Effect of xylitol varnishes on remineralization of artificial enamel caries lesions in situ

Objectives: Analyze the effect of varnishes containing xylitol compared to commercial fluoridated varnishes on the remineralization of artificial enamel caries lesions in situ. Methods: Twenty subjects took part in this crossover, double-blind study performed in four phases of 5 days each. Each subject worn palatal appliances containing four predemineralized bovine enamel specimens. Artificial caries lesions were produced by immersion in 30 ml of lactic acid buffer containing 3 mM CaCl2 center dot 2H(2)O, 3 mM KH2PO4, 6 mu M tetraetil metil diphosphanate (pH 5.0) for 6 days. The specimens in each subject were treated once with the following varnishes: 20% xylitol (experimental); Duofluorid (TM) (6% NaF, 6% CaF2), Duraphat (TM) (5% NaF, positive control) and placebo (no-F/xylitol, negative control). The varnishes were applied in a thin layer and removed after 6 h. Fifteen subjects were able to finish all phases. The enamel alterations were quantified by surface hardness and transversal microradiography. The percentage of surface hardness recovery (%SHR), the integrated mineral loss and lesion depth were statistically analyzed by Friedmann and Dunn's tests test (p < 0.05). Results: Enamel surface remineralization was significantly increased by Duraphat (TM), Duofluorid (TM) and 20% xylitol formulations. Significant subsurface mineral remineralization could also be seen for the experimental and commercial varnishes, except for DuraphatTM, when the parameter "lesion depth" was considered. Conclusions: 20% xylitol varnish seem to be a promising alternative to increase surface and subsurface remineralization of artificial caries lesions in situ. Clinical significance: effective vehicles are desirable for caries control. Xylitol varnishes seem to be promising alternatives to increase enamel remineralization in situ, which should be confirmed by clinical studies. (C) 2016 Elsevier Ltd. All rights reserved.