Minimally invasive caries-removal procedures remove only caries-infected dentin and preserve caries-affected dentin that becomes remineralized. Dental cements containing calcium phosphate promote remineralization. This study evaluated the in vivo remineralization capacity of resin-based calcium-phosphate cement (Ca-P) used for indirect pulp-capping. Carious and sound teeth indicated for extraction were randomly restored with the Ca-P base or without base (control), followed by adhesive restoration. Study teeth were extracted after three months, followed by elemental analysis of the cavity floor. Mineral content of affected or sound dentin at the cavity floor was quantified by electron probe micro-analysis to 100-μm depth. After three months, caries-affected dentin underneath the Ca-P base showed significantly increased calcium and phosphorus content to a depth of 30 μm. Mineral content of treated caries-affected dentin was in the range of healthy dentin, revealing the capacity of Ca-P base to promote remineralization of caries-affected dentin.
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References
1.
Bjørndal L, Larsen T (2000). Changes in the cultivable flora in deep carious lesions following a stepwise excavation procedure. Caries Res34:502–508.
2.
Bjørndal L, Larsen T, Thylstrup A (1997). A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals. Caries Res31:411–417.
3.
Boston DW (2003). New device for selective dentin caries removal. Quintessence Int34:678–685.
4.
Brännström M, Johnson G (1974). Effects of various conditioners and cleaning agents on prepared dentin surfaces: a scanning electron microscopic investigation. J Prosthet Dent31:422–430.
5.
Chow LC, Hirayama S, Takagi S, Parry E (2000). Diametral tensile strength and compressive strength of a calcium phosphate cement: effect of applied pressure. J Biomed Mater Res53:511–517.
6.
Daculsi G, Kerebel B, Kerebel LM (1979). Mechanisms of acid dissolution of biological and synthetic apatite crystals at the lattice pattern level. Caries Res13:277–289.
7.
Dickens SH, Flaim GM (2008). Effect of a bonding agent on in vitro biochemical activities of remineralizing resin-based calcium phosphate cements. Dent Mater24:1273–1280.
8.
Dickens SH, Flaim GM, Takagi S (2003). Mechanical properties and biochemical activity of remineralizing resin-based Ca-PO4 cements. Dent Mater19:558–566.
9.
Dickens SH, Kelly SR, Flaim GM, Giuseppetti AA (2004). Dentin adhesion and microleakage of a resin-based calcium phosphate pulp capping and basing cement. Eur J Oral Sci112:452–457.
10.
Diggle PJ, Heagerty PJ, Liang K-Y, Zeger SL (2002). Analysis of longitudinal data. 2nd ed. Oxford: Oxford University Press.
11.
Exterkate RA, Damen JJ, ten Cate JM (2005). Effect of fluoride-releasing filling materials on underlying dentinal lesions in vitro. Caries Res39:509–513.
12.
Frencken JE, Songpaisan Y, Phantumvanit P, Pilot T (1994). An atraumatic restorative treatment (ART) technique: evaluation after one year. Int Dent J44:460–464.
13.
Hossain M, Nakamura Y, Tamaki Y, Yamada Y, Jayawardena JA, Matsumoto K (2003a). Dentinal composition and Knoop hardness measurements of cavity floor following carious dentin removal with Carisolv. Oper Dent28:346–351.
14.
Hossain M, Nakamura Y, Tamaki Y, Yamada Y, Murakami Y, Matsumoto K (2003b). Atomic analysis and knoop hardness measurement of the cavity floor prepared by Er,Cr:YSGG laser irradiation in vitro. J Oral Rehabil30:515–521.
15.
Kidd EA, Joyston-Bechal S, Beighton D (1993). Microbiological validation of assessments of caries activity during cavity preparation. Caries Res27:402–408.
16.
Kitasako Y, Nakajima M, Foxton RM, Aoki K, Pereira PN, Tagami J (2003). Physiological remineralization of artificially demineralized dentin beneath glass ionomer cements with and without bacterial contamination in vivo. Oper Dent28:274–280.
17.
Klont B, ten Cate JM (1991). Remineralization of bovine incisor root lesions in vitro: the role of the collagenous matrix. Caries Res25:39–45.
18.
Levine RS, Rowles SL (1973). Further studies on the remineralization of human carious dentine in vitro. Arch Oral Biol18:1351–1356.
19.
Maltz M, de Oliveira EF, Fontanella V, Bianchi R (2002). A clinical, microbiologic, and radiographic study of deep caries lesions after incomplete caries removal. Quintessence Int33:151–159.
20.
Massara ML, Alves JB, Brandão PR (2002). Atraumatic restorative treatment: clinical, ultrastructural and chemical analysis. Caries Res36:430–436.
21.
Mertz-Fairhurst EJ, Curtis JW Jr, Ergle JW, Rueggeberg FA, Adair SM (1998). Ultraconservative and cariostatic sealed restorations: results at year 10. J Am Dent Assoc129:55–66.
22.
Mukai Y, ten Cate JM (2002). Remineralization of advanced root dentin lesions in vitro. Caries Res36:275–280.
23.
Mukai Y, Tomiyama K, Okada S, Mukai K, Negishi H, Fujihara T, et al. (1998). Dentinal tubule occlusion with lanthanum fluoride and powdered apatite glass ceramics in vitro. Dent Mater J17:253–263.
24.
Ngo H, Ruben J, Arends J, White D, Mount GJ, Peters MC, et al. (1997). Electron probe microanalysis and transverse microradiography studies of artificial lesions in enamel and dentin: a comparative study. Adv Dent Res11:426–432.
25.
Ngo HC, Mount G, McIntyre J, Tuisuva J, Von Doussa RJ (2006). Chemical exchange between glass-ionomer restorations and residual carious dentine in permanent molars: an in vivo study. J Dent34:608–613.
26.
Ogawa K, Yamashita Y, Ichijo T, Fusayama T (1983). The ultrastructure and hardness of the transparent layer of human carious dentin. J Dent Res62:7–10.
27.
Peters MC, McLean ME (2001a). Minimally invasive operative care. I. Minimal intervention and concepts for minimally invasive cavity preparations. J Adhes Dent3:7–16.
28.
Peters MC, McLean ME (2001b). Minimally invasive operative care. II. Contemporary techniques and materials: an overview. J Adhes Dent3:17–31.
29.
Ribeiro CC, Baratieri LN, Perdigão J, Baratieri NM, Ritter AV (1999). A clinical, radiographic, and scanning electron microscopic evaluation of adhesive restorations on carious dentin in primary teeth. Quintessence Int30:591–599.
30.
SAS Institute (2004). SAS/STATA v.10.0 SE. Cary, NC: SAS Publishing.
31.
ten Cate JM (2001). Remineralization of caries lesions extending into dentin. J Dent Res80:1407–1411.
32.
Tveit AB, Selvig KA (1981). In vivo recalcification of dentin demineralized by citric acid. Scand J Dent Res89:38–42.
33.
Verbeke G, Molenberghs G (2000). Linear mixed models for longitudinal data. New York: Springer Verlag Inc.
