Effects of Fluoride-containing Biomimetic Agents on Remineralization and Color Change of Enamel White Spot Lesions: An In Vitro Study.

Abstract

Introduction: The aim of this study was to evaluate the effects of fluoride-containing remineralization agents on enamel white spot lesions.

Methods and materials: Twenty bovine incisors were cut mesio-distally and occluso-gingivally, creating 80 specimens, and divided into four groups (n=20/group): 1) control (no treatment); 2) fluoride varnish (Voco Profluoroid 5% NaF Varnish, VOCO Dental, Cuxhaven, Germany); 3) CPP-ACFP (MI Paste Plus with Recaldent, GC Corporation, Tokyo, Japan),; 4) self-assembling peptide (P11-4F, CURODONT Repair Fluoride Plus, Credentis AG, Windisch, Switzerland). After a three-week demineralization-remineralization cycle, white spot lesions were observed on the specimens. Before applying the remineralization agents, baseline demineralization values were determined using DIAGNOdent 2095, QLF-D Biluminator, SEM-EDS (KaVo Dental, Charlotte, NC, USA), and color values were measured by Vita EasyShade (Vita Zahnfabrik, Bad Säckingen, Germany). Remineralization agents were applied once, following the manufacturers' instructions. The remineralization capacities of these agents and their effects on color change were evaluated at four time points: baseline (T0), demineralization (T1), and remineralization on the seventh (T2) and 30th (T3) days.

Results: After 30 days, CPP-ACFP and P11-4F showed significantly greater Ca (% by weight), F (% by weight), and Ca/P ratio than the fluoride varnish group (p<0.05). SEM images revealed that in the groups where the remineralization agent was applied, the pores and tubules were blocked, and the surfaces were covered, whereas these findings were not observed in the control group. Based on QLF-D Biluminator data, P11-4F application provided more successful fluorescence changes compared to CPP-ACFP and fluoride applications and was statistically more effective in reducing lesion volume and maximum fluorescence loss (p<0.05). Significant differences were observed among the four groups at the seventh (T2) and 30th days (T3) in the laser fluorescence evaluation with DIAGNOdent (p<0.05). On the seventh day, the fluoride group exhibited greater effectiveness than the control group, while on the 30th day, the CPPACFP group demonstrated superior improvement over the control group (p<0.05). According to color change results, applying a remineralization agent was found to be a statistically successful method in restoring the tooth's original color (p<0.05). However, there were no significant differences among the treatment groups (p>0.05).

Conclusions: CPP-ACFP and P11-4F demonstrated positive effects on remineralization at the seventh and 30th days. Applying a remineralization agent is a viable option for blocking pores and tubules on demineralized enamel. The color change related to the use of the remineralization agent showed a positive effect over time.