Topographic Evaluation of the Remineralizing Potential of Biomimetic Scaffolds on Enamel White Spot Lesions: An In Vitro Study.

Objectives: The modern approach to managing noncavitated white spot lesions (WSLs) emphasizes noninvasive strategies and biomimetic remineralization. Biomimetic scaffolds are designed to regenerate dental tissues rather than simply repair them. This study aimed to assess lesion depth, enamel structure, and the elemental composition of artificially induced WSLs after treatment with biomimetic remineralization techniques.

Materials and methods: Ninety-six freshly extracted anterior teeth, free from caries or enamel defects and extracted due to periodontal disease, were used. White spot lesions were induced on the labial surfaces, and the samples were divided into three groups based on the remineralizing agent: Group I, treated with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), which served as the positive control; Group II, treated with self-assembling peptide P11-4 (SAP-P11-4); and Group III, treated with phosphorylated nano-chitosan (Pchi-ACP). Enamel topography was analyzed at baseline and after treatment using polarized light microscopy, micro-Raman spectroscopy, and scanning electron microscopy. Statistical analysis was conducted using one-way ANOVA, Kruskal-Wallis, and Dunn's post hoc test (p = 0.05).

Results: The Kruskal-Wallis test indicated a significant difference in remineralization potential among the groups. Pchi-ACP showed the greatest reduction in lesion depth (62.65%), demonstrating significant subsurface enamel remineralization. This group also exhibited a smooth, regular enamel surface with shallow linear depressions. Elemental analysis confirmed successful calcium phosphate precipitation in Pchi-ACP, indicating a trend toward enamel regeneration.

Conclusion: Pchi-ACP represents a promising biomimetic and minimally invasive approach for treating early WSLs, signifying a transition toward regenerative dentistry. (SAP-P11-4), while effective, was less successful than phosphorylated nano-chitosan but outperformed (CPP-ACP).

Clinical significance: Pchi-ACP demonstrates significant potential for minimally invasive treatment of early noncavitated carious lesions. By preserving natural tooth structure, this approach could greatly enhance oral health outcomes in the long term.