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In Vitro Enamel Remineralization Efficacy of Calcium Silicate-Sodium Phosphate-Fluoride Salts Versus Novamin Bioactive Glass, Following Tooth Whitening

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In Vitro Enamel Remineralization Efficacy of Calcium Silicate-Sodium Phosphate-Fluoride Salts Versus Novamin Bioactive Glass, Following Tooth Whitening Published online: 2021-02-23 THIEME Original Article 515 In Vitro Enamel Remineralization Efficacy of Calcium Silicate-Sodium Phosphate-Fluoride Salts versus NovaMin Bioactive Glass, Following Tooth Whitening 1 2,3 4 5 Hatem M. El-Damanhoury Nesrine A. Elsahn Soumya Sheela Talal Bastaty 1 Department of Preventive and Restorative Dentistry, Address for correspondence Hatem El-Damanhoury, BDS, MS, College of Dental Medicine, University of Sharjah, Sharjah, PhD, Room M28-129 , College of Dental Medicine , University United Arab Emirates of Sharjah, P.O. Box: 27272, Sharjah , United Arab Emirates 2 Department of Clinical Sciences, College of Dentistry, Ajman (e-mail: [email protected] ) . University, Ajman, United Arab Emirates 3 Department of Operative Dentistry, Faculty of Dentistry, Cairo University, Cairo, Egypt 4 Dental Biomaterials Research Group, Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates 5 College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates Eur J Dent:2021;15:515–522 Abstract Objectives This study aimed to evaluate the effect of in-office bleaching on the enamel surface and the efficacy of calcium silicate-sodium phosphate-fluoride salt (CS) and NovaMin bioactive glass (NM) dentifrice in remineralizing bleached enamel. Materials and Methods Forty extracted premolars were sectioned mesio-distally, and the facial and lingual enamel were flattened and polished. The samples were equally divided into nonbleached and bleached with 38% hydrogen peroxide (HP). Each group was further divided according to the remineralization protocol ( n = 10); no remineralization treatment (nontreated), CS, or NM, applied for 3 minutes two times/ day for 7 days, or CS combined with NR-5 boosting serum (CS+NR-5) applied for 3 minutes once/day for 3 days. The average Knoop hardness number (KHN) and surface roughness (utilizing atomic force microscopy) were measured. Surface topography/ Keywords elemental analysis was analyzed by using scanning electron microscopy/energy dis- ► bleaching persive X-ray analysis. All the tests were performed at baseline, after bleaching, and ► enamel following each remineralization protocol. Data were statistically analyzed by two-way ► remineralization analysis of variance and Bonferroni post hoc multiple comparison tests (α = 0.05). ► scanning electron Results HP significantly reduced KHN and increased roughness (p < 0.05). All remin- microscopy eralization materials increased the hardness and reduced the surface roughness after ► energy dispersive bleaching except NM, which demonstrated significantly increased roughness (p < 0.05). X-ray analysis Ca/P ratio decreased after bleaching ( p < 0.05 ), and following treatment, CS and ► calcium CS+NR-5 exhibited higher remineralization capacity in comparison to NM ( p < 0.05). silicate-sodium Conclusion Although none of the material tested was able to reverse the negative phosphate-fluoride effect of high-concentration in-office HP on enamel completely, the remineralization ► NovaMin efficacy of CS and CS+NR-5 was superior to that of NM. published online DOI https://doi.org/ © 2021. European Journal of Dentistry. February 23, 2021 10.1055/s-0040-1722484 This is an open access article published by Thieme under the terms of the Creative ISSN 1305-7456 . Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India 516 Remineralization of Bleached Enamel: CSSPF vs NovaMin El-Damanhoury et al. Introduction and enamel remineralization is bioactive glass, specifically, NovaMin. Primarily, NovaMin is a ceramic material that con- Among the aesthetic management modalities of vital and sists of amorphous sodium-calcium-phosphosilicate as a nonvital discolored teeth, dental bleaching has proven to be powder of fine particle size that is highly reactive in water. a highly conservative and simple treatment option. At pres- NovaMin works in two mechanisms. One mechanism is ent, several bleaching agents are commercially available and that the fine powder itself is capable of occluding dentinal are mainly based on different concentrations of hydrogen tubules,14 and the second is by its reaction when exposed peroxide (HP) or carbamide peroxide (CP). These products to the tooth’s aqueous environment. The production of cal- are available for use at home or in the dental office, possibly cium and phosphate ions from the glass is brought about by aided by various types of light sources to intensify the oxida- the rapid exchange of particles between the sodium ions in 1 tion reaction. NovaMin and hydrogen cations from the aqueous environ- The process of bleaching teeth involves free radicals ment of the tooth.15 The release of sodium at primary expo- generation such as oxygen and perhydroxyl because of the sure of the material to water leads to a transitory and localized decomposition of HP. The presence of these radicals gener- increase in pH. This effect encourages the precipitation of the 2 ates an oxidation-reduction reaction. Due to their exceed- supplementary calcium and phosphate ions delivered by the ingly electrophilic nature, free radicals diffuse through the NovaMin ultimately forming a layer of calcium phosphate. matrices of enamel and dentin to bombard the pigment mol- This layer then crystalizes into carbonate-enriched hydroxy- ecules and ultimately gain stability, and this is possible due apatite (HCA).16 The newly formed HCA combines with the to the permeability of dental tissue. Following this reaction, residual NovaMin particles, remineralizing the enamel sur- the organic macromolecules—of which the pigments are face and hinders further demineralization.14 formed—are broken down into less complex, smaller, and The remineralization of bleached enamel has been scarcely 3 lighter molecules. Due to the unspecific nature of this reac- tackled in the literature. Therefore, this study was conducted tion, several studies have investigated its undesirable effects to investigate the remineralizing capacity of two anti-erosive/ on tooth structure such as mineral loss and alterations to sur- remineralizing agents (namely CSSPF and NovaMin bioactive face topography which can, in turn, alter the biomechanical glass) on the bleached enamel, by assessing their effect on the 4,5 properties of enamel. enamel surface hardness and roughness. The null hypothesis Morphological changes of enamel surface were being that the tested remineralizing agents have no effect on reported, mainly due to the erosive nature of the bleaching the surface hardness and surface roughness of the bleached 6 process. Bleaching affects the organic components of enamel enamel. and produces changes in the mineral phase, which ulti- mately creates visible morphological changes on the enamel Materials and Methods surface.7,8 A study by Ushigome et al described that HP selec- tively erodes rod sheath areas while CP causes mineral disso- Samples Preparation lution and decalcification, which results in etch-like erosion The compositions of the tested materials are listed in of surface and subsurface enamel.9 The erosive effects are ►Table 1. Forty sound human premolars extracted for ortho- in view of the acidity of the bleaching agents, where some dontic purposes were used in this study after ethical approval bleaching products have been reported to have a pH as low by the University of Sharjah research ethics committee and as 2.4.10 after patient consent. The teeth were examined under a The application of remineralizing agents was found to restore stereomicroscope for the presence of cracks, decay, or any the morphological defects caused by bleaching.11 Currently, other defect, and teeth with defects were excluded from the among the available remineralization promoting agents, flu- study. Any soft tissues remnants were removed by using an oride-based formulations remain the most commonly used ultrasonic scaler. The roots were sectioned at the cemen- anti-erosive materials. They enhance the precipitation of cal- to-enamel junction using a high-speed dental handpiece cium phosphates and in turn promote the formation of fluo- and a diamond bur and then the pulp tissues were removed. ro-hydroxyapatite crystals in dental tissues.12 The crown of each tooth was sectioned mesio-distally into A dentifrice containing calcium silicate, sodium phos- two halves using a diamond saw (Isomet 1000; Buehler, phate, and fluoride salts (CSSPF) has been introduced. This Lake Bluff, Illinois, United States) to obtain 80 specimens. technology was first proposed to supplement the natural The specimens were embedded in self-cured acrylic resin process of mineralization by human saliva, which was pos- (Fastray, Harry J. Bosworth Co.; Skokie, Illinois, United States) sible by providing auxiliary calcium and phosphate that with the enamel surface facing upward. The enamel surfaces nucleates hydroxyapatite (HAP) formation. This mechanism were polished using a grinding/polishing machine (EcoMet seems to promote the remineralization and repair of soft- 30; Buehler, Lake Bluff, Illinois, United States) with 400, 600, ened enamel and aids in protecting enamel from acid chal- and 1200 grit water-cooled sandpaper discs to attain flat
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