Effect of casein‑phosphopeptide amorphous calcium phosphate and fluoride with/without erbium, chromium‑doped yttrium, scandium, gallium, and garnet laser irradiation on enamel microhardness of permanent teeth

Abstract

Background: Laser therapy, along with the use of fluoridated compounds is a novel technique
suggested for caries prevention. Casein phosphopeptide amorphous calcium phosphate (CPP‑ACP) is
another product suggested for this purpose. This study compared the effect of CPP‑ACP and fluoride
with/without Erbium, chromium‑doped yttrium, scandium, gallium, and garnet laser irradiation on
enamel microhardness of permanent teeth.
Materials and Methods: This in vitro experimental study evaluated 35 extracted third molars. The
teeth were decoronated, and the crowns were split into buccal and lingual halves. The samples were
randomly divided into seven groups (n = 10) of GC Tooth Mousse, MI Paste Plus, laser, fluoride varnish,
laser + GC Tooth Mousse, laser + MI Paste Plus, and laser + fluoride varnish. The baseline microhardness
was measured before the intervention. After the intervention, the samples were kept in artificial saliva
for 1 h and were then immersed in the demineralizing solution for 3 h followed by 21 h of immersion in
the remineralizing solution for a total period of 12 days. Finally, the teeth were kept in the remineralizing
solution for 2 more days. The secondary microhardness of the teeth was then measured. Data were
analyzed using the Shapiro–Wilk test, two‑way ANOVA, and Tukey’s Honestly Significant Difference test.
Results: The fluoride varnish (14.31%) and laser + fluoride varnish (18.79%) groups experienced
minimum reduction in microhardness, while the GC Tooth Mousse group experienced maximum
reduction in microhardness (91.64%) (P < 0.001). Laser irradiation before the application of
remineralizing agents increased the microhardness only in laser + GC Tooth Mousse group ( P < 0.001).
Conclusion: Fluoride varnish increased the enamel microhardness, while GC Tooth Mousse had
no such effect. Laser therapy before the application of remineralizing agents did not significantly
enhance enamel resistance to demineralization.
Key Words: Casein phosphopeptide‑amorphous calcium phosphate nanocomplex, fluorides,
lasers, solid‑state, tooth demineralization, tooth remineralization