Etching Patterns of Sodium Hypochlorite

Pretreated Hypocalcified
Amelogenesis Imperfecta Primary Molars:
SEM Study
• Journal: The Journal of Clinical Pediatric Dentistry.
Volume 43, Number 4/2019
• Author citation:
Amel Mahmoud Ahmed
Dina Nagy
Mona Abdallah Elkateb
• Keywords: Amelogenesis imperfecta; sodium hypochlorite;
etching patterns; primary molars.
INTRODUCTION
AMELOGENESIS
IMPERFECTA
 Definition:

• AI represents a group of conditions, genomic in origin,

which affect the structure and clinical appearance of
the enamel of all or nearly all the teeth in a more or
less equal manner, and which may be associated with
morphologic or biochemical changes elsewhere in the
body.
 Pathogenesis
Enamel is the highly mineralized structure in the body with 85% of its
volume occupied by hydroxyapatite crystals.

During the organogenesis, the enamel metamorphose from a soft, pliable

tissue to its final form which is almost devoid of protein.

The final composition of enamel is a reflection of its unique molecular

and cellular activity that takes place during its genesis.

AMELOGENESIS IMPERFECTA
 CLASSIFICATION
Darling (1956)
Weinnman et al (1945)
 Witkop and Rao, 1971
Witkop (1957) based on phenotype
and mode of
Hypoplastic inheritance.
Hypocalcification Hypoplastic,

Hypomaturation
Hypocalcificied,
Pigmented hypomaturation
Hypomaturation.
Local hypoplasia
Aldred and Crawford,
1995
Molecular defect (when
known)
Biochemical result (when
known)

Mode of inheritance

Phenotype
 CLINICAL FEATURES

• Hypoplastic AI:
Hypocalcified AI
Hypomaturation AI
HYPOMATURATION-HYPOPLASTIC WITH
TAURODONTISM
 GENETIC INVOLVEMENT IN
AMELOGENESIS IMPERFECTA

• AMELX
• ENAM
• MMP-20
• KLK-4
• DLX-3
HISTOPATHOLOGY
 Diagnostic methods
1. Clinical
 Family history, clinical observation & meticulous
recording form backbone of diagnosis.
 Extraoral radiographs unerupted & sometimes
spontaneously resorbing teeth.
 Intra-oral radiographs relative contrast b/w enamel
& dentine in cases where mineralisation may have been
affected.
2. Genetic diagnosis Laboratory genetic diagnosis is
presently only a research tool.
 DIFFERENTIAL DIAGNOSIS

• Dental Fluorosis
• Dentinogenesis imperfecta
• Molar incisor hypominerilization
• Gunther disease
• Hyperbilirubinemia-related discolouration
• Tetracycline-related discolouration
 TREATMENT

• Temporary phase — undertaken during the primary and

mixed dentition
• Transitional phase – when all permanent teeth have erupted
and continue till adulthood
• Permanent phase – occurs in adulthood.
ACID ETCHING
 Development

• A concept of etching enamel surfaces with

phosphoric acid, first proposed by Buonocore in1955
to increase the bond strength between the composite
resin and etched enamel.
MECHANISM OF ACTION
 Factors affecting acid etching of
enamel
1. Type of the acid
2. Concentration of the acid
3. The time of etching.
4. Etching with 10 % or 37 % phosphoric acid produces the
highest bond strengths to enamel.
5. The use of 10 % maleic acid for etching results in a
lower bond strength. No differences in bond strengths
are observed when enamel is etched with phosphoric
acid ranging in concentration from 2 % to 37 %.
 Duration of Etching

• No differences in bond strength are detected

between 15-second and 60- second etching with
37 % phosphoric acid; however, shorter etching
times cause less enamel damage on debonding.
• Decreasing etching time between 30 and 10
seconds does not affect bond strength(11 Mpa)
or location of failure site
• Whereas etching for 0 or 5 seconds reduces
bond strength (less than 3 MPa)
 Acid-Etching Technique
• Acid etching removes approximately 10 µm of
enamel surface and creates a morphologically
porous layer (5 µm to 50 µm deep).
• The low-viscosity fluid resin contacts the surface
and is attracted to the interior of these
microporosities created by capillary attraction.
• Resin tags are formed into microporosities of
conditioned enamel that after adequate
polymerization, provide a resistant, long- lasting
bond by micromechanical interlocking with this
tissue.
AIM
• INCLUSION CRITERIA

• EXCLUSION CRITERIA
METHODOLOGY
Specimen preparation for SEM:
 STATISTICAL ANALYSIS

• Chi-square test was used to compare the etching

patterns between groups. P value of <0.05 was
considered significant.
RESULTS
 SEM findings

GROUP I (CONTROL GROUP) - TYPE I GROUP I - TYPE II ETCHING

ETCHING PATTERN PATTERN
 GROUP II (STUDY GROUP) –
TYPE III ETCHING PATTERN PREDOMINANCE OF TYPE 1 ETCHING
PATERN
 TYPE III ETCHING PATTERN
GROUP II - LARGE AREAS OF TYPE II
WITHOUT DISTINCT PRISM
ETCHING PATTERN
MORPHOLOGY
 DISCUSSION

• High failure rates – alterations ???

• control group - predominance of type III……. Wright et al
• Group II - predominance of type I and II……NaOCl
……saponification and neutralization…. Espinosa et al and
Christopher et al
CONCLUSION
 CROSS REFERENCES
AUTHOR YEAR STUDY RESULTS

Seow.et.al Observed - three types of etching Abnormal prism

patterns after phosphoric acid structure - standard
1998 application on both AI primary and etching time, acid
permanent teeth. concentration -
inappropriate -
abnormal enamel

Şaroğlu I.et.al Effect - sodium hypochlorite Deproteinization -

(NaOCl) after acid conditioning of
2006 the enamel and dentin of the
primary teeth affected - HCAI on
the shear bond strength of the
composite material.
effective in enhancing
the enamel bonding in
HCAI teeth - overcome
failure rates of adhesive
restorations

Roberto Topographical features of the Enamel deproteinization

Espinosa.et,al 2008 enamel surface deproteinized and with prior to phosphoric
etched with phosphoric acid acid etching doubles
(H3PO4) compared to phosphoric enamel’s retentive
acid alone. surface to 94.47%.
Harleen N.et.al 2011 Effect of enamel No significant effect of
deproteinization with 5.25% sodium hypochlorite
sodium hypochlorite (NaOCl) enamel deproteinization
before phosphoric acid (H3PO4)
etching on the shear bond
strength of composite resins

Topographical features of No significant

Ramakrishna Y .et.al 2014 enamel surface deproteinized enhancive effect of
with 5.25% NaOCl after H3PO4 enamel deproteinization
etching - effect of enamel after acid etching
deproteinization after acid
etching on the shear bond
strength

Ananthi 2018 Evaluate and compare the Deproteinization -

Christopher.et.al
topographical features of enamel 5.25% Sodium
surface, etched with different hypochlorite prior to
Materials. acid etching -
adhesion of
composite material
with the tooth surface.
 Critical evaluation
• Study - conducted in-vitro where different oral
environmental parameters such as oral pH and
temperature could not be verified.
• There is no picuture ….
• Possible concerns of NaOCl were the taste, tolerance by
young children and possible soft tissue reactions. NaOCl
has a chlorinated odor and has no taste.
• Further studies are recommended to evaluate the effect of
NaOCl deproteinization, in-vitro and in-vivo, on the bond
strength of different adhesive restorations to hypocalcified
AI primary teeth
 REFERENCES
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Enamel deproteinization and its effect on acid etching: An in
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composite bond strength in hypocalcified amelogenesis
imperfecta. Oral diseases 12: 305-8, 2006.
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enamel deproteinization in primary teeth. J Clin Pediatr Dent
42:45-9, 2018.
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deproteinization after acid etching–Is it worth the effort?
Dentistry 4, 2014.
• Harleen N, Ramakrishna Y, Munshi AK. Enamel
deproteinization before acid etching and its effect on the shear
bond strength – An in vitro study. J Clin Pediatr Dent 36: 19-24,
2011.
• Seow WK, Amaratunge A. The effects of acid-etching on enamel
from different clinical variants of amelogenesis imperfecta: an
SEM study. Pediatr Dent 20:37-42, 1998
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