Morphological analysis and chemical content of natural dentin carious lesion zones

Abstract

Dentin is one of the earliest bio-mineralization products to appear in the evolution of vertebrates. Dentin reactions to infection mimic earlier phylogenetic patterns, and carious lesions are divided into different zones which reflect the natural patho-morphological reaction of dentin to the carious attack. It was the aim of this study to investigate deep dentin carious lesions of human molars with combined polarization light microscopy, scanning electron microscopy and energy dispersive X-ray element analysis (EDX) for the determination of different zones of the carious lesions, their extent and the chemical content. Sixteen extracted teeth with deep dentin carious lesions were embedded in Technovit 9100 (Kulzer) and serial sections of 80 microm thickness were made. These sections were then examined with polarized light microscopy to identify the different zones of the lesions. The outlines of the zones were traced consecutively and 3D-reconstructions were made for the determination of the extent and calculation of the volumes of the different zones. From the volumes of the demineralizing dentin and the translucent zone a Dentin Demineralization Index (DDI) was calculated. Three sections of each lesion were then coated with carbon and studied with a scanning electron microscope. 3D-reconstruction of the teeth showed the rather stable translucent zone, interrupted by remnants of dead tracts, and very different volumes of demineralizing dentin. Therefore, with increasing size of the demineralizing dentin, the DDI increased. The chemical content was measured using energy dispersive X-ray analysis (EDX) in areas of intertubular dentin. The content of Ca, P, and C was significantly different in all zones. The Ca/P ratio was significantly different between sound dentin and demineralizing dentin. From the results we conclude that the mineral content of intertubular dentin of the translucent zone and demineralizing dentin is different from that of sound dentin, and the unique mineralization pattern of the translucent zone is a biological reaction to the carious attack. Because active dentin lesions exhibit many non-occluded open dentin tubules, further bacterial invasion or, in case of dentin treatment, the penetration of bonding agents towards the pulp is morphologically not prevented and therefore of clinical importance.