International Journal of Clinical Pediatric Dentistry

Register      Login

VOLUME 13 , ISSUE S1 ( Supplement Issue, 2020 ) > List of Articles

Original Article

Comparative Evaluation of Microhardness and Enamel Solubility of Treated Surface Enamel with Resin Infiltrant, Fluoride Varnish, and Casein Phosphopeptide-amorphous Calcium Phosphate: An In Vitro Study

Steffi N Dhillon, Chirag Macwan, Aishwarya A Jain

Citation Information :

DOI: 10.5005/jp-journals-10005-1833

License: CC BY-NC 4.0

Published Online: 01-12-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Aim and objective: The aim and objective of this study was to do a comparative evaluation of microhardness and enamel solubility (ES) of the treated surface enamel with resin infiltrant, fluoride varnish, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). Materials and methods: An in vitro study was conducted on freshly extracted 85 sound permanent teeth of which 5 teeth were subjected to check for microhardness by the Vickers microhardness tester and the remaining teeth were exposed to demineralizing solution to create initial enamel lesions. These 80 teeth were assigned to four groups: group I—negative control (n = 20), group II—resin infiltrant (n = 20), group III—fluoride varnish (n = 20), and group IV—CPP-ACP (n = 20), and microhardness was checked after application. These teeth were exposed to caries attack three times a day for three consecutive days. The ES of these four groups was checked by calcium ion loss in the artificial cariogenic solution and whole saliva by an atomic absorption spectrophotometer. Results: It was found that none of the experimental groups reached the microhardness values of sound intact teeth. At 3rd day, the values of microhardness were: group II = group III > group IV > group I. Maximum ES was found for group I (control) followed with group IV. Conclusion: All agents used in study remineralized initial carious lesion. Fluoride varnish has the highest microhardness and showed least ES compared to other remineralizing agents. Clinical significance: Fluoride varnish can be regarded as the choice of material to be used for the treatment of incipient carious lesions because of the low application frequency (once every 3–6 months), requires minimal patient compliance as it is a noninvasive procedure and less time consuming.

PDF Share
  1. Pradeep K, Rao PK. Remineralizing agents in the non-invasive treatment of early carious lesions. Int J Dent Case Reports 2011;1:73–84.
  2. Petersen PE, Bourgeois D, Ogawa H, et al. The global burden of oral disease and risks to oral health. Bull World Health Organ 2005;83(9):661–669.
  3. Edelstein B. The dental caries pandemic and disparities problem. BMC Oral Health 2006;15(S1):S2. DOI: 10.1186/1472-6831-6-S1-S2.
  4. Sheiham A. Dental caries affects body weight, growth and quality of life in preschool children. Br Dent J 2006;25(10):625–626. DOI: 10.1038/sj.bdj.4814259.
  5. Kielbassa AM, Muller J, Gernhardt CR. Closing the gap between oral hygiene and minimally invasive dentistry: a review on the resin infiltration technique of incipient (proximal) enamel lesions. Quintessence Int 2009;40:663–681.
  6. Paris S, Meyer-Lueckel H, Coelfen H, et al. Resin infiltration of artificial enamel caries lesions with experimental light curing resins. Dent Mater J 2007;26(4):582–588. DOI: 10.4012/dmj.26.582.
  7. Ekstrand KR, Bakhshandeh A, Martignon S. Treatment of proximal superficial caries lesions on primary molar teeth with resin infiltration and fluoride varnish versus fluoride varnish only: efficacy after 1 year. Caries Res 2010;44(1):41–46. DOI: 10.1159/000275573.
  8. Martignon S, Ekstrand KR, Gomez J, et al. Infiltrating/sealing proximal caries lesions. J Dent Res 2012;91(3):288–292. DOI: 10.1177/0022034511435328.
  9. Meyer-Lueckel H, Bitter K, Paris S. Randomized controlled clinical trial on proximal caries infiltration: three-year follow-up. Caries Res 2012;46(6):544–548. DOI: 10.1159/000341807.
  10. Peter S. Fluorides in preventive dentistry. Essentials of preventive and community dentistry. 4th ed., New Delhi: Arya Medi Publishers; 2009.
  11. Castellano JB, Donly KJ. Potential remineralization of demineralized enamel after application of fluoride varnish. Am J Dent 2004;17:462–464.
  12. Lin R, Hildebrand T, Donly KJ. In vitro remineralization associated with a bioerodible fluoridated resin and a fluoride varnish. Am J Dent 2009;22:2035.
  13. Pulido MT, Wefel JS, Hernandez MM, et al. The inhibitory effect of MI paste, fluoride and a combination of both on the progression of artificial caries-like lesions in enamel. Oper Dent 2008;33(5):550–555. DOI: 10.2341/07-136.
  14. Reynolds EC. Anticariogenic casein phosphopeptides. Prot Peptide Lett 1999;6(5/6):295–303. DOI: 10.1023/A:1008920201914.
  15. Reynolds EC. Dairy components in oral health. Aus J Dairy Tech 2003;58:79–81.
  16. Shen P, Cai F, Nowicki A, et al. Remineralization of enamel subsurface lesions by sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate. J Dent Res 2001;80(12):2066–2070. DOI: 10.1177/00220345010800120801.
  17. Reynolds EC. Calcium phosphate-based remineralization systems: scientific evidence? Aust Dent J 2008;53(3):268–273. DOI: 10.1111/j.1834-7819.2008.00061.x.
  18. Huq NL, Cross KJ, Reynolds EC. Molecular modelling of the multiphosphorylated casein phosphopeptide alpha sl-casein (59-79). J Dairy Res 2004;71(1):1–5. DOI: 10.1017/S0022029903006630.
  19. ten Cate JM, Duijsters PPE. Alternating demineralization and remineralization of artificial enamel lesions. Caries Res 1982;16(3):201–210. DOI: 10.1159/000260599.
  20. Kumar VLN, Itthagarun A, King NM. The effect of casein phosphopeptide-amorphous calcium phosphate on remineralization of artificial caries-like lesions: an in vitro study. Aus Dent J 2008;53(1):34–40. DOI: 10.1111/j.1834-7819.2007.00006.x.
  21. ten Cate JM. Fluorides in caries prevention and control: Empiricism or science. Caries Res 2004;38(3):254–257. DOI: 10.1159/000077763.
  22. Fejerskov O. Concepts of dental caries and their consequences for understanding the disease. Community Dent Oral Epidemiol 1997;25(1):5–12. DOI: 10.1111/j.1600-0528.1997.tb00894.x.
  23. Arends J, ten Bosch JJ. Demineralization and remineralization evaluation techniques. J Dent Res 1992;71(3_suppl):924–928. DOI: 10.1177/002203459207100S27.
  24. Koulourides T. Dynamics of Tooth Surface Oral Fluid Equilibrium: Advances in Oral Biology, P.H Staple. New York: Academic Press, Inc; 1966.
  25. Erhardt MCG, Rodrigues JA, Valentino TA, et al. In vitro IATBS of one-bottle adhesive systems: sound versus artificially-created caries-affected dentin. J Biomed Mater Res B Appl Biomater 2008;86B(1):181–187. DOI: 10.1002/jbm.b.31004.
  26. Tedesco TK, Gomes NG, Soares FZ, et al. Erosive effects of beverages in the presence or absence of caries simulation by acidogenic challenge on human primary enamel: an in vitro study. Eur Arch Paediatr Dent 2012;13(1):36–40. DOI: 10.1007/BF03262839.
  27. Ribeiro CC, Ccahuana-Vasquez RA, Carmo CD, et al. The effect of iron on Streptococcus mutans bio-film and on enamel demineralization. Braz Oral Res 2012;26(4):300–305. DOI: 10.1590/S1806-83242012000400003.
  28. Craig RG, Peyton FA. The microhardness of enamel and dentin. J D Res 1958;37(4):661–668. DOI: 10.1177/00220345580370041301.
  29. White DJ. Reactivity of fluoride dentifrices with artificial caries. I. Effects on early carious lesions: F-uptake, surface hardening and remineralization. Caries Res 1987;21(2):126–140. DOI: 10.1159/000261013.
  30. Torres CRG, Rosa PCF, Ferreira NS, et al. Effect of caries infiltration technique and fluoride therapy on microhardness of enamel carious lesions. Oper Dent 2012;37(4):42–57. DOI: 10.2341/11-070-L.
  31. Paris S, Schwendicke F, Seddig S, et al. Micro-hardness and mineral loss of enamel lesions after infiltration with various resins: Influence of infiltrant composition and application frequency in vitro. J Dent 2013;41(6):543–548. DOI: 10.1016/j.jdent.2013.03.006.
  32. Ogaard B, Seppa L, Rolla G. Professional topical fluoride applications-clinical efficacy and mechanism of action. Adv Dent Res 1994;8(2):190–201. DOI: 10.1177/08959374940080021001.
  33. Lippert F, Hara AT, Martinez-Mier EA, et al. Laboratory investigations into the potential anticaries efficacy of fluoride varnishes. PediatrDent 2014;36(4):291–295.
  34. Stamm JW. Fluoride uptake from topical sodium fluoride varnish measured by an enamel biopsy. J Can Dent Assoc 1974;4:501–505.
  35. Biswas A, Biswas S. Presence of fluoride in different layers of enamel after using two fluoride varnishes - an in vitro study. Young 2013;2(1):33–38.
  36. Steinberg D, Rozen R, Klausner EA, et al. Formulation, development and characterization of sustained release varnishes containing amine and stannous fluorides. Caries Res 2002;36(6):411–416. DOI: 10.1159/000066539.
  37. Ambarkova V, Gorseta K, Jankolovska M, et al. Skrinjaric 1. Effect of the fluoride gels and varnishes comparing to CPP-ACP complex on human enamel demineralization/ remineralization. Acta Stomatol Croat 2013;47(2):99–110. DOI: 10.15644/asc47/2/1.
  38. Huq NL, Cross KJ, Reynolds EC. Molecular modelling of a multiphosphorylated sequence motif bound to hydroxyapatite surfaces. J Mol Mode 2000;6(2):35–47. DOI: 10.1007/s0089400060035.
  39. Reynolds EC. Remineralization of enamel subsurface lesions by casein phosphopeptide-stabilized calcium phosphate solutions. J Dent Res 1997;76(9):1587–1595. DOI: 10.1177/00220345970760091101.
  40. Cross KJ, Huq NL, Reynolds EC. Casein phosphopeptides in oral health — chemistry and clinical applications. Curr Pharm Des 2007;13(8):793–800. DOI: 10.2174/138161207780363086.
  41. Stephan RM, Miller BF. A quantitative method for evaluating physical and chemical agents which modify production of acids in bacterial plaques on human teeth. J Dent Res 1943;22(1):45–51. DOI: 10.1177/00220345430220010601.
  42. Marsh PD, Martin M. Oral microbiology. 5th ed., London, UK: Churchill Livingstone Elsevier; 2009.
  43. Higham SM, Edgar WM. Human dental plaque pH, and the organic acid and free amino acid profiles in plaque fluid, after sucrose rinsing. Arch Oral Biol 1989;34(5):329–334. DOI: 10.1016/0003-9969(89)90105-2.
  44. Cruz R, Ogaard B, Rolla G. Uptake of KOH-soluble and KOH-insoluble fluoride in sound human enamel after topical application of a fluoride varnish (Duraphat) or a neutral 2% NaF solution in vitro. Scand J Dent Res 1992;100(3):154–158. DOI: 10.1111/j.1600-0722.1992.tb01732.x.
  45. Paris S. Meyer-Lueckel 1-1. Inhibition of caries progression by resin infiltration in situ. Caries Res 2010;44(1):47–54. DOI: 10.1159/000275917.
  46. Meyer-Lueckel H, Paris S. Progression of artificial enamel caries lesions after infiItration with experimental light curing resins. Caries Res 2008;42(2):11724. DOI: 10.1159/000118631.
  47. Tinanoff N, Palmer CA. Dietary determinants of dental caries and dietary recommendations for preschool children. J Public Health Dent 2000;60(3):197–206. DOI: 10.1111/j.1752-7325.2000.tb03328.x.
  48. Holt C, van Kemenade MJJM. The interaction of phosphoproteins with calcium phosphate Hukins DWL, ed. Calcified tissue. Boca Raton: CRC Press; 1989. pp. 175–213.
  49. Gupta R, Prakash V. CPP-ACP complex as a new adjunctive agent for remineralisation: a review. Oral Health Prey Dent 2011;9:151–165.
  50. De Rooij JF, Nancollas GH. The formation and remineralization of artificial white spot lesions: a constant composition approach. J Dent Res 1984;63(6):864–867. DOI: 10.1177/00220345840630061001.
  51. Parus M, Lacatusu S, Danila I, et al. Evaluation of calcium concentration in solution — in vitro study of fluoride action on dental enamel. The J of Prevent Med 2004;12:80–85.
  52. Yamazaki H, Litman A, Margolis HC. Effect of fluoride on artificial caries lesion progression and repair in human enamel: regulation of mineral deposition and dissolution under in vivo-like conditions. Arch Oral Biol 2007;52(2):110–120. DOI: 10.1016/j.archoralbio.2006.08.012.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.