Abstract
Dental caries remains a prevalent condition worldwide, prompting the need for minimally invasive, biomimetic approaches to treat early enamel caries (EEC) lesions, which are subsurface caries. Self-assembling peptide (SAP) P11-4 creates a scaffold within EEC lesions that guides hydroxyapatite formation. Although SAP’s remineralisation capacity is well known,
data on its combined use with calcium phosphate (CaP) agents that supply bioavailable ions are limited. This study examined the synergistic remineralisation of SAP P11-4 with three CaP agents: CPP-ACPF, F-ACP, and nHAP.
Artificial EEC lesions were created on 90 (n=18 each group) bovine enamel blocks. Specimens were subjected to a 7-day pH cycling regimen and treated with different combinations of SAP P11-4 and CaP-based agents. Micro-computed tomography (micro-CT) was used to assess changes in mineral density, while nanoindentation evaluated enamel hardness and reduced modulus across lesion depths. Scanning electron microscopy and energy-
dispersive X-ray spectroscopy (SEM/EDX) were used to evaluate elemental composition. Quantitative analyses showed all combinations achieved subsurface remineralisation, with SAP P11-4 + CPP-ACPF showing the most pronounced effect, evidenced by high mineral gain (median=18.9%, IQR=21.5) and enhanced nanomechanical properties. SAP P11-4 + F-ACP also performed well (median=12.7%, IQR=18.1), though less consistently, while SAP P11-4 + nHAP showed the least mineral gain (median=8.6%, IQR=16.9). Fluoride in CPP-ACPF and F-ACP likely improved effects, consistent with fluoride-calcium phosphate synergy in commercial agents.
This study supports the hypothesis that combining SAPs with CaP-based agents enhances enamel remineralisation more effectively than either component alone. Findings indicate the need for further in vivo and clinical research and protocol optimisation, progressing towards personalised, non-invasive caries management aligned with minimal intervention dentistry.