# Evaluating the Remineralizing Effects of Calcium Sucrose Phosphate and Casein Phosphopeptide-Amorphous Calcium Phosphate Toothpastes on Artificial Carious Lesions Using Micro-computed Tomography: An In Vitro Investigation

## TL;DR

This study compared two toothpastes for their ability to remineralize early tooth decay in lab conditions using micro-CT scans.

## Contribution

The study provides new empirical evidence on the remineralization efficacy of CaSP and CPP-ACP toothpastes using 3D micro-CT analysis.

## Key findings

- CaSP showed the largest increase in enamel volume after treatment.
- CPP-ACP demonstrated the greatest improvement in enamel mineral density.
- Both toothpastes were effective in remineralizing artificial carious lesions.

## Abstract

Background

White spot lesions (WSLs) are common early indicators of enamel demineralization, particularly in pediatric orthodontic patients. Effective remineralization of these lesions is crucial for preventing further dental decay. This study aimed to evaluate the three-dimensional remineralization efficacy of two commercial toothpastes, calcium sucrose phosphate (CaSP) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), using micro-computed tomography (micro-CT).

Objectives

To compare the remineralization efficacy of CaSP and CPP-ACP on artificially created WSLs in human premolar enamel using micro-CT assessment.

Materials and methods

Freshly extracted, caries-free human premolars were used for the purpose of the study. Teeth with any defects, including caries, non-carious lesions, fractures, or hypocalcifications, were excluded. Teeth were stored in a saline solution with 0.1% thymol at +4°C until experimentation. Enamel slabs (N = 18) of 3 x 3 x 1.5 mm were prepared from the buccal surfaces of the premolars and polished to a mirror-like finish. The slabs were divided into three groups (n=6 each): control, CaSP, and CPP-ACP. Specimens were demineralized in a demineralization solution for 72 hours and then treated with the respective toothpastes or remineralizing solutions for 13 days. Micro-CT scanning was performed to assess changes in enamel volume and mineral density. Statistical analysis included Shapiro-Wilk tests, paired t-tests, and one-way ANOVA with post-hoc Tukey's HSD tests.

Results

Enamel volume changes were significant between groups (p<0.01), with the CaSP group showing the largest remineralization effect. Enamel mineral density changes were also significant (p=0.004), with the CPP-ACP group showing the greatest improvement in mineral density.

Conclusions

CaSP and CPP-ACP are both effective in remineralizing artificial enamel lesions. While CaSP shows comparable efficacy to CPP-ACP, further research is needed to confirm these findings in clinical settings. CaSP paste can be considered a viable, cost-effective alternative for enamel remineralization.