Prevention of White Spot Lesions Using Three Remineralizing Agents: an in Vitro Comparative Study

Background. Enamel demineralization around orthodontic brackets is an important clinical problem. This study sought to compare the efficacy of sodium fluoride (NaF), casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACP-F; MI Paste Plus) and a water-based cream (Remin Pro), which contains hydroxyapatite and fluoride for prevention of enamel demineralization. Methods. Fifty-six sound human premolars extracted for orthodontic purposes were collected. After cleaning, the crowns were mounted in acrylic resin and all the surfaces were coated with nail varnish except for a 3×4-mm window on the buccal surface. The samples were randomly divided into four groups of 14 and subjected to pH cycling for 14 days, during which the teeth were immersed in artificial saliva for 21 hours and in demineralizing agent for three hours daily. Before transferring the samples from the saliva to the demineralizing solution, the remineralizing agent (0.05% NaF, MI Paste Plus or Remin Pro Paste, depending on the group) was applied on the samples once a day for five minutes. No remineralizing agent was used in the control group. Surface microhardness of samples was measured by Vickers microhardness tester at baseline and after the intervention. The data were analyzed using one-way ANOVA, ANCOVA, Bonferroni test and Tukey test. Statistical significance was set at P<0.05. Results. The mean microhardness was significantly different between the test and control groups (P<0.0001). Other differences were not significantly different (P>0.05). Conclusion. The results showed that 0.05% NaF was more efficient than Remin Pro and MI Paste Plus for prevention of white spot lesions (WSLs). Remin Pro and MI Paste Plus were not significantly difference from the control group in this regard.