Soliman Eman M, Abdelfattah Wegdan M, Mohamed Doaa R, Nagui Dina A, Holiel Ahmed A
Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
Oral Biology Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
J Esthet Restor Dent. 2025 Apr;37(4):1062-1074. doi: 10.1111/jerd.13381. Epub 2024 Dec 11.
The modern approach to managing noncavitated white spot lesions (WSLs) emphasizes noninvasive strategies and biomimetic remineralization. Biomimetic scaffolds are designed to regenerate dental tissues rather than simply repair them. This study aimed to assess lesion depth, enamel structure, and the elemental composition of artificially induced WSLs after treatment with biomimetic remineralization techniques.
Ninety-six freshly extracted anterior teeth, free from caries or enamel defects and extracted due to periodontal disease, were used. White spot lesions were induced on the labial surfaces, and the samples were divided into three groups based on the remineralizing agent: Group I, treated with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), which served as the positive control; Group II, treated with self-assembling peptide P11-4 (SAP-P11-4); and Group III, treated with phosphorylated nano-chitosan (Pchi-ACP). Enamel topography was analyzed at baseline and after treatment using polarized light microscopy, micro-Raman spectroscopy, and scanning electron microscopy. Statistical analysis was conducted using one-way ANOVA, Kruskal-Wallis, and Dunn's post hoc test (p = 0.05).
The Kruskal-Wallis test indicated a significant difference in remineralization potential among the groups. Pchi-ACP showed the greatest reduction in lesion depth (62.65%), demonstrating significant subsurface enamel remineralization. This group also exhibited a smooth, regular enamel surface with shallow linear depressions. Elemental analysis confirmed successful calcium phosphate precipitation in Pchi-ACP, indicating a trend toward enamel regeneration.
Pchi-ACP represents a promising biomimetic and minimally invasive approach for treating early WSLs, signifying a transition toward regenerative dentistry. (SAP-P11-4), while effective, was less successful than phosphorylated nano-chitosan but outperformed (CPP-ACP).
Pchi-ACP demonstrates significant potential for minimally invasive treatment of early noncavitated carious lesions. By preserving natural tooth structure, this approach could greatly enhance oral health outcomes in the long term.
现代管理非空洞型白斑病变（WSLs）的方法强调非侵入性策略和仿生再矿化。仿生支架旨在使牙体组织再生，而非仅仅修复它们。本研究旨在评估用仿生再矿化技术治疗后人工诱导的WSLs的病变深度、釉质结构和元素组成。
使用96颗因牙周病而新鲜拔除的前牙，这些牙齿无龋或釉质缺陷。在唇面诱导产生白斑病变，并根据再矿化剂将样本分为三组：第一组用酪蛋白磷酸肽 - 无定形磷酸钙（CPP - ACP）处理，作为阳性对照；第二组用自组装肽P11 - 4（SAP - P11 - 4）处理；第三组用磷酸化纳米壳聚糖（Pchi - ACP）处理。在基线和治疗后使用偏光显微镜、显微拉曼光谱和扫描电子显微镜分析釉质形态。使用单因素方差分析、Kruskal - Wallis检验和Dunn事后检验进行统计分析（p = 0.05）。
Kruskal - Wallis检验表明各组之间在再矿化潜力方面存在显著差异。Pchi - ACP显示病变深度减少最多（62.65%），表明釉质表面下有显著的再矿化。该组还呈现出光滑、规则的釉质表面，伴有浅的线性凹陷。元素分析证实Pchi - ACP中有成功的磷酸钙沉淀，表明有釉质再生的趋势。
Pchi - ACP代表了一种有前景的仿生和微创方法来治疗早期WSLs，标志着向再生牙科的转变。（SAP - P11 - 4）虽然有效，但不如磷酸化纳米壳聚糖成功，但优于（CPP - ACP）。
Pchi - ACP显示出对早期非空洞型龋损进行微创治疗的巨大潜力。通过保留天然牙体结构，这种方法从长远来看可以极大地改善口腔健康状况。
