Dose-Response Effects of Zinc and Fluoride on Caries Lesion Remineralization

The present mechanistic in vitro study aimed to investigate dose-response effects of zinc and fluoride on caries lesion remineralization and subsequent protection from demineralization. Artificial caries lesions were created using a methylcellulose acid gel system. Lesions were remineralized for 2 weeks using citrate-containing artificial saliva which was supplemented with zinc (0–153 µmol/l) and fluoride (1.1 or 52.6 µmol/l) in a 7 × 2 factorial design. Lesions were also remineralized in the absence of zinc and citrate, but in the presence of fluoride. After remineralization, all lesions were demineralized for 1 day under identical conditions. Changes in mineral distribution characteristics of caries lesions after remineralization and secondary demineralization were studied using transverse microradiography. At 1.1 µmol/l fluoride, zinc exhibited detrimental effects on remineralization in a dose-response manner and mainly by preventing remineralization near the lesion surface. At 52.6 µmol/l fluoride, zinc retarded remineralization only at the highest concentration tested. Zinc enhanced overall remineralization at 3.8–15.3 µmol/l. At 76.5 and less so at 153 µmol/l, zinc showed extensive remineralization of deeper parts within the lesions at the expense of remineralization near the surface. Citrate did not interfere with remineralization at 1.1 µmol/l fluoride, but enhanced remineralization at 52.6 µmol/l fluoride. Lesions exhibiting preferential remineralization in deeper parts showed higher mineral loss after secondary demineralization, suggesting the formation of more soluble mineral phases during remineralization. In summary, zinc and fluoride showed synergistic effects in enhancing lesion remineralization, however only at elevated fluoride concentrations.