Comparative Evaluation of the Remineralizing Potential of Fluoridated and Non-fluoridated Agents on Demineralized Primary Tooth Enamel: An In Vitro Study

Published In: Cureus
Publication Year: 2025

Study Design

This was an in vitro experimental study conducted at the Department of Pediatric and Preventive Dentistry, Kothiwal Dental College and Research Centre, Moradabad, India.

Funding Sources

The study did not receive financial support from any organization. Authors declared no conflicts of interest.

PICO Framework – What Was Studied and How?

Population:
Extracted, caries-free human primary molars from children aged 5–10 years.

Intervention:
Application of one of the following remineralizing agents for 4 minutes daily over 7 days:

• CPP-ACP paste

• Nano-hydroxyapatite toothpaste

• Grape seed extract solution

• Sodium fluoride (750 ppm)

Comparison:
Negative control using normal saline.

Outcomes:
Improvement in surface microhardness (SMH) of demineralized enamel, measured at baseline (T0), post-demineralization (T1), and post-remineralization (T2) using Vickers microhardness testing.

In Paragraph Form:
This in vitro study evaluated the surface microhardness improvement in demineralized primary molars after treatment with various remineralizing agents, both fluoridated and non-fluoridated. The goal was to determine which agent most effectively reversed enamel demineralization over a 7-day application period, comparing all interventions against a saline control.

Inclusion and Exclusion Criteria

Inclusion Criteria:

• Extracted first and second primary molars (ages 5–10)

• Intact enamel (no cracks, hypoplasia, caries, or restorations)

• Non-fluorotic teeth

Exclusion Criteria:

• Teeth with structural defects, fluorosis, prior fluoride exposure

• Excessively worn teeth

• Samples lost or lacking complete data

Demographics and Study Groups

A total of 50 teeth were used, evenly divided among five groups (n = 10 per group):

Primary Outcome Variable and Results

Variable: Surface Microhardness (SMH) in Vickers units
Significance Level: p < 0.05
Confidence Interval: 95%

Key Findings:

• CPP-ACP and Sodium Fluoride significantly improved SMH (p = 0.001).

• Nano-hydroxyapatite showed moderate improvement (p = 0.021).

• Grape Seed Extract and Saline showed no significant changes.

Conclusions

Both CPP-ACP and sodium fluoride significantly remineralized demineralized primary enamel.
Nano-hydroxyapatite showed moderate but statistically significant improvement.
Grape seed extract and saline were ineffective.

Discussion: Strengths and Limitations

Strengths:

• Standardized demineralization and remineralization protocols

• High intra-examiner reliability (ICC = 0.92)

• Use of artificial saliva to simulate oral conditions

Limitations:

• In vitro design limits real-world applicability

• Short duration (7 days)

• Only SMH was measured—other factors like mineral depth or structure not assessed

• Small sample size (n = 10/group)

• GSE formulation and dosage may not have been optimized

Simple Chart: Microhardness Before and After Remineralization