Comparison of the effects of toothpastes containing nanohydroxyapatite and fluoride on white spot lesions in orthodontic patients: A randomized clinical trial

Mohammadreza Badiee, Nima Jafari, Sayedali Fatemi, Nazila Ameli, Shahin Kasraei, Asghar Ebadifar


Background: Studies show that fluoride (F) and nano‑hydroxyapatite (nano‑HA) would result in
remineralization of white spot lesions (WSLs), which are among the most prevalent consequences
of fixed orthodontic treatment. The present study evaluates and compares the clinical effects of an
Iranian toothpaste containing nano‑HA with F‑containing one on early enamel lesions.
Materials and Methods: In this randomized clinical trial study, 50 patients who had received fixed
orthodontic treatment were recruited immediately after debonding. Three photographs, including frontal,
lateral right and left views of occlusion, were obtained. Moreover, surfaces with WSLs were recorded
using DIAGNOdent. Plaque index of each patient determined using disclosing agents. At first visit, each
patient was asked to select one type of toothpaste (nano‑HA containing vs. F containing named A or B),
randomly and were instructed how to brush their teeth (25 patients in each group). Examination was
done at 1, 3, and 6 months’ intervals. Finally, photographs were analyzed by Digimizer (V5) software,
and the lesion extent was recorded in pixels. SAS 9.4 was used to analyze data and was set at 0.05.
Results: According to data, lesion extent showed a significant decrease (P < 0.001). At baseline, the
difference between the two groups regarding the lesion extent was 268 pixels while it dropped to
89 pixels after 6 months. DIAGNOdent results showed that at baseline, fluorescence difference was
0.3 while it reached the number of 0.8 after 6 months, indicating the outperformance of nano‑HA
containing toothpaste.
Conclusion: The Iranian nano‑HA containing toothpaste performed better than F‑containing one
in terms of the amount of remineralization and diminishing the lesion extent.


Fluoride, nano‑hydroxyapatite, toothpaste, white spot lesion

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