Micro-CT analysis of naturally arrested brown spot enamel lesions

Abstract

Objectives: The aim of this study was to characterize the mineral density parameters through natural enamel brown spot lesions (BSLs) and to visualize and map their mineral distribution pattern in comparison to enamel whitespot lesions (WSLs).

Methods: Study specimens included seventeen proximal WSLs (ICDAS 1, 2), seventeen proximal BSLs and seventeen sound proximal specimens (ICDAS 0) collected from The Oral Surgery Department at Sydney Dental Hospital, Sydney, Australia. Imaging was undertaken using a high resolution, desktop micro-computed tomography system. A calibration equation was used to transform the grey level values of the images into true mineral density values. The qualitative analysis and the quantification of the lesion parameters including the mineral density and the thickness of the enamel lesion surface layer were performed using mineral density profiles plotted in FIJI and the visualized mineral maps in MATLAB respectively.

Results: The maps of brownspot lesions revealed irregular demineralization patterns with faint boundaries and outlines. The regular triangular shape of proximal lesions was recognizable only in some parts of individual BSLs or was completely unrecognizable within the entire lesion. Scattered free-form areas of high density enamel were observed within or close to the surface of BSLs. A layer of high density enamel with a mineral density close to that of sound enamel was observed in all of the BSLs. The mean mineral density of the body of BSLs, including the scattered areas of high mineral density, was significantly higher than the corresponding values in white-spot lesions. The mean thickness of the surface layer in BSLs (79±15μm) was also significantly higher than white-spot lesions (51±11μm) (p<0.05).

Conclusion: This study demonstrated that the mineralization parameters such as density and the thickness of the surface layer as well as distribution patterns through natural enamel brown spot lesions (BSLs) are different from enamel white-spot lesions (WSLs). The higher mineral density of the body of the lesion and the increased thickness of the surface layer in brown spot enamel lesions may suggest possible subsurface remineralization in the majority of naturally arrested BSLs.

Keywords: Caries arrest; Enamel caries; Micro-computed tomography; Remineralization.