Comparison between Fluoride and Nano-hydroxyapatite in Remineralizing Initial Enamel Lesion: An in vitro Study

Abstract

The aim of this study was to compare the effectiveness of nano-hydroxyapatite (nano-HAP) paste and fluoride varnish in remineralizing initial enamel lesion in young permanent teeth and their ability to resist secondary caries under dynamic pH cycling quantitatively and qualitatively. Initial caries-like lesions were artificially developed on 45 specimens. Specimens were divided into three groups: (1) Control (without treatment), (2) fluoride varnish (3M ESPE), and (3) nano-HAP paste (Desensibilize Nano P). The nano-HAP paste was applied twice separated by one pH cycle, and the varnish was applied only once followed by 7 days of pH cycling. All specimens were examined using DIAGNOdent® pen (KaVo, Germany), and a representative specimen was randomly selected from each group for qualitative evaluation using scanning electron microscope (SEM) at four stages: Baseline, after lesion formation, immediately after remineralization, and after pH cycling. Data were statistically analyzed with Statistical Package for the Social Sciences (SPSS), version 20. The degree of demineralization was significantly elevated in control group; however, no significant difference was found between fluoride varnish group and nano-HAP paste group (p < 0.001). Nano-HAP paste showed promising long-term protective effect in terms of surface depositions and maintaining a smooth surface compared with fluoride varnish. Based on the findings of this study, nano-HAP paste might be recommended as alternative remineralizing agent with lower fluoride concentration than fluoride varnish that could be beneficial for children, pregnant females, and those who are at high risk of dental fluorosis.