Preparation and Evaluation of the Remineralization Effect of a Dental Varnish Containing Casein Phosphopeptide-Amorphous Calcium Phosphate with Fluoride (Cpp-Acpf) on White Spot Lesions of Permanent Teeth: An In Vitro Study.

Abstract

Introduction: White spot lesions (WSLs) are early indicators of enamel demineralization and require effective r e m i n e r a l i z a t i o n strategies to prevent progression. This in vitro study aimed to prepare and evaluate a dental varnish containing casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF) and to compare its remineralization efficacy with a commercial MI GC varnish and a control varnish.

Methods: The dental varnish formulation was prepared. To evaluate its physicochemical properties and compare them with the MI varnish, density and viscosity measurements were conducted. To evaluate the effect of the varnishes on remineralization, 36 enamel specimens were obtained from the buccal surface of extracted human non-carious premolars. The specimens were randomly divided into three groups (n=12). Microhardness measurements of the tooth surface were taken at three stages: (1) baseline (sound enamel) before demineralization, (2) immediately after demineralization, and (3) after the remineralization period. Scanning electron microscopy (SEM) was used to examine the enamel surface morphology at each stage.

Results: Enamel surface microhardness (Vickers hardness number, VHN) significantly decreased after demineralization (baseline: 310±12; after demineralization: 185±10; P<0.001). Following treatment, the prepared CPP-ACPF group exhibited the highest recovery (275±11 VHN), compared with MI varnish (245±13 VHN) and control (210±9 VHN). Repeated-measures mixed ANOVA confirmed significant differences between the groups (P<0.001), with the Tukey test showing that prepared CPP-ACPF varnish>MI varnish>control. Scanning electron microscopy revealed smoother and more uniform remineralized surfaces in the prepared CPP-ACPF group.

Conclusion: The results indicated that the prepared CPP-ACPF varnish provided superior remineralization and could serve as a stable, cost-effective option for managing early enamel lesions.