Advances in Guided Enamel Regeneration: An In Vitro Comparative Study of Biomimetic and Conventional Remineralizing...

Purpose: To evaluate the effectiveness of various remineralizing agents on artificially induced enamel lesions in primary teeth by a pH-cycled In Vitro model. Methods: Four remineralizing agents were tested on exfoliated/extracted primary human teeth in a pH-cycled model: fluoride varnish (FLV); casein phosphopeptide-amorphous calcium phosphate (CPP-ACP); self-assembling peptides-P11-4 (SAP); and poly(amidoamine) (PAMAM) dendrimers. Surface microhardness (SMH) improvement was quantitatively evaluated using Vickers hardness number testing, and surface morphology changes were qualitatively assessed with scanning electron microscopy. Results: Compared to SAP, PAMAM had a higher VHN value, and the difference was statistically significant (P<0.001). The comparison between the FLV and CPP-ACP groups showed a non-significant difference (P=0.56). FLV demonstrated a narrow interquartile range, underscoring its reliability. PAMAM and SAP resulted in a homogenous and smooth enamel surface, indicating successful mineral deposition. FLV and CPP-ACP showed more superficial mineral recovery. Conclusions: The In Vitro findings demonstrate each remineralizing agent's distinctive benefits and limitations in a controlled setting. Poly (amidoamine) dendrimers' standout performance suggests potential enamel repair strategies, potentially revolutionizing early carious lesion management. Fluoride varnish remains a dependable choice for clinicians, while casein phosphopeptide-amorphous calcium phosphate and self-assembling peptides-P11-4 contribute to biomimetic advancements in dentistry. Guided enamel regeneration through biomimetic approaches is aligned with minimum intervention dentistry principles and could substantially improve oral health outcomes.