Effect of neodymium-doped:yttrium aluminum perovskite laser combined with two kinds of remineralizers on remineralization of early enamel caries

doi:10.12307/2023.838

Abstract

Abstract: BACKGROUND: In recent years, a variety of lasers have been widely used in various diseases related to stomatology, including the prevention and treatment of dental caries.
OBJECTIVE: To investigate the effect of neodymium-doped:yttrium aluminum perovskite (Nd:YAP) laser combined with two remineralizers on early enamel caries in vitro.
METHODS: Early enamel caries models in vitro were artificially established by 60 enamel blocks and randomly divided into 6 groups (n=10). Group A did not undergo any treatment but underwent extracorporeal pH circulation. Group B underwent remineralization of dentin (the main component of casein phosphopeptide-amorphous calcium phosphate composite) and extracorporeal pH circulation. Group C underwent remineralization treatment of Sensodyne toothpaste (the main component of bioactive glass) and then underwent extracorporeal pH circulation. Group D received Nd:YAP laser irradiation and extracorporeal pH circulation. Group E was treated with Nd:YAP laser irradiation, with remineralization of dentin, and then with extracorporeal pH circulation. In group F, Nd:YAP laser irradiation was performed, and then Sensodyne toothpaste was used for remineralization, and the extracorporeal pH circulation was performed; the remineralization treatment was conducted twice a day, and the experimental period was 20 days. Group G was a normal control group, without caries or remineralization, but only underwent extracorporeal pH circulation. After the experiment, the microhardness, morphology and Ca/P ratio of the dental enamel surface were measured in each group.
RESULTS AND CONCLUSION: (1) The surface microhardness value of dental enamel in groups B, C and D was higher than that in group A (P < 0.000 1); the surface microhardness value of dental enamel in groups E and F was significantly higher than that in groups B, C and D (P < 0.000 1), and the surface microhardness value of dental enamel in group F was significantly higher than that in group E (P < 0.000 1). (2) Scanning electron microscopy showed that there were a lot of demineralized pores on the enamel surface of group A. There were mineral deposits on the enamel surface of group B, which were uneven and loose. In group C, there were a lot of mineral deposits on the enamel surface, and demineralized pores were found between the calcified masses. The enamel surface of group D was relatively flat; the demineralized pores were significantly smaller than that of group A, and the enamel column interstitium was damaged. In group E, the mineral deposits on the enamel surface were thicker and the demineralized pores were significantly reduced. The mineralized substances deposited on the enamel surface of group F were most dense and uniform and the demineralized pores were small. (3) The Ca/P ratio on the enamel surface of groups B and C was significantly higher than that of group A (P < 0.000 1); the Ca/P ratio on the enamel surface of group E was significantly higher than that of groups B, C and D (P < 0.000 1), and the Ca/P ratio on the enamel surface of group F was higher than that of group E (P < 0.001). (4) These findings indicate that bioactive glass, casein phosphopeptide-amorphous calcium phosphate composite, and Nd:YAP laser after enamel demineralization can promote the remineralization of early enamel caries. Nd:YAP laser combined with bioactive glass or casein phosphopeptide-amorphous calcium phosphate composite can further strengthen the remineralization of dental enamel caries, and the combination of Nd:YAP laser and bioactive glass has the best effect.

Key words: enamel caries, remineralization, casein phosphopeptide-amorphous calcium phosphate composite, bioactive glass, neodymium-doped:yttrium aluminum perovskite laser, microhardness, calcium-phosphorus ratio, combination therapy

CLC Number:

Xu Yinghua, Liu Jing, You Quan, Wen Zhihao, Gao Lu. Effect of neodymium-doped:yttrium aluminum perovskite laser combined with two kinds of remineralizers on remineralization of early enamel caries[J]. Chinese Journal of Tissue Engineering Research, 2024, 28(3): 360-365.

Figures/Tables 5

A组牙釉质表面不平整，存在大量的脱矿孔隙；B组牙釉质表面有矿物质沉积，多呈现为碎片状，沉积不均匀且较为疏松；C组牙釉质表面粗糙不平整，有大量的矿物质沉积，且钙化团块间可见脱矿孔隙；D组牙釉质表面较为平整，脱矿孔隙较A组明显变小，釉柱间质有破坏，部分区域有溶解消融现象；E组牙釉质表面矿物质沉积较厚，脱矿孔隙明显减少；F组牙釉质表面沉积的矿化物最为致密且均匀，表面平坦，釉柱间质消融，脱矿孔隙细小，与G组牙釉质表面较相近。以上结果说明，生物活性玻璃及酪蛋白磷酸钙复合体均可促进脱矿牙釉质的再矿化，其中Nd:YAP激光联合生物活性玻璃或者酪蛋白磷酸钙复合体处理牙釉质龋可进一步促进牙釉质的再矿化作用，其中Nd:YAP激光联合生物活性玻璃的效果较为显著。 2.4 各组牙釉质样本X射线能谱分析结果将所有70份样本进行X射线能谱仪检测，通过各种元素特有的X射线波长不同检测出釉质表面的元素种类及含量。结果显示，A组和B组的主要元素为Ca、P、O、C等元素，C组主要元素是 Ca、P、O、C、Si，D、E、F组中主要元素种类与B、C组相同，但元素的含量有所不同。牙釉质主要是由羟基磷灰石晶体以及许多的碳酸钙盐组成，计算Ca/P比值能够相对反映出牙釉质的矿化程度，因此对各组牙釉质表面的Ca/P比值进行了定量分析，结果如表2所示。单因素方差分析显示，各组牙釉质表面的Ca/P比值比较差异有非常显著性意义(P < 0.000 1)；经Tukey法进行组间两两比较，结果见表3，图4。B、C组牙釉质表面的钙磷比值明显高于A组(P < 0.000 1)，但B、C之间牙釉质表面的Ca/P比值比较差异无显著性意义(P > 0.05)；D组牙釉质表面的Ca/P比值与A组比较差异无显著性意义(P > 0.05)；E、F组牙釉质表面的Ca/P比值明显高于B、C、D组(P < 0.000 1)，F组牙釉质表面的Ca/P比值明显高于E组(P < 0.001)，其中F组牙釉质表面的Ca/P比值平均可达到2.167，接近于G组(均值为2.230)。"

References

[1] 黎凯歌,严冬,韩文睿,等.不同正畸方式对龈上菌斑中三种致龋菌的早期影响[J].北京口腔医学,2022,30(3):182-188.
[2] 陈锐.固定矫治中不同药物应用对釉质脱矿指数的影响[J].中华全科医学,2017,15(9):1632-1634.
[3] DIDEM N, MEHMET OO, DERYA GC, et al. Prevention of demineralization around orthodontic brackets using two different fluoride varnishes. Eur J Dent. 2013;7:41-47.
[4] SHIVANANDA DH, ANSAR W, DINSHA AR, et al. Effectiveness of Various Dental Varnishes in Prevention of Enamel Demineralization around Orthodontic Brackets: An In Vitro Study. J Contemp Dent Pract. 2020;21(6): 621-625.
[5] 招顺秀,李业荣,许碧晖.多乐氟预防固定正畸矫治中牙釉质脱矿的临床研究[J].广东牙病防治,2013,21(8):441-443.
[6] 吴海苗,许衍,叶翠,等. 氟保护漆预防固定正畸牙釉质脱矿的临床观察研究[J].口腔生物医学,2020,11(2):113-115.
[7] 黄少宏.群体氟防龋指导策略[J].中国实用口腔科杂志,2014,7(7):389-394.
[8] ERDEM AP, SEPET E, AVSHALOM T, et al. Effect of CPP-ACP and APF on Streptococcusmutans biofilm: a laboratory study. Am J Dent. 2011;24(2): 119-123.
[9] PINHEIRO SL, AZENHA GR, ARAUJO G, et al. Effectiveness of casein phosphopeptide-amorphous calcium phosphate and lysozyme, lactoferrin, and lactoperoxidase in reducing Streptococcus mutans counts in dentinal caries. Gen Dent. 2017;65(2):47-50.
[10] GJORGIEVSKA E, NICHOLSON JW. Prevention of enamel demineralization after tooth bleaching by bioactive glass in corporated into toothpaste. Aust Dent J. 2011;56(2):193-200.
[11] 方萍,陈燕,周嫣,等.护牙素对正畸牙面脱矿修复的临床效果观察[J].广西医学,2012,34(8):978-980.
[12] 黄汝祥,邓文正,高健全,等.CPP-ACP与氟保护漆联合应用预防鼻咽癌患者放射性龋齿的临床研究[J]. 中国医药指南,2017,15(4):15-16.
[13] 王瑜,龚玲,郑丽纯,等.几种再矿化牙膏对釉质再矿化影响的体外研究[J].临床口腔医学杂志,2017,33(7):394-396.
[14] HENCH LL. The story of Bioglass. J Mater Sci Mater Med. 2006;17(11):967.
[15] JAFARI N, HABASHI MS, HASHEMI A, et al. Application of bioactive glasses in various dental fields. Biomater Res. 2022;26(1):31.
[16] 黄贤圣,李蓉,冯云枝,等.生物活性玻璃Novamin诱导脱矿牙本质再矿化[J].中南大学学报(医学版),2018,43(6):619-624.
[17] 江蓉,张齐梅.激光协同CPP-ACP对乳牙早期釉质龋再矿化影响的临床研究[J].医学综述,2019,25(22):4585-4588.
[18] 杜伟.激光在牙本质过敏治疗中的应用进展[J].中国医疗器械信息, 2019,25(11):51-52.
[19] LIU J F, LIU Y, STEPHEN HC. Optimal Er:YAG laser energy for preventing enamel demineralization. J Dent. 2006;34(1):62-66.
[20] 刘雪阳,刘海江.不同功率铒,铬:钇钪镓石榴石激光照射对牙釉质表面再矿化效果比较的实验研究[J].转化医学杂志,2017,6(1):22-25.
[21] YASSAEI S, AGHILI H, SHAHRAKI N, et al. Efficacy of erbium-doped yttrium aluminum garnet laser with casein phosphopeptide amorphous calcium phosphate with and without fluoride for remineralization of white spot lesions around orthodontic brackets. Eur J Dent. 2018;12(2):210-216.
[22] NAMOUR A, GEERTS S, ZEINOUN T, et al. Safety Irradiation Parameters of Nd:YAP Laser Beam for Endodontic Treatments: An In Vitro Study. Biomed Res Int. 2016;2016:4741516.
[23] MOSHONOV J, PERETZ B, BROWN T, et al. Cleaning of the rool canal using Nd:YAP Laser and its effect on the mineral content of the dentin. J Clin Laser Med Sur. 2004;22:87-89.
[24] 时晨,杨清岭,李宝花.渗透树脂联合CPP-ACP对年轻恒牙早期脱矿的影响[J].临床口腔医学杂志,2017,33(4):208-211.
[25] 伍廷芸,阮琼,李智,等.纳米级护牙剂对于釉质酸蚀后再矿化效果的定量分析[J].临床口腔医学杂志,2022,38(2):75-78.
[26] 方谦,穆玉,徐晓南,等.不同浓度生物活性玻璃对早期釉质龋再矿化的作用[J].牙体牙髓牙周病学杂志,2015,25(12):729-731.
[27] 程亚楠,吴毓聪,毛秋华,等.渗透树脂联合生物活性玻璃修复脱矿牙釉质的效果及稳定性[J].中国组织工程研究,2021,25(22):3522-3526.
[28] 董峻池,郑慧玲,卫羽雯,等.生物活性玻璃的抗菌机制及其影响因素[J].口腔医学,2022,42(6): 551-556.
[29] LUK K, ZHAO IS, YU OY, et al. Effects of 10,600 nm Carbon Dioxide Laser on Remineralizing Caries: A Literature Review. Photobiomodul Photomed Laser Surg. 2020;38(2):59-65.
[30] 梁潇月,邹朝晖,董晓曦,等.钕激光、半导体激光对窝洞消毒产热及抑菌效果的体外实验[J].中国组织工程研究,2021,25(34):5432-5438.
[31] 汪婷,朱亚琴.Nd:YAP激光与Er:YAG激光在口腔医学的应用现状[J].口腔材料器械杂志,2018,27(4):225-228.
[32] 刘耀然,赵继志,孔亚群.Nd:YAG激光与Nd:YAP激光在口腔医学应用中的比较[J].中国激光医学杂志,2016,25(3):153-159.
[33] NAMOUR A, NAMMOUR S, PEREMANS A, et al. Treatment of dentinal hypersensitivity by means of Nd:YAP Laser: apreliminary in vitro study. ScientificWorld J. 2014;2014:323-604.
[34] FORNAINI C, BRULAT-BOUCHARD N, MEDIONI E, et al. Nd:YAP laser in the treatment of dentinal hypersensitivity: An ex vivo study. J Photochem Photobiol B. 2020;203:111740.