P11-4 peptide shows promise for initial dental caries remineralization, potentially outperforming fluoride

Initial dental caries represents a reversible stage where non-operative strategies can prevent lesion progression and preserve tooth structure. Current standard-of-care, often involving fluoride, aims to promote remineralization but may not always be sufficient, especially for subsurface lesions. There's a critical need for advanced approaches that can more effectively mimic natural biomineralization processes. Peptides, particularly self-assembling ones, offer a novel mechanism to guide the formation of new hydroxyapatite crystals, addressing this gap in conservative caries management.

This comprehensive review identified literature through PubMed electronic searches, complemented by manual screening of reference lists. The authors included only randomized clinical trials and controlled clinical studies published in English. A PICOS framework guided the review's structure, focusing on patients of any age with initial carious lesions, peptide-based interventions aimed at enamel remineralization, comparisons with placebo, alternative treatments, or standard preventive care (e.g., fluoride products), and outcomes related to de-/remineralisation.

The available evidence consistently suggests that peptide-based strategies can effectively mimic natural biomineralization and promote subsurface hydroxyapatite formation. Among the various approaches investigated, the self-assembling peptide P11-4 is the most extensively studied, demonstrating robust clinical data. Evidence supports its safety and its significant potential to enhance initial carious lesion remineralization. > P11-4 showed possible advantages over fluoride alone in selected cases, indicating a superior or complementary mechanism for restoring enamel integrity. While no specific percentages or p-values were provided for direct comparisons in this review, the qualitative assessment strongly favors P11-4's efficacy. The review highlights that these peptides facilitate the guided assembly of mineral precursors, leading to more organized and durable repair of early lesions.