Surface pre-conditioning with bioactive glass air-abrasion can enhance enamel white spot lesion remineralization

• Bioactive glass air-abrasion was used to pre-condition enamel white spot lesion.
• Pre-conditioning increased the average surface roughness of the lesion.
• An ultra-thin, clinically insignificant layer was removed from the lesion surface.
• Pre-conditioning enhanced subsequent remineralization using bioactive glass 45S5.

ObjectiveTo evaluate the effect of pre-conditioning enamel white spot lesion (WSL) surfaces using bioactive glass (BAG) air-abrasion prior to remineralization therapy.MethodsNinety human enamel samples with artificial WSLs were assigned to three WSL surface pre-conditioning groups (n = 30): (a) air-abrasion with BAG-polyacrylic acid (PAA-BAG) powder, (b) acid-etching using 37% phosphoric acid gel (positive control) and (c) unconditioned (negative control). Each group was further divided into three subgroups according to the following remineralization therapy (n = 10): (I) BAG paste (36 wt.% BAG), (II) BAG slurry (100 wt.% BAG) and (III) de-ionized water (negative control). The average surface roughness and the lesion step height compared to intra-specimen sound enamel reference points were analyzed using non-contact profilometry. Optical changes within the lesion subsurface compared to baseline scans were assessed using optical coherence tomography (OCT). Knoop microhardness evaluated the WSLs’ mechanical properties. Raman micro-spectroscopy measured the v-(CO3)2−/v1-(PO4)3− ratio. Structural changes in the lesion were observed using confocal laser scanning microscopy (CLSM) and scanning electron microscopy–energy dispersive X-ray spectrometry (SEM–EDX). All comparisons were considered statistically significant if p < 0.05.ResultsPAA-BAG air-abrasion removed 5.1 ± 0.6 μm from the lesion surface, increasing the WSL surface roughness. Pre-conditioning WSL surfaces with PAA-BAG air-abrasion reduced subsurface light scattering, increased the Knoop microhardness and the mineral content of the remineralized lesions (p < 0.05). SEM–EDX revealed mineral depositions covering the lesion surface. BAG slurry resulted in a superior remineralization outcome, when compared to BAG paste.SignificancePre-conditioning WSL surfaces with PAA-BAG air-abrasion modified the lesion surface physically and enhanced remineralization using BAG 45S5 therapy.