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The aim of the study was to assess the efficacy of three methods of enamel remineralization on initial approximal caries: (1) a nano-hydroxyapatite gel, (2) gaseous ozone therapy, (3) combination of a nano-hydroxyapatite gel and ozone. Patients (n = 92, age 20–30 years) with initial approximal enamel lesions on premolar and molar teeth (n = 546) were randomly allocated to three groups subjected to a 6-months treatment: Group I: domestic nano-hydroxyapatite remineralizing gel, group II: in-office ozone therapy, group III: both domestic remineralizing gel and ozone therapy. Caries lesions were assessed on bitewing radiographs at baseline, after 1 year and after 2 years. At one-year follow-up, the smallest rate of lesions with remineralisation (36.5%) was found in group I, and the highest (69.3%)—in group III. In group III a significant remineralisation was noticed in after 1 year and then a demineralisation after 2 years. Thus nano-hydroxyapatite gel and ozone therapy exert some capacities to remineralize approximal enamel and dentine subsurface lesions of premolar and molar teeth. Moreover, the combination of both methods produces the best effect compared to nano-hydroxyapatite or ozone therapy applied alone. However, the treatment should be continued for a long time in order to achieve nonrestorative recovery of caries.

Enamel demineralisation can occur as a side effect during orthodontic treatment with fixed appliances. This study aimed to evaluate the efficacy of the self-assembling peptide P 11 -4 for remineralisation combined with fluorides, compared to application of fluoride varnish alone. De- and remineralisation was assessed by Quantitative light-induced fluorescence (QLF). Orthodontic brackets were bonded on 108 human enamel samples and white spot lesions were created. The samples were allocated randomly into three groups: Group I received no treatment, group II had a single application of fluoride varnish (22,600 ppm), and group III was treated with P 11 -4 following a single application of fluoride varnish. Quantitative light-induced fluorescence (QLF) measurements were performed at baseline, after demineralisation and after storage in remineralisation solution for 7 and 30 days. Non-parametric tests (Kruskal–Wallis test and Friedman test) were used for further analysis. After demineralisation, all samples showed a median ΔF -9.38% ± 2.79. After 30 days median ΔF values were as followed: group I = -9.04% ± 2.51, group II = -7.89 ± 2.07, group III = -6.08% ± 2.79). The median ΔF values differed significantly between all groups at all investigation times (p < 0.00001). Application of P 11 -4 with fluoride varnish was superior to the use of fluorides alone for remineralisation of enamel adjacent to brackets.

Objectives This study aimed to investigate if CPP-ACP / infiltrating resin was superior in treating enamel demineralization during orthodontic therapy compared with fluoride varnish, in order to provide early-intervention implications for dental professionals. Materials and methods In the in-vitro study, premolars were grouped into four: remineralization with fluoride varnish / CPP-ACP, sealing with infiltrating resin, and negative control. Experimental demineralization of enamel surfaces was analyzed using techniques of QLF, SEM, EDS and micro-hardness testing. An in-vivo intervention study was conducted on patients randomly assigned into three groups. At the baseline and every-3-month follow-up, QLF parameters were compared temporally and parallelly to yield potential implications for promotion in clinical practice. Results The in-vitro study performed on 48 experimental tooth surfaces demonstrated that sealing with infiltrating resin reduced enamel surface porosity and increased surface micro-hardness significantly. In the in-vivo intervention study on 163 tooth surfaces, it was suggested that for those who meet the criteria of -10 < ΔF < -6 and − 1000 < ΔQ < -20 at the baseline, all these treatment methods could achieve acceptable outcomes; with the rising of absolute values of ΔF and ΔQ, sealing with infiltrating resin showed more evident advantages. Conclusion For enamel demineralization during orthodontic therapy, all the treatment methods involved in this study showed acceptable effectiveness but had respective characteristics in treatment effects. QLF parameters could be used as indicators for clinical early-intervention strategy with regards to this clinical issue. Clinical relevance With QLF parameters, clinical early-intervention strategy for enamel demineralization during orthodontic therapy could be optimized.

The aim of the study was to examine the mean mineral density (MD) change in early proximal enamel caries lesions after applying silver diamine fluoride (SDF) using digital subtraction radiographic analysis at 6 and 12 months. A split-mouth, triple-blind, randomized controlled trial was conducted with thirty healthy participants aged 13–30 years old. Two active non-cavitated proximal caries lesions in different quadrants of each participant were randomly sampled and allocated to a test (38% SDF) and a control group (deionized water). Digital radiographs at baseline, 6 and 12 months were taken, and digital subtraction radiographic analysis was performed. The SDF group demonstrated a significantly higher mean MD on subtraction radiographs compared with the control group, after adjusting for baseline lesion depth and time, and for clustering within participants over time. The adjusted mean difference was 1.0 [95% CI 0.2, 1.9]. Therefore, applying SDF at baseline and 6 months resulted in significant remineralization compared with the control group over the 12-month period. These findings suggested that applying SDF can serve as an effective alternative treatment option for remineralizing early caries lesions on proximal surfaces.

The randomized study aimed to evaluate the comparability of in situ (iS) and in vitro (iV) study protocols regarding remineralization of artificial enamel lesions. Two toothpastes (group A: 1450 ppm sodium fluoride, group B: placebo 0 ppm F-), were investigated. IV, a pH-cycling model with toothpaste slurry treatment was applied for 10d. IS, remineralization was performed in 9 participants wearing splints with embedded enamel samples for 10 and 21d, randomly allocated to groups A and B. Samples were scanned by X-ray micro-computed tomography (μCT) and grayscale value line profiles corresponding to mineral density (rel.ΔZ) were analyzed. Statistical analyses were performed using MedCalc Statistical Software, v22.021. T-Test for dependent and independent data and analysis of variance (ANOVA) were used for further analyses (α = 0.05). Rel.ΔZ of fluoride treated samples (A) were iV = 40.2%, iS 10d = 11.5% and iS 21d = 46.1% (p > 0.05). Rel.ΔZ of placebo treated samples (B) were: iV = − 6.2%, iS 10d = 25.2% and iS 21d = 11.0% (p > 0.05). Remineralization potential of both toothpastes was significantly different regarding iV (p < 0.001) and iS after 21d (p = 0.034), while in case of iS 10d no significant difference was detected (p = 0.4). Despite different study protocols the μCT results after remineralization were comparable between iV and iS. The results suggest that selected studies can be carried out in faster, simplified iV studies using pH-cycling instead of iS studies.

To compare the effect of Nanohydroxy apatite (NHA), Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), CPP-ACP with fluoride (CPP-ACPF), versus fluoride gel on remineralization and color improvement of white spot lesions (WSLs) after clinical application followed by home treatment. Thirty-two children from 10 to 14 years with 100 teeth were participated in this study. Affected teeth were randomly allocated into five groups ( n  = 20); group I: NHA, group II: CPP-ACP, group III: CPP-ACP + F, group: IV: Fluoride gel and group V: no treatment. After application for five minutes, remineralization was assessed via diagnodent while Vita easy shade was used for color assessment before and after treatment. In- office procedures were repeated after one week and one month, while continuous home application was followed. Remineralization and color assessment were repeated at each interval. The remineralization ability and color change showed a significant difference between the examined groups at different intervals with p value < 0.001. Where group I had the significantly highest remineralization ability at different periods. While the color difference was significant in group III followed by group I after immediate application. However, at one-month group III had the most significant color change in all groups. NHA could be a potent remineralizing agent while improving the color of WSLs. CPP-ACP + F had a superior masking and sustainable effect of the WSLs. Combined in office followed by continuous home application of different remineralizing agents could mask the WSLs which satisfy the patients’ needs. Trial registration: This study was initially registered on https://ClinicalTrials.gov on 12/02/2025 as first posted date, with ID: NCT06821724 - https://clinicaltrials.gov/study/NCT06821724 .

ObjectivesTo evaluate the clinical performance of self-assembling peptides versus fluoride-based delivery systems in post-orthodontic white spot lesions.Materials and methodsThe participants were randomly assigned into two groups (n = 58) according to the remineralizing agent used, where (A) group represented participants receiving a varnish containing 22.600 fluoride ppm and tricalcium phosphate, while the second group (B) represented participants receiving self-assembling peptide. The remineralizing process of the white spot lesion was assessed using the DIAGNOdent pen and ICDAS scoring system according to the time when the remineralizing agent was used (T), where T0 represented the score taken at baseline. T1 represented the score taken after 3 months of follow-ups and T2 score represented the score taken after 6 months of follow-up. Data were collected and statistically analyzed. The parametric data: two-way ANOVA was used to test the effect of interaction among different variables. The non-parametric data: Mann–Whitney test was used. The significance level was set at p ≤ 0.05.ResultsThere was a quantitative statistically significant difference via DIAGNOpen readings between Group A (fluoride material) and Group B (self-assembling peptides). The highest mean value of 10.51 was found in Group A, while the least mean value of 6.45 was found in Group B. Besides, there was a significant difference in each group concerning the time factors T0, T1, and T2 groups where (p < 0.001. As for the qualitative results concerning the ICDAS score, there was no significant difference between the two groups along with the follow-up periods T0, T1, and T2 where the p value is equal to 0.064, 0.087, and 0.277 respectively.ConclusionsThe visual assessment using ICDAS reveals that the biomimetic remineralization using self-assembling peptides and the fluoride-based varnish material showed a similar effect in masking post-orthodontic white spot lesions. However, the laser fluorescence using DIAGNOpen showed that the self-assembling peptides reveal higher performance in subsurface remineralization than the fluoride-based varnish material. Therefore, self-assembling peptides are considered a promising material for lesion regression in post-orthodontics white spot lesions.Clinical relevanceSelf-assembling peptide SAP-14 is a new approach to reverse and mask off post-orthodontics white spot lesions.

Objectives The present trial’s aim was to compare the remineralization potential of self-assembling peptide P11-4 combined with fluoride to that of fluoride varnish. Materials and methods Twenty-eight participants with 58 incipient carious lesions were enrolled in the present trial. Participants were randomly divided into two groups with 14 participants and 29 incipient lesions in each group. Patients were assigned either to self-assembling peptide combined with fluoride (Curodont Repair Fluoride Plus™) or sodium fluoride varnish (NaF, Bifluorid 10) groups. Both agents were applied according to the manufacturer’s instructions on non-cavitated incipient carious lesions. Lesions were assessed by two calibrated and blinded assessors at baseline, and after one-, three- and six-months using a laser fluorescence device (DIAGNOdent). Results Although laser fluorescence scores significantly improved in both groups over time ( p  < 0.05), no notable differences were evident between both groups at one-month ( p  > 0.05). Yet, at three- and six-months statistically lower laser fluorescence readings were evident in the self-assembling peptide combined with fluoride group in comparison to the fluoride alone group ( p  < 0.05). There was 60% less risk for caries progression for Curodont Repair Fluoride Plus™ when compared to NaF varnish after six months. Self-assembling peptide combined with fluoride was able to change 65.5% of non-cavitated carious lesions from DIAGNOdent score 3 (11–20) to score 1 (0–4). Fluoride varnish was able to change 13.8% of the lesions from score 3 to score 1 after six months. Conclusions The self-assembling peptide combined with fluoride varnish showed higher remineralization potential than fluoride varnish alone for incipient carious lesions over a six-months follow up. Clinical relevance The combination of self-assembling peptide P11-4 and fluoride could offer a new tool in managing incipient carious lesions.

This study assessed the efficacy of 60% CPP-ACP to remineralise white spot lesions (WSLs) in enamel and to occlude patent dentinal tubules in a double-blind, randomized, cross-over, in situ study. Human enamel specimens with subsurface lesions (WSLs) and root dentine specimens with open dentinal tubules were prepared and inserted into intra-oral appliances worn by volunteers. Participants wore the appliances 24 h a day for four 14-consecutive day treatment periods with a 7-day washout period between treatments. Four treatments applied with a micro-brush once daily were 60% CPP-ACP with and without 1100ppm F as SnF 2 , 1100ppm F as SnF 2 alone and a placebo as negative control. Mineral content was measured using transverse microradiography and dentine tubules were examined using scanning electron microscopy (SEM). The data were analysed using a repeated measures ANOVA with a Sidak adjustment for multiple comparisons. Once daily application of 60% CPP-ACP with or without SnF 2 produced 36.6 ± 1.6% and 28.8 ± 1.5% remineralisation of the WSLs respectively, and both were significantly higher ( p  < 0.0001) than that for treatment by SnF 2 alone (8.8 ± 0.7%) or placebo control (2.3 ± 0.4%). SEM analysis of the dentine samples showed that daily application of 60% CPP-ACP with or without SnF 2 produced near complete dentinal tubule occlusion.

Objectives To compare the long-term remineralization of initial caries lesion (ICL) treated with different remineralizing agents during orthodontic retention using optical coherence tomography (OCT). Materials and methods This randomised clinical trial recruited 30 patients on fixed appliances with at least one ICL labially on any maxillary incisor. At debond (baseline), they were allocated to three groups, where twice daily fluoride toothpaste was given: (1) as control; (2) supplemented with daily casein phosphopeptide amorphous calcium phosphate with fluoride (CPP-ACPF); or (3) supplemented with three-monthly professional applied fluoride varnish (FV). Primary outcome was the OCT backscatter reflectance changes of the ICL, measured as integrated reflectivity (IR). Follow-ups were at three-month intervals up to 12 months. The trial was registered with Clinicaltrials.gov (NCT04788550). Results Analyses included 26 participants (nine control; nine CPP-ACPF; eight FV). There were significant reduction in integrated reflectivity over time. Post hoc comparisons showed reductions were significant up to 150-micron depth at 6-months, and up to 250-micron depth at both 9- and 12-months follow-up compared to baseline. At 12-months, FV had the lowest IR values, followed by CPP-ACPF and control, but the differences between groups were not significant. Conclusions After 12-months observation, use of fluoridated toothpaste alone or supplemented with either fluoride varnish or CPP-ACPF promotes enamel remineralization up to 250-micron depth. Clinical relevance Daily fluoridated toothpaste with regular 3-monthly recall visits from the start of orthodontic retention is recommended for effective control of initial caries lesions. FV and CPP-ACPF supplementation can be considered but their long-term benefits remain inconclusive.