White spot lesions (WSLs) are initial, flat, non-cavitated carious lesions, resulting from the reduction of the mineral component in some areas of the dental enamel. Due to this loss, the refractive index of the enamel is altered, and this leads the tooth surface to take on an opaque and white appearance. They are reversible lesions and the causes that lead to their formation are various: (i) defect in maturation of the enamel; (ii) fluorosis; (iii) trauma; (iv) orthodontic treatment. WSLs are classified following the ICDAS method. It is a procedure that aims to diagnose caries and give a level of severity to the intercepted carious lesion. The progression of WSLs can be limited or even stopped by preventive measures such as oral hygiene education, proper nutrition and remineralization techniques. In 2009, the low viscosity resin infiltration technique was introduced. It’s aim is to fill the microporosities in the wound body with a minimally invasive approach and also promotes visual masking of the lesion. The analyzes in this study were performed on three permanent and intact extracted molars with WSLs. The teeth were washed in an ultrasonic bath and preserved in artificial saliva. Two areas were selected for each sample, including a portion of healthy enamel and a portion of WSL. The area was analyzed through Raman micro-spectroscopy. On each Raman map the following were calculated: (i) the area of the band centered at 1660 cm-1; (ii) the area of the band centered at 960 cm-1; (iii) the width of the half band with center at 960 cm-1 and (iv) the intensity of the band centered at 1070 cm-1. The purpose of this thesis is the comparative characterization of white spot lesions with healthy enamel, through RAMAN spectroscopic analysis. A research protocol is also proposed for the analysis of the effectiveness of a treatment of these lesions, such as the infiltration of low viscosity resin. Healthy enamel was found to show higher Mineral/Matrix values than WSL; on the other hand, C/P is higher in WSL than in healthy enamel. Regarding crystallinity, slightly lower values were highlighted in WSL compared to healthy enamel. In the WSL both the phosphate group and the carbonate group are reduced, while the 1660 peak of amide I of collagen is higher in the WSL. The union and correlation of the results obtained will broaden the knowledge about the treatments of WSLs, offering the opportunity to transfer basic research into the clinical setting.
Le “White spot lesions” (WSLs) sono lesioni cariose iniziali, piatte, non cavitate, date dalla riduzione della componente minerale in alcune aree dello smalto dentale. A causa di questa perdita, l’indice di rifrazione della luce dello smalto risulta alterato, e ciò porta la superficie del dente ad assumere un aspetto opaco e bianco. Sono lesioni reversibili e le cause che portano alla loro formazione sono varie: (i) difetto di maturazione dello smalto; (ii) fluorosi; (iii) trauma; (iv) trattamento ortodontico. Le WSLs vengono classificate seguendo il metodo ICDAS. Si tratta di una procedura che ha lo scopo di fare diagnosi di carie e conferire un livello di gravità alla lesione cariosa intercettata. La progressione delle WSLs può essere limitata o anche arrestata mediante misure preventive come l'educazione all'igiene orale, una corretta alimentazione e tecniche di remineralizzazione. Nel 2009 è stata introdotta la tecnica di infiltrazione di resina a bassa viscosità, che mira a riempire le microporosità nel corpo della lesione con un approccio minimamente invasivo e favorisce anche un mascheramento visivo della lesione. Le analisi di questo studio sono state eseguite su tre molari estratti permanenti e intatti con WSLs. I denti sono stati lavati in una vasca ad ultrasuoni e conservati in saliva artificiale. Per ciascun campione sono state selezionate due aree, comprendenti una porzione di smalto sano e una porzione di WSL. L’area è stata analizzata attraverso la micro-spettroscopia Raman. Su ogni mappa Raman sono stati calcolati: (i) l'area della banda centrata a 1660 cm-1; (ii) l’area della banda centrata a 960 cm-1; (iii) l’ampiezza di metà banda con centro a 960 cm-1 e (iv) l'intensità della banda centrata a 1070 cm-1. Lo scopo di questa tesi consiste nella caratterizzazione comparativa delle white spot lesions con lo smalto sano, attraverso l’analisi spettroscopica RAMAN. Viene proposto inoltre un protocollo di ricerca per l’analisi dell’efficacia di un trattamento di queste lesioni, quale l’infiltrazione di resina a bassa viscosità. È risultato che lo smalto sano mostra valori più alti di Mineral/Matrix rispetto a quello della WSL; dall’altra parte, C/P risulta maggiore nella WSL rispetto allo smalto sano. Per quanto riguarda la Cristallinità, sono stati evidenziati valori leggermente inferiori nella WSL rispetto allo smalto sano. Nella WSL si riducono sia il gruppo fosfato sia il gruppo carbonato, mentre il picco 1660 dell’ammide I del collagene è più alto nella WSL. L’unione e la correlazione dei risultati ottenuti amplieranno le conoscenze riguardo i trattamenti delle WSLs, offrendo l’opportunità di trasferire la ricerca di base in ambito clinico.
White Spot Lesions: dall'analisi spettroscopica ai possibili trattamenti non invasivi
BAFFO, SARA
2020/2021
Abstract
White spot lesions (WSLs) are initial, flat, non-cavitated carious lesions, resulting from the reduction of the mineral component in some areas of the dental enamel. Due to this loss, the refractive index of the enamel is altered, and this leads the tooth surface to take on an opaque and white appearance. They are reversible lesions and the causes that lead to their formation are various: (i) defect in maturation of the enamel; (ii) fluorosis; (iii) trauma; (iv) orthodontic treatment. WSLs are classified following the ICDAS method. It is a procedure that aims to diagnose caries and give a level of severity to the intercepted carious lesion. The progression of WSLs can be limited or even stopped by preventive measures such as oral hygiene education, proper nutrition and remineralization techniques. In 2009, the low viscosity resin infiltration technique was introduced. It’s aim is to fill the microporosities in the wound body with a minimally invasive approach and also promotes visual masking of the lesion. The analyzes in this study were performed on three permanent and intact extracted molars with WSLs. The teeth were washed in an ultrasonic bath and preserved in artificial saliva. Two areas were selected for each sample, including a portion of healthy enamel and a portion of WSL. The area was analyzed through Raman micro-spectroscopy. On each Raman map the following were calculated: (i) the area of the band centered at 1660 cm-1; (ii) the area of the band centered at 960 cm-1; (iii) the width of the half band with center at 960 cm-1 and (iv) the intensity of the band centered at 1070 cm-1. The purpose of this thesis is the comparative characterization of white spot lesions with healthy enamel, through RAMAN spectroscopic analysis. A research protocol is also proposed for the analysis of the effectiveness of a treatment of these lesions, such as the infiltration of low viscosity resin. Healthy enamel was found to show higher Mineral/Matrix values than WSL; on the other hand, C/P is higher in WSL than in healthy enamel. Regarding crystallinity, slightly lower values were highlighted in WSL compared to healthy enamel. In the WSL both the phosphate group and the carbonate group are reduced, while the 1660 peak of amide I of collagen is higher in the WSL. The union and correlation of the results obtained will broaden the knowledge about the treatments of WSLs, offering the opportunity to transfer basic research into the clinical setting.| File | Dimensione | Formato | |
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Tesi SARA BAFFO.pdf
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https://hdl.handle.net/20.500.12075/1029