Evaluation of the efficacy of P11-4 and CCP-ACPF in the prevention and treatment of white spot lesions: a multi-technique approach

The aim of this study was to assess the efficacy of the self-assembling peptide P11-4 [Curodont Repair Fluoride Plus-self-assembling peptide (Curodont FP)] and casein phosphopeptide-amorphous calcium phosphate fluoride (CCP-ACPF) (MI Varnish) in the management of white spot lesions (WSLs), during orthodontic treatment. Eighty specimens were prepared from the buccal surfaces of bovine teeth and divided into five groups that received different treatment protocols with Curodont FP and MI Varnish. (1) MI- Pre-Post: MI varnish applied before and after demineralization; (2) MI-Post: MI varnish applied after demineralization; (3) Curodont- Pre-Post: Curodont FP applied before and after demineralization; (4) Curodont-Post: Curodont FP applied after demineralization; (5) Control: No remineralization agent applied after demineralization. MI Varnish was applied in a thin and uniform layer using a single-use brush. Before application of Curodont FP, the enamel surface was conditioned with 35% phosphoric acid, rinsed and gently air-dried, then applied with an applicator sponge. Generalized linear models and one-way ANOVA tests were used to analyze the data. The significance level was set at p < 0.05. Specimens were analyzed using micro-computed tomography (micro-CT), field-emission scanning electron microscopy (FE-SEM), and energy-dispersive X-ray spectroscopy (EDX). The lowest lesion depths after the 28-day period (T2) were observed in the MI-Pre-Post (0.14 mm), MI-Post (0.15 mm), and Curodont-Pre-Post (0.15 mm) groups (p = 0.003). The control group showed the lowest mineral density (2.28 gHA/cm³), while the MI-Pre-Post, MI-Post, and Curodont-Pre-Post groups exhibited the highest mineral density (2.54 gHA/cm³, 2.52 gHA/cm³, 2.56 gHA/cm³, respectively) and the lowest lesion depth. Lesion depth and mineral density notably improved over time, particularly after agent application. The application of MI varnish before orthodontic treatment protects the enamel against demineralization. MI Varnish and Curodont FP are highly effective for the remineralization of WSL and can be clinically preferred.