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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1466-1469  

Evaluation of remineralization seen in dentin related to ceramic restorations


1 Department of Conservative Dentistry and Endodontics, Dr. B. R. Ambedkar Institute of Dental Sciences and Hospital, Patna, Bihar, India
2 Reader, Meghna Institute of Dental Sciences, Nizamabad, Telangana, India
3 Department of Restorative Dentistry, School of Dentistry, University of California, Los Angeles, CA, United States of America
4 Department of Prosthodontics, Rural Dental College of Pravara Institute Medical Sciences, Loni, Ahmed Nagar, Maharashtra, India
5 Department of Conservative Dentistry and Endodontics, Dr. G D Pol Foundation's, YMT Dental College and Hospital, Mumbai, Maharashtra, India

Date of Submission26-Mar-2021
Date of Decision08-May-2021
Date of Acceptance09-May-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
Swati Priya
Department of Conservative Dentistry and Endodontics, Dr. B. R. Ambedkar Institute of Dental Sciences and Hospital, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.jpbs_255_21

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   Abstract 


Background: Recently, the caries management had shifted from extension for prevention to early detection and remineralization of remaining tooth structure using noninvasive techniques. Aim: The present trial was carried out to assess the effect of adding mono-n-Dodecyl phosphate as a surfactant to ceramic on remineralization of dentin. Materials and Methods: The 32 teeth were divided into the following four groups randomly (n = 8 each group) – Group I: cavities not restored, Group II: Restored with ceramic, Group III: restored with ceramic and 2% mono-n-Dodecyl phosphate, and Group IV: restored with ceramic and 5% mono-n-Dodecyl phosphate. Knoop indenter microhardness tests were done at 10, 20, and 40 days. The surface was evaluated under scanning electron microscope. The collected data were subjected to statistical evaluation, and the results were formulated. Results: In ceramic restored (Group II), an increase in Knoop microhardness (KHN) values was seen at 10-, 20-, and 40-day assessment with the respective values of 102.2 ± 20.3, 118.7 ± 19.4, and 127 ± 15.1. Similarly, a constant increase at different assessments was observed for Groups III and IV with 2% and 5% of mono-n-Dodecyl phosphate with ceramic with a 40-day KHN value of 128.2 ± 21.4 for Group III and 113.5 ± 17.3 for Group IV. A statistically significant difference was seen between ceramic and 5% mono-n-Dodecyl phosphate (Group IV) with hardness values of 30.31%, 29.8%, and 21.78% for Groups II, III, and IV, respectively, at 20 days. Conclusion: The present study concludes that ceramic restorations are effective in promoting dentin remineralization. However, the addition of only 2% mono-n-Dodecyl phosphate was beneficial, whereas 5% mono-n-Dodecyl phosphate reduced the efficacy of ceramic on dentin remineralization.

Keywords: Ceramic, dentin remineralization, Knoop hardness number, mono-n-Dodecyl phosphate remineralization


How to cite this article:
Sinha S, Sairam G, Aidasani GL, Madanshetty P, Priya S, Kawle S. Evaluation of remineralization seen in dentin related to ceramic restorations. J Pharm Bioall Sci 2021;13, Suppl S2:1466-9

How to cite this URL:
Sinha S, Sairam G, Aidasani GL, Madanshetty P, Priya S, Kawle S. Evaluation of remineralization seen in dentin related to ceramic restorations. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Aug 10];13, Suppl S2:1466-9. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1466/330044




   Introduction Top


The highest mineralization in the human body is seen in teeth owing to the continuous remineralization and demineralization seen in human teeth throughout life with the varying amount.[1] In the disease state, demineralization overpowers the remineralization process. Production of various acids by fermenting the dietary carbohydrates constitutes the main etiology for tooth demineralization when caries progress to dentin with activation of cathepsins and metalloproteinases.[2]

Recently, the caries management had shifted from extension for prevention to early detection and remineralization of remaining tooth structure using noninvasive techniques. Although, for a long time, fluoride is a trusted and proved method of dentin remineralization, this largely depends on calcium and phosphate ion availability from the saliva.[3] Hence, new agents are being constantly reviewed and introduced to promote dentin mineralization which assists in the process by increasing the availability of the required ions from saliva which may not be available in subjects with less saliva. In vitro adequate remineralization of enamel and dentin is seen with fluoride and saliva.[4]

However, remineralization on only superficial enamel surfaces provides only esthetic benefits. An ideal remineralization agent should transport salivary ions to the deeper surface of the lesion, allowing deep remineralization.[5] Recently, in literature, nano calcium carbonate and hydroxyapatite have shown remineralization in early carious lesions on application twice for >20 days in vitro. Hence, they are considered potentially effective in oral in vivo environments too. Dentin has better remineralization potential than enamel due to collagen scaffolds in it.[6]

Casein phosphopeptide–amorphous calcium phosphate nanocomplexes have shown remineralization in humans and animals by making nanocomplexes. A modified glass ionomer, ceramic, is a newer material that has also shown apatite formation owing to calcium aluminate in its composition.[7] This can be a breakthrough in dentistry as it can remineralize hard surfaces. Furthermore, using the remineralizing agents can arrest secondary caries by allowing a stable interface on forming apatite between teeth and material.[8] Hence, the present trial was carried out to assess the effect of adding mono-n-Dodecyl phosphate as a surfactant to ceramic on remineralization of dentin.


   Materials and Methods Top


The present trial was carried out to assess the effect of adding mono-n-Dodecyl phosphate as a surfactant to ceramic on remineralization of dentin. The study included 32 freshly extracted teeth as samples which were extracted for either periodontal or orthodontic purposes. The exclusion criteria for the study were teeth that were carious, hypocalcified/hypoplastic, malformed, fractured, or had a developmental anomaly. Immediately after extraction, the teeth were stored in chlorothymol solution after scaling with ultrasonic instruments. Following extraction, the teeth were used within 2 months for the study.

The teeth were embedded in the acrylic block with a buccal and lingual surface exposed. Exposed surfaces were grounded with silicon carbide paper using adequate water unless the dentin surface exposed was smooth and clean. After this, the surfaces were polished with alumina. Knoop hardness test for each block was carried out using Knoop intender using 50 g force for 10 s. Three consecutive values were recorded, and the mean was taken as the final value.

The prepared surfaces were etched for 5 s and then washed in deionized water for demineralization of dentin and its collagen with etched area ranging 7–8 mm. The surfaces were dried thoroughly. Knoop indenter microhardness of dentin was also measured. Thirty-millimeter round cavities were made with carbide bur, in the center of the etched surface, and were not restored/restored with different materials. The 32 teeth were divided into the following four groups randomly (n = 8 each group):

  • Group I: Cavities not restored
  • Group II: Restored with ceramic
  • Group III: Restored with ceramic and 2% mono-n-Dodecyl phosphate
  • Group IV: Restored with ceramic and 5% mono-n-Dodecyl phosphate.


Each sample was dipped in simulated body fluid which was made as per ISO recommendations. Knoop indenter microhardness tests were done at 10, 20, and 40 days. In between tests, the samples were dried completely. Mean Knoop microhardness (KHN) was calculated from three values. The changes in the mean values were calculated from baseline to before filling and etching. The surface was evaluated under scanning electron microscope. The collected data were subjected to statistical evaluation, and the results were formulated.


   Results Top


The present trial was carried out to assess the effect of adding mono-n-Dodecyl phosphate as a surfactant to ceramic on remineralization of dentin. The study sample comprised 45 teeth based on inclusion and exclusion criteria. At the baseline, the mean Knoop hardness value for the polished dentin surface was found to be 106.3 ± 18 which after acid etching was reduced to 74.3 ± 13.2. This implies a significant reduction in Knoop hardness value of dentin postetching with P < 0.0001.

On assessing the four groups for KHN values, it was seen that there was no statistically significant difference in KHN values of Group I where no restorative material was placed in the prepared cavity at all the observation time intervals. In ceramic restored (Group II), an increase in KHN values was seen at 10-, 20-, and 40-day assessment, as shown in [Table 1]. In ceramic-only restored group, a constant increase in KHN was seen from baseline to 10-, 20-, and 40-day assessment with the respective values of 102.2 ± 20.3, 118.7 ± 19.4, and 127 ± 15.1. No significant difference was seen in KHN from baseline to 10 days. However, the difference was significant for 20 and 40 days from baseline and 10 to 40 days for Groups II and III.
Table 1: Knoop hardness number values at different time intervals for different groups

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Similarly, a constant increase at different assessments was observed for Groups III and IV with 2% and 5% of mono-n-Dodecyl phosphate with ceramic with a 40-day KHN value of 128.2 ± 21.4 for Group III and 113.5 ± 17.3 for Group IV [Table 1]. For Group IV, no significant difference was seen in KHN from baseline to 10 days and from 10 days to 20 days and 40 days. The only significant difference was seen from 20 days to 40 days.

On statistically analyzing the four groups using repeated one-way ANOVA and performing the pairwise comparison of each value, it was seen that there existed no statistically significant difference in hardness values of the cavities treated with ceramic or ceramic in surfactants (Groups III and IV) at the 10-day assessment. While the change seen from baseline in hardness values at 10 days for Groups II, III, and IV, respectively, was − 6.59%, −13.68%, and − 13.79%, as described in [Table 2] and [Table 3]. At a 20-day assessment, it was seen that no statistically significant difference in hardness of samples restored with ceramic or ceramic with 2% mono-n-Dodecyl phosphate (Group III) was seen. However, a statistically significant difference was seen between ceramic and 5% mono-n-Dodecyl phosphate (Group IV) with hardness values of 30.31%, 29.8%, and 21.78% for Groups II, III, and IV, respectively, at 20 days.
Table 2: Hardness values change from baseline at different time intervals for different groups

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Table 3: Hardness values change from etched dentin at different time intervals for different groups

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At a 40-day assessment, a statistically significant difference was observed in restorations with ceramic and 2% mono-n-Dodecyl phosphate and ceramic and 5% mono-n-Dodecyl phosphate (Group III and Group IV) with their respective hardness values of 39.3% and 28.68%. However, on comparing with ceramic-only restorations, no statistically significant difference was seen in Group III with ceramic and 2% mono-n-Dodecyl phosphate [Table 2] and [Table 3].


   Discussion Top


The present trial was carried out to assess the effect of adding mono-n-Dodecyl phosphate as a surfactant to ceramic on remineralization of dentin. The study depicts that restoring the lesions affecting dentin with ceramic restorations can result in remineralization in dentin after etching. The study also showed that adding surfactants in concentrations of 2% results in increased remineralization than ceramic alone with time, whereas adding 5% surfactant reduced the efficacy of ceramic.

The present study utilized the Knoop hardness test to assess the microhardness of dentin and its alterations over a while. This is in agreement with the findings of Shimizu et al.[9] in 2013 where authors advocate using the Knoop hardness test and find it accurate in testing the hardness of dentin and enamel. The authors also concluded that Knoop hardness effectively measures demineralization. Similar findings were also suggested by Mahoney et al.[10] mentioning the accuracy and benefits of the Knoop hardness test.

The results of the present study show that there was no statistically significant difference in KHN values of Group I where no restorative material was placed in the prepared cavity at all the observation time intervals. In ceramic restored (Group II), an increase in KHN values was seen at 10-, 20-, and 40-day assessment. In ceramic-only restored group, a constant increase in KHN was seen from baseline to 10-, 20-, and 40-day assessment with the respective values of 102.2 ± 20.3, 118.7 ± 19.4, and 127 ± 15.1. No significant difference was seen in KHN from baseline to 10 days. However, the difference was significant for 20 and 40 days from baseline and 10–40 days for Groups II and III. These values were contradictory to a study by Huang et al.[11] in 2011 where authors reported higher values. This can be due to measuring KHN near to dentinoenamel junction in the present study where the higher mineral content is found.

In this study, there existed no statistically significant difference in hardness values of the cavities treated with ceramic or ceramic in surfactants (Groups III and IV) at the 10-day assessment. While the change seen from baseline in hardness values at 10 days for Groups II, III, and IV, respectively, was - 6.59%, -13.68%, and -13.79%. At a 20-day assessment, it was seen that no statistically significant difference in hardness of samples restored with ceramic or ceramic with 2% mono-n-Dodecyl phosphate (Group III) was seen. However, a statistically significant difference was seen between ceramic and 5% mono-n-Dodecyl phosphate (Group IV) with hardness values of 30.31%, 29.8%, and 21.78% for Groups II, III, and IV, respectively, at 20 days. The reduction in surface hardness was seen after etching which can be attributed to mineral removal after acid etching and rinsing. Similar results were also reported by Toledano et al.[12] in 2005 where hardness reduction after etching was observed.


   Conclusion Top


The present study concludes that ceramic restorations are effective in promoting dentin remineralization. However, the addition of only 2% mono-n-Dodecyl phosphate was beneficial, whereas 5% mono-n-Dodecyl phosphate reduced the efficacy of ceramic on dentin remineralization. Hence, the present study advocates the clinical and intraoral use of ceramic and ceramic with surfactants to promote remineralization in early caries, reduction in dentinal sensitivity, and reduction of secondary caries. The study had few limitations including a smaller sample size, a small monitoring period, and including all healthy and noncarious teeth as samples. Hence, further well-controlled and randomized longitudinal clinical trials with a larger sample size and longer monitoring period are required to reach a definitive conclusion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Arifa MK, Ephraim R, Rajamani T. Recent advances in dental hard tissue remineralization: A review of literature. Int J Clin Pediatr Dent 2019;12:139-44.  Back to cited text no. 1
    
2.
Abou Neel EA, Aljabo A, Strange A, Ibrahim S, Coathup M, Young AM, et al. Demineralization-remineralization dynamics in teeth and bone. Int J Nanomed 2016;11:4743-63.  Back to cited text no. 2
    
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Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, Eden E. Minimal intervention dentistry for managing dental caries – A review: Report of a FDI task group. Int Dent J 2012;62:223-43.  Back to cited text no. 3
    
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Philip N. State of the art enamel remineralization systems: The next frontier in caries management. Caries Res 2019;53:284-95.  Back to cited text no. 4
    
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Gamal M, El-Baily A, Osman MF. Assessment of the remineralization potential of recently developed nano-hydroxyapatite on the demineralized enamel around orthodontic brackets. Indian J Orthodont Dentofac Res 2017;3:218-25.  Back to cited text no. 5
    
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Manchery N, John J, Nagappan N, Subbiah GK, Premnath P. Remineralization potential of a dentifrice containing nanohydroxyapatite on artificial carious lesions of enamel: A comparative in vitro study. Dent Res J (Isfahan) 2019;16:310-7.  Back to cited text no. 6
    
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Divyapriya GK, Yavagal PC, Veeresh DJ. Casein phosphopeptide-amorphous calcium phosphate in dentistry: An update. Int J Oral Health Sci 2016;6:18-25.  Back to cited text no. 7
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Aras A, Celenk S, Dogan MS, Bardakci E. Comparative evaluation of combined remineralization agents on the demineralized tooth surface. Niger J Clin Pract 2019;22:1546-52.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Shimizu A, Nakashima S, Nikaido T, Sugawara T, Yamamoto T, Momoi Y. Newly developed hardness testing system, “Cariotester”: Measurement principles and development of a program for measuring Knoop hardness of carious dentin. Dent Mater J 2013;32:643-7.  Back to cited text no. 9
    
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Mahoney E, Holt A, Swain M, Kilpatrick N. The hardness and modulus of elasticity of primary molar teeth: An ultra-micro-indentation study. J Dent 2000;28:589-94.  Back to cited text no. 10
    
11.
Huang S, Gao S, Cheng L, Yu H. Remineralization potential of nano-hydroxyapatite on initial enamel lesions: An in vitro study. Caries Res 2011;45:460-8.  Back to cited text no. 11
    
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Toledano M, Osorio R, Osorio E, Prati C, Carvalho RM. Microhardness of acid-treated and resin infiltrated human dentine. J Dent 2005;33:349-54.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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