Comparative evaluation of the remineralizing potential of different calcium and fluoride-based delivery systems on artificially demineralized enamel surface; an in vitro study

Abstract

Background: Enamel is the hardest and vastly mineralized structure of the human body. Inorganic salts make up the majority of it. Water and ions pass right through the enamel. The enamel undergoes demineralization and remineralization cycle throughout life. Recently, the interest in the development of calcium, phosphate, and fluoride remineralization technology has been increased leading to the development and reintroduction of various remineralizing agents such as fluoride, casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), nano-hydroxyapatite (nano-HA), xylitol, bioglass, Ozone, etc.

Aim: The aim of this study is to evaluate and compare the potential remineralization of CPP-ACPF, calcium sucrose phosphate (CaSP), amine fluoride (AmF), and nano-HA.

Settings and design: The design of this research is experimental. This is an in vitro study. The research was carried out at the Dental Teaching Institute. This study involved human teeth. No demographic data were obtained. One hundred and twenty premolars were selected from the tooth bank of the Department of Oral and Maxillofacial Surgery. The teeth included in the study were noncarious, nonrestored, and nonfractured extracted teeth. Teeth excluded from the study were extracted teeth with any visible or detectable caries, white spot lesions, microcracks, attrition, abrasion, erosion, or abfraction.

Materials and methods: One hundred and twenty enamel samples were taken; they were divided into six groups (n = 20). The demineralization process was carried out on Groups II, III, IV, V, and VI. The remineralization process was carried out on Groups III, IV, V, and VI for 14 days using CASP, AmF, and nano-HA, respectively. No surface treatment was performed in Group I causing it a positive control group, whereas Group II was considered a negative control with only enamel surface demineralization and no remineralization. The microhardness of enamel was measured using Vickers microhardness testing machine after a 14-day remineralization regimen.

Statistical analysis: In the statistical analysis, one-way analysis of variance and post hoc Tukey's tests were performed.

Results: The mean microhardness values in declining order: positive control > nano-HA > AmF > CaSP > CPP-ACPF > negative control.

Conclusion: All remineralizing agents exhibited enhanced surface remineralization. Nano-HA showed the highest remineralization potential followed by AmF, CaSP, and CPPACPF.

Keywords: Amine fluoride; calcium sucrose phosphate; caries prevention; casein phosphopeptideamorphous calcium phosphate fluoride; microhardness; nano-hydroxyapatite; remineralization.