Remineralization Potential of Strontium-Doped Nano-Hydroxyapatite Dentifrice and Casein Phosphopeptide-Amorphous Calcium Phosphate Cream on White Spot Lesions in Enamel Following Orthodontic Debonding – A Randomized Controlled Trial

Published In: SAGE Open Medicine
Publication Year: 2024

Study Design

This study was a randomized controlled clinical trial comparing three treatments for white spot lesions (WSLs) following orthodontic debonding.

Funding Sources

The authors declared no financial support for the research, authorship, or publication of this article.

PICO Framework – what was studied and how?

Population:
Patients aged 15–25 years with at least one white spot lesion (WSL) on maxillary anterior teeth following orthodontic debonding.

Intervention:
Use of strontium-doped nano-hydroxyapatite (SrnHAp) dentifrice applied twice daily for six weeks.

Comparison:

1. Regular dentifrice (no remineralizing agents)

2. Topical cream containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)

Outcomes:
Improvement in enamel remineralization measured by changes in visual scoring (Ekstrand criteria), comparing pre- and post-treatment WSL status.

In Paragraph Form:
This randomized controlled clinical trial assessed the remineralization effectiveness of a strontium-doped nano-hydroxyapatite dentifrice against a casein phosphopeptide-amorphous calcium phosphate cream and a standard toothpaste. The population included young patients (15–25 years) with post-orthodontic white spot lesions. The primary outcome was improvement in lesion severity over six weeks, visually assessed using Ekstrand's clinical scoring criteria.

Inclusion and Exclusion Criteria

Inclusion Criteria:

• Age 15–25 years.

• At least one visible WSL (score 0–2).

• WSL developed after orthodontic treatment.

• No fluoride treatment in the previous 3 months.

• No existing caries or enamel abnormalities.

Exclusion Criteria:

• Refusal to be randomized.

• Psychological, physiological, or oral anomalies.

• Structural defects like hypoplasia or existing caries.

• Periodontal pockets in anterior teeth.

Demographics and Study Cohorts

• Total Subjects: 90

• Group 1 (Control - Regular Dentifrice): 30 patients

• Group 2 (SrnHAp Dentifrice): 30 patients

• Group 3 (CPP-ACP Cream): 30 patients

• Gender: 46 male (51.2%), 44 female (48.8%) — no significant differences between groups.

Primary Outcome Variables and Results

Outcome Measurement Tool: Ekstrand visual scoring criteria (scores 0 to 2)

Statistical Analysis:

• Kruskal–Wallis ANOVA: p = 0.001 (significant intergroup difference)

• Mann–Whitney test:

  • Group 1 vs Group 2: p = 0.001 (significant)

  • Group 2 vs Group 3: p = 0.321 (not significant)

Conclusions

Strontium-doped nano-hydroxyapatite (SrnHAp) dentifrice demonstrated superior remineralization of white spot lesions compared to CPP-ACP and regular toothpaste. While both remineralizing agents outperformed the control, SrnHAp showed slightly better efficacy than CPP-ACP, though not statistically significant. The SrnHAp formulation is a promising, non-toxic, and effective tool for early caries repair and post-orthodontic enamel care.

Discussion: Strengths and Limitations

Strengths:

• Randomized controlled design with adequate power.

• Blinded assessment using validated scoring criteria.

• Equal group sizes with no loss to follow-up.

• Ethical approval and trial registration provided.

Limitations:

• Short follow-up (6 weeks).

• Visual scoring only — no imaging or microhardness testing.

• Results may not reflect long-term remineralization potential.

• Only one Sr2+ concentration tested — more studies are needed for dose optimization.

Citation

Rajendran R, Antony DP, Ashik P, Bharath S, Thomas AJ, Heboyan A. Remineralization potential of strontium-doped nano-hydroxyapatite dentifrice and casein phosphopeptide-amorphous calcium phosphate cream on white spot lesions in enamel following orthodontic debonding – a randomized controlled trial. SAGE Open Med. 2024;12:1-9.
PubMed Link: https://pubmed.ncbi.nlm.nih.gov/

Simple Chart: White Spot Lesion Remineralization Rates