Efficacy of Self-assembling Peptide P11-4 in Remineralizing In Vitro Caries-like Lesions in Primary Enamel Samples in Combination with Calcium Phosphate-based Remineralization Agents
Ashwini Krishnamoorthi, Raghavendra S Shanbhag, Brinda S Godhi, Mirunalini Sundaravadivelu
Citation Information :
Krishnamoorthi A, Shanbhag RS, Godhi BS, Sundaravadivelu M. Efficacy of Self-assembling Peptide P11-4 in Remineralizing In Vitro Caries-like Lesions in Primary Enamel Samples in Combination with Calcium Phosphate-based Remineralization Agents. Int J Clin Pediatr Dent 2024; 17 (5):552-557.
Aims and background: The efficacy of self-assembling peptide P11-4 in combination with calcium-phosphate-based remineralization agents in remineralizing caries-like lesions in primary enamel was evaluated using a 21-day pH cycling experiment by Vickers microhardness [Vickers hardness number (VHN)] and scanning electron microscopy (SEM).
Materials and methods: A total of 120 primary enamel samples were made to undergo a demineralization cycle to produce caries-like lesions. They were divided into six groups, namely negative control (NC), positive control (P11-4), and four interventional groups in which each of the following calcium-phosphate-based agents were used in combination with P11-4—calcium sucrose phosphate (CSP), bioactive glass (BG), casein phosphopeptides, and casein phosphopeptides with fluoride. A 21-day pH cycling experiment was carried out with alternating demineralization and remineralization phases. The enamel samples were analyzed at baseline, post production of caries-like lesions, and post 21-day pH cycling using Vickers microhardness and SEM. Results were statistically analyzed using repeated measures of analysis of variance (ANOVA), keeping the level of significance at 0.05.
Results: Supplementing P11-4 with calcium-phosphate-based agents improved the surface hardness of the demineralized primary enamel samples, among which the fluoridated milk protein-based remineralization agent yielded a statistically significant improvement.
Conclusion: P11-4 promoted the regeneration of incipient caries-like lesions. However, there is added benefit when this peptide is used in combination with a fluoridated calcium-phosphate-based agent.
Clinical significance: This study would help the clinician compose an effective regimen for the patient to follow at home posttreatment with P11-4, in-office treatment.
Philip N. State of the art enamel remineralization systems: the next frontier in caries management. Caries Res 2019;53(3):284–295. DOI: 10.1159/000493031
Meyer F, Amaechi BT, Fabritius H-O, et al. Overview of calcium phosphates used in biomimetic oral care. Open Dent J 2018;12(1):406–423. DOI: 10.2174/1874210601812010406
Kirkham J, Firth A, Vernals D, et al. Self-assembling peptide scaffolds promote enamel remineralization. J Dent Res 2007;86(5):426–430. DOI: 10.1177/154405910708600507
Kind L, Stevanovic S, Wuttig S, et al. Biomimetic remineralization of carious lesions by self-assembling peptide. J Dent Res 2017;96(7):790–797. DOI: 10.1177/0022034517698419
Aggeli A, Fytas G, Vlassopoulos D, et al. Structure and dynamics of self-assembling beta-sheet peptide tapes by dynamic light scattering. Biomacromolecules 2001;2(2):378–388. DOI: 10.1021/bm000080z
Schmidlin P, Zobrist K, Attin T, et al. In vitro re-hardening of artificial enamel caries lesions using enamel matrix proteins or self-assembling peptides. J Appl Oral Sci 2016;24(1):31–36. DOI: 10.1590/1678-775720150352
Scaffolds SP, Enamel P. Self-assembling peptide scaffolds. 2007.
Alkilzy M, Tarabaih A, Santamaria RM, et al. Self-assembling peptide P11-4 and fluoride for regenerating enamel. J Dent Res 2018;97(2):148–154. DOI: 10.1177/0022034517730531
Veeramani R, Shanbhog R, Priyanka T, et al. Remineralizing effect of calcium-sucrose-phosphate with and without fluoride on primary and permanent enamel: Microhardness and quantitative-light-induced-fluorescenceTM based in vitro study. Pediatr Dent J 2021;31(1):51–59. DOI: 10.1016/j.pdj.2020.12.001
ten Cate JM, Duijsters PP. Alternating demineralization and remineralization of artificial enamel lesions. Caries Res 1982;16(1):201–210. DOI: 10.1159/000260599
Veeramani R, Shanbhog R, Bhojraj N, et al. Evaluation of mineral loss in primary and permanent human enamel samples subjected to chemical demineralization by international caries detection and assessment system II and quantitative light-induced fluorescence™: an in vitro study. J Indian Soc Pedod Prev Dent 2021:38;355–360. DOI: 10.4103/JISPPD.JISPPD_181_20
Alkilzy M, Santamaria RM, Schmoeckel J, et al. Treatment of carious lesions using self-assembling peptides. Adv Dent Res 2018;29(1):42–47. DOI: 10.1177/0022034517737025
Wierichs RJ, Kogel J, Lausch J, et al. Effects of self-assembling peptide P11-4, fluorides, and caries infiltration on artificial enamel caries lesions in vitro. Caries Res 2017;51(5):451–459. DOI: 10.1159/000477215
Özdemir Ş, Taran PK, Mammadlı N, et al. Remineralization potential of P11-4 and fluoride on secondary carious primary enamel: a quantitative evaluation using microcomputed tomography. Microsc Res Tech 2022;85(2):807–812. DOI: 10.1002/jemt.24052