Colour improvement and stability of white spot lesions following infiltration, micro-abrasion, or fluoride treatments in vitro

SUMMARYBACKGROUND/OBJECTIVES: White spot lesions (WSLs) are unwelcome side effects of fixed appliances that compromise the treatment outcome. Recently, infiltration of WSLs has been introduced as a viable treatment alternative. The objective was to evaluate the colour improvement of WSLs and their stability against discolouration following infiltration, fluoride, or micro-abrasion treatments in vitro. MATERIALS/METHODS: Artificial WSLs were created in bovine enamel (N = 96) using acidic buffer solution (pH 5, 10 days) and were randomly allocated to four groups. Specimens were treated with infiltration (Icon, DMG), fluoride (Elmex Caries Protection, GABA), and micro-abrasion (Opalustre, Ultradent) or remained untreated (control). Groups were discoloured for 24 hours in tea or tea + citric acid. Colour components and visible colour change (L*, a*, b*, ΔE) were measured spectrophotometrically on following time points: baseline, after WSL formation, after treatment, and during discolouration (8, 16, and 24 hours). Data were analysed using Kruskal-Wallis and Mann-Whitney tests. RESULTS: WSL formation increased (L*) in all groups. Only infiltration reduced this effect to baseline. Highest ΔE improvement was obtained by infiltration and micro-abrasion followed by fluoride. This improvement was stable only for infiltration during discolouration. L*, a*, and b* changed significantly during discolouration in all groups except infiltration. Within the same treatment group, discolouration solutions did not differ significantly. LIMITATIONS: In vitro testing cannot replicate the actual mode of colour improvement or stability but can be used for ranking materials and techniques. CONCLUSIONS/IMPLICATIONS: Infiltration and micro-abrasion treatments were capable of diminishing the whitish appearance of WSLs. Only infiltrated WSLs were stable following discolouration challeng

A new method for chlorhexidine (CHX) determination: CHX release after application of differently concentrated CHX-containing preparations on artificial fissures

Aims of the study were (1) to establish a method for quantification of chlorhexidine (CHX) in small volumes and (2) to determine CHX release from differently concentrated CHX-containing preparations, varnishes, and a CHX gel applied on artificial fissures. CHX determination was conducted in a microplate reader using polystyrene wells. The reduced intensity of fluorescence of the microplates was used for CHX quantification. For verification of the technique, intra- and inter-assay coefficients of variation were calculated for graded series of CHX concentrations, and the lower limit of quantification (LLOQ) was determined. Additionally, artificial fissures were prepared in 50 bovine enamel samples, divided into five groups (A-E, n = 10) and stored in distilled water (7days); A: CHX-varnish EC40; B: CHX-varnish Cervitec; C: CHX-gel Chlorhexamed; D: negative control, no CHX application; and E: CXH-diacetate standard (E1, n = 5) or CHX-digluconate (E2, n = 5) in the solution. The specimens were brushed daily, and CHX in the solution was measured. The method showed intra- and inter-assay coefficients of variation of <10 and <20%, respectively; LLOQ was 0.91-1.22nmol/well. The cumulative CHX release (mean ± SD) during the 7days was: EC40 (217.2 ± 41.8nmol), CHX-gel (31.3 ± 8.5nmol), Cervitec (18.6 ± 1.7nmol). Groups A-C revealed a significantly higher CHX release than group D and a continuous CHX-release with the highest increase from day0 to 7 for EC40 and the lowest for Chlorhexamed. The new method is a reliable tool to quantify CHX in small volumes. Both tested varnishes demonstrate prolonged and higher CHX release from artificial fissures than the CHX-gel teste

Effect of Caries Infiltrant on Margin Integrity of Composite Fillings Placed Adjacent to Demineralised Primary Enamel

PURPOSE To investigate the influence of pretreating demineralised enamel with an infiltrant on the margin integrity of Class V like composite restorations on primary teeth bonded with different adhesives. MATERIALS AND METHODS Forty specimens from primary molars were demineralised and circular class-V-like cavities were prepared. The cavities were treated with a universal adhesive (Scotchbond Universal Adhesive, 3M Oral Care), applied either in self-etch (SE) or etch-and-rinse mode (ER) mode. In groups SE-I and ER-I, the demineralised margins were pretreated with a caries infiltrant (Icon, DMG) prior to adhesive application. The cavities were restored with a nanofilled composite material and thermocycled. Marginal integrity was evaluated using SEM, and the percentage of continuous margin was statistically analysed. RESULTS Specimens treated with the caries infiltrant followed by the adhesive showed similar marginal continuity as the adhesive alone. CONCLUSIONS Pretreatment of demineralised primary enamel with a caries infiltrant before applying a universal adhesive does not influence the marginal integrity of composite fillings

Systematic evaluation of the features influencing the accuracy of third order measurements

The aims of this study were to evaluate the relationship of third order measurements on dental casts with those on lateral radiographs, and to identify those incisor features on radiographs which can best explain third order measurements on dental casts. Lateral cephalograms and corresponding dental casts were obtained from 39 untreated Caucasians (12 males, 27 females; mean age 19.5 years; standard deviation 3.7 years) with occlusal relationships considered to be ‘normal'. The upper (U1) and lower (L1) incisors were assessed with reference to the occlusal plane perpendicular which was established on the lateral radiographs, including third order angles (U1TR, L1TR) which were also derived from direct dental cast measurements (U1TA, L1TA). Both single regression and multiple linear regression analysis with stepwise variable selection were performed using third order measurements on casts as the dependent variable and crown axis (U1C, L1C), root axis (U1R, L1R), tip-apex connecting line (U1E, L1E), and radiographic third order measurements as independent variables. Single regression analysis indicated an overall difference of 0.02 degrees between radiographic third order inclination and cast assessment in the maxilla (mandible: −2.83 degrees). A change of 1 degree in radiographic third order inclination would produce a change of 0.65 degrees for U1TA and 0.86 degrees for L1TA assessments. Third order measurements on dental casts can best be explained by a linear combination of U1TR and U1E (maxilla) and of L1TR and L1C (mandible) measurements. This study demonstrates the functional enmeshment between two different third order assessments and the most common incisor features on lateral radiographs. Both methods of third order evaluation show sufficient reliability and are appropriate for routine orthodontic practic

In vitro evaluation of the erosive potential of viscosity-modified soft acidic drinks on enamel

Objective: The objective of this in vitro study was to investigate the effect of viscosity-modified soft acidic drinks on enamel erosion. Materials and methods: A total of 108 bovine enamel samples (∅ = 3mm) were embedded in acrylic resin and allocated into six groups (n = 18). Soft acidic drinks (orange juice, Coca-Cola, Sprite) were used both in their regular forms and at a kinetic viscositiy of 5mm2/s, which was adjusted by adding hydroxypropyl cellulose. All solutions were pumped over the enamel surface from a reservoir with a drop rate of 3ml/min. Each specimen was eroded for 10min at 20°C. Erosion of enamel surfaces was measured using profilometry. Data were analyzed using independent t tests and one-way ANOVAs (p < 0.05). Results: Enamel loss was significantly higher for the regular (Coca-Cola, 5.60 ± 1.04μm; Sprite, 5.49 ± 0.94μm; orange juice, 1.35 ± 0.4μm) than for the viscosity-modified drinks (Coca-Cola, 4.90 ± 0.34μm; Sprite, 4.46 ± 0.39μm; orange juice, 1.10 ± 0.22μm). Conclusion: For both regular and viscosity-modified forms, Coca-Cola and Sprite caused higher enamel loss than orange juice. Increasing the viscosity of acidic soft drinks to 5mm2/s reduced enamel erosion by 12.6-18.7%. Clinical relevance: The erosive potential of soft acidic drinks is not only dependent on various chemical properties but also on the viscosity of the acidic solution and can be reduced by viscosity modification

A new method for chlorhexidine (CHX) determination: CHX release after application of differently concentrated CHX-containing preparations on artificial fissures

Aims of the study were (1) to establish a method for quantification of chlorhexidine (CHX) in small volumes and (2) to determine CHX release from differently concentrated CHX-containing preparations, varnishes, and a CHX gel applied on artificial fissures. CHX determination was conducted in a microplate reader using polystyrene wells. The reduced intensity of fluorescence of the microplates was used for CHX quantification. For verification of the technique, intra- and inter-assay coefficients of variation were calculated for graded series of CHX concentrations, and the lower limit of quantification (LLOQ) was determined. Additionally, artificial fissures were prepared in 50 bovine enamel samples, divided into five groups (A–E, n = 10) and stored in distilled water (7 days); A: CHX-varnish EC40; B: CHX-varnish Cervitec; C: CHX-gel Chlorhexamed; D: negative control, no CHX application; and E: CXH-diacetate standard (E1, n = 5) or CHX-digluconate (E2, n = 5) in the solution. The specimens were brushed daily, and CHX in the solution was measured. The method showed intra- and inter-assay coefficients of variation of <10 and <20%, respectively; LLOQ was 0.91–1.22 nmol/well. The cumulative CHX release (mean ± SD) during the 7 days was: EC40 (217.2 ± 41.8 nmol), CHX-gel (31.3 ± 8.5 nmol), Cervitec (18.6 ± 1.7 nmol). Groups A–C revealed a significantly higher CHX release than group D and a continuous CHX-release with the highest increase from day 0 to 7 for EC40 and the lowest for Chlorhexamed. The new method is a reliable tool to quantify CHX in small volumes. Both tested varnishes demonstrate prolonged and higher CHX release from artificial fissures than the CHX-gel tested

Influence of lateral cephalometric radiographs on extraction decision in skeletal class I patients

BACKGROUND: Radiographic examination is considered 'justified' only when detection of a condition that would change the mechanisms and timing of treatment is possible. Radiographic safety guidelines have restricted the indication of lateral cephalometric radiographs (LCRs) to presence of distinct skeletal Class II or Class III. However, they are taken routinely in clinical practice and considered to be part of the 'gold' standard for orthodontic diagnosis. Therefore, the aim of this study was to test the null hypothesis that lateral cephalometric radiograph (LCR) evaluation would not alter the extraction / non-extraction decision in orthodontic treatment planning of skeletal Class I patients.Materials and methods: Intraoral and extraoral photographs, dental casts and extraoral radiographs of 60 skeletal Class I patients were prepared digitally for assessment using a presentation software. One experienced (EO) and inexperienced orthodontist (IO) was asked to decide on extraction or non-extraction on a Likert-type linear scale for treatment planning. This procedure was repeated 4 weeks later with a mixed order of patients and the LCRs being omitted. Kappa, Weighted Kappa (WK) and McNemar scores were computed to test decision consistency and Bland-Altman plots together with 95% limits of agreement were used to determine measurement accuracy and presence of systematic bias. RESULTS: Both EO (WK = 0.67) and IO (WK = 0.64) had good level of decision agreement with and without LCR evaluation. EO did not present a shift towards extraction nor non-extraction with LCR evaluation (McNemar = 0.999) whereas IO showed a tendency to extraction (McNemar = 0.07) with LCR data. Including LCR evaluation created a systematic inconsistency between EO and IO (Line of equality = 0.8, Confidence interval = 0.307-0.707). CONCLUSIONS: Lateral cephalometric radiograph evaluation did not influence the extraction decision in treatment planning of skeletal Class I patients. Reconsidering the necessity of lateral cephalograms in orthodontic treatment of skeletal Class I patients may reduce the amount of ionizing radiation. Key words: Lateral cephalometric radiograph, extraction, treatment planning, skeletal Class I

Influence of Lateral Cephalometric Radiography on Treatment Planning and Preferences in Skeletal Open-Bite Patients: Do Lateral Cephalograms Influence Treatment Planning?

WOS: 000439324700001PubMed ID: 30112480Objective: To investigate the influence of diagnostic data derived from lateral cephalometric radiographs (LCR) on treatment preferences of specialists planning skeletal open-bite treatment. Methods: Diagnostic records of 25 patients who had been treated at the University of Zurich, Department of Orthodontics, between 1988 and 2007 comprised the study material. Inclusion criteria were 1) skeletal open-bite with no marked antero-posterior discrepancy, 2) dental open-bite, and 3) crowding less than 5 mm. Records consisted of extra-intraoral photographs, panoramic-cephalometric X-rays, casts, and results of analyses. Records, with cephalograms of randomly chosen patients removed, were digitally presented to two orthodontists (A and B), and treatment preferences were asked using Likert-type questionnaires. Three months later, the same records were redelivered with missing cephalograms provided and present cephalograms removed with the questionnaire. Data were evaluated for consistency and tendency to extract using Kappa-kappa and McNemar tests. Results: Orthodontist B had no poor-agreement scores, whereas orthodontist A presented very-poor agreement for headgear use. Both A (kappa=0.833) and B (kappa=0.737) had good to very-good agreement in terms of extraction decisions. Neither orthodontist had any significant tendency for extraction/non-extraction therapy (A=0.99; B=0.5). Conclusion: Information deduced from LCRs had limited influence on treatment planning preferences in skeletal/dental open-bite patients with no marked antero-posterior discrepancy and no influence on extraction/non-extraction decision.University of ZurichThis study was supported by the University of Zurich

Margin integrity of conservative composite restorations after resin infiltration of demineralized enamel

PURPOSE: To investigate the influence of pretreating demineralized enamel with a caries infiltrant on the margin integrity of Class V composite restorations bonded with different adhesives. MATERIALS AND METHODS: A total of 60 specimens from bovine incisors were demineralized (21 days, acid buffer, pH 4.95) to create artificial enamel lesions, and circular Class V cavities were prepared. Cavities of half of the specimens were treated with either an unfilled etch-and-rinse adhesive (Syntac Classic; Ivoclar Vivadent), a filled etchand- rinse adhesive (Optibond FL; Kerr), or a self-etch adhesive (iBond Self Etch; Heraeus Kulzer) (n = 10 per group). Demineralized enamel of the other half of the specimens was pretreated with a caries infiltrant (Icon; DMG) prior to adhesive application. All cavities were restored with a nanofilled composite material and thermocycled (5000×, 5°C-55°C). Margin integrity was evaluated using scanning electron microscopy, and the percentage of continuous margin was statistically analyzed (p < 0.05). RESULTS: The significantly highest margin integrity was observed for Optibond FL, whether or not demineralized enamel was pretreated with the infiltrant. Pretreatment of demineralized enamel with the infiltrant resulted in a significant increase in margin integrity when the unfilled etch-and-rinse adhesive (Syntac Classic) or the self-etch adhesive (iBond Self Etch) was subsequently applied, but showed no significant improvement in combination with the filled etch-and-rinse adhesive (Optibond FL). CONCLUSION: Application of a caries infiltrant can improve margin integrity of composite fillings in demineralized enamel when used in combination with the examined self-etch and unfilled adhesives

Advanced transversal microradiography enables single section demineralization experiments

Transversal Microradiography (TMR) is a method for quantifying the mineral density in enamel carious lesions. In the traditional procedure, X-ray images of 100 µm thin tooth sections are compared, whereby the grinding of the samples can produce undefined artefacts at the demineralized areas. In this study, the replacement of the usual aluminium step wedge by a continuous hydroxyapatite (HAp) wedge with an extended measuring range was validated, whereby, the mineral density of sections with >500 µm thickness could be quantified reproducibly. This enabled experiments with the single section technique: the sections were made from sound teeth and X-rayed immediately. After each experimental phase, a further image was taken, so that the changes in the mineral density of an object could be normalised to its baseline image at the end of the experiment. The results of the analysis with the traditional reference area differed significantly from the single-section analysis (p < 0.03; n = 8)