Combined Application of Diode Laser and Different Remineralizing Agents on White Spot Lesions (Whitespot)

Clinical Efficacy of Combined Application of Diode Laser and Different Remineralizing Agents on Combined Application of Diode Laser and Different Remineralizing Agents on White Spot Lesions

Dental caries is a very common condition, and although it has become less common, it still represents a serious public health risk. Caries symptoms range from the earliest molecular alterations in the tooth's apatite crystals to an apparent white spot lesion (WSL) or eventual cavitation. The white spot lesion looks chalky because minerals are being lost from both the surface and the underside of the enamel. A relatively simple and noninvasive caries preventive regimen in treating white spot lesions with low-level laser irradiation, either alone or with topical fluoride treatment. This treatment results in reduced enamel solubility and dissolution.

The study was reviewed and approved by the "Ethical research committee "of the Faculty of Dental Medicine for Girls; at Al-Azhar University, Cairo, Egypt. This study was conducted on 90 teeth with white spot lesions (WSLs) detected clinically on the buccal surface of teeth. The patients with WSLs were selected randomly from the operative dentistry clinic at the Faculty of Dentistry, Girl's Branch, Al-Azhar University After examination, the teeth will be assigned into six groups of 15 teeth with white spot lesions each according to the remineralizing material used: The first group (A1B1): The teeth with WSL will be treated with nano-hydroxyapatite +fluoride with laser application. The second group (A1B2): The contralateral teeth will be treated with nano-hydroxyapatite +fluoride without laser application. The third group (A2B1): The teeth with WSL will be treated with nano-hydroxyapatite + xylitol with laser application. The fourth group (A2B2): The contralateral teeth will be treated with nano hydroxyapatite+ xylitol without laser application. The fifth group (A3B1): The teeth with WSL will be treated with 5% sodium fluoride varnish with laser application. The sixth group (A3B2): The contralateral teeth will be treated with 5% sodium fluoride without laser application.

The first group (A1B1):15 teeth with WSL were treated with Remin Pro with laser application. The second group (A1B2): The contralateral 15 teeth were treated with Remin Pro without laser application. The third group (A2B1): 15 teeth with WSL were treated with X Pur Remin with laser application. The fourth group (A2B2): The contralateral 15 teeth will be treated with XPur Remin without laser application. The fifth group (A3B1): 15 teeth with WSL were treated with 5% sodium fluoride varnish with laser application. The sixth group (A3B2): The contralateral 15 teeth were treated with 5% sodium fluoride without laser application

To avoid bias and for proper randomization, the study will be done per patient using tossing a coin to assign the tooth to be either treated with Nano hydroxyapatite with fluoride or Nano hydroxyapatite with xylitol or sodium fluoride.

A photosensitizing-remineralizing agent mixture was prepared by adding pre-green dye (0.05ml) to 1 mg of the assigned remineralizing agents. The diode laser was irradiated immediately with Average power of 1 W, Exposure time of 10 s, diode 810 nm, continuous and non-contact mode, and Irradiation speed of 1mm/ sec.

Used a pea-sized amount with a brush and allowed it to remain on the teeth for at least three minutes as it was recommended by the manufacturer. Instructed the patient to avoid rinsing, eating, and drinking for 30 minutes

A photosensitizing-remineralizing agent mixture was prepared by adding pre-green dye (0.05ml) to 1 mg of the assigned remineralizing agents. The diode laser was irradiated immediately with Average power of 1 W, Exposure time of 10 s, diode 810 nm, continuous and non-contact mode, and Irradiation speed of 1mm/ sec.

used a thin film of toothpaste on a micro brush and then applied it on the tooth surface for three minutes 2- Do not eat, drink or rinse for 30 minutes

A photosensitizing-remineralizing agent mixture was prepared by adding pre-green dye (0.05ml) to 1 mg of the assigned remineralizing agents. The diode laser was irradiated immediately with Average power of 1 W, Exposure time of 10 s, diode 810 nm, continuous and non-contact mode, and Irradiation speed of 1mm/ sec.

Used brush applicator to uniformly apply fluoride Varnish, covering the surface to be treated as a thin film.Instructed patient to avoid hard food, alcohol, brushing or flossing for the next 4

A photosensitizing-remineralizing agent mixture was prepared by adding pre-green dye The diode laser was irradiated immediately with 1 W, Exposure time of 10 s, 810 nm, continuous and non-contact mode.

A photosensitizing-remineralizing agent mixture was prepared by adding pre-green dye The diode laser was irradiated immediately with 1 W, Exposure time of 10 s, 810 nm, continuous and non-contact mode.

Experimental: fluoride varinsh with laser application, Experimental: fluoride varnish without laser application

A photosensitizing-remineralizing agent mixture was prepared by adding pre-green dye The diode laser was irradiated immediately with 1 W, Exposure time of 10 s, 810 nm, continuous and non-contact mode.

The Vita Easy shade spectrophotometer (Vita Zahnfabrik, Bad Säckingen, Germany) was employed for the color assessment WSLs

after the finalization of the remineralization protocol, another radiographic examination was undertaken. Bitewing radiographs of the lesions were taken using the same X-ray unit, film holders for bite recording and vertical angulations for standardizing the geometric projection of the X-ray beam by digital subtraction radiograph.

Inclusion Criteria: The patients should be 13-40 years old. Patients should have good oral hygiene. The patients with good general health and no systemic disease. Exclusion Criteria: - Presence of enamel hypoplasia or dental fluorosis. Presence of carious cavity. Patients who have a significant medical history, Patients who have evidence of reduced salivary flow or significant tooth wear.