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Original Article

A comparative evaluation of the remineralization

potential of three commercially available
remineralizing agents on white spot lesions in primary
teeth: An in vitro study
Pujan Kamath, Rashmi Nayak, Shobha U Kamath1, Deepika Pai
Department of Pedodontics and Preventive Dentistry, Manipal College of Dental Sciences Manipal, Manipal University, 1Department of
Biochemistry, KMC Manipal, Manipal University, Manipal, Karnataka, India

ABSTRACT Address for correspondence:

Dr. Rashmi Nayak,
Background: The focus in caries management Department of Pedodontics and Preventive Dentistry,
has shifted to early detection of caries lesions and Room No. 6, Manipal College of Dental Sciences Manipal,
targeted noninvasive management of incipient Manipal University, Manipal ‑ 576 104, Karnataka, India.
lesions using novel remineralizing agents. E‑mail: rashmi573@gmail.com
Aim: This study aimed to compare and evaluate
the remineralization potential of commercially
available agents containing nano‑hydroxyapatite Access this article online
(nano‑HA), casein phosphopeptide‑amorphous Quick response code Website:
calcium phosphate fluoride (CPP‑ACPF), and www.jisppd.com
Tricalcium phosphate (TCP) on artificially DOI:
induced white spot lesions in primary teeth. 10.4103/JISPPD.JISPPD_242_16
Settings and Design: This is an in vitro double‑blind PMID:
randomized study. Materials and Methods: Forty ******
extracted or exfoliated primary teeth were selected
and randomized as follows: Group I: FTCP, Group II:
primary teeth, remineralizing agents, tricalcium
fluoridated dentifrice, Group  III: CPP‑ACPF, and phosphate, white spot lesions
Group  IV: Nano‑HA. DIAGNOdent readings
and scanning electron microscope  (SEM) energy
dispersive X‑ray  (EDX) analysis were carried out
at baseline. The samples were subjected to the
test agents after inducing white spot lesions. The
Introduction
readings were repeated postdemineralization and
The current consensus in caries management is
postremineralization. Statistical Analysis: The that caries should be detected and managed in its
data were analyzed using IBM SPSS version  20 earliest stages when nonsurgical reversal can be
software with one‑way ANOVA, post hoc Tukey’s
HSD, and paired t‑test. Results: SEM evaluation This is an open access article distributed under the terms of the Creative
showed favorable surface changes in all the four Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which
study groups after remineralization therapy. allows others to remix, tweak, and build upon the work non‑commercially,
Intragroup comparison of DIAGNOdent and as long as the author is credited and the new creations are licensed under
EDX readings showed a highly significant the identical terms.
difference between baseline, postdemineralization, For reprints contact: reprints@medknow.com
and postremineralization values. However,
the intergroup comparison was statistically How to cite this article: Kamath P, Nayak R, Kamath SU,
nonsignificant. Conclusion: All test agents were Pai D. A comparative evaluation of the remineralization potential
comparable in their remineralization potential. of three commercially available remineralizing agents on white
spot lesions in primary teeth: An in vitro study. J Indian Soc Pedod
KEYWORDS: Casein phosphopeptide‑amorphous Prev Dent 2017;35:229-37.
calcium phosphate, DIAGNOdent, hydroxyapatite,

© 2017 Journal of Indian Society of Pedodontics and Preventive Dentistry | Published by Wolters Kluwer - Medknow 229
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Kamath, et al.: A comparative evaluation of remineralising agents on white spot lesions
achieved. While fluoride is a time‑tested, effective,
caries‑preventive agent, the search for compounds
with additional and synergistic benefits has yielded a
plethora of novel agents for targeted remineralization
therapy.[1]
Enamel of primary teeth is less mineralized, exhibits
a greater diffusion coefficient, and consequently
more susceptible to acid dissolution compared to
enamel of permanent teeth.[2] Early childhood caries
which affects the primary dentition frequently
manifests as white spot lesions, and aggressive
preventive therapy for remineralization of these
lesions is essential for their reversal. Thus, the aim of
the present study was to compare and evaluate the
remineralization potential of commercially available
agents containing hydroxyapatite  (HA), casein
phosphopeptide‑amorphous calcium phosphate
fluoride  (CPP‑ACPF), and tricalcium phosphate on
artificially induced white spot lesions in primary teeth.
A null hypothesis was proposed that there will be no
difference in the remineralization potential of the test
agents.
Materials and Methods
The present study was conducted in the Department of
Pedodontics and Preventive Dentistry, in collaboration
with the Department of Biochemistry with Institutional
Ethical Committee’s approval (IEC 454/2012).
Test agents used
• Nano‑HA  –  Reminpro  (VoCo, Germany; Lot No:
1106330)
It is a water‑based cream containing HA and
fluoride (1450 ppm sodium fluoride)
• CPP‑ACPF  –  GC Tooth Mousse Plus  (GC
Corporation, Tokyo, Japan; Lot No: 1108171)
It is a water‑based cream containing CPP‑ACPF
with incorporated fluoride (0.2% w/w, 900 ppm)
• Tricalcium Phosphate – Clinpro™ (3M ESPE, USA;
Lot No: 10021)
Tooth cream containing tricalcium phosphate and
0.21% w/w sodium fluoride
• Fluoridated dentifrice – Colgate (Colgate‑Palmolive,
India)
Sodium monofluorophosphate with 1000  ppm
fluoride.
Sample collection
Sample size of forty was estimated using the power
calculation α =  0.05 and β =  0.20 with 80% being the
power of the study. Based on previous findings reported
by Hegde and Moany,[3] a total of 65 primary teeth
indicated for extraction were obtained from patients
in the age group of 3–14  years. A  written informed
consent was obtained from the parents at the outset.
Owing to the difficulty in obtaining sound, caries‑free
primary teeth, sound tooth surfaces obtained from
carious primary teeth were considered in this study.
230 Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 35 | Issue 3 | July-September 2017 |
Teeth with at least one sound tooth surface, without
any visible caries, hypoplastic lesions, stains, or
white spot lesions were included in the study. After
extraction, the teeth were cleaned, washed with water,
and stored in isotonic saline.
Sample preparation
The coronal portion of the teeth was separated from
the roots using a diamond disc  (Diatech CH‑9435,
Swiss Dental Instruments, Lot: 9605) mounted on a
Micro Motor Straight Hand Piece  (NSK, Japan) in
the presence of a water coolant. The samples were
then embedded into the partially set acrylic resin in
cylindrical plastic molds.
A 3  mm  ×  3  mm sticking plaster was placed on the
exposed tooth surface and acid‑resistant nail varnish
was applied around it to delineate the area to be
studied.
Baseline recordings
The baseline DIAGNOdent  (Kaltenbach and Voigt
GmbH and Co. KG, Biberach, Germany) readings were
recorded for all the samples. The present study used
the newly formulated DIAGNOdent cutoff limits given
by Goel et  al.[4] for detection of early carious lesions
in primary teeth. Of the 65 teeth initially collected,
25  samples showing a value >6 were discarded,
establishing a final sample size of 40.
Randomization
The samples were randomly divided into four groups
(I–IV) comprising ten samples each using simple
randomized sampling  (n  =  10). Individual sample
within each group was assigned an alphabetical
denotation (A–J).
Demineralizing regimen
The freshly prepared demineralization solution
comprised 2.2 mM CaCl2, 2.2 mM NaH2PO4, 0.05
M lactic acid, and 0.2  ppm fluoride.[5] The pH was
adjusted to 4.5 with 50% NaOH. The solution was
maintained at 37°C. Each sample was immersed in
an individual sterile container containing 12  mL of
demineralization solution ensuring that the section
was completely immersed in the solution. The samples
were maintained at 37°C in an incubator  (Autoflow
N‑5510, NuAire, USA) for 72 h.[5] This demineralization
procedure was intended to produce a consistent
subsurface lesion.
Recording of readings
After demineralization, the samples were thoroughly
washed with deionized water and allowed to dry. The
samples were evaluated for demineralization using
DIAGNOdent.
Following DIAGNOdent readings, six out of
the ten samples from each group  (A–F) were
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Kamath, et al.: A comparative evaluation of remineralising agents on white spot lesions

subjected to scanning electron microscopic  (SEM) Re‑evaluation of test parameters

evaluation  (EVO MA18 with Oxford EDS  [X‑act])
to evaluate surface morphology. Estimation of
calcium  (Ca), phosphate, and fluoride  (F)  (weight
percentage) content was done using energy
dispersive X‑ray  (EDX) analysis for which the
samples were mounted firmly using a graphite
tape on a disc comprising nine specimen holders
and maintained under vacuum. The samples
were analyzed at 15  kV and  ×  500, ×1500, ×2000,
and × 5000 magnifications.
Blinding
A double‑blind investigation was planned since all
the test agents had the same color (white) and similar
consistency. However, since the packaging was not
similar, in order to confirm the double‑blind design
of the study, each of the test agents was coded as I,
II, III, and IV and entrusted to the chief supervisor
of the study. Half pea‑sized quantity of test agent
was dispensed half an hour prior to the initiation of
treatment in a palette with four wells. The sanctity of
the double‑blind study was strictly maintained and
decoding was done after statistical evaluation of the
data.
Application of test agents
The samples in each group were treated with the
allocated remineralizing agent once every 24  h for
14  days. The test agents were continuously applied
onto the tooth surface within the window area with
the help of a disposable cotton tip applicator for
3  min. Samples were then washed with deionized
water and placed in artificial saliva, maintained at
ambient temperature. Artificial saliva was changed
every 24  h, just before the immersion of freshly
treated samples.
Following is the composition of artificial saliva used:[5]
• Na3PO4‑3.90 mM, NaCl2‑4.29 mM, KCl ‑ 17.98 mM
• CaCl2‑1.10 mM, MgCl2‑0.08 mM, H2SO4‑0.50 mM
• NaHCO3‑3.27 mM, distilled water, and the pH was
set at 7.2.
After the 14‑day remineralization regimen, the
surface was reassessed using DIAGNOdent. The
samples (A–F) were also assessed using SEM‑EDX
to study the change in surface characteristics and
estimate the mineral content  (Ca, phosphate  [P],
and F).
Statistical analysis
The data were analyzed by IBM Statistical Package
for Social Sciences version  20 (IBM corp., Armonk,
New York)  software using one‑way ANOVA, post
hoc Tukey’s HSD, and paired t‑test. P <  0.005 was
considered statistically significant.
Results
On comparing the DIAGNOdent readings Paired
t-test showed a statistically significant increase in
the readings from baseline to post-demineralization
[Table 1].
Paired t‑test showed a statistically significant
increase in the readings from baseline to
post‑demineralization  (P  <  0.001) and a statistically
significant decrease postremineralization  (P  <  0.001)
and approaching the baseline values for each of the
experimental groups [Table 2].
However, post hoc Tukey’s HSD test showed statistically
nonsignificant difference among the four groups at the
different experimental stages.
Scanning electron microscopy
Postdemineralization
SEM images [Figures 1-4] taken after 72  h of
demineralization revealed loss of surface integrity.
Loss of aprismatic enamel was evident and it was
noticeable that the enamel comprised indistinct,
completely destructed enamel rods with loss of prism
cores, wide inter‑rod spaces, and leftovers of fractured
enamel prism bases suggestive of demineralization.

Table 1: Comparison of DIAGNOdent readings among the four groups

Group Experimental phases Mean SD n P Post hoc test
I Baseline characteristics (a) 2.90 1.29 10 <0.001** b>c>a
DIAGNOdent reading postdemineralization (b) 11.70 3.86 10
DIAGNOdent reading postremineralization (c) 4.00 1.05 10
II Baseline characteristics (a) 3.50 1.08 10 <0.001** b>c>a
DIAGNOdent reading postdemineralization (b) 11.80 4.52 10
DIAGNOdent reading postremineralization (c) 4.40 0.97 10
III Baseline characteristics (a) 3.50 1.51 10 <0.001** b > a, c
DIAGNOdent reading postdemineralization (b) 10.50 2.76 10
DIAGNOdent reading postremineralization (c) 4.10 1.10 10
IV Baseline characteristics (a) 3.10 1.60 10 0.001** b>c>a
DIAGNOdent reading postdemineralization (b) 10.60 4.53 10
DIAGNOdent reading postremineralization (c) 4.40 1.51 10
**Highly significant; *Significant. SD=Standard deviation

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Kamath, et al.: A comparative evaluation of remineralising agents on white spot lesions

Figure 1: Group I  ‑  Postdemineralization  (scanning electron Figure 2: Group I  ‑  Postremineralization  (scanning electron
microscopic image) microscopic image)

Figure 3: Group II  ‑  Postdemineralization  (scanning electron Figure 4: Group II  ‑  Postremineralization  (scanning electron
microscopic image) microscopic image)

Figure 5: Group III  ‑  Postdemineralization  (scanning electron Figure 6: Group III  ‑  Postremineralization  (scanning electron
microscopic image) microscopic image)

Postremineralization [Figures 5‑8] cavities and micropores and re‑establishment of

On observation, the samples demonstrated plugging surface integrity in all the four groups. Distinct surface
of the porous defects with resultant decrease in the coatings deposited by different agents were evident.

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Kamath, et al.: A comparative evaluation of remineralising agents on white spot lesions

Table 2: Intragroup comparison of mean fluoride levels postdemineralization and postremineralization

Group Experimental phases Demineralization Remineralization P
Mean SD Mean SD
I SEM‑EDX postdemineralization ‑ fluoride 4.02 0.50 5.75 0.65 <0.001**
II SEM‑EDX postdemineralization ‑ fluoride 4.20 0.65 5.27 0.42 0.006*
III SEM‑EDX postdemineralization ‑ fluoride 5.21 1.12 7.20 1.86 0.015*
IV SEM‑EDX postdemineralization ‑ fluoride 5.12 3.01 6.59 2.96 0.02*
**Highly significant; *Significant. SD=Standard deviation; SEM=Scanning electron microscope; EDX=Energy dispersive X‑ray analysis

Figure 7: Group IV  ‑  Postdemineralization  (scanning electron Figure 8: Group IV  ‑  Postremineralization  (scanning electron
microscopic image) microscopic image)

However, in comparison to other groups, samples postdemineralization to postremineralization for each

of nano‑HA group showed a superior and uniform
re‑establishment of surface integrity.
Energy dispersive X‑ray analysis
Calcium and phosphate levels
The Ca/P content  (weight %) of demineralized and
remineralized enamel was converted into Ca/P ratios
for each group.
The percentage gain of Ca/P was calculated using the
following formula:
Remineralization ratio − De min eralization ratio
× 100
De min eralization ratio
An intergroup comparison of the mean percentage
gain of the four study groups showed statistically
nonsignificant gain posttreatment (P = 0.159) [Graph 1].
Estimation of fluoride content
One‑way ANOVA test showed statistically
nonsignificant difference between the mean
fluoride content of the four experimental
groups postdemineralization (P  =  0.275) and
postremineralization (P = 0.494) [Graph 2].
Paired t‑test demonstrated a statistically significant
difference (P < 0.05) in the mean fluoride content from
of the experimental groups.
Thus, the proposed null hypothesis was accepted.
Discussion
The oral cavity is a battlefield of activities of
demineralization and remineralization, the balance
between them being the crucial determining factor of
the caries process.[6]
Demineralization of enamel leads to dissolution of HA
and diffusion of Ca/P ions toward the enamel surface.
Hypersaturation of Ca/P ions on the surface results in
a re‑precipitation of HA forming the intact superficial
layer on the enamel surface. Remineralization of
enamel is enhanced by the presence of fluoride ions.[7]
The noninvasive treatment of early lesions by
remineralization bridges the traditional gap between
prevention and surgical procedures.[8] Central to this
vision is the ability to detect caries lesions at an early
stage and correctly quantify the degree of mineral loss,
ensuring that the correct intervention is instituted.[9]
Assessment of in vitro demineralization and
remineralization can be done using different
methods. The methods used are SEM/SEM‑EDX,[10‑12]
DIAGNOdent,[10] surface microhardness,[5] and

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Kamath, et al.: A comparative evaluation of remineralising agents on white spot lesions
20
17.75
18
15.53
16
14
Percentage Gain
12
10.01
10
8
6.27
6
4
2
0
Experimental Groups
Graph 1: Percentage gain of calcium and phosphate for the four
experimental groups
polarized light microscopy. DIAGNOdent was used
[13,14]
in the present study with three main objectives. To aid
in the selection of caries‑free, sound enamel surfaces at
the outset of the study, to ensure decalcification prior
to subjecting the samples to SEM‑EDX, and to detect
and compare the changes before and after application
of the remineralizing agents. DIAGNOdent  (KAVO,
Biberach, Germany), a noninvasive method, uses
laser fluorescence to measure early demineralization.
Various literature reports have shown the value of
DIAGNOdent as a reliable noninvasive caries‑detecting
device.[15‑17]
DIAGNOdent has demonstrated promising results
for the detection of incipient enamel lesions in studies
undertaken in vivo and in vitro in permanent teeth,
but literature regarding its use in deciduous teeth
is scanty. Results from permanent teeth cannot be
extrapolated to primary teeth because these have
different morphological, anatomical, and physiological
characteristics. In view of this, newly formulated cutoff
limits with histological validation developed by Goel
et al.[4] were considered in the present study as against
the manufacturer’s cutoff limits.
Prior to recording DIAGNOdent readings at baseline,
postdemineralization, and postremineralization,
each sample was air‑dried for 10 s. This was in
accordance with Pinelli et  al.[18] who emphasized that
reproducibility of the device increased under dry
condition, thereby advising drying to detect caries‑like
lesions on free smooth surfaces.
In the present study, low frequency  (LF) values
increased postdemineralization and subsequently
decreased postremineralization. Similar results were
demonstrated in studies conducted by Al‑Khateeb
et al.,[19,20] Eggertsson et al.,[21] Shi et al.,[17] Mendes et al.,[22]
Pai et al.,[23] Bahrololoomi et al.,[24] and Patil et al.[2] who
also used DIAGNOdent to assess remineralization.
Mendes et al.[25] attributed the increase in LF values to
enhanced porosity in enamel surface due to decrease
234 Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 35 | Issue 3 | July-September 2017 |
fTCP
Fluoride
Nano-HA
CPP-ACPF
Graph 2: Mean fluoride content pre‑ and post‑treatment for the four
experimental groups
in the overall mineral content. Furthermore, decrease
in values postremineralization can be due to decrease
in porosity of the enamel surface.
Artificially produced caries‑like lesions are of
considerable interest as they can be compared to the
earliest detectable ultrastructural change in the caries
process.[26]
To produce and study in vitro enamel demineralization
models, many demineralizing agents have been
used such as acetic acid,[27] lactic acid,[28] or acidified
hydroxyethylcellulose system[29] for different time
periods. In the present study, demineralization was
carried out as described by Lata et al.[5] The specimens
were kept in the demineralization solution for 72  h
at 37°C, creating a subsurface demineralization of
approximately 150 µ width with an intact surface
simulating an early enamel lesion. The concentration
of both Ca and P, in the demineralization solution, was
at 50% of saturation level, causing dissolution of only
enamel subsurface. Addition of fluoride prevented
surface demineralization by forming fluorapatite at the
surface, which simulated the naturally occurring early
enamel lesions having intact surface layer.
The present study used paste‑type formulation of
the test agents, applied with disposable cotton tip
applicators. This was done in view of replication of
patient convenience in using the tooth creams like a
toothpaste with toothbrushes or along with cotton
tip applicators.[30] The remineralization regimen
comprised 3 min daily application for 14 days. This is
in accordance with the manufacturer’s prescription.
Pai et al.[23] followed a similar regimen of 3 min daily
application for 14  days. In contrast, in a study by
Shirahatti et  al.,[31] the treatment pastes were applied
twice daily for 3 min for 14 days. Hegde and Moany[3]
in their study performed twice daily application of
CPP‑ACP for 3 min for 7, 14, 21, 28, and 35 days. The
difference in remineralization regimen could be the
possible reason for variation in outcomes in our study.
In the present study, artificial saliva was changed
every 24 h during the 14‑day remineralization regimen
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Kamath, et al.: A comparative evaluation of remineralising agents on white spot lesions
to ensure ionic balance and maintenance of pH. In
contrast, Shirahatti et al.[31] changed the artificial saliva
solution every 72 h in their study.
SEM is one of the most sensitive, time‑tested techniques
to assess the demineralization and remineralization
of the carious lesions in vitro as reported in earlier
studies,[23,32,33] while in most studies, using SEM,
samples are coated with metals such as gold or
palladium to improve image quality.[29,34] Harding
et al.[35] and Nicolae et al.[36] studied the samples using
SEM without metal sputtering so that they could be
observed again, if necessary, once the study ended.
Consequently, this version was considered in our
study as there would not be loss of samples and
re‑evaluation of the same samples after treatment
regimen would be possible. A graphite tape was used
to aid in conduction.
The demineralized enamel specimens were observed
at different magnifications. At  ×5000 magnification,
numerous depressions in a honeycomb pattern were
revealed which corresponded to the observations
made by other investigators.[37] Correlation of SEM
observations made it possible to conclude that
DIAGNOdent is effective in detecting demineralization
of enamel. Postremineralization, all the test specimens
showed re‑establishment of surface integrity. The
potential to induce remineralization of the test agents
was demonstrated as seen by the increase in crystal
size and occlusion of porous defects. However, there
were minor differences in the surface morphology,
which may be due to their different mechanisms for
promoting remineralization.[27] The SEM results were
in accordance with Huang et al.,[27] Roveri et al.,[38] and
Swarup and Rao.[39]
A superior surface texture of enamel was noted in the
present study on SEM evaluation postremineralization
with nano‑HA compared to other groups. This could
be attributed to similarity of the nano‑sized particles
to the apatitic crystals of tooth enamel in morphology,
crystal structure, and crystallinity.[40]
A correlation of SEM observations and LF readings
postremineralization indicated that DIAGNOdent was
effective in detecting enamel remineralization.
EDX analysis was used to determine the mineral content
postdemineralization and postremineralization,
thereby facilitating estimation of alteration in mineral
content pre- and post-treatment. Eggerath et al.,
(2011),[41] used EDX elemental analysis to estimate Ca,
P, and F content of enamel after exposure to fl uoride-
containing tablets in vitro.[41] used EDX elemental
analysis to estimate Ca, P, and F content of enamel
after exposure to fluoride‑containing tablets in vitro.
In the present study, EDX analysis showed that the
percentage gain of Ca and P postremineralization
Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 35 | Issue 3 | July-September 2017 |
was greatest in the fTCP group followed by nano‑HA,
CPP‑ACPF, and fluoride groups, the difference
between the groups being statistically nonsignificant.
This is in contrast to the results of the study by Hedge
et al.[42] and Hegde and Moany.[3]
The fall in the surface Ca/P ratio following
demineralization did not appreciably increase after
remineralizing with fluoridated dentifrice. This
finding suggests that fluorides alone bring about only
structural modification of apatite crystal, restricted to
partial hydroxyl group replacement by fluoride ions
without influencing the Ca and P content. Furthermore,
this reinforces the fact that fluoride in the presence of
Ca and P is more effective in driving the mineral for
remineralization. The specimens treated with nano‑HA
exhibited surface Ca/P ratio close to that of the biological
enamel and synthetic nano‑HA, indicating an apatitic
coating deposition on the demineralized enamel surface.
A study done by Roveri et  al.[43] demonstrated that
biomimetic nonsized HA crystals produce an apatitic
coating deposition on the enamel surface, which is
much less crystalline than native enamel apatite, but
consists of a new apatitic mineral deposition which
progressively fills the surface defects as against the
mere structural modification induced by fluoride,
restricted to a partial hydroxyl group replacement by
fluoride ions without affecting the Ca and P structural
network appreciably.
The present study is in agreement with previous
studies that demonstrated the capability of the chosen
test agents to induce remineralization of early enamel
lesions.[44‑47]
Although the remineralization potential of fluoride
in the present study was found to be lower
compared to the other test agents, its utility cannot
be underestimated by virtue of the nonsignificant
difference in remineralization potential among the test
agents. Judicious use at the target site could facilitate
remineralization of the early enamel lesions. Sjögren
et  al.[48] observed that the retention of fluoride in the
mouth is site specific and there is minimal transport of
fluoride ions between left and right sides of the mouth
and between arches. This explains the development of
localized lesions in patients using fluoride dentifrice
routinely. Hence, judicious use of fluoride at the
appropriate localized site could provide an economical
alternative to facilitate remineralization of incipient
enamel lesions in vivo.
A limitation of the present study is that SEM‑EDX
was done only for postdemineralization and
postremineralization samples. SEM‑EDX at baseline
could have facilitated a better comparison of the ability
of the test agents to induce remineralization and their
potential to bring the mineral content closer to baseline
levels.
235
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Kamath, et al.: A comparative evaluation of remineralising agents on white spot lesions
Thus, although the mechanisms of action of the
agents were different, the results obtained indicate
that each of the tooth creams enhanced enamel
remineralization. To the best of our knowledge,
this is the first in vitro study comparing the
remineralization potential of the four agents in
primary teeth. However, one must bear in mind
that remineralization in vitro may be quite different
when compared with dynamic complex biological
system, which usually occurs in the oral cavity
in vivo. Thus, direct extrapolations to clinical
conditions must be exercised with caution because
of obvious limitations of in vitro studies. Long‑term
clinical trials are required to establish the utility of
remineralizing agents in remineralization of white
spot lesion in primary teeth in in vivo conditions and
to single out the superiority of any one agent.
Conclusion
Based on the findings of the present study, the
following conclusions were drawn:
1. All the test agents were comparable in their
remineralization potential
2. Role of fluoridated dentifrice as a remineralizing
agent cannot be underestimated and judicious use
of fluoridated dentifrice could serve as a valuable
therapeutic aid
3. DIAGNOdent has the potential to be used as a
noninvasive diagnostic as well as monitoring tool
during remineralization therapies.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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