Comparative Evaluation of Three Remineralization Agents—Bioactive Glass, Nanohydroxyapatite and Casein Phosphopeptide-amorphous Calcium Phosphate Fluoride-based Slurry on Enamel Erosion of Primary Teeth: An In Vitro Study

Abstract

Aims and background:To compare and evaluate the effects of bioactive glass (BAG), nano hydroxyapatite (nHAp), and casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF)-based slurry on surface microhardness (SMH) of demineralized enamel. Materials and methods: Thirty-eight extracted deciduous teeth were disinfected in 5.25% sodium hypochlorite solution for 1 hour and stored in 1% thymol prior to specimen preparation. Each tooth was decoronated at the level of the cemento-enamel junction (CEJ), and the crown was sectioned mesiodistally into two halves using a diamond disc. The slurry was prepared by suspending the respective remineralizing agent. The solutions were thoroughly stirred using a magnetic stirrer for 1 minute at room temperature before starting the potential of hydrogen (pH)-cycling. The pH values of all solutions were monitored with a pH-sensitive electrode. After completion of all cycles, microhardness and surface evaluation were done using the Vickers hardness test and sent for scanning electron microscopy (SEM) analysis. Results: Data obtained were compiled, tabulated, and subjected to statistical analysis using IBM SPSS software version 23. ANOVA test and post hoc analysis—Bonferroni test—were used to assess SMH, with ≤0.05 considered statistically significant. Vickers hardness values were analyzed using the ANOVA test. Group I (65.4 ± 3.49) showed the highest hardness value, followed by group IV (58.2 ± 5.02), group III (55.8 ± 10.8), the least among group V (54.2 ± 7.44), and group II (54.1 ± 6.37). The mean hardness values of group I showed a significant difference with all groups except group IV (p = 0.072). Conclusion: nHA had better potential to remineralize enamel. BAG, nHA, and CPP-ACPF enhanced the SMH values, thus can be considered effective for remineralization. Clinical significance: (1) Nano hydroxyapatite promotes remineralization of enamel and would be advantageous in the treatment of enamel erosion. (2) Bioactive glass, nHAp, and CPP-ACPF improve the SMH values, thus can be considered effective for remineralization.