Remineralization of early enamel caries lesions using different bioactive elements containing toothpastes: An in vitro study.

BACKGROUND: Demineralization can be arrested or reversed when remineralization agents are applied to incipient carious or non-cavitated carious lesions. A large number of therapeutic agents including non-fluoridated products have been developed to promote enamel remineralization.

OBJECTIVE: This study aims to evaluate the efficacy of different bioactive elements containing toothpastes in remineralization of artificial enamel lesions.

METHODS: Artificial carious lesions were created on 40 human enamel slabs, and were randomly divided into four groups: (1) control group (no treatment), (2) casein phosphopeptide-amorphous calcium phosphate group (CPP-ACP, GC Tooth Mousse), (3) 8% arginine and calcium carbonate group (ACC, Colgate Sensitive Pro-Relief), (4) calcium sodium phosphosilicate group (CSP, NovaMin®). All samples were subjected to 15 days of pH-cycling. Subsequently, a one-hour acid resistance test was carried out. Surface hardness of the samples was assessed using the Knoop hardness test, and surface morphology and roughness were assessed by scanning electron microscopy (SEM) and atomic force microscopy (AFM). Data were analyzed using one-way ANOVA, Tukey's test and paired t test.

RESULTS: The three tested toothpastes exhibited a significantly higher remineralization efficacy compared with the control group (P< 0.05 for all). After pH-cycling, the specimens treated with Colgate Sensitive Pro-Relief and NovaMin® showed a significant higher surface hardness (P< 0.001 and P= 0.03, respectively) and lower surface roughness (P< 0.05 for both) compared those treated with GC Tooth Mousse. While after the acid resistance test, all groups showed a significant loss of surface hardness (P< 0.001 for all) and significant increase of surface roughness (P< 0.05). The specimens treated with Colgate Sensitive Pro-Relief and NovaMin® still showed a significant higher surface hardness and lower surface roughness in comparison with those treated with GC Tooth Mousse (P< 0.05 for all). No significant difference was found in surface hardness and roughness between Colgate Sensitive Pro-Relief and NovaMin® during the pH-cycling test and acid resistance test (P= 0.45 and P= 0.83, respectively).

CONCLUSIONS: Colgate Sensitive Pro-Relief and NovaMin® present an advantage in enhancing remineralization and inhibiting demineralization for early enamel carious lesions in comparison with GC Tooth Mousse.