Dr. MacLean is an international speaker and owner of Affiliated Children’s Dental Specialists in Glendale, AZ. She is a Diplomate of the American Board of Pediatric Dentistry, Fellow of the American Academy of Pediatric Dentistry, Fellow of the American College of Dentists, and Fellow of the Pierre Fauchard Academy. Check out her YouTube channel on minimally invasive dental procedures, @affiliatedchildrensdental, which includes Curodont application tutorials.
As a pediatric dentist, I want to help my young patients maintain good oral health well beyond the time they “graduate” from my practice. That’s one reason why I offer several preventive and noninvasive dental treatments that help delay or avoid surgical restorations. Parents and patients appreciate being given these conservative options that reduce the need for sedation and “drill and fill” dentistry while preserving natural tooth structure for as long as possible.
Curodont Repair Fluoride Plus is the newest option available for the treatment of incipient caries lesions. Thanks to revolutionary biomimetic hard tissue remineralization, Curodont avoids a surgical approach by utilizing a self-assembling peptide, P11–4. A recent systematic review and meta-analysis published in the Journal of the American Dental Association found P11–4 to reduce cavitation in initial caries lesions.1 It works by diffusing into the subsurface lesion, forming a 3D matrix, attracting minerals from saliva, and then forming de novo hydroxyapatite crystals.2, 3, 4
The End of “Watch and Wait”
A 19-year-old patient presented for a recall visit with incipient proximal caries lesions on his permanent molars. I reviewed the importance of improving diet and oral hygiene and discussed why preventing cavitation was critical for the long-term well-being of his teeth. I discussed various treatment options, including topical fluorides, resin infiltration, silver diamine fluoride (SDF), and Curodont Repair Fluoride Plus. The patient promised to improve his brushing and flossing, and along with his mother, opted to have Curodont applied to a noncavitated proximal caries lesion on the distal of the mandibular left first permanent molar (Figure 1).
They opted for this approach rather than just “watching and waiting” because unlike topical fluoride that would not penetrate as deeply into enamel, or SDF that can cause staining, Curodont rebuilds natural hydroxyapatite vs artificial resin filtration.5,6
Straightforward Application
The patient’s teeth were isolated and cleaned with plain pumice (Figure 2). I also could have applied 5% sodium hypochlorite for 20 seconds to remove tooth pellicle. The treatment site was isolated, and 37% phosphoric acid etch was applied for 20 seconds (Figures 3A and 3B), and then rinsed and dried (Figures 4A and 4B).
The Curodont applicator was prepared according to manufacturer’s instructions and applied by squeezing the sponge onto the proximal contact area from the buccal, occlusal, and lingual aspects (Figures 5A and 5B). Then, I allowed it to absorb for 5 minutes.
You can use a Hollenback or plastic instrument to help press the sponge against the teeth, as well as twist and fold the applicator—like wringing out a mop—to help express the liquid out of the sponge and onto the tooth. The liquid must come directly from the sponge in order for the peptide technology to be delivered to the enamel.
After 5 minutes, fluoride varnish was applied, which is optional. The patient was instructed not to rinse, eat, or drink for 30 minutes. A new bitewing x-ray was taken at a 6-month follow-up visit, confirming the incipient proximal lesion did not cavitate (Figure 6).
Well Received Remineralization
The patient and his mother were extremely grateful for this conservative approach to remineralizing natural dentition and avoiding the restorative cycle. Offering minimally invasive treatment options like Curodont has been well-received by the families in my practice, which helps build patient loyalty and increases my word-of-mouth referrals.
References:
1. Keeper, JH, Kibbe LJ, Thakkar-Samtani M, et al. Systematic review and meta-analysis on the effect of self-assembling peptide P11–4 on arrest, cavitation, and progression of initial caries lesions. JADA. 2023;154:580–591.
2. Welk A, Ratzmann A, Reich M, et al. Effect of self-assembling peptide P11–4 on orthodontic treatment-induced carious lesions. Sci Rep. 2020;10(1):6819.
3. Doberdoli D, Bommer C, Begzati A, et al. Randomized clinical trial investigating self-assembling peptide P11–4 for treatment of early occlusal caries. Sci Rep.2020;10(1):4195.
4. Kind L, Stevanovic S, Wuttig S, et al. Biomimetic remineralization of carious lesions by self-assembling peptide. J Dent Res. 2017;96(7):790–797.5.
5. Alkilzy M, Santamaria RM, Schmoeckel J, Splieth CH. Treatment of carious lesions using self-assembling peptides. Adv Dent Res. 2018;29(1):42–47.
6. Schlee M, Schad T, Koch JH, et al. Clinical performance of self-assembling peptide P11–4 in the treatment of initial proximal carious lesions: A practice-based case series. J Investig Clin Dent. 2018;9(1):e12286.