Comparative Evaluation of Efficacy of Bioactive Glass, Tricalcium Phosphate, and Ozone Remineralizing Agents on Artificial Carious Lesion

Abstract

Objectives:

Evaluation of efficacy of bioactive glass (BAG), tricalcium phosphate, and ozone remineralizing agents on artificial carious lesion.

Materials and Methods:

Freshly extracted 48 human premolar teeth were included for this in vitro study. Remineralization of demineralized teeth was done with respective remineralizing agents (Group A – calcium sodium phosphosilicate [BAG], Group B – tricalcium phosphate [Clinpro Tooth Crème], Group C – ozone remineralizing agents, and control group: Group D – deionized water) three times a day for 12 days for 4 min. The degree of demineralization and remineralization was evaluated with Vickers hardness number.

Results:

There was a decrease in microhardness from baseline to demineralization in all the groups. The difference in microhardness values from demineralization to remineralization in all the three test groups was found to be statistically highly significant.

Conclusion:

BAG and Tricalcium phosphate had higher remineralizing capacity, which can be used clinically to treat early carious lesions.

INTRODUCTION

White spot lesion on the tooth surface is the first clinical sign of dental caries which can be considered as the initial stage of enamel demineralization.[1]

To overcome from the drawbacks of fluoride, various nonfluoridated remineralizing agents were tried such as, casein phosphopeptide-amorphous calcium phosphate (CPP-ACFP), CCP-ACFP, bioactive glass (BAG) (NovaMin), ozone, xylitol, tricalcium phosphate (f-TCP), nano-hydroxyapatite (nHAp), and self-assembling peptide.[1,2]

BAG is commercially available as NovaMin (e.g., bioglass).[3] The mechanism of healing ozone's action is related to ozone's potent antimicrobial properties and its ability to oxidize proteins associated with caries.[4]

The present in vitro study was done to evaluate the efficacy of BAG, tricalcium phosphate, and ozone remineralizing agents on artificial carious lesion.

MATERIALS AND METHODS

The study was done at the Department of Conservative Dentistry and Endodontics. Freshly extracted 48 human premolar teeth due to orthodontic purposes free from pathologies were included for this in vitro study.

Artificial carious lesion/demineralization was created on buccal surfaces by keeping teeth in calcium chloride (2.0 mmol/L) and trisodium phosphate (2.0 mmol/L) in a buffer solution of acetate (75 mmol/L) for 5 days at a 4.6 pH.

Remineralization of demineralized teeth was done with respective remineralizing agents (Group A – calcium sodium phosphosilicate (CSP; BAG), Group B – tricalcium phosphate (Clinpro Tooth Crème), Group C –

ozone remineralizing agents, and control group: Group D – deionized water) three times a day for 12 days for 4 min. The degree of demineralization and remineralization was evaluated with Vickers hardness number.

The obtained values were tabulated and statistically evaluated with Statistical Package for Social Sciences version 21.0 for Windows (SPSS Inc., Chicago, IL, USA) by ANOVA and Tukey's Honestly Significant Difference test. The significance level was set at P < 0.05.

RESULTS

There was a decrease in microhardness from baseline to demineralization in all the groups and this reduction was found to be statistically considerable [Table 1].

Table 1.

Mean microhardness values at baseline and postdemineralization

Group	Baseline value	Mean postdemineralization	Percentage demineralization	Significance
Group I	334.67	232.38	32*	0.001**
Group II	321.45	234.75	30*
Group III	324.45	238.83	26*
Group IV	342.34	240.21	22*

**P<0.001 highly significant, *-significant

After remineralization of demineralized samples with respective remineralizing agents, there was increase in microhardness of 310.43, 284.87, and 267.34 in Group I, II, and III, respectively, whereas in Group IV, there were no changes. This indicated that higher remineralization percentage with Group I and followed by Group II and III. There were 0% changes in Group IV, a control group [Table 2].

Table 2.

Mean microhardness values at postremineralization

Group	Baseline value	Mean postremineralization	Percentage of remineralization
Group I	232.38	310.43	38.4**
Group II	234.75	284.87	29.7**
Group III	238.83	267.34	19.2**
Group IV	240.21	240.31	0

**P<0.001 highly significant

DISCUSSION

The remineralization process is dependent on the mineral changes in the structure of dental hard tissue.[1] The remineralizing agents provide the required ions by generating some surface coatings which perform as diffusion blocks and thus reduce the solubility of the enamel by mineral deposition within the enamel crystals.[5] Demineralization can be reversed if the pH is neutralized and with the availability of sufficient calcium and phosphate ions in the oral environment.[6]

Joshi et al. found that BAG NovaMin, f-TCP, and nHAp showed considerable remineralization (RML).[3] Patil et al. assessed the efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), casein phosphopeptide-

amorphous calcium phosphate fluoride (CPP-ACPF), and tricalcium phosphate fluoride (TCP-F) in remineralizing enamel surface on artificial caries. They observed higher remineralization with tested products.[7]

Balakrishnan et al. observed increased Vickers hardness number values of the enamel specimens after treating with remineralizing agents ([CPP-ACP], 0.21% sodium fluoride-[f-TCP], and CSP) similar to our findings.[8] BAG (Bioglass®) acts as a biomimetic mineralizer matching the body's own mineralizing traits and also affecting cell signals, thereby benefitting the restoration of tissue structure and function.[9]

The drawback of the study was smaller sample size. Further, clinical studies are needed with larger sample size to evaluate the efficacy of remineralizing agents.

CONCLUSION

BAG and f-TCP had higher remineralizing capacity which can be used clinically to treat early carious lesions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.