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Materials and Methods

RESULTSData analysis using Paired t-test and ANOVA followed by Student-Newman-Keuls at 5% significance level revealed significantly higher gain in hardness (remineralization) in CR (23.32%) and CRp (3.82%) compared to significant loss in hardness in CON (74.21%) and CRs (8.86%). CR and CRp were not significantly different from each other.

CONCLUSIONSUnder the limitations of this study it can be concluded that treating white spot lesions with Curodont Repair© was capable of inhibiting further progression and re-hardened theincipient enamel lesions. Although Curodont Repair© followed by application of high fluoride prescription toothpaste showed a significant gain in surface microhardness,results reflect that adding prescription toothpaste does not provide significant additional remineralization relative to applying Curodont Repair© alone. The results suggest thatCurodont Repair© efficacy might be reduced when used in conjunction with standard fluoride toothpaste. Further research ought to be conducted to investigate thisdiscrepancy in efficacy.

REFERENCES1) M. Esteves-Oliveira a, c D.M. Zezell d J. Meister a R. Franzen a S. Stanzel b F. Lampert a C.P. Eduardo c C. Apel. CO 2 Laser (10.6) Parameters for Caries Prevention in Dental Enamel. Caries Res 2009;43:261–268.2) Aggeli A, Bell M, Boden N et al. Engineering of peptide beta-shee nanotapes. J Mater Chem 1991; 7; 1135 –1145.3) Aggeli A, Bell M, Carrick L M et al. pH as a trigger of peptide beta-sheet self assembly and reversible switching between nematic and isotrophic phases. J Am Chem Soc 2003; 125: 9619-9628. 4) Bruton PA, Davies RP, Burke JL, Smith A, Aggeli A, Brookes SJ, Kirkham J. Treatment of early caries lesions using biomimetic self-assembling peptides– a clinical safety trial. Br. Dent J. 2-10 Aug;2015

Remineralization of Early-Enamel Lesions Using Biomimetic Regeneration Combined with Fluoride-Toothpaste

* L. Brubaker1, * A. Vinh1, S. Patel1, E. Solomon1, B. T. Amaechi2, A. Noureldin1

1Texas A&M University Baylor College of Dentistry, Dallas, TX, USA2University of Texas Health Science Center at San Antonio, TX, USA

ABSTRACTObjectives: A self-assembling peptide (Curodont Repair©) has shown great potential for natural repair of early caries lesions. However, combination of this treatment withfluoride agents has not been investigated. The aim of the present study was to compare the efficacy in re-hardening white-spot lesion (WSL) using Curodont Repair© (CR)alone and combining CR with either high-fluoride prescription toothpaste or standard-fluoride toothpaste.Methods: Eighty specimens were prepared from extracted human teeth. Using an acidified gel, WSL was created on an exposed enamel window in all specimens. Surfacemicrohardness measurement was carried out at baseline before WSL (SMH1) and after WSL (SMH2). Specimens were randomly assigned to four treatment groups: controlreceived no treatment (CON); treated with Curodont Repair (CR); CR + 5000 ppm prescription toothpaste (CRx); and CR + 1100 ppm standard fluoride-toothpaste (CRs). Allgroups were subjected to 2-week pH-cycling caries model. Between demineralization and remineralization, specimens in CRx and CRs received 2-min exposure to theirrespective toothpaste slurry. Following pH-cycling SMH2, was measured on each WSL, and (%ΔSMH) was calculated [%ΔSMH= (SMH3-SMH2)/SMH2 x100] . Data wereanalyzed using Paired t-test and ANOVA followed by Student-Newman-Keuls at 5% significance level.Results: Data analysis revealed significantly higher gain (p<0.05) in hardness (remineralization) in CR (23.32%) and CRp (3.82%) compared to significant loss in hardness(p<0.05) in CON (74.21%) and CRs (8.86%). CR and CRp were not significantly different from each other but significantly higher than CON and CRs.Conclusions: Findings suggest that treating WSL with CR was capable of inhibiting further progression and re-hardened incipient-enamel lesions. Although CR followed byhigh-fluoride prescription toothpaste showed significant gain in hardness, results showed that adding prescription toothpaste does not provide significant additionalremineralization relative to applying only CR. Results suggested that CR efficacy might be reduced when used in conjunction with standard fluoride-toothpaste.

70%

-22%

10%

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-125% -105% -85% -65% -45% -25% -5% 15% 35% 55% 75%

Curodont Repair

Curodont + OTC Paste

Curodont + Rx Paste

Control

Percent Surface Micro-hardness Recovery

INTRODUCTIONCurrent treatment for early caries lesion (white spot lesion (WSL)) has shifted from the traditional drill and fill methodologies to a less invasive approach that surrounds activemonitoring of WSL progression and remineralization with topical fluorides or fluoride containing toothpastes. However, the penetrability of fluorides is limited and can onlyreach a few µm into enamel subsurface caries lesions1. “Curodont Repair” by Credentis a product in the European market, offers the capability of natural repair of WSLthrough emerging biomimetic remineralization strategies. Curodont Repair made up of monomeric self-assembling peptides (P11-4), which diffuses into the subsurface of WSLand self-assembles into 3D fibrillar scaffolds in response to local conditions of high ionic strength and acidic pH within the lesion body2,3. The assembled P11-4 scaffold iscapable of promoting de novo hydroxyapatite crystal nucleation and supports mineral crystal growth in a process of biomimetic mineralization. It is able to regenerate enamelusing a process that is analogous to the enamel matrix during enamel formation4. This study investigated whether or not the use of Curodont Repair combined with either high-fluoride prescription toothpaste or standard-fluoride toothpaste might improve the efficacy of Curodont Repair.

40 Human Molars 80 Enamel sections

Control-(No treatment)

(CON)

Curodont Repair +Prescription Toothpaste

(CRp)

2 week pH-cycle (4 hr demineralization/20 hr remineralization)

Post TreatmentSMH3

(Baseline) SMH1

Created WSL

(Post WSL)SMH2

Curodont Repair +OTC Toothpaste

(CRs)

Curodont Repair (CR)

ACKNOWLEDGMENTSThis research was supported in part by the the Baylor Oral Health Foundation and the Office of the Associate Dean for Research and Graduate Studies, Texas A&M University Baylor College of Dentistry.

(%SMH Recovery = ( [(SMH3- SHM2)/(SMH1-SHM2)] X 100) (%ΔSMH= [(SMH3-SMH2)/SMH2 ]x100)(* Significantly different than Control P>0.05)

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Curodont + Rx Paste

Curodont

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Percent Change in SMH of WSL Following Treatment