Effect of papain gel pretreatment on the remineralizing potential of casein phosphopeptide–amorphous calcium phosphate fluoride varnish in white spot lesions: A randomized controlled trial

Aim: This study aimed to compare the remineralizing potential of casein phosphopeptide–amorphous calcium phosphate fluoride (CPP-ACPF) varnish alone and CPP-ACPF varnish after applying papain gel, quantitatively using LASER fluorescence readings and qualitatively using scanning electron microscopy (SEM). Materials and Methods: A total of 108 permanent teeth with white spot lesions were divided into Group I: papain gel applied before CPP-ACPF varnish and Group II: CPP-ACPF varnish alone. Remineralization was monitored with DIAGNOdent laser fluorescence readings at baseline, 1, 3, 6, and 9 months. In addition, we randomly selected three samples from each Group after treatment for SEM evaluation. Results: Statistical analysis revealed no significant difference in remineralization efficacy between the two groups. However, the percentage reduction in DIAGNOdent readings from baseline to 9 months was significantly higher in Group I than in Group II. SEM analysis supported these findings by showing better surface integrity in Group I samples. Conclusion: Although overall remineralization efficacy did not differ significantly between groups, the combination treatment (papain gel + CPP-ACPF varnish) demonstrated increased longevity of preventive outcomes compared to CPP-ACPF varnish alone. The trial was prospectively registered at CTRI under registration number 2020/01/022962.