Curodont^TM Repair

Guided Enamel Regeneration (GER) is essentially a tissue regeneration treatment concept wherein tooth enamel is rebuilt after being lost to caries and wear, without the need to drill the tooth.

Curodont^TM Repair is a low-viscosity liquid material that carries the globally patented ‘Monomer-Peptide 10⁴‘ technology in the highest concentration. This revolutionary technology employs a short, ‘intelligent’ peptide, made of naturally occurring amino acids, to promote deposition of hydroxyapatite (the main tooth-building mineral) within carious lesions and stop the progression of incipient lesions

Curodont^TM Repair employs the clinically proven and award-winning ‘Monomer-Peptide 10⁴‘ technology to bring about guided enamel regeneration within early, non-cavitated enamel lesions. When applied, this technology penetrates until the very depth of the carious lesion. Once inside and triggered by the acidic environment of carious lesions, the intelligent peptide monomers assemble to form a matrix, which resembles the natural enamel matrix. This matrix then attracts calcium and phosphate ions from the saliva and promotes the formation and deposition of new hydroxyapatite crystals, essentially reversing the mineral loss seen as a result of caries.

Curodont^TM Repair is a first-in-class, regenerative liquid material that induces guided enamel regeneration in early, active, non-cavitated carious lesions. These lesions appear as white spots with a rough, but intact surface. Visual inspection should be supported by intraoral bitewing or periapical radiographs to assess the depth of the caries and confirm if the lesions are amenable to regenerative measures. For proximal lesions, which may not be visually accessible, radiographs are crucial to the diagnosis of early lesions.
Advanced diagnostic measures, such as laser fluorescence, fibre-optic transillumination, impedance measurement, etc. maybe used to achieve an accurate diagnosis.

Curodont^TM Repair works on active, early, non-cavitated carious lesions. Cavitated lesions, which represent an advanced stage of the carious process, must be treated with restorations that require drilling of the tooth. Detection of caries in their incipient stages is essential to avoid the need to drill the tooth and to provide a simple, pain-free, and anxiety-free solution to patients with Curodont^TM Repair.

Curodont^TM Repair can be used for treatment of early, non-cavitated carious lesions on all tooth surfaces. Therefore, the range of lesions that be treated using Curodont^TM Repair, according to popular classification systems, are as follows:

i. E1, E2, and D1 carious lesions (according to E0-E2, D1-D3 notation system). D1 lesions treated only if they are not cavitated.
Anusavice K. Present and future approaches for the control of caries. J Dent Educ. 2005;69(5):538-854.

ii. D1, D2, and D3 lesions only if they are not cavitated (according to Marthaler/WHO caries classification)
Marthaler TM: A standardized system of recording dental conditions. Helv Odontol Acta 1966;10:1–18.

iii. Score 1, score 2, and score 3 (according to ICDAS II scoring system)
https://iccms-web.com/uploads/asset/592848be55d87564970232.pdf. Accessed 01/02/2022

If the carious lesion is in the form of a microcavity (ICDAS score 3), Curodont^TM Repair may be used to stop the progression of the lesion, but ‘filling’ of the microcavity should not be expected. Further, if frank cavitatation is present, which means a hole has developed in the tooth due to the decay, removal of the caries and a restoration to fill the cavity is needed.

Caries is a slowly progressing dental disease. In its advanced stages, when it has progressed to the middle or inner thirds of dentin, the carious lesions may get cavitated. Once a cavity develops, the only resort is to restore with an artificial plastic material. Drilling and filling of carious lesions is the beginning of the death spiral of a tooth, which eventually ends with tooth loss. Therefore, intervening when the carious lesion is still in its incipient stages avoids or delays the need for restorations and elongates the life of a tooth. Curodont Repair helps regenerate the ‘lost’ enamel and gives teeth a fresh start.

For each lesion, only one application of Curodont^TM Repair is sufficient to bring about reminerlisation over a course of 4-6 months, provided the patient maintains good oral hygiene in this period. The remineralization may continue to increase thereafter.

Curodont^TM Repair has no known side effects and can safely be utilized in children. Regular dental appointments to detect caries in the earliest stages and their drill-free management using Curodont^TM Repair is recommended.

Natural enamel formation in primary and permanent teeth requires a few months to a few years, respectively. As Curodont^TM Repair employs the X+GER technology, which mimics Nature to regenerate enamel, it requires at least 4-6 months to demonstrate discernible remineralization.

When Curodont^TM Repair regenerates enamel within incipient carious lesions, the newly formed hydroxyapatite crystals are deposited in a fan-shaped arrangement on the biomatrix, unlike the prismatic structure of natural enamel. This leads to slightly different optical properties as compared to natural enamel. Due to this, the white appearance of incipient caries treated with Curodont^TM Repair may fade to a significant extent but may not completely disappear.

Curodont^TM Repair, owing to its low viscosity and high affinity to hydroxyapatite, has been found to reach to the depth of early carious lesions and bring about remineralization. Other known remineralising agents, such as fluoride, have been known to bring about a more superficial remineralization leading to arrest of the carious lesion. With fluoride formulations, accompanied by good oral hygiene, inactivation of early carious lesions has been seen to be ~35%, while that with Curodont^TM Repair, inactivation of caries has been observed to be over 80%.* Schmidlin et al. observed that Curodont^TM Repair was able to restore the hardness of enamel at a depth 8 times greater that was possible with fluoride varnish.**

*Alkilzy M, Tarabaih A, Santamaria RM, Splieth CH. Self-assembling Peptide P11-4 and Fluoride for Regenerating Enamel. J Dent Res. 2018 Feb;97(2):148-154 Comment CB: here you could also add the Doberdoli study as additional reference.
**Schmidlin P, Zobrist K, Attin T, Wegehaupt F. In vitro re-hardening of artificial enamel caries lesions using enamel matrix proteins or self-assembling peptides. J Appl Oral Sci. 2016 Jan-Feb;24(1):31-6.

No. Curodont^TM Repair can be used in conjunction with other remineralising agents, such as fluoride varnish, to optimize enamel regeneration and mineralization. In fact, the concurrent use of Curodont^TM Repair and fluoride varnish has been successfully used to produce greater inactivation of caries compared to fluoride varnish alone.*

However, all treatments should be carried out only after an interval of at least 5 minutes after the application of Curodont^TM Repair and not before.

*Alkilzy M, Tarabaih A, Santamaria RM, Splieth CH. Self-assembling Peptide P11-4 and Fluoride for Regenerating Enamel. J Dent Res. 2018 Feb;97(2):148-154.

Doberdoli D et al. Randomized Clinical Trial investigating Self-Assembling Peptide P11-4 for Treatment of Early Occlusal Caries. Sci Rep 2020;10:4195.

Routine oral hygiene measures including brushing with fluoridated toothpastes twice a day must strictly be followed. Additionally, and especially, in cases with early caries on proximal surfaces, interdental flossing must be performed after meals to ensure the cleanliness of the area. Good oral hygiene maintenance is a pre-requisite for the success of any dental treatment.

Resin infiltration is a micro-invasive technology which aims to infiltrate the pores and microspaces of an early carious lesion with a low-viscosity, hydrophilic resin (tetraethyleneglycol dimethacrylate, TEGDMA). While it also aims to treat early non-cavitated carious lesions like Curodont^TM Repair, resin infiltration restores the lost minerals with a foreign, plastic material as opposed to with hydroxyapatite as Curodont^TM Repair does. As the tooth is naturally made up of hydroxyapatite, guided enamel regeneration restores the tooth to its natural, sound state. Moreover, the use of Curodont^TM Repair does not require any special armamentarium and the application can be completed start-to-finish within 10-15 minutes.

Although one application of Curodont^TM Repair per lesion promotes remineralization, it can nevertheless be re-applied 3-6 months after the first application, if the dental professional finds the carious lesion to still be active.

In-vitro studies have shown that Curodont^TM Repair not only promotes enamel regeneration but also inhibits further demineralization of the enamel. * Therefore, the regenerative effect of Curodont^TM Repair on enamel is not limited in time.

*Kirkham J, et al. Self-assembling peptide scaffolds promote enamel remineralization. J Dent Res 2007;86:426-43s