Effects of Dentifrices Differing in Fluoride Content on Remineralization Characteristics of Dentin in vitro

Objectives: The aim of this study was to compare the caries preventive effect of highly fluoridated dentifrices and gels on sound dentin as well as on artificial dentin caries-like lesions. Methods: Bovine dentin specimens (n = 240), with 2 different surfaces each (1 sound surface [sound treatment (ST)] and one caries lesion [demineralized treatment (DT)]), were prepared and randomly allocated to one highly (6 × 120 min demineralization/day [H]) and one lowly cariogenic (6 × 60 min demineralization/day [L]) pH-cycling model. Treatments during pH-cycling (28 days) were: brushing 2×/ day with: 0 ppm F [H0/L0], 1,450 ppm F [H1,450/L1,450], 2,800 ppm F [H2,800/L2,800], 5,000 ppm F [H5,000/L5,000], 5,000 ppm F plus TCP [H5,000+TCP/L5,000+TCP], and 12,500 ppm F [H12,500/ L12,500] containing dentifrices/gels. Dentifrice/gel slurries were prepared with deionized water (1: 2 wt/wt). Differences in integrated mineral loss (ΔΔZ) and Δ lesion depth were calculated between values before and after pH-cycling using transversal microradiography. Results: The correlation between ΔΔZDT and F– was strong for the highly (rH = 0.691; p < 0.001) and moderate (rL = 0.500; p < 0.001) for the lowly cariogenic model, indicating a fluoride dose-response for both. Significant differences for ΔΔZDT and ΔΔZST could be found between H0, H1,450, H5,000, and H12,500 as well as L0, L5,000, and L125,000 (p ≤ 0.046; analysis of covariance [ANCOVA]). Except for 0 ppm F–, no significant difference in ΔΔZST and ΔΔZDT could be found between the highly and lowly cariogenic model (p ≥ 0.056; ANCOVA). Conclusion: For both pH-cycling conditions a dose-response for fluoride could be revealed. For elderly people with exposed root surfaces, the use of gels containing 12,500 ppm F instead of regularly (1,450 ppm F) or highly (5,000 ppm F) fluoridated dentifrices should be further investigated, as it offered higher cariespreventive effects in vitro

Randomized in situ evaluation of surface polishing protocols on the caries-protective effect of resin Infiltrant.

The aim of this placebo-controlled randomized in situ study was to evaluate the effect of different surface polishing protocols on enamel roughness, bacterial adhesion and caries-protective effect of a resin infiltrant. Seventy-five bovine enamel samples having artificial caries lesions were treated with a resinous infiltrant and afterwards randomly dividided into five polishing protocols: aluminum oxide flexible disks (Al2O3-Disks), silicon carbide tips (SIC-Tips), silicon carbide brush (SIC-Brush), silicon carbide polyester strips (SIC-Strips) or no polishing [negative control (NC)]. Average surface roughness (Ra) was assessed by profilometry. Samples were mounted in palatal appliances under a mesh for biofilm accumulation. Fifteen volunteers wore the intraoral appliances (14-days) and cariogenic challenge was triggered by sucrose solutions. Biofilm formed was collected for microbiological analysis of caries-related bacteria (Streptococcus mutans, Lactobacillus acidophilus) and demineralization was assessed by cross-sectional microhardness. Mean Knoop hardness numbers (Kg/mm2) were plotted over lesion depth (µm) and area under the lesion curve was subtracted from sound enamel to determine demineralization (ΔS, Kg/mm2xµm). Data were analyzed by ANOVA and post-hoc comparisons (α = 0.05). NC resulted in significantly higher Ra means than Al2O3-Disks and SIC-Strips. Bacterial counts were not significantly different between the groups (p > 0.05). Regards ΔS means, however none of the groups were significantly different to NC (6983.3 kg/mm2xµm /CI 4246.1-9720.5, p > 0.05). Conclusions: Polishing protocols (Al2O3-Disks, SIC-Strips) significantly decreseased roughness of infiltrated-enamel, however none of the polishing protocols could signicantly decrease bacterial counts nor resulted in significant less demineralization

Long-term costs of post-restorations: 7-year practice-based results from Germany.

OBJECTIVES We evaluated the initial and follow-up treatment costs of different post-restorations in a practice-based German healthcare setting. METHODS A total of 139 incisors, canines, or premolars received post-restorations placed by eight general dental practitioners in Germany, and were followed over a mean ± SD 7.1 ± 4.5 years. Preformed metal (MP, n = 68), glass-fiber (GF, n = 28), or cast post-and-core buildups (MC, n = 23) had been used to retain crowns or bridge anchors. Preformed metal and glass-fiber had also been used to retain directly built up post-retained composite restorations (PC, n = 20). Material and treatment costs for the initial post-restorations as well as restorative, endodontic, or surgical re-treatments were estimated from a public-payer-perspective in Germany. Associations between total and annualized total costs and covariates were assessed using generalized linear modeling. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00012938). RESULTS MC showed highest initial treatment costs (557.23 Euro), but the least re-treatments (6/23, 26%), while PC showed lowest initial costs (203.52 Euro) but the most re-treatments (11/20, 55%). Costs for MP/GF post-crowns were initially similarly costly (496.47/496.87 Euro), and both also showed similar re-treatments (35%/36%). The overall annual failure rate was 5.2% (MC: 3.5%, MP: 4.6%, GF: 5.3%, PC: 10.3%). Including costs for the resulting re-treatments, mean total costs were 591.66 Euro (MC), 548.31 Euro (MP), 526.37 Euro (GF), and 361.81 Euro (PC). Annualized total costs were 171.36 Euro (MC), 141.75 Euro (MP), 146.12 Euro (GF), and 135.65 Euro (PC). Total and annualized total costs were highest for MC, with PC being the significantly less costly option (p < 0.001). CONCLUSIONS Within German healthcare, both initial and follow-up costs for post-restorations were considerable. Saving costs initially may, at least partially, be offset by more complications long-term. CLINICAL RELEVANCE Dentists need to be aware that the placement of posts is not only initially costly but also comes with significant long-term costs for treating occurring complications. This should be communicated with patients and considered during treatment planning

Dentareport - Automated longevity and risk factor analysis in dental patient care.

BACKGROUND AND OBJECTIVE During routine patient care practitioners have to document several aspects. However, currently it is difficult to methodically analyze the longevity of therapeutic concepts in dental private practice. Thus, the aim of the present paper was to introduce a software (Dentareport) to compare the success of different treatment options and to identify risk factors for failures in dental patient care. METHODS Dentareport has a digital interface to automatically collect data of electronic patient files of practice management programs. By using computer-aided routines descriptive analyses of the treatments can be visualized. Dentareport also visually displays a bivariate risk factor analysis of treatment options. For this, crude associations between baseline characteristics (e.g. age) and time until failure (e.g. tooth loss) are calculated for the chosen treatment option by fitting separate models for each baseline characteristic as the independent variable. Furthermore, annual failure rates and survival graphs can be displayed. RESULTS The software has already been used to self-analyze treatment decisions. It highlighted the most long-lasting treatments for specific indications. Risk factors on practice-, patient- and tooth-level were easily identified. Furthermore, the software has been used to collect data for analysis of retrospective practice-based, mono-as well as multi-center observational studies. CONCLUSIONS By using Dentareport practitioners can easily and objectively self-analyze treatment successes and risk factors. Furthermore, for researchers the software easily generates huge data sets in different fields in dentistry and enables the analysis on a multi-center level. Most relevant factors can, thus, be taken into account for treatment decisions

Risk factors for failure in the management of cervical caries lesions

OBJECTIVES The aim of this retrospective, non-interventional clinical study was to analyze factors influencing the survival of restorative treatments of active cervical (root) caries lesions (aCCLs) and the success of non-invasive treatment options of inactive cervical (root) caries lesions (iCCLs). MATERIAL AND METHODS Records from patients who visited a single private practice regularly were searched for the presence of solely buccal CCLs. Data from 345 aCCLs and 232 iCCLs being detected at least 6 months before the last recall visit in 295 patients were recorded. Kaplan-Meier analyses were used to analyze time to failure in both groups. Cox proportional hazards models were used to evaluate the association between clinical factors and time until failure. RESULTS Within 120 months, 20 aCCLs had received a second restorative follow-up treatment. For iCCLs, 35 lesions had to be restored within 120 months. Median survival/success time was 111 months for aCCLs (annual failure rate 1.7%) and 120 months for iCCLs (annual "restoration" rate 4.3%). In multivariate Cox regression, active and inactive CCLs being checked up more than twice a year showed significantly higher failure/restoration rates than CCLs being checked up less than twice a year (p < 0.001). CONCLUSION Low failure/restoration rates could be found for both treatment strategies for CCLs, and only the "number of check-ups per year" was significantly positively associated with failures. CLINICAL RELEVANCE Caries monitoring is a viable way to manage CCLs. However, individual check-up interval should be defined carefully, since higher rate of check-ups seems to lead to increased intervention rates in the management of CCLs. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00010003)

Remineralizing efficacy of a CPP-ACP cream on enamel caries lesions in situ

The aim of this double-blind, randomized, cross-over in situ study was to compare the remineralizing effects induced by the application of casein phosphopeptide-stabilized amorphous calcium phosphate complexes (CPP-ACP)-containing cream (without fluoride) after the use of fluoride toothpaste with the prolonged use of fluoride toothpaste on enamel caries lesions in situ. During each of three experimental legs of 4 weeks, 13 participants wore intra-oral mandibular appliances with 8 pre-demineralized bovine enamel specimens in the vestibular flanges mimicking either &#39;easily cleanable&#39; or &#39;proximal&#39; surfaces (n = 312). The three randomly allocated treatments were as follows: (1) application of CPP-ACP-containing cream (GC Tooth Mouse, non-fluoride) after the use of fluoride toothpaste (1,400 ppm NaF; TM), (2) prolonged application of fluoride toothpaste (1,400 ppm NaF; positive control, PC) and (3) prolonged application of fluoride-free toothpaste (negative control, NC). Additionally, one of each of the two flanges was brushed twice daily with the respective toothpaste. The differences in integrated mineral loss as assessed by transversal microradiography were calculated between values before and after the in situ period. Changes in mineral loss were analysed for those pairs of subgroups differing in only one of the three factors (intervention, brushing and position). The PC treatment induced a significantly higher mineral gain compared with the TM and NC treatments. No significant differences between TM and NC for both positions were observed. In conclusion, the additional use of a CPP-ACP-containing cream seems to be less efficacious in remineralizing caries lesions than the prolonged application of fluoride toothpaste

Interradicular Root Canals in Mandibular First Molars: A Literature Review and Ex Vivo Study.

INTRODUCTION Successful endodontic treatment vastly depends to a high degree on an accurate knowledge of root canal system morphology. It is a prerequisite to be aware of all possible reservoirs where bacteria and/or toxins can persist, compromising the surrounding tissues; such knowledge results in endodontic success. METHODS The presence of interradicular canals and diverticula between the pulp chamber floor and the bifurcation area surface of 117 mandibular first molars was investigated. Access cavities were prepared, the teeth were embedded in plastic, and the pulp chambers were flooded with methylene blue and then centrifuged. An average of 4.2 (0.145 ± 0.03 mm thickness) slices per tooth were obtained by means of a diamond band saw. The presence of interradicular canals and diverticula was investigated using a light microscope (125×). RESULTS Interradicular canals were observed in 9 teeth. Seven teeth had 1 interradicular canal, and 2 teeth had 2 interradicular canals. Diverticula (blind interradicular canals) were observed in 11 teeth originating either on the pulp chamber floor or the bifurcation side. The number of diverticula per tooth varied between 1 and 5 and originated in 3 teeth in the pulp chamber floor and 8 teeth in the bifurcation area. Two teeth had both 1 interradicular canal and 3 diverticula. Of the 117 mandibular molars investigated, 18 had either 1 or 2 interradicular canals, 1 to 5 diverticula, or an interradicular canal and 3 diverticula. CONCLUSIONS Based on the results obtained with this ex vivo study and because of the difficulties involved in the clinical performance of mechanical cleaning of possibly existing interradicular canals, it is highly recommended to perform thorough chemical cleaning and disinfection of the pulp chamber floor area in order to enhance the sealing possibility of such structures and minimize treatment failure

Caries-Preventive Effect of NaF, NaF plus TCP, NaF plus CPP-ACP, and SDF Varnishes on Sound Dentin and Artificial Dentin Caries in vitro

The aim of this study was to compare the caries-preventive effect of different fluoride varnishes on sound dentin as well as on artificial dentin caries-like lesions. Bovine dentin specimens (n = 220) with one sound surface (ST) and one artificial caries lesion (DT) were prepared and randomly allocated to 11 groups. The interventions before pH cycling were as follows: application of a varnish containing NaF (22,600 ppm F-; Duraphat [NaF0/NaF1]), NaF plus tricalcium phosphate (22,600 ppm F-; Clinpro White Varnish Mint [TCP0/TCP1]), NaF plus casein phosphopeptide-stabilized amorphous calcium phosphate complexes (CPP-ACP; 22,600 ppm F-; MI Varnish [CPP0/CPP1]), or silver diamine fluoride (SDF; 35,400 ppm F-; Cariestop 30% [SDF0/SDF1]) and no intervention (NNB/N0/N1). During pH cycling (14 days, 6 × 120 min demineralization/day) half of the specimens in each group were brushed (10 s; 2 times/day) with either fluoride-free ("0"; e.g., TCP0) or 1,100 ppm F- ("1"; e.g., TCP1) dentifrice slurry. In another subgroup, the specimens were pH cycled but not brushed (NNB). Differences in integrated mineral loss (ΔΔZ), lesion depth (ΔLD), and colorimetric values (ΔΔE) were calculated between the values after initial demineralization and those after pH cycling, using transversal microradiography and photographic images. After pH cycling, no discoloration could be observed. Furthermore, NNB, N0, and N1 showed significantly increased ΔZDT/LDDT and ΔZST/LDST values, indicating further demineralization. In contrast, CPP0, CPP1, SDF0, and SDF1 showed significantly decreased ΔZDT/LDDT values, indicating remineralization (p ≤ 0.004; paired t test). CPP0, CPP1, SDF0, and SDF1 showed significantly higher changes in ΔΔZDT/ΔLDDT and ΔΔZST/ΔLDST than NNB, N0, and N1 (p < 0.001; Bonferroni post hoc test). In conclusion, under the conditions chosen, all fluoride varnishes prevented further demineralization. However, only NaF plus CPP-ACP and SDF could remineralize artificial dentin caries-like lesions under net-demineralizing conditions, thereby indicating that NaF plus CPP-ACP and SDF may be helpful to high-caries-risk patients

Effects of Dentifrices Differing in Fluoride Content on Remineralization Characteristics of Dentin in vitro

Objectives: The aim of this study was to compare the caries preventive effect of highly fluoridated dentifrices and gels on sound dentin as well as on artificial dentin caries-like lesions. Methods: Bovine dentin specimens (n = 240), with 2 different surfaces each (1 sound surface [sound treatment (ST)] and one caries lesion [demineralized treatment (DT)]), were prepared and randomly allocated to one highly (6 × 120 min demineralization/day [H]) and one lowly cariogenic (6 × 60 min demineralization/day [L]) pH-cycling model. Treatments during pH-cycling (28 days) were: brushing 2×/ day with: 0 ppm F [H0/L0], 1,450 ppm F [H1,450/L1,450], 2,800 ppm F [H2,800/L2,800], 5,000 ppm F [H5,000/L5,000], 5,000 ppm F plus TCP [H5,000+TCP/L5,000+TCP], and 12,500 ppm F [H12,500/ L12,500] containing dentifrices/gels. Dentifrice/gel slurries were prepared with deionized water (1: 2 wt/wt). Differences in integrated mineral loss (ΔΔZ) and Δ lesion depth were calculated between values before and after pH-cycling using transversal microradiography. Results: The correlation between ΔΔZDT and F– was strong for the highly (rH = 0.691; p < 0.001) and moderate (rL = 0.500; p < 0.001) for the lowly cariogenic model, indicating a fluoride dose-response for both. Significant differences for ΔΔZDT and ΔΔZST could be found between H0, H1,450, H5,000, and H12,500 as well as L0, L5,000, and L125,000 (p ≤ 0.046; analysis of covariance [ANCOVA]). Except for 0 ppm F–, no significant difference in ΔΔZST and ΔΔZDT could be found between the highly and lowly cariogenic model (p ≥ 0.056; ANCOVA). Conclusion: For both pH-cycling conditions a dose-response for fluoride could be revealed. For elderly people with exposed root surfaces, the use of gels containing 12,500 ppm F instead of regularly (1,450 ppm F) or highly (5,000 ppm F) fluoridated dentifrices should be further investigated, as it offered higher cariespreventive effects in vitro

Effects of Self-Assembling Peptide P11-4, Fluorides, and Caries Infiltration on Artificial Enamel Caries Lesions in vitro

The application of a self-assembling peptide on noncavitated caries lesions is supposed to be a feasible approach to facilitate remineralization and mask their unfavorable appearance. However, demineralizing conditions are common in the oral environment, so the aim of this pH-cycling study was to compare recommended and novel treatment methods regarding their ability to hamper demineralization and as a consequence mask artificial enamel caries lesions. Artificial caries lesions were prepared in bovine enamel and randomly allocated to 11 groups (n = 22). Treatments before pH-cycling were as follows: the application of a self-assembling peptide (Curodont™ Repair [C]), a low-viscosity resin (Icon® [I]), 2 fluoride solutions (10,000 ppm F-: Elmex fluid [E] and 43,350 ppm F-: Tiefenfluorid® [T]), and no intervention (N). During pH-cycling (28 days, 6 × 60 min demineralization/day) half of the specimens in each group were brushed (10 s; 2 ×/day) with either fluoride-free (named e.g., C0) or NaF (1,100 ppm F-; e.g., C1) dentifrice slurry. In another subgroup specimens were pH-cycled but not brushed (NNB). Differences in integrated mineral loss (ΔΔZ), lesion depth (ΔLD), and colorimetric values (ΔΔE) were calculated between values after pre-demineralization, surface treatment, and pH-cycling. Specimens of C0, C1, NNB, N0, N1, T0, and E0 showed significantly increased ΔZ and LD values after pH-cycling (p ≤ 0.003; paired t test). C0, C1, NNB, and N0 showed significantly higher changes in ΔΔZ than E1, I0, I1, and T1 (p < 0.001; ANOVA). Significantly reduced colorimetric values could only be observed for I1, I0, E1, and E0 after treatment and after pH-cycling (p ≤ 0.027; paired t test). In conclusion, under the conditions chosen only the application of a low-viscosity resin could mask caries lesions significantly, whereas self-assembling peptides could neither inhibit lesion progression nor mask the lesions considerably