title: A Comparative Analysis of Caries Inhibitory Effect of Remineralizing Agents on Human Enamel Treated With Er:YAG Laser: An In-vitro Atomic Emission Spectrometry Analysis.
abstract: BACKGROUND
  The tug of war to maintain tooth integrity is dependent on a ratio between demineralization and remineralization. Hence, demineralization should be retarded and remineralization should be enhanced to maintain a natural equilibrium in the oral cavity.
  
  
  OBJECTIVE
  To compare in-vitro acid resistance of human enamel when using Casein Phosphopeptides Amorphous Calcium Phosphate (CPP-ACP) [GC Tooth mousse] cream, Casein Phosphopeptide Amorphous Calcium Fluoride Phosphate (CPP-ACFP) [GC Tooth mousse plus] cream, Er:YAG laser alone, combination of CPP-ACP with Er:YAG laser, CPP-ACFP with Er:YAG laser.
  
  
  METHODS
  An in-vitro study was done on 100 specimens which were prepared from 50 human premolars to investigate the caries inhibitory effect of remineralizing agents and laser on enamel using an atomic emission spectrometry analysis. The enamel specimens were randomly allocated into 6 groups: Untreated (control); CPP-ACP (GC Tooth mousse); CPP-ACFP (GC Tooth mousse plus); Er:YAG laser treatment alone; CPP-ACP with Er:YAG laser; CPP-ACFP with Er: YAG laser. Then specimens were immersed individually in 5ml of acetate buffer solution (0.1mol/L, pH 4.5) and incubated at 37°C for 24 hours, to determine the acid resistance by analyzing the calcium release using atomic emission spectrometry. An ANOVA model was constructed (p-value 0.05), followed by post-hoc Tukey's test for multiple pair wise comparisons of mean values.
  
  
  RESULTS
  There was a significant difference among the various groups with respect to amount of calcium released (p<0.001). The lowest mean score of calcium release was observed for CPP-ACFP with Er:YAG laser followed by CPP-ACFP but the differences between these groups were statistically not significant (p>0.05). Similarly the differences between CPP-ACP with Er:YAG laser and CPP-ACP also were not significant (p>0.05). The highest mean score of calcium release was for Er:YAG laser and no significant statistical difference was noticed in comparison with control group (p>0.05).
  
  
  CONCLUSIONS
  Combination of CPP-ACFP with Er:YAG laser is more effective in decreasing enamel demineralization when compared with other groups.
authors.affiliation: Senior Lecturer, Department of Paedodontics, Noorul Islam College of Dental Sciences , Aralumoodu, Neyyatinkara, Trivandrum, Kerala, India .
authors.forename: Aswin Saseendran
authors.initials: AS
authors.lastname: Nair
authors.affiliation: Professor, Department of Paedodontics and Preventive Dentistry, Rajah Muthaih Dental College and Hospital, Annamalai University , Chidambaram, Tamil Nadu, India .
authors.forename: R Krishna
authors.initials: RK
authors.lastname: Kumar
authors.affiliation: Professor, Department of Paedodontics, Noorul Islam College of Dental Sciences , Aralumoodu, Neyyatinkara, Trivandrum, Kerala, India .
authors.forename: Sunil Thomas
authors.initials: ST
authors.lastname: Philip
authors.affiliation: Senior Lecturer, Department of Paedodontics and Preventive Dentistry, Rajah Muthaih Dental College and Hospital, Annamalai University , Chidambaram, Tamil Nadu, India .
authors.forename: Syed Shaheed
authors.initials: SS
authors.lastname: Ahameed
authors.affiliation: Senior Lecturer, Department of Paedodontics and Preventive Dentistry, Rajah Muthaih Dental College and Hospital, Annamalai University , Chidambaram, Tamil Nadu, India.
authors.forename: Sairaj
authors.initials: S
authors.lastname: Punnathara
authors.affiliation: Reader, Department of Paedodontics and Preventive dentistry, Rajah Muthaih Dental college and Hospital, Annamalai University , Chidambaram, Tamilnadu, India .
authors.forename: Joby
authors.initials: J
authors.lastname: Peter
keywords: Acid resistance; Enamel remineralization; Erbium laser; Tooth mousse