Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of developmentally hypomineralised enamel after surface pretreatment with Papacarie Duo gel and different etching modes: an in vitro SEM and AFM study

  • Original Scientific Article
  • Published:
European Archives of Paediatric Dentistry Aims and scope Submit manuscript

Abstract

Purpose

This study aimed at investigating the surface morphology and nanotopography of normal enamel (NE) and developmentally hypomineralised enamel (HE) when subjected to various pretreatment protocols under scanning electron microscopy (SEM) and atomic force microscopy (AFM).

Methods

Sixteen NE, 16 creamy/white (CW) HE and 16 yellow/brown (YB) HE specimens sectioned from extracted hypomineralised first permanent molars (FPMs) were included in this study. They were randomly distributed into 12 experimental groups (n = 4). Each group involved the following: (1) deproteinisation with Papacarie Duo® gel or no deproteinisation, and (2) the use of Scotchbond™ Universal Adhesive (Scotchbond) in self-etch (SE) mode or 37% phosphoric acid etchant. Subsequently, the surface morphology and nanotopography of pretreated enamel specimens were evaluated under SEM and AFM, respectively.

Results

SEM observation showed that deproteinisation with Papacarie Duo® gel before phosphoric acid etching led to favourable etching patterns. This was consistent across all groups irrespective of the type of enamel specimen and the severity of hypomineralisation. In contrast, AFM results identified three factors that influenced surface parameters: (1) type of enamel specimen, (2) severity of hypomineralisation and (3) etching mode. YB HE recorded higher surface roughness values than CW HE and NE when subjected to the same pretreatment protocol. Deproteinisation and the application of Scotchbond in SE mode led to minimal topographic changes; however, acid etching was associated with an increase in surface roughness.

Conclusion

Deproteinisation with Papacarie Duo® gel followed by acid etching contributed to improved etching patterns on HE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

Availability of data and material

The datasets generated and analysed during the study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

References

  • Abdelmegid FY. Effect of deproteinization before and after acid etching on the surface roughness of immature permanent enamel. Niger J Clin Pract. 2018;21:591–6.

    Article  Google Scholar 

  • Agarwal RM, Yeluri R, Singh C, Munshi AK. Enamel deproteinization using papacarie and 10% papain gel on shear bond strength of orthodontic brackets before and after acid etching. J Clin Pediatr Dent. 2015;39:348–57.

    Article  Google Scholar 

  • Bedran-Russo A, Leme-Kraus AA, Vidal CMP, Teixeira EC. An overview of dental adhesive systems and the dynamic tooth-adhesive interface. Dent Clin North Am. 2017;61:713–31.

    Article  Google Scholar 

  • Beech DR, Jalaly T. Bonding of polymers to enamel: influence of deposits formed during etching, etching time and period of water immersion. J Dent Res. 1980;59:1156–62.

    Article  Google Scholar 

  • Bozal CB, Kaplan A, Ortolani A, Cortese SG, Biondi AM. Ultrastructure of the surface of dental enamel with molar incisor hypomineralization (MIH) with and without acid etching. Acta Odontol Latinoam. 2015;28:192–8.

    Google Scholar 

  • Buonocore MG. A simple method of increasing the adhesion of acrylic filling materials to enamel surfaces. J Dent Res. 1955;34:849–53.

    Article  Google Scholar 

  • Bussadori SK, Castro LC, Galvao AC. Papain gel: a new chemo-mechanical caries removal agent. J Clin Pediatr Dent. 2005;30:115–9.

    Article  Google Scholar 

  • Cerci BB, Roman LS, Guariza-Filho O, Camargo ES, Tanaka OM. Dental enamel roughness with different acid etching times: atomic force microscopy study. Eur J Gen Dent. 2012;1:187–91.

    Article  Google Scholar 

  • Chan YL, Ngan AH, King NM. Degraded prism sheaths in the transition region of hypomineralized teeth. J Dent. 2010;38:237–44.

    Article  Google Scholar 

  • Chay PL, Manton DJ, Palamara JE. The effect of resin infiltration and oxidative pre-treatment on microshear bond strength of resin composite to hypomineralised enamel. Int J Paediatr Dent. 2014;24:252–67.

    Article  Google Scholar 

  • Chen C, Niu LN, Xie H, Zhang ZY, Zhou LQ, Jiao K, Chen JH, Pashley DH, Tay FR. Bonding of universal adhesives to dentine—old wine in new bottles? J Dent. 2015;43:525–36.

    Article  Google Scholar 

  • Crombie F, Manton D, Palamara J, Reynolds E. Resin infiltration of developmentally hypomineralised enamel. Int J Paediatr Dent. 2014;24:51–5.

    Article  Google Scholar 

  • Da Costa-Silva CM, Ambrosano GM, Jeremias F, De Souza JF, Mialhe FL. Increase in severity of molar-incisor hypomineralization and its relationship with the colour of enamel opacity: a prospective cohort study. Int J Paediatr Dent. 2011;21:333–41.

    Article  Google Scholar 

  • de Melo MA, Passos VF, Lima JP, Santiago SL, Rodrigues LK. Carbohydrate-electrolyte drinks exhibit risks for human enamel surface loss. Restor Dent Endod. 2016;41:246–54.

    Article  Google Scholar 

  • de Souza JF, Fragelli CB, Jeremias F, Paschoal MAB, Santos-Pinto L, de Cordeiro CLR. Eighteen-month clinical performance of composite resin restorations with two different adhesive systems for molars affected by molar incisor hypomineralization. Clin Oral Investig. 2017;21:1725–33.

    Article  Google Scholar 

  • Ekambaram M, Yiu CKY. Bonding to hypomineralized enamel—a systematic review. Int J Adhes Adhes. 2016;69:27–32.

    Article  Google Scholar 

  • Ekambaram M, Anthonappa RP, Govindool SR, Yiu CKY. Comparison of deproteinization agents on bonding to developmentally hypomineralized enamel. J Dent. 2017;67:94–101.

    Article  Google Scholar 

  • Elhennawy K, Manton DJ, Crombie F, Zaslansky P, Radlanski RJ, Jost-Brinkrnann PG, Schwendicke F. Structural, mechanical and chemical evaluation of molar-incisor hypomineralization-affected enamel: a systematic review. Arch Oral Biol. 2017;83:272–81.

    Article  Google Scholar 

  • Elhoshy A, Aboelenein K. Microtensile bond strength of self-etching adhesives to enamel. Tanta Dent J. 2018;15:192–8.

    Article  Google Scholar 

  • Espinosa R, Valencia R, Uribe M, Ceja I, Saadia M. Enamel deproteinization and its effect on acid etching: an in vitro study. J Clin Pediatr Dent. 2008;33:13–9.

    Article  Google Scholar 

  • Espinosa R, Valencia R, Uribe M, Ceja I, Cruz J, Saadia M. Resin replica in enamel deproteinization and its effect on acid etching. J Clin Pediatr Dent. 2010;35:47–51.

    Article  Google Scholar 

  • Farah RA, Monk BC, Swain MV, Drummond BK. Protein content of molar-incisor hypomineralisation enamel. J Dent. 2010;38:591–6.

    Article  Google Scholar 

  • Fernandez-Barrera MA, da Silva AF, Pontigo-Loyola AP, Zamarripa-Calderon JE, Piva E, Cuevas-Suarez CE. The effect of deproteinizing agents on bond strength of resin-based materials to enamel: a systematic review and meta-analysis of in vitro studies. J Adhes Dent. 2021;23:287–96.

    Google Scholar 

  • Fragelli CMB, Souza JF, Bussaneli DG, Jeremias F, Santos-Pinto LD, Cordeiro RCL. Survival of sealants in molars affected by molar-incisor hypomineralization: 18-month follow-up. Braz Oral Res. 2017;31:e30.

    Article  Google Scholar 

  • Galil KA, Wright GZ. Acid etching patterns on buccal surfaces of permanent teeth. Pediatr Dent. 1979;1:230–4.

    Google Scholar 

  • Gandhi G, Kalra JPS, Goyal A, Sharma A. Microphotographic assessment of enamel surface using self-etching primer and conventional phosphoric acid: an in vitro study. Contemp Clin Dent. 2018;9:15–9.

    Google Scholar 

  • Gardner A, Hobson R. Variations in acid-etch patterns with different acids and etch times. Am J Orthod Dentofacial Orthop. 2001;120:64–7.

    Article  Google Scholar 

  • Hamama HH, Yiu CK, Burrow MF, King NM. Chemical, morphological and microhardness changes of dentine after chemomechanical caries removal. Aust Dent J. 2013;58:283–92.

    Article  Google Scholar 

  • Hamama H, Yiu C, Burrow M. Current update of chemomechanical caries removal methods. Aust Dent J. 2014a;59:446–56.

    Article  Google Scholar 

  • Hamama HH, Yiu CK, Burrow MF. Viability of intratubular bacteria after chemomechanical caries removal. J Endod. 2014b;40:1972–6.

    Article  Google Scholar 

  • Hilliard JE. Quantitative analysis of scanning electron micrographs. J Microsc. 1972;95:45–58.

    Article  Google Scholar 

  • Hirokane E, Takamizawa T, Kasahara Y, Ishii R, Tsujimoto A, Barkmeier WW, Latta MA, Miyazaki M. Effect of double-layer application on the early enamel bond strength of universal adhesives. Clin Oral Investig. 2021;25:907–21.

    Article  Google Scholar 

  • Ibarra G, Vargas MA, Armstrong SR, Cobbb DS. Microtensile bond strength of self-etching adhesives to ground and unground enamel. J Adhes Dent. 2002;4:115–24.

    Google Scholar 

  • Jalevik B, Klingberg GA. Dental treatment, dental fear and behaviour management problems in children with severe enamel hypomineralization of their permanent first molars. Int J Paediatr Dent. 2002;12:24–32.

    Google Scholar 

  • Jalevik B, Klingberg G. Treatment outcomes and dental anxiety in 18-year-olds with MIH, comparisons with healthy controls - a longitudinal study. Int J Paediatr Dent. 2012;22:85–91.

    Article  Google Scholar 

  • Kramer N, Bui Khac NN, Lucker S, Stachniss V, Frankenberger R. Bonding strategies for MIH-affected enamel and dentin. Dent Mater. 2018;34:331–40.

    Article  Google Scholar 

  • Lagarde M, Vennat E, Attal JP, Dursun E. Strategies to optimize bonding of adhesive materials to molar-incisor hypomineralization-affected enamel: a systematic review. Int J Paediatr Dent. 2020;30:405–20.

    Article  Google Scholar 

  • Loyola-Rodriguez JP, Zavala-Alonso V, Reyes-Vela E, Patino-Marin N, Ruiz F, Anusavice KJ. Atomic force microscopy observation of the enamel roughness and depth profile after phosphoric acid etching. J Electron Microsc (tokyo). 2010;59:119–25.

    Article  Google Scholar 

  • Lygidakis NA. Treatment modalities in children with teeth affected by molar-incisor enamel hypomineralisation (MIH): a systematic review. Eur Arch Paediatr Dent. 2010;11:65–74.

    Article  Google Scholar 

  • Lygidakis NA, Dimou G, Stamataki E. Retention of fissure sealants using two different methods of application in teeth with hypomineralised molars (MIH): a 4 year clinical study. Eur Arch Paediatr Dent. 2009;10:223–6.

    Article  Google Scholar 

  • Lygidakis NA, Wong F, Jalevik B, Vierrou AM, Alaluusua S, Espelid I. Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an EAPD policy document. Eur Arch Paediatr Dent. 2010;11:75–81.

    Article  Google Scholar 

  • Mahoney EK, Farah R. Molar incisor hypomineralization: structure, composition, and properties. Berlin: Springer; 2015.

    Google Scholar 

  • Martinovic B, Ivanovic M, Milojkovic Z, Mladenovic R. Analysis of the mineral composition of hypomineralized first permanent molars. Vojnosanit Pregl. 2015;72:864–9.

    Article  Google Scholar 

  • Meredith L, Farella M, Lowrey S, Cannon RD, Mei L. Atomic force microscopy analysis of enamel nanotopography after interproximal reduction. Am J Orthod Dentofacial Orthop. 2017;151:750–7.

    Article  Google Scholar 

  • Moura SK, Pelizzaro A, Dal Bianco K, de Goes MF, Loguercio AD, Reis A, Grande RH. Does the acidity of self-etching primers affect bond strength and surface morphology of enamel? J Adhes Dent. 2006;8:75–83.

    Google Scholar 

  • Moura SK, Reis A, Pelizzaro A, Dal-Bianco K, Loguercio AD, Arana-Chavez VE, Grande RHM. Bond strength and morphology of enamel using self-etching adhesive systems with different acidities. J Appl Oral Sci. 2009;17:315–25.

    Article  Google Scholar 

  • Munoz MA, Luque-Martinez I, Hass V, Gutierrez MF, Reis A, Loguercio AD. The sonic application of universal adhesives in self-etch mode improves for their performance on enamel. Int J Adhes Adhes. 2019;88:43–9.

    Article  Google Scholar 

  • Oliver K, Messer LB, Manton DJ, Kan K, Ng F, Olsen C, Sheahan J, Silva M, Chawla N. Distribution and severity of molar hypomineralisation: trial of a new severity index. Int J Paediatr Dent. 2014;24:131–51.

    Article  Google Scholar 

  • Papadogiannis D, Dimitriadi M, Zafiropoulou M, Gaintantzopoulou MD, Eliades G. Universal adhesives: setting characteristics and reactivity with dentin. Materials (basel). 2019;12:1720.

    Article  Google Scholar 

  • Pashley DH, Tay FR. Aggressiveness of contemporary self-etching adhesives. Part II: etching effects on unground enamel. Dent Mater. 2001;17:430–44.

    Article  Google Scholar 

  • Pithon MM, Ferraz Cde S, de Oliveira GC, Pereira TB, Oliveira DD, de Souza RA, de Freitas LM, dos Santos RL. Effect of 10% papain gel on enamel deproteinization before bonding procedure. Angle Orthod. 2012;82:541–5.

    Article  Google Scholar 

  • Pithon MM, Ferraz CS, Oliveira GD, Dos Santos AM. Effect of different concentrations of papain gel on orthodontic bracket bonding. Prog Orthod. 2013;14:22.

    Article  Google Scholar 

  • Pithon MM, Campos MS, Coqueiro RS. Effect of bromelain and papain gel on enamel deproteinisation before orthodontic bracket bonding. Aust Orthod J. 2016;32:23–30.

    Google Scholar 

  • Poggio C, Ceci M, Beltrami R, Lombardini M, Colombo M. Atomic force microscopy study of enamel remineralization. Ann Stomatol (roma). 2014;5:98–102.

    Google Scholar 

  • Retief DH. Effect of conditioning the enamel surface with phosphoric acid. J Dent Res. 1973;52:333–41.

    Article  Google Scholar 

  • Rolim TZC, da Costa TRF, Wambier LM, Chibinski AC, Wambier DS, da Silva Assuncao LR, de Menezes J, Feltrin-Souza J. Adhesive restoration of molars affected by molar incisor hypomineralization: a randomized clinical trial. Clin Oral Investig. 2021;25:1513–24.

    Article  Google Scholar 

  • Rosa WL, Piva E, Silva AF. Bond strength of universal adhesives: a systematic review and meta-analysis. J Dent. 2015;43:765–76.

    Article  Google Scholar 

  • Schwendicke F, Elhennawy K, Reda S, Bekes K, Manton DJ, Krois J. Global burden of molar incisor hypomineralization. J Dent. 2018;68:10–8.

    Article  Google Scholar 

  • Shinohara MS, de Oliveira MT, Di Hipolito V, Giannini M, de Goes MF. SEM analysis of the acid-etched enamel patterns promoted by acidic monomers and phosphoric acids. J Appl Oral Sci. 2006;14:427–35.

    Article  Google Scholar 

  • Silva Junior ZS, Botta SB, Ana PA, Franca CM, Fernandes KP, Mesquita-Ferrari RA, Deana A, Bussadori SK. Effect of papain-based gel on type I collagen—spectroscopy applied for microstructural analysis. Sci Rep. 2015;5:11448.

    Article  Google Scholar 

  • Silverstone LM, Saxton CA, Dogon IL, Fejerskov O. Variation in the pattern of acid etching of human dental enamel examined by scanning electron microscopy. Caries Res. 1975;9:373–87.

    Article  Google Scholar 

  • Sofan E, Sofan A, Palaia G, Tenore G, Romeo U, Migliau G. Classification review of dental adhesive systems: from the IV generation to the universal type. Ann Stomatol (roma). 2017;8:1–17.

    Article  Google Scholar 

  • Somani C, Taylor GD, Garot E, Rouas P, Lygidakis NA, Wong FSL. An update of treatment modalities in children and adolescents with teeth affected by molar incisor hypomineralisation (MIH): a systematic review. Eur Arch Paediatr Dent. 2021. https://doi.org/10.1007/s40368-021-00635-0.

    Article  Google Scholar 

  • Sonmez H, Saat S. A clinical evaluation of deproteinization and different cavity designs on resin restoration performance in MIH-affected molars: two-year results. J Clin Pediatr Dent. 2017;41:336–42.

    Article  Google Scholar 

  • Spencer HR, Ike V, Brennan PA. Review: the use of sodium hypochlorite in endodontics—potential complications and their management. Br Dent J. 2007;202:555–9.

    Article  Google Scholar 

  • Takamizawa T, Barkmeier WW, Tsujimoto A, Scheidel DD, Erickson RL, Latta MA, Miyazaki M. Effect of phosphoric acid pre-etching on fatigue limits of self-etching adhesives. Oper Dent. 2015;40:379–95.

    Article  Google Scholar 

  • Tay FR, Pashley DH, King NM, Carvalho RM, Tsai J, Lai SC, Marquezini L Jr. Aggressiveness of self-etch adhesives on unground enamel. Oper Dent. 2004;29:309–16.

    Google Scholar 

  • Van Meerbeek B, Yoshihara K, Yoshida Y, Mine A, De Munck J, Van Landuyt KL. State of the art of self-etch adhesives. Dent Mater. 2011;27:17–28.

    Article  Google Scholar 

  • Vitkov L, Kastner M, Kienberger F, Hinterdorfer P, Schilcher K, Grunert I, Dumfahrt H, Krautgartner WD. Correlations between AFM and SEM imaging of acid-etched tooth enamel. Ultrastruct Pathol. 2008;32:1–4.

    Article  Google Scholar 

  • Weerheijm KL. Molar incisor hypomineralisation (MIH). Eur J Paediatr Dent. 2003;4:114–20.

    Google Scholar 

  • Weerheijm KL. Molar incisor hypomineralization (MIH): clinical presentation, aetiology and management. Dent Update. 2004;31:9–12.

    Article  Google Scholar 

  • Weerheijm KL, Jalevik B, Alaluusua S. Molar-incisor hypomineralisation. Caries Res. 2001;35:390–1.

    Article  Google Scholar 

  • Weerheijm KL, Duggal M, Mejare I, Papagiannoulis L, Koch G, Martens LC, Hallonsten AL. Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies: a summary of the European meeting on MIH held in Athens, 2003. Eur J Paediatr Dent. 2003;4:110–3.

    Google Scholar 

  • William V, Burrow MF, Palamara JE, Messer LB. Microshear bond strength of resin composite to teeth affected by molar hypomineralization using 2 adhesive systems. Pediatr Dent. 2006;28:233–41.

    Google Scholar 

  • Yamauchi K, Tsujimoto A, Jurado CA, Shimatani Y, Nagura Y, Takamizawa T, Barkmeier WW, Latta MA, Miyazaki M. Etch-and-rinse vs self-etch mode for dentin bonding effectiveness of universal adhesives. J Oral Sci. 2019;61:549–53.

    Article  Google Scholar 

  • Yoshihara K, Nagaoka N, Okihara T, Kuroboshi M, Hayakawa S, Maruo Y, Nishigawa G, De Munck J, Yoshida Y, Van Meerbeek B. Functional monomer impurity affects adhesive performance. Dent Mater. 2015;31:1493–501.

    Article  Google Scholar 

  • Zanet CG, Arana-Chavez VE, Fava M. Scanning electron microscopy evaluation of the effect of etching agents on human enamel surface. J Clin Pediatr Dent. 2006;30:247–50.

    Article  Google Scholar 

  • Zhao D, Dong B, Yu D, Ren Q, Sun Y. The prevalence of molar incisor hypomineralization: evidence from 70 studies. Int J Paediatr Dent. 2018;28:170–9.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the participants for donating their extracted teeth and the support of the University of Otago. SEM laboratory support for this work was provided by Ms. Elizabeth Girvan from the Micro and Nanoscale Imaging (OMNI) unit.

Funding

This work was supported by the New Zealand Dental Research Foundation and International College of Dentists (grant reference: RF 8.04 2018).

Author information

Authors and Affiliations

  1. Discipline of Paediatric Dentistry, Department of Oral Sciences, Faculty of Dentistry, University of Otago, PO Box 56, Dunedin, 9054, New Zealand

    Y.-L. Lee, D. H. Boyd & M. Ekambaram

  2. Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand

    K. C. Li

  3. Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong (SAR), People’s Republic of China

    C. K. Y. Yiu

Authors
  1. Y.-L. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. C. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. K. Y. Yiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. H. Boyd
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Ekambaram
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YL conducted the research in partial fulfillment of requirements for the degree of DClinDent (Paediatric Dentistry). YL, KL and ME conceived the ideas and finalised the experimental design. YL performed the experiments, collected the data and analysed the results. KL and ME supervised the research project and helped with the analysis tools. YL took the lead in writing the manuscript. All authors provided critical feedback, discussed the results and contributed to the final manuscript.

Corresponding author

Correspondence to M. Ekambaram.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study involving the collection of extracted developmentally hypomineralised first permanent molars from human participants were in accordance with the ethical standards of the institutional Human Ethics Committee (Health) and the national Health and Disability Ethics Committee. The ethical approval reference number is H18/086.

Consent to participate

Written informed assent was obtained from all participating children, and additional written informed consent was obtained from their legal guardians.

Consent for publication

The authors affirm that all individual participants and their legal guardians provided written informed assent and written informed consent, respectively, for the publication of data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, YL., Li, K.C., Yiu, C.K.Y. et al. Evaluation of developmentally hypomineralised enamel after surface pretreatment with Papacarie Duo gel and different etching modes: an in vitro SEM and AFM study. Eur Arch Paediatr Dent 23, 117–131 (2022). https://doi.org/10.1007/s40368-021-00671-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40368-021-00671-w

Keywords

Search

Navigation