Comparative Evaluation of Zwitterionic Material, Self-assembling Peptide, and Bioactive Glass Incorporated with MI Varnish for Fluoride, Calcium, and Phosphorus Ion Release, Enamel Remineralization, and Microhardness
Snehal V Patil, Sachin C Gugwad, Shashikiran N Devendrappa, Namrata N Gaonkar, Savita G Hadakar, Sonali K Waghmode
Keywords :
Casein phosphopeptide–amorphous calcium phosphate, Dentinal caries, Incipient lesions, In vitro study
Background: White spot lesions occur when the pathogenic bacteria have broken through the enamel layer. White spot lesions (WSLs) can be treated using a complex approach. The most crucial step is to stop demineralization and biofilm formation and use assorted strategies for remineralization of lesions, thinning, microabrasion, erosion infiltration, adhesive composite resin restorations, and the bonded facets.
Aim: To evaluate and compare the fluoride, calcium, and phosphorus ion release, remineralizing efficacy, and microhardness of zwitterionic material, self-assembling peptide, and bioactive glass (BGA) incorporated with MI Varnish.
Materials and methods: The original study was conducted on 60 extracted premolars; the sample size calculated was 10 per group. All samples were divided into four groups—group A, MI Varnish (control), group B, MI Varnish + zwitterionic material, group C, MI Varnish + self-assembling peptide, and group D, MI Varnish + BGA. All these groups were further evaluated and compared for fluoride, calcium, and phorphorus ion release, remineralizing efficacy, and surface microhardness (SMH).
Results: Zwitterionic material, when incorporated with MI Varnish showed high fluoride and calcium ion release and high remineralizing efficacy under polarized light microscopy (PLM). BGA, when incorporated with MI Varnish showed high phosphorus ion release and higher values in the evaluation of SMH, followed by zwitterionic material and self-assembling peptide.
Conclusion: MI varnish alone had remineralizing properties of WSLs, but when novel materials like zwitterionic ion, self-assembling peptide, and BGA are incorporated, its efficacy increases. Among all zwitterionic ions showed superior results for fluoride and calcium ion release and remineralization and BGA for phosphorus ion release and SMH.
Tulumbaci F, Gungormus M. In vitro remineralization of primary teeth with a mineralization-promoting peptide containing dental varnish. J Appl Oral Sci 2020;28(1):e20200259. DOI: 10.1590/1678-7757-2020-0259
Roopa KB, Pathak S, Poornima P, et al. White spot lesions: a literature review. J Pediatr Dent 2015;3(1):1–7. DOI: 10.4103/2321-6646.151839
Puleio F, Fiorillo L, Gorassini F, et al. Systematic review on white spot lesions treatments. Eur J Dent 2022;16(1):41–48. DOI: 10.1055/s-0041-1731931
Khoroushi M, Kachuie M. Prevention and treatment of white spot lesions in orthodontic patients. Contemp Clin Dent 2017;8(1):11–19. DOI: 10.4103/ccd.ccd_216_17
Indrapriyadharshini K, Kumar PM, Sharma K, et al. Remineralizing potential of CPP-ACP in white spot lesions–a systematic review. Indian J Dent Res 2018;29(4):487–496. DOI: 10.4103/ijdr.IJDR_364_17
Weyant RJ, Tracy SL, Anselmo TT, et al. Topical fluoride for caries prevention: executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc 2013;144(11):1279–1291. DOI: 10.14219/jada.archive.2013.0057
Mangal U, Kwon JS, Choi SH, et al. Bio-interactive zwitterionic dental biomaterials for improving biofilm resistance: characteristics and applications. Int J Mol Sci 2020;21(23):9087. DOI: 10.3390/ijms21239087
Kim D, Lee MJ, Kim JY, et al. Incorporation of zwitterionic materials into light-curable fluoride varnish for biofilm inhibition and caries prevention. Sci Rep 2019;9(1):19550. DOI: 10.1038/s41598-019-56131-5
Kamal D, Hassanein H, Elkassas D, et al. Complementary remineralizing effect of self-assembling peptide (P11-4) with CPP-ACPF or fluoride: an in vitro study. J Clin Exp Dent 2020;12(2):e161–e168. DOI: 10.4317/jced.56295
Gulzar RA, Ajitha P, Subbaiyan H. Self-assembling peptide P11-4 for enamel remineralization: a biomimetic approach. J Pharmaceut Res Int 2020;32(19):83–89. DOI: 10.9734/jpri/2020/v32i1930712
Dai LL, Mei ML, Chu CH, et al. Mechanisms of bioactive glass on caries management: a review. Materials 2019;12(24):4183. DOI: 10.3390/ma12244183
Virupaxi SG, Roshan NM, Poornima P, et al. Comparative evaluation of longevity of fluoride release from three different fluoride varnishes–an invitro study. J Clin Diagn Res 2016;10(8):ZC33–ZC36. DOI: 10.7860/JCDR/2016/19209.8242
Martinez-Mier EA, Cury JA, Heilman JR, et al. Development of gold standard ion-selective electrode-based methods for fluoride analysis. Caries Res 2011;45(1):3–12. DOI: 10.1159/000321657
Shivanna V, Shivakumar B. Novel treatment of white spot lesions: a report of two cases. J Conserv Dent 2011;14(4):423–426. DOI: 10.4103/0972-0707.87217
Agrawal A, Kausal RS, Soni UN, et al. White spot lesions: formation, prevention and treatment. Int J Dent Health Sci Review Article 2015;2(2):380–384.
Bakhurji E. Fluoride varnish application in preschoolers have a modest effectiveness in reducing the incidence of dentinal caries. J Evid Dent Pract 2020;20(4):101489. DOI: 10.1016/j.jebdp.2020.101489
Mazyad OT, El-marakby AM, Sorour YR, et al. Topical application of fluoride and its anti-cariogenic effect. Int J Adv Res 2017;5:1483–1488. DOI: 10.21474/IJAR01/6110
Seppä L. Fluoride varnishes in caries prevention. Med Principl Pract 2004;13(6):307–311. DOI: 10.1159/000080466
Tuloglu N, Bayrak S, Tunc ES, et al. Effect of fluoride varnish with added casein phosphopeptide-amorphous calcium phosphate on the acid resistance of the primary enamel. BMC Oral Health 2016;16(1):103. DOI: 10.1186/s12903-016-0299-4
Mellanby M. Diet and the Teeth. An Experimental Study. Part II. A. Diet and Dental Disease. B. Diet and Dental Structure in Mammals Other than the Dog. 1930.
Lena Sezici Y, Yetkiner E, Aykut Yetkiner A, et al. Comparative evaluation of fluoride varnishes, self-assembling peptide-based remineralization agent, and enamel matrix protein derivative on artificial enamel remineralization in vitro. Prog Orthod 2021;22(1):4. DOI: 10.1186/s40510-020-00345-1
Golpayegani MV, Sohrabi A, Biria M, et al. Remineralization effect of topical NovaMin versus sodium fluoride (1.1%) on caries-like lesions in permanent teeth. J Dent 2012;9(1):68–75.
Arends J, Ten Bosch JJ. Demineralization and remineralization evaluation techniques. J Dent Res 1992;71:924–928. DOI: 10.1177/002203459207100S27
Li T, Lu XM, Zhang MR, et al. Peptide-based nanomaterials: self-assembly, properties and applications. Bioact Mater 2022;11:268– 282.
Huang WT, Shahid S, Anderson P. Validation of a real-time ISE methodology to quantify the influence of inhibitors of demineralization kinetics in vitro using a hydroxyapatite model system. Caries Res 2018;52(6):598–603. DOI: 10.1159/000488597
Kooshki F, Pajoohan S, Kamareh S. Effects of treatment with three types of varnish remineralizing agents on the microhardness of demineralized enamel surface,. J Clin Exp Dent 2019;11(7):e630–e635. DOI: 10.4317/jced.55611
Hicks J, Flaitz C. Role of remineralizing fluid in in vitro enamel caries formation and progression. Quintessence Int 2007;38(4):313–319.
Lara-Carrillo E, Lovera-Rojas N, Morales-Luckie RA, et al. The effects of remineralization via fluoride versus low-level laser IR810 and fluoride agents on the mineralization and microhardness of bovine dental enamel. Appl Sci 2018;8(1):78. DOI: 10.3390/app8010078
Amaechi BT. Protocols to study dental caries in vitro: pH cycling models. Methods Mol Biol 2019;1922:379–392. DOI: 10.1007/978-1-4939-9012-2_34
Mehta AB, Kumari V, Jose R, et al. Remineralization potential of bioactive glass and casein phosphopeptide-amorphous calcium phosphate on initial carious lesion: an in-vitro pH-cycling study. J Conserv Dent 2014;17(1):3–7. DOI: 10.4103/0972-0707.124085
Hassanein OE, EI-Brolossy TA. An investigation about the remineralization potential of bio-active glass on artificially carious enamel and dentin using Ramanspectroscopy. Egypt J Solids 2006;29(1):69–80.
Taha AA, Patel MP, Hill RG, et al. The effect of bioactive glasses on enamel remineralization: a systematic review. J Dent. 2017;67:9–17.