Discussion
carious lesions, carious lesion, caries, caries lesion, Tooth enamel, carious enamel lesion, tooth
DENTAL CARIES, DEMINERALIZATION, GROUP B, DENTAL PLAQUE, CARIES, PLAQUE, HYDROXYAPATITE
Orthodontic therapy with fixed appliances may lead to a rapid increase in the volume of dental plaque with an elevated level of acidogenic bacteria. The low pH of dental plaque and subsequent imbalance of the remineralization-demineralization equilibrium favor demineralization in areas where optimum oral hygiene becomes difficult [Clinically, enamel carious lesions in their early stage look like white, opaque spots softer than the surrounding sound enamel, and their whiteness increases with air drying. The early carious enamel lesion is characterized by subsurface damage with an intact enamel surface. This progressive subsurface demineralization, if not reversed, will lead to cavitation and eventually needs to be restored. Moreover, natural remineralization is difficult to be attained due to low calcium, phosphate, and fluoride concentration in the saliva. That is why intervention using remineralizing agents is needed to promote the mechanism of ion exchange to reverse the lesion avoiding invasive interventions [Tooth enamel regeneration is the goal today, through the true regeneration of hydroxyapatite crystals in subsurface lesions. This in fact can be mimiced by guided enamel repair with the use of self-assembling peptide P11-4 (SAP11-4) where monomeric P11-4 diffuses through the pores of decalcified enamel, fiber formation is triggered, and the 3D matrix is produced [Kirkham J (2007) was the first to publish the proof of concept that self-assembling peptide P11-4 facilitates biomimetic enamel remineralization [In the current study, both quantitative and qualitative analyses using DIAGNOpen and ICDAS are used in the current study as none of the diagnostic methods alone is enough for the diagnosis of dental caries. DIAGNOdent device was evidenced to be an efficient addition to other detection methods in caries detection as stated by a systematic review in 2021 [The qualitative analysis using ICDAS is considered to be an easy chairside system that omits the use of sharp explorer that may endanger the enamel during caries detection, so it encourages preventative strategies that enable remineralization of non-cavitated lesions [The quantitative analysis utilizing DIAGNOpen can detect the initial carious lesion where the laser beam fluorescence of demineralized enamel is lower than that of normal sound enamel. Six hundred fifty nanometer red diode laser beam is applied to the surface of the tooth. It is collected using a single optical fiber, filtered by high-frequency light wavelengths, and calculated by a photodiode. The amount of low-frequency fluorescence that passes through the caries lesion is measured and quantified [In the study, both ICDAS and DIAGNOpen showed a significant increase in remineralization of post-orthodontic white spot lesions in both groups and over different time intervals. However, the remineralizing capacity of self-assembling peptides was superior to that of the fluoride varnish.Fluoride follows the concept of ion-to-ion attachment for eventual enamel crystal growth. It is also called Fluoride varnish presents a successful non-invasive treatment modality for reversing the lesion in its early stage as it contains high concentrations of fluoride in comparison to the daily used toothpaste and mouthwash. So, surface fluoridation is maintained owing to the high level of fluoride ions. Moreover, it was suggested by some researchers that the combined formulation of fluoride varnish with tricalcium phosphate (TCP) with its mild acidity affects the saliva buffering capacity and plaque pH whereas the baseline salivary pH after immediate application of the fluoride varnish with tricalcium phosphate (TCP) is 6.7 that reaches 6.9 after 12 weeks [Perhaps, it is attributed to the use of fluoride varnish that contains 5% sodium fluoride and tricalcium phosphate. During the manufacturing process, there is a protective barrier around the calcium ions. Once the varnish becomes in contact with the enamel surface and saliva, this barrier is broken, making fluoride, phosphate, and calcium ions enhance ion remineralization [The remineralizing process of self-assembling peptide P11-4 showed significantly superior ability in enamel repair when compared to fluoride-based material. There was a statistically significant difference between Group A (fluoride vehicle material) and Group B (self-assembling peptides) groups where Brunton et al. [In post-orthodontic white spot lesions, self-assembling peptides P-114 displayed greater remineralization properties when mineral content was measured through radiographic and digital subtraction radiography, as in the case series by Schlee M [Welk et al. (2020) documented a noticeable decrease in impedance readings (using CarieScan) after self-assembling peptide P11-4 application. The mean impedance value of the self-assembling peptides group showed 46.7 that decreased to 19.7 after 180 days. Also, the lesion size decreased from 8.8 to 6.5 after 180 days of SAP application [As for the qualitative analysis using ICDAS, there is harmony between the results of the current study and the clinical study that was verified by other researchers [In the present clinical trial, there was a moderate positive relationship between quantitative analysis through the remineralizing process and visual or qualitative assessment using the ICDAS scoring system. This may be contributed to the occurrence of remineralization whether through the classical theory or the non-classical theory by decreasing in laser fluorescence. Also, it was revealed visually by fading the lesions. This agreed with other researchers [All these findings support the repair potential of the self-assembling peptide that can perform a true stable 3D scaffold. Thanks to the surface pre-treatment through conditioning the surface followed by surface etching, which allows high surface reactivity for better peptides diffusion, then again negatively charged scaffold formation acting as binding sites for positively charged calcium and phosphate ions confirming subsurface remineralization in a bottom-up direction [Eventually, enamel repair through biomimetic remineralization utilizing self-assembling peptides is considered to be a new avenue for remineralizing, reversing, and repair the early enamel lesion. Without a doubt, it will open the door to regenerative dentistry.According to the previously discussed results of this study, the null hypothesis is rejected where self-assembling peptides have a superior remineralizing potential over fluoride-based delivery systems quantitatively using laser fluorescence; however, both materials have the same visual effect on masking the early lesion. This new approach possibly reverses and masks off post-orthodontics white spot lesions.