Citation Information :
Sain S, Hegde SK, Bhat SS, Satheesh GJ. Remineralization of Enamel Using Topical Agents among Patients with Orthodontic Brackets: In Vivo and In Vitro Randomized Control Trial. Int J Clin Pediatr Dent 2024; 17 (10):1093-1098.
Aim and background: To evaluate the in vivo and in vitro effects of three topical agents in reducing enamel demineralization around orthodontic brackets. Postorthodontic enamel demineralization persists to be undesirable and common complication.
Materials and methods: Twenty patients, who consented, were included into three experimental and a control group, following screening for inclusion, exclusion, and randomization. The experimental group was intervened with either GC Tooth Mousse Plus®, Clinpro® Tooth Cream, or Amflor® toothpaste. The baseline values were recorded using DIAGNOdent® following oral prophylaxis and brackets were bonded. The intervention group received the respective topical application of agents. Posttreatment values were recorded after 90 seconds of intervention and 20th day postintervention. Extraction of respective tooth was done on the 21st day to evaluate the microhardness using the Vickers hardness test.
Results: The results show the effectiveness of GC Tooth Mousse Plus® over Amflor® toothpaste followed by Clinpro® Tooth Cream for remineralization among patients undergoing orthodontic treatment and microhardness was highest for GC Tooth Mousse Plus®.
Conclusion: Topical agents can be used effectively as remineralizing agents in patients undergoing orthodontic treatment.
Clinical significance: Advanced diagnostic tools like the DIAGNOdent Pen® and remineralizing agents contribute to a comprehensive and proactive approach to dental care, particularly in populations with specific risk factors like children with high sucrose consumption.
Uysala T, Amasyalib M, Koyuturkc AE, et al. Efficiency of amorphous calcium phosphate-containing orthodontic composite and resin modified glass ionomer on demineralization evaluated by a new laser fluorescence device. Eur J Dent 2009;3(2):127–134.
Zachrisson BU, Zachrisson S. Caries incidence and oral hygiene during orthodontic treatment. Scand J Dent Res 1971;79(6):394–401.
Balakrishnan A, Jonathan R, Benin P, et al. Evaluation to determine the caries remineralization potential of three dentifrices: an in vitro study. J Conserv Dent 2013;16(4):375–379.
Walsh LJ. Topical CPP-ACP crèmes: beyond caries prevention. Int Dent Afr Ed 2014;4(5):26–32.
Cross KJ, Huq NL, Stanton DP, et al. NMR studies of a novel calcium, phosphate and fluoride delivery vehicle-alpha(S1)-casein(59-79) by stabilized amorphous calcium fluoride phosphate nanocomplexes. Biomaterials 2004;25(20):5061–5097.
Muhlemann HR, Schmid H, Konig KG. Enamel solubility reduction studies with inorganic and organic fluoride. Helv Dontol Acta 1957;1:233–237.
Galuscan A, Podariu AC, Jumanca D. The decreasing of carious index by using toothpaste based on amine fluoride. Oral Health Dent Man Black Sea Countries 2003;1:42–46.
Busscher HJ, Uyen HM, De Jong HP, et al. Adsorption of amine fluorides on human enamel. J Dent 1988;16:166–171.
Lussi A. Validity of diagnostic and treatment decisions of fissure caries. Caries Res 1991;25:296–303.
Lussi A. Comparison of different methods for the diagnosis of fissure caries without cavitation. Caries Res 1993;27:409–416.
Lussi A, Hibst R, Paulus R. DIAGNOdent: an optical method for caries detection. J Dent Res 2004;83(Spec Iss C):80–83.
Featherstone JBD, ten Cate JM, Shariati M, et al. Comparison of artificial caries-like lesion by quantitative microradiography and microhardness profiles. Caries Res 1983;17:385–391.
Shetty S, Hegde MN, Bopanna TP. Enamel remineralization assessment after treatment with three different remineralizing agents using surface microhardness: an in vitro study. J Conserv Dent 2014;17(1):49–52.
Mathias J, Kavitha S, Mahalaxmi S. A comparison of surface roughness after micro abrasion of enamel with and without using CPP-ACP: an in vitro study. J Conserv Dent 2009;12(1):22–25.
Harper DS, Osborn JC, Hefferren JJ, et al. Cariostatic evaluation of cheeses with diverse physical and compositional characteristics. Caries Res 1986;20:123–130.
Reynolds EC. Remineralization of enamel subsurface lesions by casein phosphopeptide-stabilized calcium phosphate solutions. J Dent Res 1997;76(9):1587–1595.
Reynolds EC. Anticariogenic complexes of ACP stabilized by CPP: a review. Spec Care Dent 1998;18(1):8–16.
Raphael S, Blinkhorn A. Is there a place for Tooth Mousse in the prevention and treatment of early dental caries? A systematic review®. BMC Oral Health 2015;15:113.
Uysal T, Amasyali M, Koyuturk AE, et al. Effects of different topical agents on enamel demineralization around orthodontic brackets: an in vivo and in vitro study. Aust Dent J 2010;55(3):268–274.
Bailey DL, Adams GG, Tsao CE, et al. Regression of post-orthodontic lesions by a remineralizing cream. J Dent Res 2009;88(12):1148–1153.
Sionov RV, Tsavdaridou D, Aqawi M, et al. Tooth mousse containing casein phosphopeptide-amorphous calcium phosphate prevents biofilm formation of Streptococcus mutans. BMC Oral Health 2021;21(1):136. DOI: 10.1186/s12903-021-01502-6
Krithikadatta J, Fredrick C, Abarajithan M, et al. Remineralisation of occlusal white spot lesion with a combination of 10% CPP-ACP and 0.2% sodium fluoride evaluated using DIAGNOdent: a pilot study. Oral Health Prevent Dent 2013;11(2):191–196.
Sitthisettapong T, Phantumvanit P, Huebner C, et al. Effect of CPP-ACP paste on dental caries in primary teeth: a randomized trial. J Dent Res 2012;91(9):847–852.
Beerens MW, van der Veen MH, van Beek H, et al. Effects of casein phosphopeptide amorphous calcium fluoride phosphate paste on white spot lesions and dental plaque after orthodontic treatment: a 3-month follow-up. Eur J Oral Sci 2010;118(6):610–617.
Jo SY, Chong HJ, Lee EH, et al. Effects of various toothpastes on remineralization of white spot lesions. Korean J Orthod 2014;44(3):113–118.
Robert LK, Allen CM, Emily RW, et al. Remineralization potential of 5,000 ppm fluoride dentifrices evaluated in a pH cycling model. J Dent Oral Hygiene 2010;29(1):1–6.
Priyadarshini S, Ramya R, Ashish S, et al. Effect of organic versus inorganic fluoride on enamel microhardness: an in vitro study. J Conserv Dent 2013;16:203–207.
Shetty KP, Satish SV, Gouda V, et al. Comparative evaluation and effect of organic and inorganic fluoride dentifrices on enamel microhardness: an in vitro study. J Int Soc Prev Community Dent 2016;6(2):130–133.
Pascotto RC, Navarro MFL, Capelozza F L, et al. In vivo effect of a resin-modified glass ionomer cement on enamel demineralization around orthodontic brackets. Am J Orthod Dentofacial Orthop 2004;125:36–41.
Gordon N. Understanding Dental Caries, Etiology and Mechnaisms, Basic and Clinical Aspects: The Caries Process—Morphological and Chemical Events, 1st edition. 1985; pp. 261–289.