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      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/mm 2), followed by Remin Pro (283.8±119.3kgf/mm 2), and varnish (270.9±78.3 kgf/mm 2). 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.

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          Most cited references31

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          State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management

          The principles of minimally invasive dentistry clearly dictate the need for clinically effective measures to remineralize early enamel caries lesions. While fluoride-mediated remineralization is the cornerstone of current caries management philosophies, a number of new remineralization strategies have been commercialized or are under development that claim to promote deeper remineralization of lesions, reduce the potential risks associated with high-fluoride oral care products, and facilitate caries control over a lifetime. These non-fluoride remineralizing systems can be broadly categorized into biomimetic enamel regenerative technologies and the approaches that repair caries lesions by enhancing fluoride efficacy. This paper discusses the rationale for non-fluoride remineralization and the mechanism of action, challenges, and evidence behind some of the most promising advances in enamel remineralization therapies.
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            Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children

            Objective This in situ study compared the effectiveness of two toothpastes containing hydroxyapatite or 500 ppm fluoride in promoting remineralization and inhibiting caries development. Materials and methods Two enamel blocks (human primary teeth), one sound and one with artificially-produced caries lesion, were exposed to toothpaste containing either 10% hydroxyapatite or 500 ppm F− (amine fluoride) via intra-oral appliance worn by 30 adults in two-arm double blind randomized crossover study lasting 14 days per arm (ClinicalTrials.gov: NCT03681340). Baseline and post-test mineral loss and lesion depth (LD) were quantified using microradiography. One-sided t-test of one group mean was used for intragroup comparison (baseline vs. post-test), while two-sided t-test of two independent means was used to compare the two toothpaste groups. Results Pairwise comparison (baseline vs. test) indicated significant (p < 0.0001) remineralization and LD reduction by either toothpaste; however, when compared against each other, there was no statistically significant difference in remineralization or LD reduction between the two toothpastes. No demineralization could be observed in sound enamel blocks exposed to either toothpaste. While F− induced lesion surface lamination, HAP produced a more homogenous lesion remineralization. Conclusions 10% hydroxyapatite achieved comparable efficacy with 500 ppm F− in remineralizing initial caries and preventing demineralization. Thus the HAP toothpaste is confirmed to be equal to the fluoride toothpaste in this study.
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              Enamel remineralization assessment after treatment with three different remineralizing agents using surface microhardness: An in vitro study

              Aim: The aim of this study is to evaluate the enamel remineralization after treatment with three different remineralizing agents using surface microhardness assessment. Materials and Methods: This in vitro study involves 50 enamel samples divided into five groups of 10 samples each. The positive control group consisted of intact enamel and a negative control group consisted of demineralized enamel samples. All groups excluding the positive control group were subjected to demineralization following which three of these groups were remineralized using remineralizing agents (casein phosphopeptide amorphous calcium phosphate [CPP-ACP] [GC tooth mousse], casein phosphopeptide amorphous calcium phosphate with fluoride [CPP-ACPF] [GC tooth mousse plus], sodium fluoride [phos-flur]). The groups treated with remineralizing agents were subjected to pH cycling over a period of 28 days. This was followed with assessment of surface microhardness (Micro Vickers Hardness tester, Matsuzawa Co., Ltd, Toshima, Japan). Statistical Analysis: One-way analysis of variance test and posthoc Tukey test were conducted for multiple group comparison. Results: There was an improved enamel remineralization in the group, remineralized using CPP-ACPF in comparison with the other groups. Conclusion: Casein phosphopeptide with fluoride is a promising material for remineralization of enamel subsurface lesions.
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                Author and article information

                Journal
                Front Dent
                Front Dent
                FID
                Frontiers in Dentistry
                Tehran University of Medical Sciences (Tehran, Iran )
                2676-296X
                2023
                8 July 2023
                : 20
                : 23
                Affiliations
                [1 ]Department of Pediatric Dentistry, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
                [2 ]Department of Restorative Dentistry, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
                Author notes
                [* ]Corresponding author: Department of Pediatric Dentistry, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran. Email: katayoun.salem@ 123456gmail.com
                Article
                FID-20-23
                10.18502/fid.v20i23.13167
                10493113
                37701656
                7f545ebd-d8e0-4409-9826-c730a6d2922e
                Copyright © 2023 The Authors. Published by Tehran University of Medical Sciences.

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International license ( https://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited.

                History
                : 21 April 2022
                : 3 November 2022
                Categories
                Original Article

                dental caries,tooth remineralization,tooth, deciduous

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