UCSF

A primary goal of dental tissue engineering is the biological reconstruction of tooth substrate destroyed by caries or other diseases affecting tooth mineralization. Traditionally, dentists treat caries by using invasive techniques to remove the diseased dental tissue and restore the lesion, ideally preventing further progression of decay. Success in strategies associated with remineralization of enamel and root caries have contributed to the less invasive prospect of remineralization of dentinal carious lesions. The central hypothesis of this dissertation is that carious dentin lesions can be remineralized if the lesions contain residual mineral. Caries Detector (CD) stained zones (pink, light pink, transparent and normal) of arrested carious dentin lesions were characterized according to microstructure by atomic force microscopy (AFM) imaging, mineral content by digital transverse microradiography, and nanomechanical properties by AFM-based nanoindentation. CD-stained and unstained zones had significantly different microstructure, mineral content and nanomechanical properties. Furthermore, the most demineralized carious zone contained residual mineral. To obtain reproducible, standardized dentin caries lesions, we characterized the lesions from an artificial carious dentin lesion model using a 0.05M acetate demineralization buffer. The artificial caries-like lesions produced by the buffer had similar mineral content and nanomechanical properties in the stained and unstained zones as natural dentin lesions. Both natural and artificial lesions had significant correlations between mineral content and nanomechanical properties. Mineral crystallite size and shape was examined by small angle x-ray scattering. Both natural and artificial carious dentin had different mineral sizes than normal dentin. Collagen in natural and artificial carious dentin lesions was examined by trichrome stain, AFM high-resolution imaging, and UV resonance Raman spectroscopy, to determine if fibrils were intact and mineralization levels. It appeared that the collagen in the most demineralized pink zones of the lesions was intact and contained intrafibrillar mineral. Natural and artificial carious dentin lesions were treated with remineralization solutions containing different amounts of Ca²⁺ and PO₄^3-, with and without CO₃^2- and with and without 2 ppm fluoride. The hydrated nanomechanical properties of the lesions were partially restored. This suggests that the most CD-stained zones of arrested dentin caries lesions may be remineralizable. These results suggest that remineralization as an approach of minimally invasive dentistry using non-invasive treatments to restore dental tissues is possible.