Introduction
White spot lesions, chronic infectious diseases
DEMINERALIZATION, OPACITY, WHITE SPOT LESION, DENTAL CARIES, HYDROXYAPATITE
Dental caries is one of the most prevalent chronic infectious diseases, which remains a major public health concern. Dental caries passes through multi-stages, starting from molecular changes in the apatite crystal to visible white spot lesions, through to dentin involvement, and eventual cavitation. Advancement through these phases requires continual imbalance between pathological and protecting factors, resulting in the dissolution of crystals apatite and a net loss of calcium and phosphate which is known as demineralization [White spot lesions (WSLs), defined as “white opacity,” occur because of subsurface enamel demineralization that is located on smooth surfaces of teeth. The reason for the white appearance is the changes in light-scattering optical properties of the decalcified enamel. Various risk factors such as acid-producing bacteria, fermentable carbohydrates, and many host factors, such as poor oral hygiene, low salivary volume, and a sugary diet, further contribute to the development of these incipient lesions [Conservative dentistry no longer favors the “drill and fill” concept and supports the reversal of lesions via remineralization [Regenerative medicine-based dental approaches, where the damaged tissues are substituted with biologically similar tissues, hence shift from reparative to regenerative dentistry [On applying the P11-4-containing solution, P11-4 forms tapes and ribbons within seconds, and fibrils and fibers within the following 24 h under physicochemical conditions. These resulting self-assembling peptide fibers forming the 3D Self-Assembling Peptide Matrix (SAPM) can grow into a significant length of peptide diffusing into the lesion [In the lesion, it is thought to self-assemble spontaneously and produce 3-dimensional gels comprised of self-styled β-sheet aggregates. In this manner, the attachment of calcium and phosphate from saliva is supposed to be improved, so-called the body’s saliva-driven-remineralization. eventually de novo hydroxyapatite formation [Owing to the limited evidence-based data in the literature concerning the self-assembling peptide p11-4 in the management of white spot lesions, it was found that it will be goal-directed to assess the clinical performance of this recently introduced biomimetic material using a randomized controlled trial, to examine the null hypothesis that self-assembling peptide p11-4 will have the similar clinical performance as fluoride delivery systems in the management of white spot lesion after orthodontic treatment.