CaneStat Modulates Pellicle Properties and Reduces Enamel Erosion In Vivo

This study investigated the interaction of CaneStat, a recombinant hybrid protein, with hydroxyapatite using quartz crystal microbalance with dissipation monitoring (QCM-D), and evaluated its effect on early enamel erosion in vivo. For QCM-D analysis, hydroxyapatite-coated sensors were treated with CaneStat (0.01, 0.025, 0.05, 0.1, and 0.5 mg/mL), followed by saliva exposure to allow acquired pellicle formation. Frequency (Δf) and dissipation (ΔD) shifts were analyzed to estimate film mass, thickness, viscosity, and elasticity. In vivo, a randomized, triple-blind, crossover study was conducted with 18 healthy volunteers. After prophylaxis, participants rinsed with deionized water (negative control), Elmex Erosion Protection (positive control), or CaneStat (0.025 mg/mL). The pellicle was allowed to form for 3 min or 2 h prior to an erosive challenge. The percentage of surface reflection intensity (%SRI) was measured. Data normality was assessed using the Shapiro–Wilk test, and a 2-way repeated-measures analysis of variance/Šidák’s multiple comparisons test was applied ( P  < 0.05). QCM-D results showed that the 0.025-mg/mL concentration produced a film with reduced thickness and mass but higher viscosity and elasticity than other concentrations. Frequency shifts confirmed stable adsorption after saliva exposure and rinsing, while dissipation changes suggested the formation of a viscoelastic layer. In vivo, %SRI was influenced by both treatment and pellicle formation time. At 3 min and 2 h, Elmex (94.2% ± 21.3% and 99.4% ± 21.1%, respectively) and CaneStat (96.6% ± 19.6% and 115.7% ± 33.7%, respectively) showed higher values than deionized water (60.1% ± 11.7% and 77.5% ± 16.8%, respectively), indicating protection against initial erosion compared with the negative control. CaneStat promoted the formation of a pellicle with distinct physicochemical properties and was associated with increased resistance to an early erosive challenge in vivo, highlighting the potential of recombinant hybrid proteins as a novel strategy for dental erosion prevention.