Comparison between fluoride varnish and nanohydroxyapatite in the remineralisation of active white spot lesions: a prospective clinical study

Objective: The initial expression of dental caries, white spot, is still frequent and requires professional care that may or may not be preventive. It is important to carry out research that evaluates different methods of remineralisation of these lesions, both in primary and permanent dentition. Thus, the aim of this study was to compare the remineralisation potential using fluoride varnish and nano-hydroxyapatite toothpaste in split-mouth design. Materials and Methods: For the research, 21 children between 6 and 12 years of age, with active non-cavitated white spots on primary and permanent teeth were selected. As a methodology, the remineralisation procedures were performed in different hemiarchs and each tooth received a different product: fluoride varnish and nano-hydroxyapatite toothpaste, both in 4 sessions, once a week. Results: Were analyzed by a calibrated examiner with no prior knowledge of the applied product; through visual criteria and measurement of white spots in their largest diameter with a digital caliper. Changes in gloss, color, texture and surface integrity were observed. The collected data received statistical treatment by means of the t-Student test, which identified the effectiveness in the reduction and remineralisation of white spots (p<0.05), by the use of fluoride varnish. Conclusion: The fluoride varnish presented statistically significant results in the treatment of active white spots. In the visual clinical evaluation, no differences were observed between fluoride varnish and nano-hydroxyapatite toothpaste. Therefore, more research is needed to offer patients viable and safe alternatives in carie prevention. mayor diámetro, con un pie de rey digital. Se observaron cambios en el brillo, el color, la textura y la integridad de la superficie. Los datos recolectados recibieron tratamiento estadístico por medio de la prueba t-Student, que identificó la efectividad en la reducción y remineralización de las manchas blancas (p<0,05), por el uso del barniz de flúor. Conclusión: El barniz de flúor mostró resultados estadísticamente significativos en el tratamiento de las manchas blancas activas. En la evaluación visual no se observaron diferencias entre el barniz de flúor y el dentífrico nanoparticulado. Se necesita más investigación para ofrecer a los pacientes alternativas viables y seguras en la prevención de caries. In order to minimize individual factors, control for independent variables and biases, and standardize procedures, Grewal et al., 2018 performed an in vitro study in which the therapeutic role of nanohydroxyapatite toothpaste could be observed in mineral loss situations. or damage to enamel. The authors showed that the adoption of biocompatible and bioactive remineralizing materials can be an alternative to fluoride toothpastes. Juntavee et al., 2021 evaluated the effects of two concentrations of nanohydroxyapatite gel on remineralization of an artificial carious lesion compared with nanohydroxyapatite toothpaste and fluoride varnish. The results obtained in this study also showed that nanohydroxyapatite in both toothpaste and gel form was able to remineralize better than fluoride varnish. Although this evaluation was carried out in artificial carious lesions, it does not corroborate our results. Huang et al., 2010 also support the importance of daily use of nano-hydroxyapatite toothpastes. And it reinforces the importance of prospective studies for results close to the reality of patients, since there is a lack of this type of studies as well as good scientific evidence, which is a constant challenge in dentistry, and this corroborates the results found in this clinical study. Therefore, further studies are needed to establish a standardized protocol as an alternative clinical treatment. Although a positive effect of nanohydroxyapatite has not yet been proven in in vivo studies under everyday conditions and with long-term follow-ups, the results of in situ studies may have some clinical relevance for the future. In clinical practice, dentists who, compelling evidence use products. effects of nanohydroxyapatite proved valid vivo nanohydroxyapatite viable option