Comparison of the Remineralisation Potential between Flaxseed Paste, Aloe Vera Gel and Fluoride Toothpaste on Artificially Created White Spot Lesions around Orthodontic Brackets: An In-vitro Study

Abstract

Introduction: White Spot Lesion (WSL) is one of the major iatrogenic effect at the end of treatment that might reduce both patient’s and orthodontist’s satisfaction in otherwise promising treatment results. Flaxseed and Aloe Vera (AV) have been used as phytotherapeutic agents because of inherent antimicrobial, anti-inflammatory, antioxidants and healing properties. They were considered in this study for their effectiveness in remineralisation of WSL. Aim: To evaluate and compare the remineralisation potential of organic flaxseed paste, Aloe Vera gel and fluoride toothpaste on artificially created white spot lesions around orthodontic brackets using Vicker’s microhardness assessment, spectrophotometry and Scanning Electron Microscope (SEM). Materials and Methods: This experimental in-vitro study was undertaken in Department of Orthodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India, in October 2020. Forty eight extracted premolar teeth were exposed to demineralising solution for 48 hours in-vitro and randomly assigned to four groups: Group 1- untreated control, group 2- treated with flaxseed paste, group 3- treated with Aloe Vera gel and group 4-treated with fluoride toothpaste. All groups except control were treated with their respective remineralising paste for 28 days. Vicker’s Microhardness Number (VHN) and spectrophotometric values (∆L, ∆a, ∆b, ∆E) were evaluated for normal enamel, WSL, remineralisation after 14 and 28 days. The surface characteristics were analysed using SEM. Statistical analysis was performed using repeated measures Analysis of Variance (ANOVA) and post hoc Bonferroni test was for pairwise comparison between groups with significance level p≤0.05. Results: Total of 48 extracted teeth were treated and analysed in their respective groups after 28 days. Aloe Vera gel showed highest surface microhardness (SMH) (144.09±6.05 VHN) and has statistically significant difference (p<0.001) compared to flaxseed paste (125.28±3.75 VHN) and then the fluoride toothpaste (121.20±5.12 VHN). There was no significant difference (p-value=0.31) between flaxseed paste and fluoride toothpaste. Significant (p-value=0.05) ∆E changes were observed in groups treated with flaxseed paste (16.39) and fluoride toothpaste (15.08) after 28 days. SEM verified mineral gain in all three treatment groups. Conclusion: All the three groups increased mineral gain. Aloe Vera gel showed promising results by significantly remineralising WSLs. Flaxseed paste and fluoride toothpaste had SMH recovery which was lesser than Aloe Vera gel but, these two groups significantly improved the colour of WSL.