Remineralization of early enamel caries lesions using self-assembling peptides P11-4: Systematic review and meta-analysis

To compare the effectiveness of self-assembling peptides (SAP) P11-4 in remineralising early enamel lesions to that of other remineralising agents.This review was conducted according to PRISMA guidelines. MEDLINE (PubMed), Cochrane and Google Scholar databases were searched up to June 2021. For qualitative analysis, randomised controlled trials and in-vitro investigations were included. For quantitative synthesis, randomised controlled trials with comparable outcomes were used. The risk of bias assessment and meta-analysis were carried out using the RoB 2 tool and RevMan software.This systematic review and meta-analysis included a total of 12 in-vitro studies and 6 randomised controlled trials. SAP P11-4 had superior effect in remineralising early enamel lesions compared to control groups. In Meta-analysis, SAP P11-4 showed superior remineralization when measured using the VAS data {SMD [-0.61 (-0.88, -0.34)]}; significant caries regression according to Nyvad criteria {OR [0.16(0.03,0.88)]}; and significant improvement in the extent of demineralization in test group {SMD [-0.67 (-1.29, -0.05)]} when measured for fluorescence in comparison with other remineralising agents. On the other hand, morphometric measurements {MD [-0.12(-0.25, -0.00)]} and ICDAS criteria {OR [4.91(0.80, 30.22)]} found no difference among the tested materials.Both in-vitro and in-vivo studies showed evidence of superior biomimetic remineralization in the SAP P11-4 group compared to other remineralising agents. However, long term studies are necessary to confirm its suitability in clinical use.