Contemporary Clinical Dentistry
   
  Home | About us | Editorial board | Search
Ahead of print | Current Issue | Archives | Advertise
Instructions | Online submission| Contact us | Subscribe |

 

Login  | Users Online: 120  Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size 


Previous Article Table of Contents Next Article
ORIGINAL ARTICLE
Year :   |  Volume :   |  Issue :   |  Page :  

Effect of eggshell powder and nano-hydroxyapatite on the surface roughness and microhardness of bleached enamel


 Restorative and Dental Materials Department, National Research Centre, Giza, Egypt

Date of Submission08-Aug-2021
Date of Decision07-Mar-2022
Date of Acceptance03-May-2022
Date of Web Publication03-Nov-2022

Correspondence Address:
Lamiaa Mahmoud Moharam,
National Research Centre, 33 El Bohouth St (Former El Tahrir St.), Giza, Dokki
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ccd.ccd_590_21

   Abstract 


Background: The aim of the study was to evaluate the remineralizing potential of prepared solutions of eggshell powder (ESP) and nano-hydroxyapatite (nHA) on the surface roughness and microhardness of bleached enamel. Materials and Methods: Fifty bovine anterior teeth were selected and cleaned then bleached using a chemically activated in-office bleaching agent then the teeth were randomly allocated into five groups (n = 10) according to the tested remineralizing agents (10% ESP solution, 10% nHA solution, and MI Paste Plus) into; control, bleached, bleached + ESP solution, bleached + nHA solution, and bleached + MI Paste Plus groups. Then, the teeth were tested for surface roughness and microhardness of the bleached enamel, respectively. Results: There was a statistically significant difference in the surface roughness and microhardness values of the tested groups. The highest surface roughness mean value was found in bleached enamel group, while the least mean value was found in the control group. The highest mean microhardness value was found in the bleached enamel + ESP solution group, while the least mean value was found in the bleached enamel group. Conclusions: The application of the tested remineralizing agents following the bleaching procedure had improved the surface roughness and microhardness of the bleached enamel. ESP and nHA present promising and potent remineralizing agents.

Keywords: Surface roughness–Vickers' microhardness-teeth bleaching-eggshell powder-nano-hydroxyapatite



How to cite this URL:
Hassan SN, Moharam LM. Effect of eggshell powder and nano-hydroxyapatite on the surface roughness and microhardness of bleached enamel. Contemp Clin Dent [Epub ahead of print] [cited 2023 Feb 2]. Available from: https://www.contempclindent.org/preprintarticle.asp?id=360378




   Introduction Top


Bleaching is a high-demand esthetic procedure to treat discolored teeth, and it is highly desired by patients who care about an attractive smile. Several bleaching systems and techniques were introduced to meet such requests.[1] Hydrogen peroxide is the main active component of the bleaching agents that can be either applied directly to the tooth surface or released from the chemical reaction of carbamide peroxide. It diffuses through the enamel surface, and unstable oxygen-free radicals are then released attacking the organic large, pigmented molecules and shift the absorption spectrum of the chromophore molecules to promote teeth whitening.[2]

However, teeth bleaching was proven to be easy, safe, and an effective method, studies revealed its deleterious impact on the enamel surface with decreased surface microhardness[3] and increased roughness.[4] Remineralizing agents' application on the bleached enamel surface was found to compensate for the negative consequences that might occur from the bleaching procedure.[5]

Eggshell powder (ESP) is well known for being a rich source of calcium and essential elements. It contains about 1% calcium phosphate, 94% calcium carbonate, and 1% magnesium carbonate. Thus, ESP was proven to be efficient in remineralization of the enamel surface,[6] especially when it is used as a solution since its minerals could easily diffuse into the enamel obstructing the enamel surface porosities.[7]

Furthermore, nano-hydroxyapatite (nHA) is a biocompatible and bioactive agent. It attracts large amounts of calcium and phosphorous ions from the remineralizing solutions to the enamel surface promoting enamel remineralization.[8]

Therefore, this study was conducted to study the effect of the application of ESP and nHA in the form of a solution on the surface roughness and microhardness of the bleached enamel. The null hypothesis proposed was that the application of the different tested remineralizing agents had no effect on the bleached enamel surface roughness and microhardness.


   Materials and Methods Top


Selected materials

Two experimentally prepared remineralizing agents; 10% ESP and nHA solutions, one commercial remineralizing agent and one commercial bleaching agent were investigated in this study. The materials' brand name, description, composition and their manufacturers are listed in [Table 1].
Table 1: Investigated materials, ingredients, and manufacturers

Click here to view


Study design and specimens' grouping

A total of 50 bovine anterior extracted teeth (approved by the Medical Ethics Committee of the National Research Centre in Egypt with approval number 206 in March 2021) were selected then allocated to five groups (n = 10): Control (nonbleached), bleached enamel, bleached enamel treated with 10% ESP solution, bleached enamel treated with 10% nHA solution, bleached enamel treated with MI paste Plus. The five groups were tested for their surface roughness and microhardness, respectively. The tested bovine teeth were obtained from animals that have been humanely sacrificed in full accordance with the World Medical Association Declaration of Helsinki in 2013.

Sample size estimation was done using R statistical package, version 2.15.2 (October 26, 2012). Copyright (C) 2012-The R Foundation for Statistical Computing. In a one-way ANOVA study, results showed that a total sample size of 10 samples would be adequate to detect a mean difference between study groups with a power of 80% and a two-sided significance level of 5%.

Teeth preparation

The extracted bovine teeth were cleansed manually using a scaler under running tap water to remove any soft tissues and/or calculus residues and then stored in 0.1 g/mL Thymol at 4°C until use. A double side-cutting diamond disc mounted at a low-speed handpiece was used to remove the roots of the teeth at the cemento-enamel junction level. The pulpal tissues were removed with a barded-broach, and then pink wax was used to seal the pulpal chamber. SiC abrasive papers of 1000–1200 grits were used to grind the enamel surfaces of the teeth under wet condition to obtain a standardized flat enamel surface without jeopardizing the underlying dentin.

Production of eggshell powder

ESP was produced according to the protocol proposed by the World Property Intellectual Organization (WO/2004/105912: ESP production method) in a process known as “calcination process,” in which a pathogen-free pure powder of high alkalinity is produced. Twenty chicken eggshells were cleansed using distilled water. Then the eggshells were put in a hot water bath at 100°C for 10 min followed by shells membrane removal. The eggshells were crushed in a sterile mortar, then heated at 1200°C and finally powdered into small-sized particles. One gram of ESP was liquified in 20 ml of 4% acetic acid (PioChem, Giza, Egypt), and finally, the clear solution formed at the top was collected, and its pH was 12.

Bleaching procedure

The labial surface of each specimen was coated with acid-resistant varnish, excluding a 4-mm X 4-mm window at the cervical 1/3 of the crown. WHITEsmile® chemically activated bleaching gel was applied to the marked window of each tooth in a 1.5–2 mm thick layer. The gel was left undisturbed for 15 min on the teeth surfaces. Afterward, the bleaching gel was removed from the surface of each specimen using a dry piece of cotton. This procedure was repeated for three times to ensure a total of 45 min of the bleaching procedure. The bleached specimens were rinsed thoroughly with distilled water for 1 min then dried with cotton rolls prior to the following immediate application of the two tested remineralizing agents.

Application of the remineralizing agents

MI paste Plus remineralizing agent was applied immediately in generous amounts to the bleached marked windows of the labial surfaces of the specimens using an application swap and left undisturbed for 1–3 min as recommended by the manufacturer. Then the paste was removed with cotton rolls, and the tooth surfaces were rinsed with distilled water. On the other hand, ESP and nHA solutions were applied to the marked windows of the bleached specimens using small micro-brushes, and the solution was left undisturbed for 5–10 min. Then, the solutions were removed using cotton rolls then rinsed with distilled water. The treated specimens were fixed in copper molds (10 mm height × 30 mm length × 20 mm width). The labial surfaces of the treated specimens were directed downwards. Then the molds were poured with self-cure acrylic resin. The set acrylic blocks were removed from the molds after complete setting. Then the prepared specimens were kept in distilled water at 37°C in tight-seal polyethylene vessels for 24 h before the surface roughness and surface microhardness tests were conducted, respectively.

Surface roughness evaluation

The lens of a digital camera (C 5060, Olympus, Japan) mounted on a stereomicroscope (Olympus® BX 60, Olympus Optical Co. LTD, Tokyo, Japan), which was adjusted at the marked window at the cervical 1/3 of the specimens and images were taken at ×9 magnification. An image analysis software (Image J, 1.4 1a, NIH, USA) was used to calculate the Ra factor. Arithmetic means of elevations and depressions (Ra) factor calculations were achieved according to the light reflected from the surface of the tested specimens.

Microhardness assessment

A 200-g load for 15-s dwell time at 20X magnification was applied to assess the surface microhardness of the tested specimens using Digital Vickers hardness tester (Nexus 4000TM, INNOVTEST, model number 4503, The Netherlands). A total of three random indentations were done at the center of the marked window of each specimen using Vickers's pyramidal diamond indenter. Surface microhardness calculations were assessed using a computer software (Hardness-Course Brinell/Vickers/Rockwell, copyright IBS 2012, version 10.4.4).

Statistical analysis

Mean and standard deviation values were calculated for each group in each test (surface roughness and microhardness). Data were explored for normality using Kolmogorov–Smirnov and Shapiro–Wilk tests. The obtained data showed parametric (normal) distribution. One-way ANOVA followed by Tukey post hoc tests were used to compare between more than two groups in nonrelated specimens in each test. The significance level was set at P ≤ 0.05. Statistical analysis was performed with IBM® SPSS® Statistics Version 20 for Windows.


   Results Top


[Table 2] shows a statistically significant difference between the surface roughness values of the (Control), (Bleached enamel), (Bleached enamel + MI paste), (Bleached enamel + ESP paste), and (Bleached enamel + nHA solution) groups. A statistically significant difference was found between (Control) and each of (Bleached enamel), (Bleached enamel + MI paste), (Bleached enamel + ESP solution), and (Bleached enamel + nHA solution) groups. No statistically significant difference was found between (Bleached enamel + MI paste) and each of (Bleached enamel + ESP solution) and (Bleached enamel + nHA solution) groups where (P = 0.599) and (P = 0.945). Furtherrmore, no statistically significant difference was found between (Bleached enamel + ESP solution) and (Bleached enamel + nHA solution) groups where (P = 0.941). The highest mean value was found in (Bleached enamel) group, while the least mean value was found in (Control) group.
Table 2: Mean and standard deviation values of the surface roughness of the different tested groups

Click here to view


[Table 3] shows a statistically significant difference between the microhardness values of the (Control), (Bleached enamel), (Bleached enamel + MI paste), (Bleached enamel + ESP slotution) and (Bleached enamel + nHA solution) groups. A statistically significant difference was found between (Control) and each of (Bleached enamel), (Bleached enamel + MI paste), (Bleached enamel + ESP slotution) and (Bleached enamel + nHA solution) groups. Furthermore, a statistically significant difference was found between (Bleached enamel + ESP solution) and (Bleached enamel + nHA solution) groups where (P = 0.040). The highest mean value was found in (Bleached enamel + ESP solution) group, while the least mean value was found in (Bleached enamel) group.
Table 3: Mean and standard deviation values of the microhardness of the different tested groups

Click here to view



   Discussion Top


The present study aimed to investigate the effect of ESP and nHA application in the form of 10% concentration solutions on the surface roughness and Vickers' microhardness of the bleached enamel. Based on the findings of the current study, the null hypothesis was rejected. Since the application of the tested remineralizing agents after bleaching procedures had positively influenced the enamel microhardness and surface roughness. Nevertheless, Huang et al.[9] showed that using two different concentrations of 10% and 15% nHA had the same effect. Furthermore, Haghgoo et al.[10] concluded no significant difference in the enamel remineralization after using eggshell extract solution in 3% and 10% concentrations. In this context, 10% concentration of nHA and ESP solutions were investigated in the present study.

The results showed that the bleached enamel group represented the least mean microhardness value and the highest mean roughness value compared to the control group. Such reduction in the mean microhardness value of the bleached enamel group could be attributed to the peroxide action on the enamel matrix. As a result to the degradation of the organic substance of the intraprismatic enamel, a fragile enamel results compromising the surface strength due to the development of surface microporosities, an aspect that could be identified by a decrease in the microhardness values.[11] De Arruda et al.[12] agreed with our study. They reported a significant reduction in the enamel microhardness following bleaching procedures.

Furthermore, Vilhena et al.[13] reported changes in the enamel microhardness after prolonged excessive bleaching. A previous study pointed out that different bleaching systems decreased the enamel microhardness, although there has been a recovery for these values after treatment due to the contact with the saliva.[14] Nonetheless, Sasaki et al.[15] contradicted our findings. They stated that bleaching the enamel surface had no negative effects on the enamel microhardness.

On the other hand, roughness is described as irregularities that are closely spaced and coarse in texture. Its significance depends on the scale of measurement. The reduction in the enamel surface roughness following bleaching might be owed to the mineral loss, reduced surface toughness in addition to the reduced mineral loss. Therefore, Setien et al.[16] agreed with the results of this study. They concluded that bleaching resulted in increasing the enamel porosity and this might be due to the immediate enamel liability for staining. In contrast, it was observed that bleached enamel was not susceptible to stain.[17] Vilhena et al.[13] disagreed with our surface roughness results. They stated that bleaching did not cause any changes in the enamel surface roughness. The disagreement might be due to the immersion of their specimens in artificial saliva which could reverse the demineralization process and there was no structural loss.

The results of this study recorded the highest microhardness and the least roughness values with the bleached enamel + ESP solution group, followed by the bleached enamel + nHA group and finally, the bleached enamel + MI paste with no significant difference between them. This can be explained by their comparable ion-rich composition. As remineralization is a process of restoring the mineral ions into the HA lattice. It relies on the existence of calcium and phosphate ions assisted by fluoride to aid in rebuilding a new surface on already existing crystal remnants that are left after demineralization.[18] Haghoo et al.[10] agreed with our study. They revealed that ESP could be used as a remineralizing agent in addition to it is efficiency as the nHA for enamel surface remineralization. Moreover, Yeberi and Haghgoo[19] reported an elevated microhardness of the enamel surface following treatment with ESP, which might be owed to its increased alkalinity (pH = 11.7) that could be considered the main reason for the elevated ionic activity and anions availability essential for the remineralization process.[20]

Feroz et al.[21] agreed with our findings. They stated that ESP application reduced the enamel surface roughness. A state of supersaturation could be maintained because of the bioavailability of the calcium and phosphate ions, which could enhance the remineralization process of the enamel surface due to rapid precipitation of the minerals on the enamel surface filling all the surface micro porosities ending with their closure and hence enamel remineralization.[22] Meanwhile, Elolimy[23] concluded that ESP increased microhardness and decreased enamel surface roughness and it could be used effectively as a remineralizing agent. As it promotes remineralization and prevents demineralization, it also acts as a reservoir of ions, so it might be efficient to remineralize the demineralized enamel surface.

Consequently, nHA has exclusive properties due to its higher solubility, optimal biocompatibility and high surface energy compared to the typical HA. It has been stated that nHA particles have superior bioactivity to large crystals. Furthermore, synthetic nHA has the same physiochemical properties of the enamel apatite. They can adsorb strongly to the superficial enamel surfaces and has strong affinity to the tooth structure.[10]

The increase in the microhardness and reduction in the surface roughness in (bleached enamel + nHA) group might be since nHA is characterized by having greater surface area and hydrophilic properties. They form a strong and thin layer once applied to the enamel surface resulting in precipitation of a compound that ends in enamel remineralization.[24]

Kunam et al.[25] supported our findings. They reported that nHA showed a significant elevation on the surface enamel microhardness. It acted as a template precipitating calcium and phosphate ions to fill micropores and surface defects of the demineralized enamel surface. Hence, they enhance surface enamel remineralization. Furthermore, it was concluded that both nHA and ESP have a high potential to remineralize the demineralized enamel reflecting on increasing its microhardness.[19]

MI paste consists of casein phosphopeptide-Amorphous calcium phosphate (CPP-ACP) and it was reported that CPP in CPP-ACP prevents the calcium and phosphate ions from being transformed into a crystalline form by stabilizing them at the tooth surface so it acts as a reservoir of ions released from the nanocomplexes and being deposited into the apatite crystals, hence achieving remineralization.[18] Khoroushi et al.[26] agreed with the results of the current study, they concluded that CPP-ACP decreased the enamel surface roughness following bleaching. Additionally, ACP was found to increase the enamel prism density, thus reducing the surface roughness.[27] Moreover, a former study concluded that the application of MI paste remineralizing agents following bleaching procedures reduced the enamel surface roughness.[28] Likewise, Penumatsa et al.[29] revealed the efficiency of MI paste to improve the bleached enamel microhardness and surface roughness. On the contrary, Yesilyurt et al.[30] found that the surface roughness is neither increased nor decreased in enamel surface following treatment with MI paste remineralizing agent. Furthermore, it was concluded that nHA was as effective as MI paste bleached enamel remineralization.[27]

Finally, one can predict that the natural source as well as the ease of bioavailability of the calcium and phosphate ions together with its elevated pH, enabled ESP to have a promising future in treating different dental defects. However, increasing its remineralization potential requires more clinical studies to compare its remineralization efficiency with various available commercial agents.

Limitations and future study prospects

This study is an in vitro study which represents one of the limitations of the current research. Another limitation of the study could be presented in using only one in-office chemical-cured bleaching agent. Therefore, further studies are recommended to investigate the effect of ESP using at-home chemical-cured bleaching agents and in-office light-cured bleaching agents on the surface roughness and microhardness of the bleached and unbleached enamel. More clinical studies are required to assess the remineralizing effect of ESP on the bleached and unbleached enamel.


   Conclusions Top


Under the limitations of this in vitro study, it can be concluded that enamel bleaching had reduced its surface roughness and microhardness. Moreover, the application of remineralizing agents following bleaching procedure had improved the surface roughness and microhardness of the enamel. Chicken ESP and nHA present promising and potent remineralizing agents that can overcome the deleterious effect of the bleaching procedure on the enamel surface.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kutuk ZB, Ergin E, Cakir FY, Gurgan S. Effects of in-office bleaching agent combined with different desensitizing agents on enamel. J Appl Oral Sci 2018;27:e20180233.  Back to cited text no. 1
    
2.
Rauen CA, Filho JC, Bittencourt BF, Gomes GM, Gomes JC, Gomes OM. Effect of bleaching agents containing fluoride or calcium on enamel microhardness, roughness, and permeability. Braz J Oral Sci 2015;14:262-6.  Back to cited text no. 2
    
3.
Borges BC, Borges JS, de Melo CD, Pinheiro IV, Santos AJ, Braz R, et al. Efficacy of a novel at-home bleaching technique with carbamide peroxides modified by CPP-ACP and its effect on the microhardness of bleached enamel. Oper Dent 2011;36:521-8.  Back to cited text no. 3
    
4.
Pimenta-Dutra AC, Albuquerque RC, Morgan LS, Pereira GM, Nunes E, Horta MC, et al. Effect of bleaching agents on enamel surface of bovine teeth: A SEM study. J Clin Exp Dent 2017;9:e46-50.  Back to cited text no. 4
    
5.
da Costa Soares MU, Araújo NC, Borges BC, Sales Wda S, Sobral AP. Impact of remineralizing agents on enamel microhardness recovery after in-office tooth bleaching therapies. Acta Odontol Scand 2013;71:343-8.  Back to cited text no. 5
    
6.
Elsheik AE, Etman WM, Genaid TM. Resistance of chicken eggshell powder treated demineralized enamel to further acidic challenges. Tanta Dent J 2020;17:38-44.  Back to cited text no. 6
    
7.
Taher HM, Bayoumi R. Remineralization of initial enamel like lesions with chicken eggshell powder solution versus amorphous calcium phosphate. Egypt Dent J 2018;64:3703-12.  Back to cited text no. 7
    
8.
Kunam D, Manimaran S, Sampath V, Sekar M. Evaluation of dentinal tubule occlusion and depth of penetration of nano-hydroxyapatite derived from chicken eggshell powder with and without addition of sodium fluoride: An in vitro study. J Conserv Dent 2016;19:239-44.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Huang SB, Gao SS, Yu HY. Effect of nano-hydroxyapatite concentration on remineralization of initial enamel lesion in vitro. Biomed Mater 2009;4:034104.  Back to cited text no. 9
    
10.
Haghgoo R, Mehran M, Ahmadand M, Ahmadvand MJ. Remineralization effect of eggshell versus nano-hydroxyapatite on caries-like lesions in permanent teeth (In vitro). J Int Oral Health 2016;8:435-9.  Back to cited text no. 10
  [Full text]  
11.
Vohra FA, Kasah K. Influence of bleaching and antioxidant agent on microtensile bond strength of resin-based composite to enamel. Saudi J Dent Res 2014;5:29-33.  Back to cited text no. 11
    
12.
de Arruda AM, dos Santos PH, Sundfeld RH, Berger SB, Briso AL. Effect of hydrogen peroxide at 35% on the morphology of enamel and interference in the de-remineralization process: An in situ study. Oper Dent 2012;37:518-25.  Back to cited text no. 12
    
13.
Vilhena KF, Nogueira BC, Fagundes NC, Loretto SC, Angelica RS, Lima RR, et al. Dental enamel bleached for a prolonged and excessive time: Morphological changes. PLoS One 2019;14:e0214948.  Back to cited text no. 13
    
14.
Mondelli RF, Gabriel TR, Rizzante FA, Magalhães AC, Bombonatti JF, Ishikiriama SK. Do different bleaching protocols affect the enamel microhardness? Eur J Dent 2015;9:25-30.  Back to cited text no. 14
    
15.
Sasaki RT, Arcanjo AJ, Flório FM, Basting RT. Micromorphology and microhardness of enamel after treatment with home-use bleaching agents containing 10% carbamide peroxide and 7.5% hydrogen peroxide. J Appl Oral Sci 2009;17:611-6.  Back to cited text no. 15
    
16.
Setien V, Roshan S, Cala C, Ramirez R. Pigmentation susceptibility of teeth after bleaching with 2 systems: An in vitro study. Quintessence Int 2009;40:47-52.  Back to cited text no. 16
    
17.
Adeyemi A, Pender N, Higham SM. The susceptibility of bleached enamel to staining as measured by Quantitative Light-induced Fluorescence (QLF). Int Dent J 2008;58:208-12.  Back to cited text no. 17
    
18.
Attia RM, Kamel MM. Changes in surface roughness of bleached enamel by using different remineralizing agents. Tanta Dent J 2019;13:179-86.  Back to cited text no. 18
    
19.
Yaberi M, Haghgoo R. A comparative study of the effect of nanohydroxyapatite and eggshell on erosive lesions of the enamel of permanent teeth following soft drink exposure: A randomized clinical trial. J Int Oral Health 2018;10:176-9.  Back to cited text no. 19
  [Full text]  
20.
Mony B, Ebenezar AV, Ghani MF, Narayanan A, Anand S, Mohan AG. Effect of chicken egg shell powder solution on early enamel carious lesions: An in vitro preliminary study. J Clin Diagn Res 2015;9:C30-2.  Back to cited text no. 20
    
21.
Feroz S, Moeen F, Haq SN. Protective effect of chicken eggshell powder solution (CESP) on artificially induced dental erosion: An in vitro atomic force microscope study. Int J Dent Sci Res 2017;5:49-55.  Back to cited text no. 21
    
22.
Asmawati A. Identification of inorganic compounds in eggshell as a dental remineralization material. J Dentomaxillofacial Sci 2017;2:168-71.  Back to cited text no. 22
    
23.
Elolimy GA. In-vitro evaluation of remineralization efficiency of chicken eggshell slurry on eroded deciduous enamel. Egypt Dent J 2020;66:2519-28.  Back to cited text no. 23
    
24.
Brown CJ, Smith G, Shaw L, Parry J, Smith AJ. The erosive potential of flavoured sparkling water drinks. Int J Paediatr Dent 2007;17:86-91.  Back to cited text no. 24
    
25.
Kunam D, Sampath V, Manimaran S, Sekar M. Effect of indigenously developed nano-hydroxyapatite crystals from chicken egg shell on the surface hardness of bleached human enamel: An in vitro study. Contemp Clin Dent 2019;10:489-93.  Back to cited text no. 25
  [Full text]  
26.
Khoroushi M, Shirban F, Doustfateme S, Kaveh S. Effect of three nanobiomaterials on the surface roughness of bleached enamel. Contemp Clin Dent 2015;6:466-70.  Back to cited text no. 26
[PUBMED]  [Full text]  
27.
Mettu S, Srinivas N, Reddy Sampath CH, Srinivas N. Effect of casein phosphopeptide-amorphous calcium phosphate (cpp-acp) on caries-like lesions in terms of time and nano-hardness: An in vitro study. J Indian Soc Pedod Prev Dent 2015;33:269-73.  Back to cited text no. 27
[PUBMED]  [Full text]  
28.
Salama F, Abdelmegid F, Al-Sharhan M, Al-Mutairi F, Abdulrahman A. Effect of remineralizing agents on enamel surface roughness of primary teeth: An in-vitro study. Dent Sci 2020;19:1-12.  Back to cited text no. 28
    
29.
Penumatsa NV, Kaminedi RR, Baroudi K, Barakath O. Evaluation of remineralization capacity of casein phosphopeptide-amorphous calcium phosphate on the carbamide peroxide treated enamel. J Pharm Bioallied Sci 2015;7:S583-6.  Back to cited text no. 29
    
30.
Yesilyurt C, Sezer U, Ayar MK, Alp CK, Tasdemir T. The effect of a new calcium-based agent, Pro-Argin, on the microhardness of bleached enamel surface. Aust Dent J 2013;58:207-12.  Back to cited text no. 30
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
Previous Article Next Article
 
  Search
 
    Ahead Of Print
     Search Pubmed for
 
    -  Hassan SN
    -  Moharam LM
    Access Statistics
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusions
    References
    Article Tables

 Article Access Statistics
    Viewed499    
    PDF Downloaded14    

Recommend this journal