Review details contemporary management of white spot lesions with fluoride, CPP-ACP, BioMin, and P11-4

Following orthodontic treatment, white spot lesions (WSLs) are a common complication, representing areas of initial enamel demineralization. These lesions primarily arise from excessive dietary fermentable carbohydrates and inadequate plaque control, leading to aesthetic concerns and increased caries risk. Current standard-of-care often involves basic oral hygiene and fluoride, but more advanced, targeted interventions are needed to effectively reverse or mask these lesions. This review explores various contemporary approaches, including novel peptide-based therapies, to address the persistent challenge of WSL management.

This review article synthesized contemporary evidence on white spot lesion (WSL) management following orthodontic treatment. Researchers conducted a comprehensive overview of high-quality trials, focusing on the aetiology and various treatment modalities. The scope included topical agents such as fluoride treatments, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), BioMin, and the self-assembling peptide P11-4, alongside resin infiltration. The article also incorporated a cost comparison of these different approaches to inform clinical decision-making for general dental practitioners and specialists.

The review highlights several contemporary approaches for WSL management, each targeting different aspects of enamel repair or masking. Topical agents discussed include fluoride treatments, which promote remineralization by enhancing enamel's resistance to acid dissolution. Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is presented as an agent that delivers bioavailable calcium and phosphate ions to the enamel surface, facilitating remineralization. BioMin, a bioactive glass, is also noted for its ability to release ions that aid in enamel repair. A key focus is the self-assembling peptide P11-4, which forms a biomimetic scaffold within the demineralized lesion, guiding the natural remineralization process. Additionally, resin infiltration is detailed as a technique to mask lesions by altering enamel optics, thereby improving aesthetic appearance. The article synthesizes evidence from high-quality trials for these methods and includes a cost comparison to aid clinical decision-making.

The self-assembling peptide P11-4 offers a unique biomimetic approach by creating a scaffold for guided enamel regeneration within WSLs.