An In-vitro Comparative Study of Fluoride Varnish and Two Calcium-Containing Fluoride Products on the Remineralization of Primary Teeth Enamel
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Abstract
Objectives: To compare the effectiveness of fluoride varnish and two calcium-based fluoride products on the remineralization of primary teeth enamel.
Materials and Methods: Surface-microhardness (SMH) of 36 extracted anterior primary teeth was measured by Vickers test (50gr/5 seconds) to provide a baseline for later comparisons. All teeth were immersed in demineralizing solution for 96 hours to create caries-like lesions and SMH was determined for the artificially-induced caries. The teeth were randomly assigned to three groups consisting of 5% fluoride varnish once daily/10 seconds, Clinpro™ 5000 toothpaste once daily/2 minutes, and Remin Pro cream once daily/3 minutes for 28 days. All specimens were kept in artificial saliva with pH cycling during the study period. After remineralization, SMH was evaluated for the last time. Data were analyzed by one-way ANOVA, Mauchly's sphericity, and RM-ANOVA with Bonferroni correction for inter-and- intra-group comparisons at the three stages of the study.
Results: Neither the baseline SMH nor the SMH of the artificially created caries showed significant differences among the samples (P>0.05). The post-treatment SMH was highest in the Clinpro group (296.4±73.1kgf/mm2), followed by Remin Pro (283.8±119.3kgf/mm2), and varnish (270.9±78.3 kgf/mm2). There was no significant difference among the groups after treatment (P>0.05). We also did not observe a significant difference among the three different study stages (P>0.05).
Conclusion: Within the limitations of this in-vitro study, daily application of low fluoride-calcium compound seems to be as effective as the professional use of fluoride varnish or high-content fluoride toothpaste in remineralizing initial caries of primary teeth.
1. AlFeel J, Laflouf M, AlKurdi S, Alkhouli M. Evaluating the effect of Clinpro Tooth Crème on remineralization of pre-carious White Spot Lesions in anterior primary teeth: Randomized controlled clinical trial. Pediatr Dent J. 2021 Aug 1;31(2):152-8.
2. Philip N. State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management. Caries Res. 2019;53(3):284-295.
3. Amaechi BT. Remineralization therapies for initial caries lesions. Curr Oral Health Rep. 2015 Jun;2:95-101.
4. Gargouri W, Zmantar T, Kammoun R, Kechaou N, Ghoul-Mazgar S. Coupling xylitol with remineralizing agents improves tooth protection against demineralization but reduces antibiofilm effect. Microb Pathog. 2018 Oct;123:177-182.
5. Lippert F, Gill KK. Carious lesion remineralizing potential of fluoride- and calcium-containing toothpastes: A laboratory study. J Am Dent Assoc. 2019 May;150(5):345-351.
6. Amaechi BT, AbdulAzees PA, Alshareif DO, Shehata MA, Lima PPCS, Abdollahi A, et al. Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children. BDJ Open. 2019 Dec 9;5:18.
7. Amaechi BT, AbdulAzees PA, Okoye LO, Meyer F, Enax J. Comparison of hydroxyapatite and fluoride oral care gels for remineralization of initial caries: a pH-cycling study. BDJ Open. 2020 Jul 22;6:9.
8. Salehzadeh Esfahani K, Mazaheri R, Pishevar L. Effects of Treatment with Various Remineralizing Agents on the Microhardness of Demineralized Enamel Surface. J Dent Res Dent Clin Dent Prospects. 2015 Fall;9(4):239-45.
9. Tulumbacı F, Oba AA. Efficacy of different remineralization agents on treating incipient enamel lesions of primary and permanent teeth. J Conserv Dent. 2019 May-Jun;22(3):281-286.
10. Nourolahian H, Parisay I, Mir F. The effect of Remin Pro on the microhardness of initial enamel lesions in primary teeth: An in vitro study. Dent Res J (Isfahan). 2021 Mar 17;18:16.
11. Haghgou HR, Haghgoo R, Asdollah FM. Comparison of the microhardness of primary and permanent teeth after immersion in two types of carbonated beverages. J Int Soc Prev Community Dent. 2016 Jul-Aug;6(4):344-8.
12. Haghgoo R, Ahmadvand M, Moshaverinia S. Remineralizing Effect of Topical NovaMin and Nano-hydroxyapatite on caries-like Lesions in Primary teeth. J Contemp Dent Pract. 2016 Aug 1;17(8):645-9.
13. Cardoso CA, de Castilho AR, Salomão PM, Costa EN, Magalhães AC, Buzalaf MA. Effect of xylitol varnishes on remineralization of artificial enamel caries lesions in vitro. J Dent. 2014 Nov;42(11):1495-501.
14. Western JS, Dicksit DD. A systematic review of randomized controlled trials on sterilization methods of extracted human teeth. J Conserv Dent. 2016 Jul-Aug;19(4):343-6.
15. Memarpour M, Soltanimehr E, Sattarahmady N. Efficacy of calcium- and fluoride-containing materials for the remineralization of primary teeth with early enamel lesion. Microsc Res Tech. 2015 Sep;78(9):801-6.
16. Meshki R, Basir L, Rahbar N, Kazempour M. Comparison of the effect of fluoride gel and two toothpastes with different materials on remineralization of initial carious lesions in primary teeth. J Family Med Prim Care. 2021 Sep;10(9):3309-13.
17. Ozgul BM, Orhan K, Oz FT. Micro-computed tomographic analysis of progression of artificial enamel lesions in primary and permanent teeth after resin infiltration. J Oral Sci. 2015 Sep;57(3):177-83.
18. Kucuk EB, Malkoc S, Demir A. Microcomputed tomography evaluation of white spot lesion remineralization with various procedures. Am J Orthod Dentofacial Orthop. 2016 Sep;150(3):483-90.
19. Tahmasbi S, Mousavi S, Behroozibakhsh M, Badiee M. Prevention of white spot lesions using three remineralizing agents: An in vitro comparative study. J Dent Res Dent Clin Dent Prospects. 2019 Winter;13(1):36-42.
20. Shetty S, Hegde MN, Bopanna TP. Enamel remineralization assessment after treatment with three different remineralizing agents using surface microhardness: An in vitro study. J Conserv Dent. 2014 Jan;17(1):49-52.
21. Cherian NM, Girish TN, Ponnappa KC. Comparative evaluation of remineralizing potential of commercially available agents MI paste, Remin pro, and Clinpro using Scanning Electron Microscope and Energy Dispersive X-ray: An in vitro study. J Conserv Dent. 2020 Sep-Oct;23(5):457-462.
22. Sahiti JS, Krishna NV, Prasad SD, Kumar CS, Kumar SS, Babu KSC. Comparative evaluation of enamel microhardness after using two different remineralizing agents on artificially demineralized human enamel: An in vitro study. J Clin Transl Res. 2020 Sep 5;6(3):87-91.
23. Rao R, Jain A, Verma M, Langade D, Patil A. Comparative evaluation of remineralizing potential of Fluoride using three different remineralizing protocols: An in vitro study. J Conserv Dent. 2017 Nov-Dec;20(6):463-466.
24. Talwar M, Borzabadi-Farahani A, Lynch E, Borsboom P, Ruben J. Remineralization of Demineralized Enamel and Dentine Using 3 Dentifrices-An InVitro Study. Dent J (Basel). 2019 Sep 2;7(3):91.
25. Valian A, Raeisi-Sarkhooni A, Moravej-Salehi E, Emamieh S. Effect of Remin Pro and neutral sodium fluoride on enamel microhardness after exposure to acidic drink. J Iran Dent Assoc. 2017 Apr 10;29(2):44-50.
26. O'Hagan-Wong K, Enax J, Meyer F, Ganss B. The use of hydroxyapatite toothpaste to prevent dental caries. Odontology. 2022 Apr;110(2):223-230.
27. Vicente A, Ortiz-Ruiz AJ, González-Paz BM, Martínez-Beneyto Y, Bravo-González LA. Effectiveness of a toothpaste and a serum containing calcium silicate on protecting the enamel after interproximal reduction against demineralization. Sci Rep. 2021 Jan 12;11(1):834.
28. Amaechi BT, Phillips TS, Evans V, Ugwokaegbe CP, Luong MN, Okoye LO, et al. The Potential of Hydroxyapatite Toothpaste to Prevent Root Caries: A pH-Cycling Study. Clin Cosmet Investig Dent. 2021 Jul 21;13:315-324.
29. Ebrahimi M, Mehrabkhani M, Ahrari F, Parisay I, Jahantigh M. The effects of three remineralizing agents on regression of white spot lesions in children: A two-week, single-blind, randomized clinical trial. J Clin Exp Dent. 2017 May 1;9(5):e641-e648.
30. Casals E, Boukpessi T, McQueen CM, Eversole SL, Faller RV. Anticaries potential of commercial dentifrices as determined by fluoridation and remineralization efficiency. J Contemp Dent Pract. 2007 Nov 1;8(7):1-10.
31. Benson PE, Parkin N, Dyer F, Millett DT, Germain P. Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment. Cochrane Database Syst Rev. 2019 Nov 17;2019(11):CD003809.
2. Philip N. State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management. Caries Res. 2019;53(3):284-295.
3. Amaechi BT. Remineralization therapies for initial caries lesions. Curr Oral Health Rep. 2015 Jun;2:95-101.
4. Gargouri W, Zmantar T, Kammoun R, Kechaou N, Ghoul-Mazgar S. Coupling xylitol with remineralizing agents improves tooth protection against demineralization but reduces antibiofilm effect. Microb Pathog. 2018 Oct;123:177-182.
5. Lippert F, Gill KK. Carious lesion remineralizing potential of fluoride- and calcium-containing toothpastes: A laboratory study. J Am Dent Assoc. 2019 May;150(5):345-351.
6. Amaechi BT, AbdulAzees PA, Alshareif DO, Shehata MA, Lima PPCS, Abdollahi A, et al. Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children. BDJ Open. 2019 Dec 9;5:18.
7. Amaechi BT, AbdulAzees PA, Okoye LO, Meyer F, Enax J. Comparison of hydroxyapatite and fluoride oral care gels for remineralization of initial caries: a pH-cycling study. BDJ Open. 2020 Jul 22;6:9.
8. Salehzadeh Esfahani K, Mazaheri R, Pishevar L. Effects of Treatment with Various Remineralizing Agents on the Microhardness of Demineralized Enamel Surface. J Dent Res Dent Clin Dent Prospects. 2015 Fall;9(4):239-45.
9. Tulumbacı F, Oba AA. Efficacy of different remineralization agents on treating incipient enamel lesions of primary and permanent teeth. J Conserv Dent. 2019 May-Jun;22(3):281-286.
10. Nourolahian H, Parisay I, Mir F. The effect of Remin Pro on the microhardness of initial enamel lesions in primary teeth: An in vitro study. Dent Res J (Isfahan). 2021 Mar 17;18:16.
11. Haghgou HR, Haghgoo R, Asdollah FM. Comparison of the microhardness of primary and permanent teeth after immersion in two types of carbonated beverages. J Int Soc Prev Community Dent. 2016 Jul-Aug;6(4):344-8.
12. Haghgoo R, Ahmadvand M, Moshaverinia S. Remineralizing Effect of Topical NovaMin and Nano-hydroxyapatite on caries-like Lesions in Primary teeth. J Contemp Dent Pract. 2016 Aug 1;17(8):645-9.
13. Cardoso CA, de Castilho AR, Salomão PM, Costa EN, Magalhães AC, Buzalaf MA. Effect of xylitol varnishes on remineralization of artificial enamel caries lesions in vitro. J Dent. 2014 Nov;42(11):1495-501.
14. Western JS, Dicksit DD. A systematic review of randomized controlled trials on sterilization methods of extracted human teeth. J Conserv Dent. 2016 Jul-Aug;19(4):343-6.
15. Memarpour M, Soltanimehr E, Sattarahmady N. Efficacy of calcium- and fluoride-containing materials for the remineralization of primary teeth with early enamel lesion. Microsc Res Tech. 2015 Sep;78(9):801-6.
16. Meshki R, Basir L, Rahbar N, Kazempour M. Comparison of the effect of fluoride gel and two toothpastes with different materials on remineralization of initial carious lesions in primary teeth. J Family Med Prim Care. 2021 Sep;10(9):3309-13.
17. Ozgul BM, Orhan K, Oz FT. Micro-computed tomographic analysis of progression of artificial enamel lesions in primary and permanent teeth after resin infiltration. J Oral Sci. 2015 Sep;57(3):177-83.
18. Kucuk EB, Malkoc S, Demir A. Microcomputed tomography evaluation of white spot lesion remineralization with various procedures. Am J Orthod Dentofacial Orthop. 2016 Sep;150(3):483-90.
19. Tahmasbi S, Mousavi S, Behroozibakhsh M, Badiee M. Prevention of white spot lesions using three remineralizing agents: An in vitro comparative study. J Dent Res Dent Clin Dent Prospects. 2019 Winter;13(1):36-42.
20. Shetty S, Hegde MN, Bopanna TP. Enamel remineralization assessment after treatment with three different remineralizing agents using surface microhardness: An in vitro study. J Conserv Dent. 2014 Jan;17(1):49-52.
21. Cherian NM, Girish TN, Ponnappa KC. Comparative evaluation of remineralizing potential of commercially available agents MI paste, Remin pro, and Clinpro using Scanning Electron Microscope and Energy Dispersive X-ray: An in vitro study. J Conserv Dent. 2020 Sep-Oct;23(5):457-462.
22. Sahiti JS, Krishna NV, Prasad SD, Kumar CS, Kumar SS, Babu KSC. Comparative evaluation of enamel microhardness after using two different remineralizing agents on artificially demineralized human enamel: An in vitro study. J Clin Transl Res. 2020 Sep 5;6(3):87-91.
23. Rao R, Jain A, Verma M, Langade D, Patil A. Comparative evaluation of remineralizing potential of Fluoride using three different remineralizing protocols: An in vitro study. J Conserv Dent. 2017 Nov-Dec;20(6):463-466.
24. Talwar M, Borzabadi-Farahani A, Lynch E, Borsboom P, Ruben J. Remineralization of Demineralized Enamel and Dentine Using 3 Dentifrices-An InVitro Study. Dent J (Basel). 2019 Sep 2;7(3):91.
25. Valian A, Raeisi-Sarkhooni A, Moravej-Salehi E, Emamieh S. Effect of Remin Pro and neutral sodium fluoride on enamel microhardness after exposure to acidic drink. J Iran Dent Assoc. 2017 Apr 10;29(2):44-50.
26. O'Hagan-Wong K, Enax J, Meyer F, Ganss B. The use of hydroxyapatite toothpaste to prevent dental caries. Odontology. 2022 Apr;110(2):223-230.
27. Vicente A, Ortiz-Ruiz AJ, González-Paz BM, Martínez-Beneyto Y, Bravo-González LA. Effectiveness of a toothpaste and a serum containing calcium silicate on protecting the enamel after interproximal reduction against demineralization. Sci Rep. 2021 Jan 12;11(1):834.
28. Amaechi BT, Phillips TS, Evans V, Ugwokaegbe CP, Luong MN, Okoye LO, et al. The Potential of Hydroxyapatite Toothpaste to Prevent Root Caries: A pH-Cycling Study. Clin Cosmet Investig Dent. 2021 Jul 21;13:315-324.
29. Ebrahimi M, Mehrabkhani M, Ahrari F, Parisay I, Jahantigh M. The effects of three remineralizing agents on regression of white spot lesions in children: A two-week, single-blind, randomized clinical trial. J Clin Exp Dent. 2017 May 1;9(5):e641-e648.
30. Casals E, Boukpessi T, McQueen CM, Eversole SL, Faller RV. Anticaries potential of commercial dentifrices as determined by fluoridation and remineralization efficiency. J Contemp Dent Pract. 2007 Nov 1;8(7):1-10.
31. Benson PE, Parkin N, Dyer F, Millett DT, Germain P. Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment. Cochrane Database Syst Rev. 2019 Nov 17;2019(11):CD003809.
| Issue | Vol 20 (Continuously Published Article-Based) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/fid.v20i23.13167 | |
| Keywords | ||
| Dental Caries Tooth Remineralization Tooth, Deciduous | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Larie Baghal SM, Salem K, Saati K. An In-vitro Comparative Study of Fluoride Varnish and Two Calcium-Containing Fluoride Products on the Remineralization of Primary Teeth Enamel. Front Dent. 2023;20.
