Classical versus non-classical strategies for remineralization of early enamel lesions: Systematic review and meta-analysis

Aim: The aim of this paper was to assess the clinical performance of self-assembling peptide (SAP) in comparison to fluoride varnish in treatment of early enamel lesions. Materials and Methods: The literature search covered the electronic databases such as PubMed, Google Scholar, EBSCOhost, and Cochrane from 2010 to 2020. Only articles published in English were included. In vivo studies, involving human subjects in whom SAP was delivered, were included. Results: Eight hundred and sixty articles were identified from the search after excluding duplicates. Abstracts of articles were reviewed independently. Eight hundred and twenty-four articles were excluded after reading the abstracts. Full-text articles were retrieved for 36 relevant studies. After reviewing articles independently, 25 were excluded after full-text reading. Finally, 11 studies were selected based on the eligibility criteria. All 11 articles reviewed SAP, seven of them compared SAP to fluoride, one compared SAP to no treatment, and three were case series studies. Conclusion: For the treatment of early enamel lesions, non-classical remineralization using SAP whether used alone or in combination with fluoride showed a positive outcome that was superior to that of fluoride varnish. Future studies are speculated to show higher probability to detect a positive effect with SAP.