Evaluation of the effect of self-assembling peptide and fluoride varnish, alone or in combination with laser irradiation, on artificial enamel caries: a SEM/EDS and Micro-CT study.

Abstract

Objective: The aim of this study was to investigate the effect of remineralization agents such as fluoride varnish and P₁₁-4, alone and in combination with Er: YAG laser, on in-vitro hard tissue repair in artificial enamel lesions.

Materials and methods: A total of sixty enamel surfaces of 4 × 5 mm in size were created on both the buccal and lingual sides of thirty extracted wisdom teeth. Remineralization agents were applied to the specimens that were grouped as follows: Group 1, control; Group 2, fluoride varnish (FV); Group 3, P₁₁-4; Group 4, laser; Group 5, laser + FV; and Group 6, laser + P₁₁-4. The fluorescence level was determined with DiagnoDent. The enamel mineral density, area and volume, and caries lesion area and volume were determined with micro-computed tomography (µCT), surface features were evaluated using scanning electron microscopy (SEM), and elemental analysis was performed using energy dispersive x-ray spectroscopy (EDS) .

Results: For specimens treated only with self-assembling peptide P₁₁-4, the caries lesion area (mm²) values were 38.19 and 21.62, and the caries lesion volume (mm³) values were 6.27 and 2.99, respectively for pre- and post-treatment. In combination usage of self-assembling peptide P₁₁-4 and laser, the caries lesion area (mm²) values were 38.39 and 16.91, and the caries lesion volume (mm³) values were 11.15 and 3.64, respectively for pre- and post-treatment. In the application of the P₁₁-4 alone and in combination with laser, there was a statistically significant decrease in DiagnoDent values, an increase in enamel volume(mm³),enamel area(mm²) and mineral density(g/cm³) values and a decrease in caries lesion volume(mm³) and area(mm²) obtained by µCT, and an increase in %Ca and %F values obtained by SEM/EDS analysis (p < 0.05). It was discovered that the samples treated with P₁₁-4 had a considerably higher rise in the Ca/P ratio than the samples treated with FV (p < 0.05). The calcium content increased significantly more when P₁₁-4 application was combined with laser irradiation (p < 0.05).

Conclusions: The combined use of self-assembling peptide P₁₁-4 and laser accelerated the remineralization process and increased the remineralization capacity.

Clinical relevance: FV and P₁₁-4, alone or in combination with laser, can be successfully used as remineralization agents in initial enamel caries.