03.11.2014 1 Potential of tin in the therapy of erosion and of other oral diseases Old acquaintance with a new face? Department for Conservative and Preventive Dentistry JUSTUS-LIEBIG- UNIVERSITY GIESSEN Dental Clinic Nadine Schlueter October 2014 Compounds containing stannous ions • Numerous potentials for applications and use in industry and healthcare • Oral health care products • SnCl 2 • SnF 2 • SnF 2 one of the first fluoride compounds used in toothpastes in the USA => 1956 - „Fluoristan“ (Crest, Procter & Gamble) • Problems with stability and following with formulation of products • Water-free, glycerine based, and abrasive free formulations as a solution (1963) • Problems with taste => adstringent feeling on teeth and mucosa • Replaced by NaF, MFP
Transcript
03.11.2014
1
Potential of tin in the therapyof erosion and
of other oral diseases
Old acquaintance with a new face?
Department for Conservative and Preventive Dentistry
JUSTUS-LIEBIG-
UNIVERSITYGIESSEN
Dental Clinic
Nadine Schlueter October 2014
Compounds containing stannous ions• Numerous potentials for
applications and use in industry and healthcare
• Oral health care products
• SnCl2• SnF2
• SnF2 one of the first fluoride compounds used in toothpastes in the USA=> 1956 - „Fluoristan“ (Crest, Procter & Gamble)
• Problems with stability and following with formulation of products
• Water-free, glycerine based, and abrasive free formulations as a solution (1963)
• Problems with taste => adstringent feeling on teeth and mucosa
• Replaced by NaF, MFP
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• Tin member of the carbon groupTwo configurations: Sn2+ und Sn4+
• Only Sn2+ reduces acid solubility of enamel=> Sn4+ shows nearly no effect (Wachtel et al. 1964)
• Aging of Sn-containing solutions by oxidation and hydrolysis(Muhler et al. 1952)
=> Reduction of acid solubility of enamel by approximately50% after 13 days of aging
SnF2 + H2O Sn(OH)2
SnF2+ O2 Sn4+
• Tin member of the carbon groupTwo configurations: Sn2+ und Sn4+
• Only Sn2+ reduces acid solubility of enamel=> Sn4+ shows nearly no effect (Wachtel et al. 1964)
0
5
10
15
20
25
0 h 24 h
Tin
co
nte
nt
(wt%
)
original Meridol inactivated Meridol
• Conversion of Sn2+
into Sn4+ by gassing with oxygen (Inactivation)
• Storage in “artificial saliva”
• Reduction of tin retention by approximately 50%
Own measurements, not published
Stabilization of Sn2+ by
1. AmF
2a. Sodium-Tri-metaphosphate(originally used as a tooth-whitener;Pepsodent – 1930s)
2b. Sodium-Hexa-Metaphosphate
3. Sodium-Gluconate
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Dental hardtissues
Soft tissues
Sn2+
Effect of Sn2+ on…
Dental hardtissues
Soft tissues
Effect of Sn2+ on…
Sn2+
Effect of tin on dental hard tissues
Sn2+ Hard tissue
Erosion
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Basic pathomechanism:
Erosive demineralisation occurs after chronic exposure of clean tooth surfaces to acidsprovided that the surrounding fluid is undersaturated with respect to tooth minerals
Clinical appearance – occlusal surfaces
Clinical appearance – smooth surfaces
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Result:centripetal loss of mineral +loss of microhardness, thus increased susceptibility to abrasion
Schlueter N, Ganss C, De Sanctis S, Klimek J : Evaluation of a profilometrical method for monitoringerosive tooth wear. Eur J Oral Sci. 2005;113:505-11
-107 µm~213 µm / year
-111 µm~222 µm / year
-74 µm~148 µm / year
Progression of Erosion
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Effect of different fluoride compounds on the dental hard tissue
Ganss C, SchlueterN, Hardt M,
Schattenberg P, Klimek J: Effect of
fluoride compounds on enamel erosion in vitro-a comparison of amine,
sodium and stannous fluoride. Caries Res
2008;42:2-7
Additionally, reduction of hypersensitivity by use of stannous containing preparations by up to 87%Sharma et al. 2010
Application of Sn-containing preparations
Incorporation
50 µm 50 µm 50 µm50 µm
1400 ppm Sn2+:
15 wt%
10 µm: 6 wt%20 µm: 3 wt%30 µm: 1 wt%
- 81%
2100 ppm Sn2+:
18 wt%
10 µm: 6 wt%20 µm: 3 wt% 30 µm: 1 wt%
- 81%
400 ppm Sn2+:
6 wt%
10 µm: 2 wt%20 µm: 0.5 wt%30 µm: n.n.
- 47%
Schlueter N, Hardt M, Lussi A, Engelmann F, Klimek J, Ganss C. Tin-containing fluoride solutions as anti-erosive agents in enamel: an in vitro tin-uptake, tissue-loss, and scanning electron micrograph study. Eur J Oral Sci 2009; 117: 427-434.
Retention of Sn on the surface
Reduction
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NaF/AmF- mouth rinse after each vomiting
Observation period 6 month
7 µm
15 µm
Sn/F- mouth rinse after each vomiting
Observation period 7 month
-107 µm~213 µm / year
-111 µm~222 µm / year
-74 µm~148 µm / year
Hard tissue
Erosion
Caries
Effect of tin on dental hard tissues
Sn2+
Gray. Acid dissolution rate of sound and white-spot enameltreated with tin(II) and fluoride compounds. J Dent Res 1965
Treatment of enamel specimens
• 5 min SnF2 (pH 3.4),
SnCl2 (pH 2.2),
NaF (pH 7.0)
• 0.1 M Lactate buffer pH 4.5
Effect of stannous fluoride in
comparison to sodium fluoride
• Small in sound enamel
• ~ 70% reduction of solubility in
carious enamel
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Effekt of SnF2 und NaF on coronal caries and on root caries (rat model)
Application of SnF2 und NaF (1000 ppm F-) Two times per day over a period of 9 weeks
Beiraghi et al., Arch Oral Biol 1990
Reduction SnF2 vs. NaF: 60% coronal caries83% root caries
Reduction SnF2 vs. control: 70% coronal caries92% root caries
Group Coronal caries Root caries
SnF2 3.06 ± 0.91a 1.06 ± 5.20a
NaF 5.06 ± 0.50a 6.01 ± 0.89b
Aqua Dest. (Kontrolle) 9.72 ± 5.91b 14.1 ± 2.52c
SnF2 (500 ppm F-) NaF(500 ppm F-)
F uptake(ppm)
pH F uptake(ppm)
pH
68.3 3.3 20.5 6.3
122.5 3.0 23.4 6.3
185.3 2.7 23.8 6.2
304.0 2.6 19.9 6.2
374.0 2.4 24.0 6.3
Significant higher retention of KOH-soluble fluoride (CaF2) by application of Sn2+-containing solutions in comparison to NaF-solutions
Wegehaupt et al., Acta OdontolScand 2012
Significant higher fluoride-incorporation by application of Sn2+-containing solutions in comparison to NaF-containing solutions
Muhler et al., J Dent Res 1952
0
1
2
3
4
5
SnCl2/AmF/NaF NaF SnCl2/AmF/NaF NaF
neutral conditions erosive conditions
KO
H-s
olu
ble
Flu
ori
de
(µg
/cm
²)
+ 45%
+ 99%
Incidence of root caries after AmF/SnF2 und NaF-application in patients suffering from periodontitis
Use of an AmF/SnF2 or an NaF toothpaste and mouth rinse (250 ppm F-) –observation period 24 month
No difference between AmF/SnF2 and NaF
Paraskevas et al., J Clin Periodontol 2004
0
10
20
30
40
Patients with new lesions Number of active lesions
AmF/SnF2 NaF
HOWEVER: Additionally professional tooth cleaning and oral
hygiene instruction
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Hard tissue
Erosion
CariesPlaque
Acido-genity
Effect of tin on dental hard tissues
Food intake
Critical pH
Sn2+
Inhibition of pH-decline within
plaque by a 1-minute rinsing with 0.2% SnF2-
solution
Svatun and Attramadal 1978, Acta Odontol Scand
Control (prior to SnF2)
24 h after SnF2
7 h after SnF2
2 h after SnF2
10 min after SnF2
15% sucrose-solution
Hard tissue
Erosion
CariesPlaque
Acido-genity
Accumu-lation
Effect of tin on dental hard tissues
Sn2+
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Short- and long-term effectof AmF/SnF2-mouthrinse
on plaque formation
2 x daily 10 ml for 1 minute
Brecx et al. 1990 and 1993
Antibacterial activity of SnF2-containing products
0
20
40
60
80
100
CHX AmF/SnF2 Wasser
Bio
film
-Vit
alit
y (%
of
init
ial v
alu
e)
Auschill et al. 2005Water
Hard tissue
Erosion
CariesPlaque Adhesive Bond
Strength
Acido-genity
Accumu-lation
Effect of tin on dental hard tissues
Sn2+
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Tin application und Bond strength
• Only few data on this issue
• negative effect on bond strength after application of NaF or basic phospho-fluoride
• Increase of adhesion
by application of 8% SnF2 in comparison to NaF and APF
of a self-etching adhesive system in eroded dentine by application of a AmF/NaF/SnCl2-solution
