MATERIALS AND METHODS: The study was in three main parts. The first part with interfacial characteristics of FBLC. The micropermeability of the FBLC/dentin interface of restored cavities in extracted teeth, after fluorescent dye was introduced into the pulp chamber, was assessed by confocal microscopy. In other teeth, confocal microscopy was also used to examine trhe failure of FBLC bonded to flat dentin surfaces, on shear loading. In the second part, cervical cavities restored with FBLC (with and without light-curing) and a resin-based composite were examined for stability of the interface over the first 15 minutes. In the last part of the study, a new fluorescent dye was mixed with FBLC for restoration of cavities and subsequent examination using 2-photon imaging techniques. RESULTS: FBLC adapted well to tooth structure, had an interface with dentin that was permeable to fluid and displayed the absorption layer. Shear loading at the dentin interface resulted in complex failure with areas of cohesive failure where the absorption layer was present. Light-curing of FBLC seemed to produce a stable restorative while "co-curing" resulted in an unstable situation, with the appearance of an emmisable exudate from the FBLC. Advanced fluorescent imaging of the material itself seemed to suggest that there was a movement of aluminum ions in a manner similar to other glass-ionomer cements. The presence of HEMA in the matrix of the cement associated with the absorption layer was also demonstrated.

Absorption↗

The ultrastructure of copper amalgam-covered dentin from human deciduous teeth.

The structure of dentin subjacent to Cu-amalgam restorations was studied. The restorations had been inserted 7-8 years before extraction of the teeth. No lining had been applied. The dentin subjacent to the restorations had a greenish-grayish discoloration, and in the pulpal end irregular secondary dentin had formed. Energy-dispersive X-ray microanalysis of areas showing discoloration confirmed the presence of Cu. Semithin and ultrathin undemineralized sections were studied. Vital pulp tissue and irregular secondary dentin were observed. Close to the predentin and halfway into the dentin most of the dentinal tubules were occluded. In the control material only an occasional occluded tubule was seen. Close to the Cu-amalgam restoration some tubules were occluded or partly occluded, and some were open. The odontoblasts had responded to the irritating agent by obturation of the tubules, thus reducing the permeability of the dentin. Furthermore, irregular secondary dentin had formed in another attempt to wall off the irritating agent.

Child↗

Influence of dentinal polyelectrolytes on wet demineralized dentin, a bonding substrate.

The objective of this study was to show the influence of dissolved dentinal polyelectrolytes on the characteristics of dentin (bonding substrate) demineralized by citric acid in the absence or presence of ferric chloride. The demineralizing agent was an aqueous mixture of 0, 1, 3, or 10% ferric chloride in 10% citric acid (10-0, 10-1, 10-3, 10-10, respectively). The hypothesis was that the concentration of dissolved dentinal noncollagenous substances, mainly polyelectrolytes soluble in water, must be decreased by their aggregation with ferric ions, which changes the characteristics of demineralized dentin, the rates of demineralization, and dehydration. Cervical bovine dentin was prepared in 3 x 2 x 2-mm blocks, each weighing 20.0 +/- 0.5 mg. The rate of demineralization was investigated by measuring the weight loss resulting from demineralization by immersion in 10 mL of conditioner at 2-h intervals. The dehydration rate of wet demineralized dentin was determined using two methods: (1) weight loss in a desiccator under 263 Pa pressure and (2) differential scanning calorimetry (DSC). Twenty, 12, 8, and 4 h were required to complete demineralization of the blocks with the 10-0, 10-1, 10-3, and 10-10 solutions, respectively. The 10-10 wet demineralized dentin showed the highest rate of dehydration, followed in descending order by the 10-3, 10-1, and 10-0 specimens. Ferric chloride in dentin conditioners provided both a higher rate of dentin demineralization and a higher dehydration rate of wet demineralized dentin. These results suggest that in the presence of ferric chloride, a decreasing amount of dissolved polyelectrolytes aggregated with ferric ions in the substrates may increase the permeability of dentin to water and citric acid. Improvement of monomer permeability is essential to the preparation of good hybridized dentin, providing a more stable and reliable bonding and also protecting the dentin and pulp from infection. A further study of bonding substrates is required in order to understand the role of hybridized dentin in improved dental treatment.

Animals↗

Current concepts on adhesion to dentin.

This review examines fundamental concepts in bonding to dentin. Emphasis is placed on the structure and permeability characteristics of dentin and how they may influence its interaction with adhesive resin. Several new techniques to examine the interfaces between resin and dentin are reviewed along with some of their limitations. The advantages and disadvantages of acid etchants/conditioners vs. self-etching conditioners/primers are discussed. The problems of matching the surface tension of resin-bonding systems to the surface energy of the substrate are reviewed in terms of wetting the various components of dentin. The problems associated with matching the permeability of intertubular dentin to the diffusibility of bonding reagents are explored. Speculation is advanced on how to ensure polymerization and wetting of dentinal collagen. Theoretical problems associated with dentin bonding and with bond testing are reviewed to encourage future research in this rapidly developing area.

Adhesives↗

Adhesive permeability affects composite coupling to dentin treated with a self-etch adhesive.

Dentin bonded with one-step self-etch adhesives does not couple well to chemically-cured composites despite the presence of ternary catalysts in some systems. To determine whether additional factors are responsible for the poor coupling of dentin bonded with these adhesives, the authors used a one-step self-adhesive in which the ternary catalyst is incorporated separately in the brush applicator for activating the adhesive. The activated adhesive was bonded to dentin or prepolymerized composites. For microtensile bond strength evaluation, a dual-cured hybrid composite was used for coupling to the bonded substrates and activated using: (1) the light-cured mode (LC), (2) delayed light-activation (DL) and (3) the chemical-cured mode (CC). In addition, the composite polymerized in the CC mode was coupled to the two substrates bonded with (4) additional experimental adhesive versions without the ternary catalyst and (5) without the ternary catalyst and tertiary amine. Silver tracer penetration into bonded interfaces was examined using TEM by replacing the dual-cured composite with a light-cured or a chemically-cured microfilled composite. In the CC mode, the composites coupled poorly to both substrates bonded with the unactivated adhesive (5). The use of activated adhesives allowed for good coupling of the composites polymerized in all curing modes to bonded composite, but only in the LC mode to bonded dentin. Water-filled channels in the form of water trees and water blisters were present in the adhesive layer under all composite-curing modes in bonded dentin. These features were completely absent in the bonded composites, showing that the source of the water was from dentin. Water blisters were also observed along the adhesive-composite interfaces in bonded dentin when the coupling composites were polymerized using the CC or DL modes.

Adhesives↗

A permeability barrier to lanthanum and the presence of collagen between odontoblasts in pig molars.

Previous experiments in rat incisors indicate that the odontoblasts form an impermeable barrier which prevents fluid movement between pulp and dentine. The permeability of the odontoblast layer has now been investigated in pig molars which are more analogous to human teeth. The heads and necks of anesthetised piglets were perfused intra-arterially with lanthanum nitrate in Ringer's solution or with Ringer's solution alone. Molar tooth germs were removed, sliced, fixed by immersion and embedded in resin. Ultrathin sections including pulp and dentine were examined by transmission electron microscopy. Fenestrated capillaries were permeable to the electron dense lanthanum which thus entered the extracellular space between the odontoblast cell bodies. The lanthanum was excluded from predentine indicating that a barrier to permeability is present. In the above specimens and in others from 2 animals which were fixed by perfusion fixation, longitudinally oriented bundles of collagen fibrils were found passing from dentine through predentine into the odontoblast layer. Longitudinal collagen was also present between odontoblast cell bodies and entering the pulp at their basal ends. This suggests that classical von Korff fibres are present during primary circumpulpal dentinogenesis. In some sections longitudinally oriented collagen was absent. The junctions showed features of classical tight junctions but open tight junctions containing longitudinal collagen were also observed, suggesting that the junctions may modulate. Despite a trace of evidence that lanthanum can leak through adjacent to longitudinally penetrating collagen we concluded that the biological permeability barrier is maintained. The presence of the barrier indicates that other than the longitudinal collagen fibrils of which the source is unknown, all molecules incorporated into dentine are deposited there by the odontoblasts. An advantage of the barrier may be that it provides a closed environment for the orderly process of matrix deposition and mineralisation of dentine.

Animals↗

Self-etching adhesives: review of adhesion to tooth structure part II.

UNLABELLED: Self-etching adhesives are steadily increasing in popularity among dental practitioners with their easy handling technique and their promise of no post-op sensitivity. As with any new bonding material, in vitro and in vivo investigations are required to assess the clinical efficacy of these systems. OBJECTIVES: The current literature was reviewed to provide information on these systems, including the influence of their acidity and permeability on the quality of the bond, the role of water in long-term degradation of the bond in in vivo and in vitro studies, and the clinical efficacy of the self-etching adhesives in clinical research studies. DATA SOURCES: Published abstracts, reviews, laboratory reports and clinical research papers in the dental literature. CONCLUSIONS: Very little information is available on self-etching systems pertaining to the long-term in vitro and in vivo durability of their bond and their medium- to long-term clinical outcome. Although post-op sensitivity seems to be something of the past, short-term clinical studies show that some self-etching adhesives do not perform as well as total-etch systems.

Acid Etching, Dental↗

Conversion of one-step to two-step self-etch adhesives for improved efficacy and extended application.

PURPOSE: One-step self-etch adhesives have restricted use due to their acid-base incompatibility with autocured composites and their behavior as permeable membranes after polymerization. This study examined the feasibility of their conversion to two-step self-etch adhesives via the adjunctive use of a non-solvented, relatively hydrophobic resin coating. METHODS: iBond, Xeno III and Adper Prompt were used either in multiple coats, or in a single coat followed by the use of a layer of Scotchbond Multi-Purpose Plus bond resin for coupling to light- and auto-cured composites. Four types of experiments were performed. Bonded specimens were examined with TEM after immersion in an ammoniacal silver nitrate tracer. Fluid flow measurements of iBond were conducted using the two application protocols to compare the permeability of the bonded dentin with the original smear layer. Permeability of vital dentin bonded with both application protocols were compared for the transudation of dentin fluid across the bonded dentin. Microtensile bond strengths of dentin bonded with the two protocols were examined for their compatibility with an auto-cured composite. RESULTS: The results of the four experiments were complementary. iBond and Xeno III exhibited "apparent incompatibility" to auto-cured composites that resulted from their inherent permeability. This was confirmed by the presence of dentin fluid transudate on the adhesive surfaces when they were bonded to vital dentin. Conversely, Adper Prompt exhibited "true incompatibility" to auto-cured composites that was caused by adverse acid-base interaction, masking the inherent permeability of this adhesive. "True" and "apparent" incompatibility issues were eliminated upon their conversion to two-step self-etch adhesives.

Bisphenol A-Glycidyl Methacrylate↗

Measurement of the permeability of dental enamel and its variation with depth using an electrochemical method.

To investigate the permeability of the dental enamel of erupted and unerupted human pre-molars and its variation with depth, we determined the resistivity of successive 100-micron-thick layers. The electrical resistance of halved tooth crowns at zero Hertz, which according to Scholberg et al. (1982, 1984) is inversely related to the permeability, was measured before and after removal of successive enamel layers from the outer surface toward the dentino-enamel junction (D.E.J.). The resistivity of the successive enamel layers increased from the D.E.J. toward the outer surface in approximately the same way in erupted as well as in unerupted pre-molars, except within the outermost layer of 100 to 200 microns thickness. The resistivity of this layer in erupted pre-molars was considerably higher than that in unerupted pre-molars, which may be due to post-eruptive mineralization.

Adolescent↗

The effect of 25% tannic acid on prepared dentin: a scanning electron microscope-methylene blue dye study.

The effect on the permeability of prepared dentin treated with 25% tannic acid and 6% citric acid was compared with the untreated dentinal surface. Methylene blue was applied to the dentin surface after treatment to evaluate penetration into dentinal tubules. The tannic acid solution reduced or prevented dye penetration of the dentinal tubules. Citric acid treatment permitted severe penetration. The 25% tannic acid solution removed the smear layer while inhibiting penetration of the dye.

Acid Etching, Dental↗