Effect of NaF, AmF, KF gels and NaF toothpaste combined with a saliva substitute on dentin lesions in vitro

  • Carolin Walther
  • Manana Kreibohm
  • Sebastian Paris
  • Hendrik Meyer-Lueckel
  • Peter Tschoppe
  • Richard Johannes WierichsEmail author
Original Article



The aim of the present in vitro study was to evaluate the remineralizing effects of NaF, AmF, KF gels and NaF toothpaste in combination with a potentially demineralizing saliva substitute (Glandosane; pH = 5.1) being widely used in Germany.


In each of 120 dentin specimens, three artificial lesions were created. One lesion was covered for analysis of pre-demineralization (ΔZB). Treatments during pH cycling (3 × 1 h demineralization/day [pH = 5.0] and 3 × 3 h Glandosane/day; 12 h 100%humidity) were as follows: no treatment (NT), application (5 min,2×/day) of 12.500 ppm F [pH = 6.04] (NaF-gel1), 12.500 ppm F [pH = 7.34] (NaF-gel2), 12.500 ppm F [pH = 5.82] (AmF-gel), 1450 ppm F [pH = 7.35] (KF-gel), and 5000 ppm F [pH = 8.14]; (NaF-TP) for 7 days (E1). Subsequently, from each specimen, one lesion was covered, while the remaining lesion was cycled for another 7 days (E2). Differences in integrated mineral loss (ΔΔZE1/ΔΔZE2) were calculated between values before and after pH cycling.


Mean (95%CI) ΔZB was 3851 (3762;3939) vol% × μm. Except for NaF-gel2 and NaF-TP, specimens of all other groups further demineralized. Only NaF-gel2 induced a significant gain in mineral content (p ≤ 0.004; paired t test). Significant differences in the change of mineral loss were found between NT and all fluoride groups for both ΔΔZE1 and for ΔΔZE2 (p < 0.05, Bonferroni post hoc test). However, only NaF-gel2 and NaF-TP induced remineralization.


Under the in vitro conditions chosen, all fluoride agents could significantly hamper the adverse effects of a demineralizing saliva substitute.

Clinical significance

In combination with a demineralizing saliva substitute, slight mineral gain was only observed for neutral NaF-gel2 and 5000 ppm F toothpaste.


Remineralization Fluorides Saliva Dentin Non-cavitated caries lesions pH cycling Hyposalivation 



This study was conducted as part of the doctoral thesis of M.K.


This study was funded by the authors and their institution. Products were not provided by the manufacturers.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interests.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Operative Dentistry, Periodontology and Preventive DentistryUniversity Hospital RWTH AachenAachenGermany
  2. 2.Department of Operative Dentistry and PeriodontologyUniversity School of Dental Medicine, CharitéCentrum 3, Charité – Universitätsmedizin BerlinBerlinGermany
  3. 3.Department of Restorative, Preventive and Pediatric Dentistry, zmk bernUniversity of BernBernSwitzerland
  4. 4.Department of Biohybrid & Medical Textiles (BioTex), AME - Institute of Applied Medical EngineeringHelmholtz InstituteAachenGermany

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