Evaluation of Self-assembling Peptides Versus Amorphous Calcium Phosphate in the Treatment of White Spot Lesions

Ain Shams University18 enrolled

Overview

This clinical trial aims to compare the effectiveness of two remineralizing treatments for white spot lesions (WSLs) on the enamel surfaces of the front teeth. WSLs are early signs of tooth decay, often appearing after orthodontic treatment with braces. These white spots may persist for years and affect the esthetic appearance of teeth. The study will include male and female patients aged 15 to 25 who have at least one early carious lesion (ICDAS scores 1 or 2) on each side of their upper or lower front teeth. The purpose is to determine which treatment - Self-Assembling Peptides (SAP P11-4, Curodont Repair™) or Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP, MI Varnish™) - is more effective in improving the color and reducing the size of these lesions. Researchers will use a split-mouth design, where each patient receives both treatments - one on each side of the mouth. Standardized digital photographs will be taken before and after treatment to assess color changes and lesion size. Patients will also rate their satisfaction with the appearance of their teeth after treatment. The main questions the study will answer are: Does SAP P11-4 improve the color of white spot lesions more effectively than CPP-ACP? Is there a noticeable difference in lesion size reduction between the two treatments? How satisfied are patients with the outcomes of each treatment? Participants will be followed up at 3, 6, and 9 months after treatment. The results aim to guide clinicians toward the most effective treatment to improve the appearance of white spot lesions in young patients after orthodontic care.

White spot lesions (WSLs) are early signs of tooth decay that appear as milky white spots on tooth enamel, especially common after wearing braces. These lesions can last for many years and negatively affect appearance, especially on front teeth. This study investigates two promising treatment options to reverse or reduce the appearance of WSLs. Study Design This is a randomized, split-mouth, double-blinded clinical trial conducted at the Operative Dentistry Department, Faculty of Dentistry, Ain Shams University. The trial includes patients between the ages of 15 and 25 with visible white spot lesions on both sides of their front teeth (ICDAS scores 1-2). Each patient will receive: SAP P11-4 (Curodont Repair) on one side of the mouth. CPP-ACP (MI Varnish) on the other side. The split-mouth design helps reduce differences between participants and improves the reliability of the results. Intervention Procedure Participants will undergo: Initial oral hygiene instructions and professional cleaning. Standardized digital and cross-polarized photography of the teeth. Treatment application according to manufacturer instructions: SAP P11-4 is applied twice (at baseline and 3 months), after cleaning and etching the enamel surface. CPP-ACP is also applied twice (at baseline and 3 or 6 months), with post-application care instructions (avoid brushing or eating for 4 hours). Outcome Measures Primary outcome: Change in color of the white spot lesions over 9 months, measured using digital photography and color analysis software (eLAB-prime). Secondary outcomes: Change in lesion size. Visual scoring using the ICDAS II system. Patient satisfaction with the treatment results, collected through a questionnaire. The study aims to determine which treatment is more effective at improving the appearance and reducing the visibility of WSLs, with the goal of guiding future esthetic dental care.

Interventions

Self-Assembling Peptide P11-4 Self-Assembling Peptide P11-4 is a biomimetic material applied topically to white spot lesions on the enamel. It diffuses into the lesion body and forms a three-dimensionOTHER

Intervention: Self-Assembling Peptide P11-4 Intervention Description: Self-Assembling Peptide P11-4 (SAP P11-4) is a synthetic peptide designed to mimic natural enamel matrix proteins. It is applied to cleaned, etched enamel surfaces with white spot lesions. The peptide diffuses into the subsurface lesion and self-assembles into a 3D scaffold that promotes nucleation and growth of hydroxyapatite crystals. In this study, it is applied at baseline and re-applied after 3 months. The product used is Curodont™ Repair. Intervention: Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) Intervention Description: CPP-ACP is a milk-derived peptide complex that stabilizes calcium and phosphate ions in an amorphous form. When applied to enamel surfaces, it delivers these ions to promote remineralization of white spot lesions. In this study, MI Varnish™ is used as the source of CPP-ACP. The varnish is stirred and applied as a thin, uniform layer to cleaned tooth surfaces at baseline and

Eligibility

Sex: ALLMin age: 15 YearsMax age: 25 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age between 15 and 25 years * Presence of at least one tooth on each side of the anterior region (from right canine to left canine) affected by early carious lesions (ICDAS II code 1 or 2) * Lesion size and form must be fully visible and accessible * Willing and able to attend all study visits and follow instructions * Good general health and oral hygiene * Not taking any medication that affects salivary flow * Provided written informed consent Exclusion Criteria: * Evidence of tooth erosion * Prior fluoride varnish application before study treatment * Hypoplastic enamel defects or multiple restorations on facial surfaces of anterior teeth * High caries risk patients * Known or suspected allergy to milk proteins * Use of medications affecting salivary flow

Outcomes

Primary Outcomes

Change in white spot lesion color using standardized cross-polarized photography and digital color analysis

The primary outcome is the change in the color of enamel white spot lesions, assessed through standardized digital photographs taken at baseline and at 3, 6, and 9 months. Images will be analyzed using eLAB-prime software for objective color quantification.

Time frame: Baseline, 3 months, 6 months, and 9 months

Secondary Outcomes

Change in lesion size of white spot lesions based on standardized clinical photographs

Lesion size will be evaluated using standardized digital photographs taken at baseline and at 3, 6, and 9 months. Photographs will be used to measure lesion dimensions and determine any reduction or progression in size over time.