Dental
Communication
Biosci. Biotech. Res. Comm. 10(2): 208-212 (2017)
Comparing uoride release in preventa and enamel pro
in laboratory environment
Ramshid Tork-Zaban,
1
* Beheshteh Malek-Afzali,
2
Mahshid Tork Zaban
3
and
Yasaman Rezvan
i4
1
Dentist
2
Associate Professor, Department of Pediatric Dentistry, Faculty of Dentistry, Shahid Beheshti University of
Medical Sciences and Health Services, Tehran, Iran
3
PhD in Medical Physiology
4
Assistance Professor, Department of Pediatric Dentistry, Faculty of Dentistry, Shahid Beheshti University of
Medical Sciences and Health Services, Tehran, Iran
ABSTRACT
According to high prevalence of tooth decay in the world and Iran, and based on side effects and costs related to
their treatment, study different methods for prevention of decay is on priority. The purpose of this study is comparing
uoride release in preventa and enamel pro in laboratory environment.+ In this experimental- laboratory study, 40
varnishes were used including 20 Iranian varnish and 20 outsider varnishes. Celluloid matrix strip was completely
covered with under studied varnishes. Covered strips were placed in 25 ml deionized stilled water and washed were
brought out at rst, fourth, 24th and 72th hours of experiment and were washed with 5 ml deionized stilled water.
Then strips were placed in new solution. Finally, uoride release rate was measured by potentiometer and was
reported by ppm. Data were analyzed by SPSS 20th version of software. Results indicated that uoride release rate
had signi cant changes during the time in enamel-pro and in preventa (p<0.001 in two case) and in all times enamel-
pro had highest release rate in 4,24, and 72 hours respectively (P<0.001). In prevental group had highest release rate
in 4, 24 and 72 hours respectively (P<0.001). Enamel-pro varnish release signi cantly more uoride in all mentioned
hours rather than preventa.
KEY WORDS: FLUORIDE RELEASE, FLUORIDE VARNISH, ENAMEL PRO PREVENTA
208
ARTICLE INFORMATION:
*Corresponding Author:
Received 27
th
March, 2017
Accepted after revision 29
th
June, 2017
BBRC Print ISSN: 0974-6455
Online ISSN: 2321-4007 CODEN: USA BBRCBA
Thomson Reuters ISI ESC and Crossref Indexed Journal
NAAS Journal Score 2017: 4.31 Cosmos IF : 4.006
© A Society of Science and Nature Publication, 2017. All rights
reserved.
Online Contents Available at: http//www.bbrc.in/
Ramshid Tork-Zaban et al.
INTRODUCTION
Tooth decay is a disease related to calci ed tissue of
tooth which is exposed by decalci ed cation of mineral
section of tooth and decomposition of organic section
of tooth (Pinkham 1999). This disease is the most preva-
lent disease in people that had always been a problem
in spite of all attempt to stop it (Harry’s 1996). In last
decade, prevalence of tooth decay has been consider-
ably decreased in developed countries such as united
states and other developed countries while this disease
has remained as problematic as the past in developing
countries.
Prevention has been identi ed as the best and most
effective coping method with any diseases including
tooth decay. While consumed cost of tooth decay pre-
vention is much less than its treatment (Mehrdad 1992).
Stated theories are different in this context however one
of the main aims for plans of tooth decay prevention
and its control is increasing resistance of tooth enamel
surface against acidic products (Forrest 1981). The most
important and effective way of achieving these goals
is using uoride. Vital role of uoride in prevention
of teeth decay has been recognized since last 50 years
(Axelsson 2000). Fluoride in tooth plaque penetrates into
enamel of new tooth consequently lead to calci cation
which reduces tooth talent for decaying. Tooth struc-
ture which is at the presence of remineralized uoride
including high density of uorapatite hydroide which
makes remineralized tissue more resistant than initial
structure (Mehrdad 1992).
It is proven that repeated application of uoride has
considerable effect on controlling and prevention of
tooth decay in children and adults (McDonald 2000) dif-
ferent methods exist for using uoride including using
uoridation of drinking water, local uorides of pills
with uoride, toothpaste and mouthwash and varnishes
with uoride (Finn 1995).
Usage of drinking water with 50-59% uoride pre-
vents tooth decay (Mehrdad 1992). According to lack of
suf cient uoride in drinking water in our society, there
is need to provide uoride from other resources includ-
ing toothpaste, gels, and varnishes with uoride. Based
on theories, consistent use of uoride through differ-
ent forms causes creation of prophylaxisstatus against
decay (Stewart 1982).
Treatments which are performed by varnish of uo-
ride gel have high effect in control and prevention of
decay. In addition, previous studies indicated that using
varnishes with uoride have advantages over other
methods. These advantages include instance, easy use,
less risk in swallowing of forbidden value of uoride,
high collaboration of children in using it, lack of need to
professional prophylaxis, cleaning tooth surface before
using it, its hardening near saliva moisture. Thus, using
varnishes is very favorable method for preventing tooth
decay.
According to lack of studies in case of enamel pro
and preventa varnishes we decided to perform a research
aiming at comparing level of uoride ion release in pre-
venta and enamel pro varnishes during 2014-2015. We
therefor made this research in research center of den-
tistry university of Shahid-Beheshti University.
MATERIALS AND METHODS
Method of sample preparation was as follow: 20 cel-
luloid matrix strips by 40*20 mm dimensions were fully
covered with each under studied varnishes, with similar
brush, by an operator and with 8reciprocatingmotion.
Value of varnishes on these strips was measured in order
to homogenization of all samples weight. In this way,
weight of each strip was measured before and after cov-
ering by each varnished by digital scale (AL-104, Accu-
lab, a machine for measuring material mass with 0/0001
g accuracy and measurable 100 g maximum mass
(Figure 1). in fact, difference of these two status weight
is equal to weight of applied varnish for covering strips.
Covered strips were placed in 25 ml deionized dis-
tilled water and incubated in 37 degree temperature
and 95% humidity in cold incubator machine. at rst,
fourth, 24
th
and 72th of experiment, samples were
extracted from the solution, and were washed by 5ml
deionized stilled water. Then strips were placed in new
solution. 5ml of 30 ml nal solution were separated by
gauged electric pipettes and mixed with 0/5 ml TIZAB
(Total Ionic Strength Adjustment Buffer made by Merck
German company).
In TIZAB mixture, 0/2 g/L CDTA with formula 1 and
-2 trans diaminocyclohexane- N, N, N, N tetra Acetic
Acid (C
14
H
2
N
2
O
8
H
2
O) and 57 mg/lit glacial acetic acid
(CH
2
COOH) and 85 g/L chloride Sodium (NaCl) were
used and by adding sodium hydroxide (NaOH) 4 mular
was set in -5/5 pH.
Then obtained solutions were assessed considering
level of uoride ion in Ion Analyzer (Crison, Instrument,
S.A/ Spain).
Crison, Instrument, S.A/ Spain machined ( gure 2)
has two channel for measuring acidity (pH) and different
ionic density which are used as follow:
Chanel 1: it was used for acidity and has capacity
of calibration containing 1,2,3 point with refer-
ence solutions. Measurement unit of this canal is
pH and its accuracy is 0/01.
Canal 2: it was used for measuring ionic den-
sity such as level of uoride ion release with
BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS COMPARING FLUORIDE RELEASE IN PREVENTA AND ENAMEL PRO IN LABORATORY ENVIRONMENT 209
Ramshid Tork-Zaban et al.
potentiometer method and has capacity of 5 point
calibration with 0/1, 0/01, 0/001, 0/0001, 0/00001
standards for measuring density of uoride ion.
Measuring unit of this canal is mol/litter and mil-
ligram/litter. In this study we used canal 2.
Average of uoride release and standard deviation
(SD) was calculated for all experimented cases in all
times. For studying normality of data distribution, we
used Shapiro-Wil. For assessing different materials and
groups, variance analysis test with repetitive data and
pairwise bonferoni test were applied. The level (p<0/05)
was statistically signi cant.
RESULTS AND DISCUSSION
In this study, level of uoride ion release was measured
in two varnishes at rst hour. But as level of released in
preventa varnish was less than 1ppm, it is considered as
zero and is not statistically valuable and it is not con-
sidered in analysis. Based on Shapiro-Wilk and inves-
tigation of theoretic distribution of data in different
times all values are higher than 0/05 thus normality of
data was accepted and parametric tests at the following
were used for testing hypothesis.Pattern of decrease and
increase in uoride release level in different time is not
the same in both materials. In each time both materials
are compared and each arterial is investigated consider-
ing uoride release level. Results of variance analysis
of repeated measurements indicated that uoride release
level during the time had signi cant change either in
enamel- pro or preventa (P<0.001 in both cases).Pair-
wise compare of times by Bonferroni illustrated that in
enamel- pro group maximum release happened in fourth
hour (P<0.001). 24
th
hour had signi cant more release
than 72th hour (P<0.001) and less release than fourth
hour (P<0.001).
In Preventa group, 72th hour has maximum release
value and fourth hour had least release and this differ-
ence was signi cant (P<0.001). In Preventa group, 72th
hour has most release value and 4
th
hour has least release
value and this difference was signi cant (P<0.001). in
210 COMPARING FLUORIDE RELEASE IN PREVENTA AND ENAMEL PRO IN LABORATORY ENVIRONMENT BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS
Ramshid Tork-Zaban et al.
BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS COMPARING FLUORIDE RELEASE IN PREVENTA AND ENAMEL PRO IN LABORATORY ENVIRONMENT 211
addition, 24
th
hour had highest release than 4
th
hour
(P<0.001) and less release than 72th hour (P<0.001).Two
sample t test (independent simples t-test) indicated that
in all times enamel- pro had higher level of release than
Preventa (P<0/001 in each 3 times).
Results of the study indicated that uoride release
level had signi cant change during the time either in
enamel pro or in Preventa (P<0.001 in both cases) and
in all times, enamel- pro had more uoride release level
than Preventa. Although in each study, both varnishes
have the same density of uoride but uoride release
level in different times indicated signi cant change
between two varnish. Based on results of this study, in
all times, enamel pro had more uoride release level
than Preventa. When uoride release level is more, it can
show more uoride absorption by tooth enamel (Comar
LP. Et al., 2014). Additionally, this difference can be due
to difference in resin transporters or applied additives by
producers which it may have effect on uoride release.
Another possibility is existence of ACP in enamel pro
combination.
In addition, in this study, uoride release has been
observed in rst hour of observation but in it was not
observed in case of preventa varnish (less than 1 ppm).
This nding was clinically very important because
in rst hour we had maximum varnish volume in
child mouth. On the other hand, preventa varnish had
increase of release in hours after 24
th
hour. According
to Cochrane studies and his colleagues in 2014 it is
illustrated that uoride varnish has short lifespan in the
mouth around 24 hours and it is washed due to tongue,
cheek, saliva and tooth brushing (Cochrane NJ., 2014).
So we can conclude that increase of uoride release level
is clinically not important after 24
th
hour in preventa
varnish.
In Cochrane studies and his colleagues in 2014, cal-
cium ion release, inorganic phosphate and uoride was
measured in MI, White varnishes and signi cant differ-
ences had been reported in uoride release in rst 24
th
hour in different varnishes (Cochrane NJ., 2014). How-
ever, in this study arti cial suliva and human tooth was
not used. Enamel Pro, Bi uorid 5, and Duraphat
In Jablonowski et al (2012) study uoride ion released
from uoride of Enamel Pro, Duraphat and varnish XT
uoride varnishes was studied. Results indicated that
in Enamel pro and varnish XT, uoride release cur-
vature was signi cantly different with Duraphat Van-
ish, and Enamel pro varnish in all time had highest
level of uoride release which was consistent with this
study.
In Ritwik et al study (2012) uoride level released
from Premiere Enamel pro, Premiere, Colgate PreviDent,
Omni Vanish, and Omni Vanish XT was compared in 48
years’ period. Obtained results indicated that curvature
of uoride release in each varnishes were signi cantly
different. Premier Enamel pro showed highest level of
uoride release after using each varnishes in all hours of
assessment which is compatible with our study.
In Bolis et al. (2015) uoride absorption rate was
compared with uoride release level inside saliva.
After 4 hours, highest absorption of uoride by enamel
in arti cial saliva was respectively in Fluor Protector
and Enamel Pro varnishes. Absorption of uoride had
no signi cant relation with uoride release in arti cial
saliva. MI Varnish had highest level of uoride release in
rst 4 hours (Ritwik 2012).in this study; enamel pro had
highest level of uoride release in 4
th
hour.
In Lipert (2014) study uoride released from uoride
sodium varnishes was measured under acidic condition.
Final result indicated that uoride release in different
varnishes dependent on decomposing factors had no
signi cant difference. Enamel Pro and Nupro had high-
est level of uoride release (Comar et al., 2014).
In Cochraneet al (2014) study uoride release level
was experimented in all products in experimental envi-
ronment from rst hour until reaching to 168
th
hour was
increasing. However, in Ritwik et al study (2012) uoride
release level was experimented in all products from rst
hour until 48 hours was decreasing. Researchers reported
that fastest uoride release was related to rst 7 hours
and then in rst week. This difference is due to varnish
transporter in Peventa product because transporter has
effect on uoride release (Ritwik 2012).
In this study, uoride release of enamel pro in 4
th
hour was the most and in 72th hour was the least and
had decreasing trend but in Preventa this level was least
in 4
th
hour and was most at 72th hour.As providers of
oral hygine cares this is our responsibility to identify
dentistry products and bene t patients. It is proved that
products supporting prevention of decay need to be
necessary part of total preventive treatment. Based on
results of the experimental study, both assessed products
are the best method for prevention of tooth decay how-
ever choosing need to be based on clinical signs of every
patient.Here, the question is whether enamel pro which
release more uoride is better? Directly it seems that
the more uoride releases the more uoride is available
for tooth enamel absorption. However, this needs broad
studies which speci cally measures uoride absorption
by tooth after using uoride varnish.
CONCLUSION
During the time, uoride release has had signi cant
change either in enamel pro or Preventa (P<0.001 in
both cases). In all times, enamel- pro had more uoride
release than Preventa.
Ramshid Tork-Zaban et al.
212 COMPARING FLUORIDE RELEASE IN PREVENTA AND ENAMEL PRO IN LABORATORY ENVIRONMENT BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS
REFERENCES
Axelsson P. (2000). An introduction to risk prediction and pre-
ventive dentistry. London: Qaintessence Book; p: 77-98.
Cochrane NJ, Shen P, Yuan Y, Reynolds EC. (2014). Ion release
from calcium and uoride containing tooth varnishes. Aust
Dent J. 59 (1):100-5.
Comar LP, Souza BM, Grizzo LT, Buzalaf MA, Magalhaes AC.
(2014). Evaluation of uoride release from experimental TiF4
and NaF varnishes in vitro. J Appl Oral Sci. 22 (2):138-43.
Finn SB. (1995). Clinical pedodontics. 4 ed.: WB Saunders
Company; p: 11,574-5.
Forrest JO. (1981). Preventive dentistry. 2 ed. p: 1-9, 57,67-6.
Harry’s R. (1996). Cosmeticology. Longman Scienti c & Tech-
nical. p: 595-602.
Jablonowski BL, Bartoloni JA, Hensley DM, Vandewalle KS.
(2012). Fluoride release from newly marketed uoride var-
nishes. Quintessence Int. 43 (3):221-8.
McDonald RE, Avery DR. (2000). Dentitry for the child and
Adolescent. 7 Ed. St L ouis: The C.V Mosby Co.
Mehrdad K. (1992). Tooth decay and prevention. Tehran: Sha-
hid Beheshti University Publication. page 53-117.
Pinkham JR, Casamassimo P, Metignae DJ, HW Fields J, Nowak
A. (1999). Pediatric dentistry, Infancy through adolescence. 3
ed.: WB Saanders Cu. p: 197-200.
Ritwik P, Aubel JD, Xu X, Fan Y, Hagan J. (2012). Evaluation
of short-term uoride release from uoride varnishes. J Clin
Pediatr Dent. 36 (3):275-8.
Stewart R, Barber T, Troutman K, Wei S. (1982). Pediatric den-
tistry. 2 ed. St louis: The CV Mosby Co. p: 765-777.