Evaluation of Self-assembling Peptides Versus Amorphous Calcium Phosphate in the Treatment of White Spot Lesions

White spot lesions (WSLs) are early signs of tooth decay that appear as milky white spots on tooth enamel, especially common after wearing braces. These lesions can last for many years and negatively affect appearance, especially on front teeth. This study investigates two promising treatment options to reverse or reduce the appearance of WSLs.

Study Design This is a randomized, split-mouth, double-blinded clinical trial conducted at the Operative Dentistry Department, Faculty of Dentistry, Ain Shams University. The trial includes patients between the ages of 15 and 25 with visible white spot lesions on both sides of their front teeth (ICDAS scores 1-2).

Each patient will receive:

SAP P11-4 (Curodont Repair) on one side of the mouth.

CPP-ACP (MI Varnish) on the other side.

The split-mouth design helps reduce differences between participants and improves the reliability of the results.

Intervention Procedure

Participants will undergo:

Initial oral hygiene instructions and professional cleaning.

Standardized digital and cross-polarized photography of the teeth.

Treatment application according to manufacturer instructions:

SAP P11-4 is applied twice (at baseline and 3 months), after cleaning and etching the enamel surface.

CPP-ACP is also applied twice (at baseline and 3 or 6 months), with post-application care instructions (avoid brushing or eating for 4 hours).

Outcome Measures Primary outcome: Change in color of the white spot lesions over 9 months, measured using digital photography and color analysis software (eLAB-prime).

Secondary outcomes:

Change in lesion size.

Visual scoring using the ICDAS II system.

Patient satisfaction with the treatment results, collected through a questionnaire.

The study aims to determine which treatment is more effective at improving the appearance and reducing the visibility of WSLs, with the goal of guiding future esthetic dental care.

Inclusion criteria

• Age between 15 and 25 years
• Presence of at least one tooth on each side of the anterior region (from right canine to left canine) affected by early carious lesions (ICDAS II code 1 or 2)
• Lesion size and form must be fully visible and accessible
• Willing and able to attend all study visits and follow instructions
• Good general health and oral hygiene
• Not taking any medication that affects salivary flow
• Provided written informed consent

Exclusion criteria

• Evidence of tooth erosion
• Prior fluoride varnish application before study treatment
• Hypoplastic enamel defects or multiple restorations on facial surfaces of anterior teeth
• High caries risk patients
• Known or suspected allergy to milk proteins
• Use of medications affecting salivary flow