ABSTRACT
Evaluat ion of t he r em ineralizat ion capacit y of
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quant it at ive m et hods
Selcuk SAVAS, Fevzi KAVRÌK, Ebru KUCUKYÌLMAZ
Department of Pediatric Dentistry, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey.
Corresponding address: Selcuk Savas - Izmir Katip Celebi University, Faculty of Dentistry, Department of Pediatric Dentistry - Cigli - Izmir - Turkey - e-mail: selcuksavas1983@hotmail.com - Phone: +902323524040 - Fax: +902323252535
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EMHFWLYH7KHDLPRIWKLVVWXG\ZDVWRHYDOXDWHWKHHI¿FDF\RI&33$&3FRQWDLQLQJÀXRULGH YDUQLVK IRU UHPLQHUDOL]LQJ ZKLWH VSRW OHVLRQV :6/V ZLWK IRXU GLIIHUHQW quant it at ive m et hods. Mat er ial and Met hods: Four w indow s ( 3x3 m m ) w er e cr eat ed on t he enam el sur faces of bovine incisor t eet h. A cont r ol w indow was cover ed w it h nail var nish, DQG :6/V ZHUH FUHDWHG RQ WKH RWKHU ZLQGRZV DIWHU GHPLQHUDOL]DWLRQ ¿UVW ZHHN DQG IRXUWKZHHNLQDFLGL¿HGJHOV\VWHP7KHWHVWPDWHULDO0,9DUQLVKZDVDSSOLHGRQWKH GHPLQHUDOL]HGDUHDVDQGWKHWUHDWHGHQDPHOVDPSOHVZHUHVWRUHGLQDUWL¿FLDOVDOLYD$WWKH fourt h week, t he enam el surfaces were t est ed by surface m icrohardness ( SMH) , quant it at ive OLJKWLQGXFHGÀXRUHVFHQFHGLJLWDO4/)'HQHUJ\GLVSHUVLYHVSHFWURVFRS\('6DQGODVHU ÀXRUHVFHQFH/)SHQ7KHGDWDZHUHVWDWLVWLFDOO\DQDO\]HGD= 0.05) . Result s: While t he /)SHQPHDVXUHPHQWVVKRZHGVLJQL¿FDQWGLIIHUHQFHVDWEDVHOLQHDIWHUGHPLQHUDOL]DWLRQ and aft er t he one- w eek r em ineralizat ion per iod ( p< 0.05) , t he differ ence bet w een t he 1- DQGZHHNZDVQRWVLJQL¿FDQWS!:LWKUHJDUGVWRWKH60+DQG4/)'DQDO\VHV VWDWLVWLFDOO\VLJQL¿FDQWGLIIHUHQFHVZHUHIRXQGDPRQJDOOWKHSKDVHVS$IWHUWKH 1- and 4- w eek t r eat m ent per iods, t he calcium ( Ca) and phosphat e ( P) concent rat ions and Ca/ P rat io w er e higher com par ed t o t hose of t he dem ineralizat ion sur faces ( p< 0.05) . &RQFOXVLRQ&33$&3FRQWDLQLQJÀXRULGHYDUQLVKSURYLGHVUHPLQHUDOL]DWLRQRI:6/VDIWHU a single applicat ion and seem s suit able for clinical use.Ke y w or ds: Har dness. Dent al enam el. Toot h r em ineralizat ion.
I N TROD UCTI ON
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appearance of a whit e spot lesion ( WSL) on t he t oot h
sur face t hat can be consider ed t he init ial st age of
enam el dem ineralizat ion12,19.I f t he dem ineralizat ion
process cont inues, t he init ial lesion m ay progress t o cavit y for m at ion. Thus, enhancing r em ineralizat ion of early carious lesions is an effect ive, non- invasive t r eat m ent for m aint aining healt hy dent it ion19,20,26.
Am on g t h e av ailab le st r at eg ies, t h e u se of
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in m anaging WSLs1 0 , 1 8 , 2 2. Fluor ide incr eases t he
rem ineralizat ion of t he out er enam el and decreases t he dem ineralizat ion of t he inner enam el, r esult ing
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have suggest ed t hat using high concent rat ions of
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m igh t r et ar d calciu m an d ph osph at e, in h ibit in g deeper r em ineralizat ion and lim it ing t he cosm et ic im pr ovem ent of t he WSLs10,25. Ther efor e, t her e is a need t o inv est igat e ot her ant i- car ious agent s
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or be an alt er nat ive t o enhance r em ineralizat ion of dent al car ies.
Casein p h osp h op ep t id e am or p h ou s calciu m phosphat e ( CPP- ACP) is a t echnology based on am or phous calcium phosphat e ( ACP) st abilized by casein phosphopept ides ( CPP)7,8. The int egr it y of
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sat urat ed or supersat urat ed wit h t oot h m inerals4,21.
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phosphat e in dent al plaque in t he pr oxim it y of t he t oot h, t hus m ak ing it available w hen needed4,21.
I n r ecent st udies, t he r em ineralizat ion pot ent ial o f CPP- ACP co m b i n ed w i t h f l u o r i d e h as b een invest igat ed, and a sy ner gist ic effect w hen t hey are adm inist ered t oget her was found4,7,10,21,24,27. The
r em ineralizat ion capacit y of CPP- ACP pr oduct s has been st udied in det ail; how ever, t o our know ledge, t h er e is on ly on e st u dy t h at evalu at ed t h e ion
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r em ineralizat ion of WSLs. Thus, t her e is a need t o invest igat e t he r em ineralizat ion pot ent ial of t his m at er ial.
Cur r ent ly, pr ev ent iv e and m inim ally invasiv e dent ist r y ar e offer ing a w ide var iet y of m et hods t o det ect and care for even t he t iniest changes in hard t oot h t issue. Select ing an appr opr iat e t r eat m ent
t o r em ineralize WSLs and accurat ely and r eliably
m onit or lesion pr ogr ess or r egr ession is t he key t o avoid t he need for invasive t r eat m ent s. Ther efor e, t h e p u r p o se o f t h i s st u d y w a s t o d e t e r m i n e t h e p o t e n t i a l o f CPP- ACP co n t a i n i n g f l u o r i d e
var nish t o r em ineralize WSLs using four t ypes of
analy sis: enam el sur face m icr ohar dness ( SMH) , q u an t it at iv e lig h t - in d u ced f lu or escen ce- d ig it al ( QLF- D) , ener gy- disper sive spect r oscopy ( EDS) ,
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M ATERI AL AN D M ETH OD S
The pr esent st udy was appr oved by t he Medical Et hics Com m it t ee under r epor t num ber 2015/ 150.
Sa m ple pr e pa r a t ion
Thir t y bovine incisor s fr ee fr om clinically visible ab n or m alit y w er e u sed . Th ey w er e clean ed of debr is/ st ains w it h pum ice, st or ed in a 1% t hym ol solut ion at 4°C, and used w it hin 1 m ont h of t heir ext ract ion. The t eet h w er e t hor oughly r insed and ex am in ed u n der a st er eom icr oscope ( Oly m pu s SZ61; Oly m pus Opt ical Co.; Tok yo, Japan) . Any t oot h w it h defect s, er osions, or m icr ocracks in it s enam el sur faces was excluded. The soft t issue and calculus w er e r em oved m echanically fr om t oot h su r f aces w it h a scaler ( U1 5 / 3 0 Hu Fr iedy, Hu
-Fr iedy Manufact ur ing I nc., Chicago, I L, USA). The r oot s w er e r em oved by sect ioning appr oxim at ely 2 m m b elow t h e cem en t oen am el j u n ct ion an d perpendicular t o t he long axis, using a wat er- cooled diam ond disk ( I som et , Buehler I nc.; Lake Bluff, I L, USA) . Then, t he cor onal par t of each t oot h was hor izont ally em bedded in self- cur ed acr ylic r esin ( Vert ex Dent al; Zeist , Net herlands) in prefabricat ed cy l i n d r i cal m ol d s, k eep i n g t h e b u ccal su r f ace exposed, and cured overnight . The exposed enam el surface of each t oot h was polished w it h 600- , 800- , and 1000- gr it silicon car bide paper for 5 s each t o
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was coat ed w it h a clear nail var nish, leaving four en am el w in d ow s w it h ap p r ox im at ely 3 × 3 m m exposed in t he cent er.
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Following preparat ion of t he specim ens, a cont rol w in dow w as coat ed w it h acid- r esist an t v ar n ish
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exposed w indow s by dem ineralizing t he specim ens
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pr epar ed by adding 100 m m ol/ L sodium hydr oxide
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of 4 . 51. To t h is solu t ion , 6 % w / v hy dr ox y et hy l
cellulose was added w hile vigor ously st ir r ing. The
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of 100 cP. Aft er t he 7- day dem ineralizat ion per iod, each specim en was cleaned of t he dem ineralizat ion solut ion w it h de- ionized wat er and st or ed at r oom t em perat ur e.
Re m in e r a liz a t ion
At t he end of t he dem ineralizat ion phase on
each specim en, a dem ineralizat ion w indow w as paint ed w it h nail var nish. The ot her t w o w indow s w er e t r eat ed w it h t he t est ed m at er ial ( MI Var nish;
GC Cor p.; Tokyo, Japan) . The var nish was applied
in a t h in , u n if or m lay er on t h e su r f ace w it h a disposable br ush and r em ained undist ur bed on t he t eet h for 4 h, accor ding t o t he m anufact ur er ’s inst r uct ions. I m m ediat ely aft er t his applicat ion, each sam ple was placed in an individual cont ainer
FRQWDLQLQJ P/ RI DUWL¿FLDO VDOLYD >MgCl26H2O ( 0.148 m m ol/ L) , K2HPO4 ( 4.59 m m ol/ L) , KH2PO4 ( 2.38 m m ol/ L) , KCl ( 8.39 m m ol/ L) , calcium lact at e ( 1 . 7 6 m m o l / L) , f l u o r i d e ( 0 . 0 5 p p m ) , so d i u m car box y m et hy lcellulose ( 2 . 2 5 m m ol/ L) , m et hy l-4- hydr oxybenzoat e ( 13.14 m m ol/ L) ; pH 7.2] . All sam ples w er e placed in an incubat or at 37°C w it h 5% CO2 for 1 w eek and 4 w eeks, and t he enam el of t he t w o w indow s was r em ineralized. At t he end of t he 1- w eek r em ineralizat ion phase, one exposed w indow was paint ed w it h nail var nish. Dur ing t he 4- w eek r em ineralizat ion pr ocedur e,WKH DUWL¿FLDO
saliva w as r enew ed daily. Follow ing t he 4- w eek
t est per iod, t he nail var nish was r em oved fr om all t he specim ens w it h acet one. Then, t he baseline, d em in er alizat ion , 1 - w eek p ost - t r eat m en t , an d 4- w eek post - t r eat m ent specim ens w er e t est ed by t he follow ing four m et hods: SMH, QLF- D, EDS, and LF pen analyses.
QLF- D a n a ly sis
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DI¿[HG WR WKH 4/)'in v it r o st and. The v ideo-reposit ioning soft ware of t he QLF- D syst em was used t o ensur e t hat im ages ar e aut om at ically capt ur ed w hen t he cor r elat ion is higher t han 0.9. Befor e t he m easur em ent s, t he specim ens w er e dr ied for 5 s w it h an air syr inge. I n addit ion, t o ensur e t hat t he specim ens w er e dr ied equally, m easur em ent s of each enam el specim en w er e per for m ed aft er 15 m inut es. All im ages w er e capt ur ed in a dar k r oom w it h n o am bien t ligh t . For each specim en , th e
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sound enam el and of t he dem ineralized lesion)
was calculat ed at pr et r eat m ent phase ( baseline) ,
1 w eek aft er t he t r eat m ent , and 4 w eek s aft er t he t r eat m ent. Dur ing t he analysis, a cont our was
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t he Whit e Spot Wizar d. The cont our of t he ar ea was m ar ked on t he or iginal, sound enam el. The difference bet ween t he sound enam el ( t he reference ar ea) an d t h e lesion ar ea w as calcu lat ed, an d quant it at ive r esult s w er e obt ained for t he follow ing
SDUDPHWHUVPHDQÀXRUHVFHQFHORVVRYHUWKHOHVLRQ Ʃ)DQGDUHDRIWKHOHVLRQSL[HO2) .
M e a su r e m e n t s w it h LF pe n
The LF pen ( DI AGNOdent 2190; KaVo; Biberach, Ger m any) m easur em ent s w er e per for m ed using a
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designed for sm oot h sur faces, accor ding t o t he m an u f act u r er ’s in st r u ct ion s. Th e ex am in er h ad been exper ienced in using and handling t he device befor e t he m easur em ent s w er e done. The device was calibrat ed against a ceram ic st andar d, and it was r ecalibrat ed aft er t est ing 10 specim ens. Aft er calibrat ion, each block was dried wit h a paper t issue and air - dr ied for 5 s. Each block w as analy zed 3 t im es an d t h e m ean valu es w er e calcu lat ed.
Th e f l u o r e sce n ce v a l u e s f o r e a ch sp e ci m e n w er e m easu r ed in 4 st ep s: at b aselin e, af t er dem ineralizat ion, 1 w eek aft er r em ineralizat ion, and 4 w eeks aft er r em ineralizat ion.
SM H m e a su r e m e n t s
The m icr ohar dness of t he 30 specim ens was m easur ed for 15 s using a Vicker s m icr ohar dness t est er ( Shim adzu Micr o Har dness Test er HMV- 2;
Shim adzu Cor porat ion; Kyot o, Japan) w it h a load of 200 g. All r eadings w er e per for m ed by t he sam e exam iner using t he sam e calibrat ed m achine. For each enam el specim en, t he average value of t hr ee in d en t at ion scor es w as u sed t o r ep r esen t t h e specim en ’s h ar dn ess valu e. Th e m icr oh ar dn ess v a l u es f o r ea ch sp eci m en w er e m ea su r ed i n 4 st eps: at baselin e, af t er dem in er alizat ion , 1 w eek aft er r em ineralizat ion, and 4 w eek s aft er r em ineralizat ion.
ED S a n a ly sis
Fo l l o w i n g t h e Q LF- D , LF p e n , a n d S M H m easur em ent s, t he sam ples w er e left t o air dr y at r oom t em perat ur e for 24 h. Then, befor e EDS exam inat ion, t he t eet h w er e sput t er- coat ed w it h gold- palladium ( EMI TECH K550X Sput t er Coat er ; Em it ech Lt d.; Ashfor d, UK) and t he sam ples w er e placed in t he vacuum cham ber. EDS exam inat ion was perform ed using a scanning elect ron m icroscope ( Quant a- FEG 250; FEI Co.; OR, USA) equipped wit h an EDS det ect or ( w it h spot size at 3.0 and volt age at 1 0 k V) t o assess m in er al con t en t . For each enam el slab, t he m ean calcium ( Ca) , phosphat e
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w er e calculat ed.
St a t ist ica l a n a ly sis
The SMH, QLF- D, EDS, and LF pen scor es w er e analy zed using t he I BM SPSS St at ist ics v er sion 20.0 st at ist ical package ( SPSS; Chicago, I L, USA) .
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Shapir o- Wilk t est . The r epeat ed m easur es ANOVA t est was used t o com par e t he m ean values at t he
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set at 0.05 Į
RESULTS
Table 1 pr esent s t he m ean QLF- D values for
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aft er bot h one- and four- w eek t r eat m ent per iods. The m ean lesion area values in t he rem ineralizat ion
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values ( p< 0.05) . How ever, t he differ ence bet w een
ǻ) Area (pixel2)
Baseline 1-week 4-weeks Baseline 1-week 4-weeks
-44.20a -32.24b -26.35c 2173.17a 1925.90b 1844.17b
(5.7) (5.7) (9.7) -254.72 -284.3 -272.84
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( p> 0.05) .
Table 2 present s the m ean SMH and ÀXRUHVFHQFH
values for t he LF pen and t he st andar d deviat ions of t he enam el in each m easur em ent phase. Wit h r egar d t o t he SMH analysis, differ ences am ong t he
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Th e SMH v alu es of t h e d em in er alized en am el
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aft er bot h t he one- and t he four- w eek t r eat m ent periods ( p< 0.05) . The LF pen m easurem ent s showed sig n if ican t d if f er en ces b et w een m easu r em en t s m ade at baseline, aft er dem ineralizat ion, and aft er on e w eek of r em in er alizat ion , w it h t h e h igh est v alu es bein g obt ain ed f or t h e dem in er alizat ion phase ( p< 0.05) . How ever, t he differ ence bet w een t he one- w eek and t he four- w eek t im e point s was
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Table 3 show s t he r esult s of t he EDS analysis. Aft er t he one- and four- w eek t r eat m ent per iods,
Ca and P concent rat ions and t he Ca/ P rat io w er e higher com par ed t o t hose of t he dem ineralized
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d i f f er en ce b et w een t h e d em i n er a l i za t i o n a n d one- w eek t r eat m ent phases, aft er t he four- w eek
t r eat m ent per iod tKH ) FRQWHQW ZDV VLJQL¿FDQWO\
higher com par ed w it h t hat in t he dem ineralized ar eas ( p< 0.05) .
D I SCUSSI ON
I ncr easing dem and for noninvasive t r eat m ent o f WSLs h as l ed d en t al r esear ch er s t o f o cu s o n d e v e l o p i n g m a t e r i a l s t h a t h a v e g r e a t e r r em in er alizat ion ab ilit y t h an t h e con v en t ion al
agent s. Am ong t hese, m at erials cont aining CPP-ACP
have becom e popular for r em ineralizing incipient car ies lesions4,7,10,21,27. Alt hough num er ous st udies
r elat ed t o CPP- ACP p ast e h av e d em on st r at ed t he r em ineralizing pot ent ial of t he agent , t o our k now ledge, t her e has been lim it ed st udy of t he
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for r em ineralizing WSLs. Ther efor e, in t he pr esent st u dy, an in v it r o m odel w as u sed t o com par e
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effect s of t he m at er ial w er e assessed using SMH,
QLF- D, EDS, and LF pen.
The m ineral loss or gain in enam el caused by dem ineralization or rem ineralization can be m easured by evaluat ing changes in t he SMH of t he enam el. SMH m easur em ent s pr ov ide a r elat ively sim ple, n on dest r u ct iv e, an d r apid m et h od of assessin g dem ineralizat ion and r em ineralizat ion28. Accor ding WRWKHUHVXOWVRIWKLVVWXG\VLJQL¿FDQWGLIIHUHQFHV
were found bet ween t he baseline, dem ineralizat ion, and post - t r eat m ent SMH m easur em ent s, and t he
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of t he dem ineralized enam el. Pr eviously, several st udies have invest igat ed t he syner gist ic effect of
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st udy assessed t he ion r elease of MI Var nish; t he
r esu lt s obt ain ed w er e con sist en t w it h t h ose of pr evious st udies4,5,7,10,21,27.Cochrane, et al.5 ( 2014)
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an d calciu m ion r elease com p ar ed w it h ot h er
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phosphat e, am or phous calcium phosphat e, and f lu or id e5. Resear ch er s ex p lain ed t h e r ap id ion
r elease fr om MI Var nish t o t he high wat er solubilit y of t he CPP- ACP com plexes: I t is t hought t hat t he gr eat r em ineralizat ion abilit y of MI Var nish m ay Baseline Demineralization 1-week 4-weeks
SMH 267.80 ± 17.29a 60.96 ± 6.80b 92.60 ± 19.81c 113.78 ± 19.57d
LF pen 4.13 ± 0.40a 21.17 ± 2.21b 18.21 ± 3.38c 17.82 ± 2.72c
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Table 2-6XUIDFHPLFURKDUGQHVVYDOXHVIRUPLFURKDUGQHVVWHVWDQGÀXRUHVFHQFHYDOXHVIRU/)SHQLQGLIIHUHQWWLPHSRLQWV PHDQ6'Q
Baseline Demineralization 1-week 4-week
Ca 39.43 ± 2.03a 32.18 ± 2.41b 35.99 ± 3.42c 36.89 ± 3.52d
P 17.95 ± 0.52a 16.14 ± 0.91b 17.09 ± 0.82c 17.29 ± 1.03d
F 0.07 ± 0.09a 0.00 ± 0.00b 0.02 ± 0.04a,b 0.05 ± 0.08a
Ca/P 2.20 ± 0.08a 1.99 ± 08b 2.10 ± 0.12c 2.13 ± 0.11c
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be caused by t his rapid r elease of ions fr om t he m at er ial and by t he bioavailable nat ur e of t he CPP-ACP cont ained in t he var nish.
Because t he convent ional m et hods of m onit oring t he m ineral loss or gain occur r ing as a r esult of d em in er alizat ion an d r em in er alizat ion ar e n ot possible t o be used clinically, quant it at ive m et hods t hat ar e clinically applicable have been developed t o d e t e ct a n d m o n i t o r ca r i e s i n t h e m i n e r a l cont ent . One such m et hod, QLF, is a visible light syst em t hat can quant it at ively det ect t he degr ee of dem in er alizat ion an d af t er w ar ds m on it or it s p r og r ession or r eg r ession n on d est r u ct iv ely1 3 , 2 8. Pr evious st udies have t est ed t he QLF m et hod in in
vit ro experim ent s wit h t ransverse m icroradiography
( TMR) , o p t i cal co h er en ce t o m o g r ap h y ( OCT) , scanning elect r on m icr oscopy / ener gy disper siv e X- ray spectroscopy ( SEM/ EDS) , SMH tests, and digital phot ography2, 3, 14, 17. These st udies have r epor t ed t hat QLF can be used t o m onit or t he pr ogr ession or r egr ession of enam el dem ineralizat ion. The QLF- D
Bilum inat or™ 2 used in t his st udy is an upgraded
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Am st er dam , Net her lands) and has ot her upgrades t o en h an ce t h e ch ar act er ist ics of t h e QLF. I n
4/)'DQDO\VLVVLJQL¿FDQWGLIIHUHQFHVZHUHIRXQG
b et w een d em in er alizat ion an d p ost - t r eat m en t QLF- D m easur em ent s. I n addit ion, w it h r egar d t o
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b et w een t h e on e- an d f ou r - w eek t r eat m en t s,
DQG ÀXRUHVFHQFH JDLQ ZDV LQFUHDVHG JUDGXDOO\ 7KHVH¿QGLQJVVXJJHVWHGWKDWDVLQJOHDSSOLFDWLRQ RI ÀXRULGH YDUQLVK FRQWDLQLQJ &33$&3 FDXVHV D VLJQL¿FDQWLQFUHDVHLQÀXRUHVFHQFHDQGDUHGXFWLRQ
of t he lesion ar ea.
LF is a m et hod of det ect ing caries and m onit oring t he m ineral loss or gain of t oot h st r uct ur e. The D I AGNOd en t LF p en i s cap ab l e o f cap t u r i n g , a n a l y zi n g , a n d q u a n t i f y i n g t h e f l u o r e sce n ce changes in t he t oot h st r uct ur e21. I n t he pr esent
VWXG\ WKH /) SHQ ÀXRUHVFHQFH YDOXHV VKRZHG VLJQL¿FDQW GLIIHUHQFHV DPRQJ WKH WKUHH SKDVHV
( baseline, aft er dem ineralizat ion, and aft er one w eek o f r em i n er a l i za t i o n ) , b u t t h er e w a s n o
VLJQL¿FDQWGLIIHUHQFHEHWZHHQWKH¿UVWDQGIRXUWK ZHHNV7KHVH¿QGLQJVVXJJHVWHGWKDW0,9DUQLVK
is an effect ive agent for r em ineralizing of WSLs.
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and QLF analyses w it h LF pen for 1- and 4- w eek r em in er alizat ion ch an ges m ay be ex plain ed by t he fact t hat t he LF pen device is not capable of d et ect in g sm all ch an g es in m in er al con t en t of WSLs. Som e st udies evaluat ing t he per for m ance of LF p en in m on it or in g r em in er alizat ion h av e
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m onit or ing of WSLs, and lit t le evidence is available
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incipient caries6,11,15,16,23. I n t he current st udy, LF pen was found t o be an appropriat e device for det ect ing d e m i n e r a l i za t i o n a n d l a r g e r r e m i n e r a l i za t i o n
FKDQJHVKRZHYHULWZDVQRWHI¿FLHQWLQGHWHFWLQJ
sm all r em in er alizat ion ch an g es u n d er in v it r o condit ions.
The r em ineralizat ion pr ocess is dependent on t he m ineral changes in t he st r uct ur e of dent al har d
WLVVXHV7KHOHYHOVRI&D3DQGÀXRULGHHOHPHQWV
in enam el r epr esent an indicat ion of t he rat e of dem ineralizat ion or rem ineralizat ion, and quant ifying t h ese l ev el s can d en o t e l esi o n p r o g r ess9 , 1 1 , 1 7. I n t h i s st u d y, EDS w as u sed t o ev al u at e t h e changes generat ed by t he r em ineralizat ion agent on t he dem ineralized enam el. EDS is a pow er ful inst r um ent t hat per for m s quant it at ive elem ent al analyses by m easur ing t he charact er ist ics of r e-em it t ed X- ray s, and using t his dev ice can help t o com par e t h e effect s of var iou s m at er ials on
dem ineralized enam el sam ples17. I n t he pr esent
st udy, Ca and P cont ent and t he Ca/ P rat io w er e
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w er e com par ed t o dem ineralized ar eas aft er one- and four - w eek t r eat m ent s. This r esult indicat es t he r em ineralizat ion pot ent ial of t he agent used in t he st udy.
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of MI Var nish was evaluat ed by analyzing enam el using SMH, QLF- D, EDS, and LF pen. The r esult s
clearly dem onst rat ed t hat MI Varnish is an effect ive ag en t an d u sef u l f or r em i n er al i zi n g of WSLs. Alt hough t he com plex oral environm ent could not be ent ir ely m im icked in t he pr esent st udy, t he r esult s provided useful inform at ion about t he effect iveness of t he t est ed agent for r em ineralizing of enam el. Fut ur e in vivo, com parat ive st udies, and in vit r o/ in vivo st udies should be designed t o assess t he
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CON CLUSI ON S
Under t he lim it at ions of t he pr esent st udy, t he follow ing conclusions can be m ade:
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r em ineralizat ion of incipient car ious lesions aft er a single applicat ion and seem s suit able for clinical use.
2- An upgraded QLF- D device seem s helpful in in vit r o st udies and pr ovides quant it at ive, consist ent r esult s.
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