Characterizing the appearance of ex vivo remineralized white spot lesions with a novel peptide

Sherwin Habibi

Background: White spot lesions (WSLs) are unfortunate post-orthodontic sequelae that compromise the final esthetics of treatment, can result in caries, and can persist indefinitely. Current methods to treat WSLs may promote remineralization, but have not demonstrated consistent improvement with respect to the appearance of the lesion.

Purpose: This study explores the remineralizing potential of a novel peptide, amelogenin-derived peptide 5 (ADP5), in comparison with MI Paste Plus (MIPP) and topical fluoride treatment.

Methods: Artificial WSL lesions were created on ex vivo human molars. Teeth were sectioned into samples and randomly assigned to 1 of 4 arms: (1) a daily regimen of ADP5 solution, (2) a daily regimen of MIPP, (3) a daily regimen of 20,000 ppm fluoride solution, and (4) incubation in an artificial saliva control. Samples were treated for a period of 2 weeks. Photographs were taken prior to and after treatment. Two panels comprising 5 dental professionals and 5 laypersons assessed before-and-after pairs of photographs in a blinded fashion. Scanning electron microscopy was performed on most samples after treatment to assess the subsurface lesion microstructure and the effects of treatment.

Results: After creating WSLs, 11 of these were assigned to the ADP5 group, 12 to the MIPP group, 12 to the fluoride group, and 10 to the control group. The mean improvements assessed by the expert panel were 16%, 16%, 15%, and 8% in the ADP5, MIPP, fluoride solution, and control groups, respectively. The mean improvements assessed by the lay panel were 16%, 13%, 16%, and 8%, respectively. Single factor ANOVA revealed no difference in the amount of improvement across the 4 study groups. SEM images were qualitatively assessed. Samples treated with ADP5 showed an appositional layer of approximately 5 m and a subsurface remineralization depth of 25 m. Control samples did not appear to display any apposition or any remineralization. MIPP and fluoride samples were more variable in their presentation, with subsurface remineralization depths ranging from 0 to 25 m in both groups.

Conclusions: Treatment of WSLs with ADP5 did not produce a significantly greater visual improvement when compared to the other treatment groups or the control over the 2-week period. SEM imaging revealed a more consistently achieved penetrative remineralization in ADP5 groups compared to MIPP and fluoride groups, as well as a thin appositional layer that was often present.

Bio: While Sherwin was born in Halifax, Nova Scotia, his family soon after moved to Ottawa, the beautiful capital city of Canada. There, he went through his formative years, instructed martial arts, and completed his undergraduate degree in Biology at Carleton University. Upon graduation, Sherwin was awarded the Governor General’s Academic Medal for the highest academic standing amongst his peers. He then set out for dental school at the University of Toronto, where he enjoyed immersing himself in all that the program and city had to offer. While in dental school, he developed an interest in orthodontics, and was ecstatic to be accepted to UW Orthodontics.

Calling the faculty by their first names was an uneasy adjustment at first, but Sherwin quickly learned that it reflected the department’s collegiality and warmth. Sherwin feels privileged and extremely proud to have been given the opportunity to complete his orthodontic residency here and to be in such a wonderful environment of excellence and encouragement by its incredible faculty, administration, and support staff. He strongly believes in the noble station of teachers, and hopes to, in some capacity, teach up-and-coming generations of students himself in the future. Sherwin treasures the friendships that he has developed here at UW and is looking forward to continuing them as he moves forward in his career.

Sherwin plans to return home to Canada to practice, where he is excited to enhance the smiles and confidence of his patients. He will continue with his other passions of snowboarding, directing and editing videos, and beatboxing!