Effect of fluoride varnish with casein phosphopeptide-amorphous calcium phosphate on remineralization of early enamel lesions

Abstract Background Modern dentistry aims to enhance the noninvasive treatment of white spot lesions (WSLs) before they become cavitated and require invasive intervention. This can be achieved by the application of products that can encourage the remineralization process. Fluoride varnish combined with Casein phosphopeptide- amorphous calcium phosphate (CPP-ACP) is currently available as (MI) varnish that releases more fluoride, calcium, and phosphate ions, which synergistically impacts enamel remineralization. This study has been done to evaluate the effect of fluoride varnish with CPP-ACP on remineralization of teeth with early enamel lesions. Patients and methods Twenty-five children aged 12–16 years old having at least two WSLs on the facial surface of the maxillary permanent incisors with a total of 50 permanent maxillary incisors were randomly allocated into two equal groups using a split-mouth technique. Group I treated with CPP-ACP plus fluoride ‘MI varnish’. In group II, the selected teeth were treated with sodium fluoride 5% ‘Proshield varnish’. Standardized digital radiographs were taken at base line and after 12 months then analyzed with Digital subtraction radiography. In laboratory evaluation, twenty human sound premolars were used. WSLs were established on the buccal surfaces of the teeth. Each tooth was sectioned into two halves. One half was treated with MI varnish for group I and Proshield varnish for group II and the other half served as a control. All specimens were exposed to the pH cycling model over a period of 30 days then exposed to the energy dispersive radiography spectrometer to measure calcium and phosphate content. Results The mean values of radiography pixel subtraction after treatment application from those at baseline revealed greater potential of remineralization of MI varnish (CPP-ACP + NaF) than Proshield varnish (5%NaF) (mean = 15 845.24 and 10 757.84), respectively. A greater percentage increase of calcium was observed in MI than Proshield specimens (mean = 49.86 and 21.78, P = 0.008), with a greater Ca/p ratio percentage increase (mean = 44.09 and 20.62, P = 0.035) while there was statistically nonsignificant difference in percent of change in P content between the two groups (mean = 5.314 and 2.779, P = 0.528). Conclusion CPP-ACP plus fluoride ‘MI varnish’ showed a significantly higher remineralization potential than sodium fluoride 5% ‘Proshield varnish’.