Quantitative evaluation of remineralizing potential of three agents on artificially demineralized human enamel using scanning electron microscopy imaging and energy‑dispersive analytical X‑ray element analysis: An in vitro study

Background: The aim of this study is to quantitatively evaluate the remineralization potential of three remineralizing systems as follows: fluoride, casein phosphopeptide‑amorphous calcium phosphate (CPP‑ACP), and CPP‑ACP with fluoride, under scanning electron microscope with energy‑dispersive X‑ray analysis. Materials and Methods: In this in vitro study A total of 40 enamel specimens were prepared from the buccal or lingual surfaces of human premolars extracted for orthodontic reason. Specimens were then placed in demineralizing solution for 96 h, to produce artificial caries‑like lesion. Calcium and phosphate weight percentage of demineralized specimens was measured. Specimens were divided into four groups as follows: (a) control, (b) CPP‑ACP, (c) CPP‑ACP with fluoride, and (d) fluoride varnish. Except for the control group, the entire specimens were subjected to remineralization using respective remineralizing agents of their groups. The prepared specimens were assessed for calcium and phosphate weight percentage using scanning electron microscopy‑energy dispersive X‑ray spectroscopy. One way analysis of variance (ANOVA), followed by Tukey’s test, was performed with the help of critical difference (CD) or least significant difference at 5% and 1% level of significance. P ≤ 0.05 was taken to be statistically significant and P < 0.001 as statistically highly significant. Results: The mean weight percentage of calcium and phosphorus of specimens treated with CPP‑amorphous calcium phosphate nanocomplexes plus fluoride (ACPF) was significantly higher than other groups. Conclusion: All the groups showed statistically significant remineralization. However, because of added benefit of fluoride, CPP‑ACPF showed statistically significant amount of remineralization than CPP‑ACP.