The effect of casein phosphopeptide-amorphous calcium phosphate on remineralization of artificial caries-like lesions: an in vitro study

Effect of resin-modified glass ionomer containing bioactive glass on the flexural strength and morphology of demineralized dentin

INTRODUCTION

Recently, bioactive materials have been incorporated into glass ionomer cements to promote the precipitation of calcium phosphates in surrounding tooth structures. This in vitro study was undertaken to evaluate the effect of resin-modified glass ionomer (RMGI) containing bioactive glass (RMGI-BAG) on the flexural strength (FS) of demineralized dentin.

MATERIALS AND METHODS

A total of 120 dentin bars (2×2×6 mm) were prepared from sound human third molars. Of these, 60 bars were immersed in a demineralizing solution for 96 hours. This produced dentin in two demineralization conditions (DC): untreated and demineralized. Each dentin bar was immersed for 14 days in simulated body fluid (SBF) at 37°C. Three immersion conditions (IC) were investigated: IC1-SBF only; IC2-SBF + an RMGI bar; IC3-SBF + an RMGI-BAG bar. The combination of the DCs and ICs produced six groups (n=20). FS values of the specimens were measured using a three-point bending test. The microstructural changes and the elemental contents of dentin surfaces were evaluated by scanning electron microscopy. Data were analyzed using a two-way analysis of variance (ANOVA) for the effects of the two independent variables, ie, DC and IC, on mean flexural strength. Tukey multiple comparison tests and simple main effects models were used as needed. The significance level of all tests was set at α=0.05.

RESULTS

Both DC (p=0.001) and IC (p=0.049) significantly influenced FS (two-way ANOVA). The interaction between DC and IC did not significantly affect FS (p=0.36). For undemineralized dentin, IC did not affect the mean FS (simple main effects model; p=0.4). However, for demineralized dentin, IC significantly affected FS (small main effects model; p=0.008). The Tukey test showed that for demineralized dentin, the mean FS produced by immersion in SBF + RMGI-BAG was significantly stronger than that produced by either immersion in SBF only (p=0.011) or in SBF + RMGI (p=0.034). Scanning electron microscope/energy-dispersive x-ray spectroscopy analyses revealed more calcium and phosphate ions on the surface of dentin immersed in SBF + RMGI-BAG than on dentin immersed in SBF + RMGI.

CONCLUSION

Immersion in SBF + RMGI-BAG increased the FS of demineralized dentin more than immersion in SBF + RMGI.

Biofunctional properties of caseinophosphopeptides in the oral cavity

Caseinophosphopeptides (CPPs), bioactive peptides released from caseins, have the ability to enhance bivalent mineral solubility. This is relevant to numerous biological functions in the oral cavity (promotion of tooth enamel remineralisation, prevention of demineralisation and buffering of plaque pH). Therefore, CPPs may play a positive role as prophylactic agents for caries, enamel erosion and regression of white spot lesions. Most in vitro and in situ studies demonstrate strong evidence for the bioactivity of CPPs in the oral cavity. Nevertheless, relatively little is known concerning their use as adjuvants for oral health and more particularly regarding their long-term effects on oral health.

Remineralization of early enamel lesions using casein phosphopeptide amorphous calcium Phosphate: an ex-vivo study

Objective:

This study aimed at qualitatively evaluating the remineralization potential of casein phosphopeptide amorphous calcium phosphate on artificial early enamel lesions in an ex-vivo scenario by observing the treated tooth surface using a scanning electron microscope (SEM).

Materials and Methods:

This randomized study was conducted on 10 subjects undergoing orthodontic treatment with premolar extraction as part of their treatment. Artificial white lesions were created with the application of 37% phosphoric acid for 20 mins. Teeth were then divided into two groups: one experimental and the other control. Customised orthodontic band with a window was luted with intermediate restorative material in the experimental group whereas in the control group, band without a window was luted. The casein phosphopeptide amorphous calcium phosphate (GC TOOTH MOUSSE) paste was then applied on the window region of the experimental group for 3 mins thrice daily after meals for 14 days, whereas no paste was applied in the control group. After 14 days, teeth were extracted and viewed under an SEM.

Results:

The study groups showed remineralization of the lesions as compared with the control group in most of the samples.

Conclusion:

Casein phophopeptide could significantly remineralize the artificial enamel lesions in vivo.

In vivo remineralising effect of GC tooth mousse on early dental enamel lesions: SEM analysis

OBJECTIVE

Casein phosphopeptide-amorphous calcium phosphate nanocomplexes (CPP-ACP) exhibit anticariogenic potential in laboratory, animal and human experiments. The remineralising potential of synthetic CPPs on early enamel caries was investigated.

DESIGN

In vivo study.

SETTING

University of Naples 'Federico II', School of Dentistry, Department of Paediatric Dentistry, 2010, Italy.

PARTICIPANTS

40 volunteers (age range 10-16 years) were recruited and divided in two groups of 20 (Group A and B).

INTERVENTIONS

In Group A subjects two demineralised enamel specimens were placed on the buccal surfaces of the first molars and subjects were instructed to apply a commercial product containing CPPs (GC Tooth Mousse) only on the right-sided specimen and a placebo mousse on the left, for 1 month. In Group B subjects two enamel specimens were similarly placed into the mouth and used as controls.

RESULTS

SEM analysis revealed a diffuse and homogeneous mineral coating, reducing the surface alterations only in the demineralised specimens treated with synthetic CPPs into the mouth.

CONCLUSIONS

Results demonstrate that CPPs are able to promote remineralisation of early enamel lesions.

Early childhood caries

Dental caries is one of the most common childhood diseases, and people continue to be susceptible to it throughout their lives. Although dental caries can be arrested and potentially even reversed in its early stages, it is often not self-limiting and progresses without proper care until the tooth is destroyed. Early childhood caries (ECC) is often complicated by inappropriate feeding practices and heavy infection with mutans streptococci. Such children should be targeted with a professional preventive program that includes oral hygiene instructions for mothers or caregivers, along with fluoride and diet counseling. However, these strategies alone are not sufficient to prevent dental caries in high-risk children; prevention of ECC also requires addressing the socioeconomic factors that face many families in which ECC is endemic. The aim of this paper is to systematically review information about ECC and to describe why many children are suffering from dental caries.

Effect of CPP-ACP Application on Flexural Strength of Bleached Enamel and Dentin Complex

In the absence of saliva, flexural strength of the bovine enamel-dentin complex decreases after in vitro simulation of both at-home and in-office bleaching procedures. Application of Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) subsequent to both bleaching regimens could compensate for this decrease.

Effect of prophylactic pastes containing active ingredients on the enamel-bracket bond strength of etch-and-rinse and self-etching systems

OBJECTIVE

To evaluate the effect of prophylactic pastes containing active ingredients such as amorphous calcium phosphate (ACP), fluoride, or a combination of both on the enamel-bracket tensile bond strength.

MATERIALS AND METHODS

Human molars were randomly divided into four groups (N = 40) according to the type of prophylactic pastes: control (no active ingredients), paste containing fluoride, paste containing ACP, and paste containing both fluoride and ACP. After prophylaxis, 20 brackets per group were bonded using an etch-and-rinse bonding technique (37% phosphoric acid and Ortho solo), and the other remaining 20 brackets were bonded using a self-etch bonding technique (Clearfil S(3)Bond). Samples were tested for tensile strength 24 hours after bonding using a universal testing machine. Data were analyzed using analysis of variance (ANOVA) and Student's t-test with significance level at .05.

RESULTS

The mean tensile bond strength varied between 3.043 (ACP) and 9.232 (control) MPa. The etch-and-rinse bonding technique was significantly affected by pastes containing active ingredients (P < .001). The self-etching system was not significantly affected by different pastes (P > .05).

CONCLUSIONS

Cleaning enamel surfaces with prophylactic pastes that contain ACP and/or fluoride, prior to orthodontic bonding, resulted in a statistically significant decrease in the tensile bond strength of etch-and-rinse bonding technique.

Effects of a fluoride-containing casein phosphopeptide-amorphous calcium phosphate complex on the shear bond strength of orthodontic brackets

The purpose of this study was to investigate the effects of enamel pre-treatment with a new fluoride-containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) complex on the shear bond strength (SBS) of brackets bonded with etch-and-rinse or self-etching adhesive systems. The material comprised 66 extracted human premolars randomly divided into six equal groups with respect to the enamel pre-treatment and adhesive system employed: 1. No pre-treatment and brackets bonded with the etch-and-rinse adhesive system (Transbond XT). 2. Pre-treatment with fluoride-containing CPP-ACP paste (MI Paste Plus) and Transbond XT. 3. Pre-treatment with non-fluoride CPP-ACP paste (MI Paste) and Transbond XT.4. No pre-treatment and brackets bonded with the self-etching adhesive system (Transbond Plus). 5 and 6. Enamel pre-treated as for groups 2 and 3, respectively, and the Transbond Plus. Bonded specimens were subjected to thermal cycling (×1000) before SBS testing. The residual adhesive on the enamel surface was evaluated after debonding with the adhesive remnant index (ARI). Data evaluation was made using one-way analysis of variance and Tukey test for SBS results, and Kruskal-Wallis test for ARI results. The results showed that enamel pre-treatment with either fluoride or non-fluoride CPP-ACP paste had no significant effect on the SBS of the self-etching adhesive system (P > 0.05). Enamel pre-treatment with non-fluoride CPP-ACP in group 3 significantly reduced the SBS of the etch-and-rinse adhesive (P < 0.001), while pre-treatment with fluoride-containing CPP-ACP paste (groups 2 and 5) did not affect debonding values (P > 0.05). The fluoride-containing CPP-ACP did not compromise the SBS of brackets bonded with the tested etch-and-rinse and self-etching systems, but its non-fluoride version significantly decreased the SBS of the etch-and-rinse adhesive system.

Comparison of the remineralization potential of CPP-ACP and CPP-ACP with 900 ppm fluoride on eroded human enamel: An in situ study

OBJECTIVE

The aim of this in situ study was to compare the remineralization potential of pastes containing CPP-ACP and CPP-ACP with 900 ppm fluoride on human enamel softened by a cola drink.

DESIGN

Forty-five enamel specimens obtained from human third molar teeth were eroded in a cola drink for 8 min and then attached to intra-oral devices worn by five volunteers. The specimens were subjected to three different in situ remineralization protocols using: (1) CPP-ACP (Group I), (2) CPP-ACP with 900 ppm fluoride (Group II), and (3) saliva (Group III, control). Vickers microhardness measurements were obtained at baseline followed by demineralization and remineralization stages.

RESULTS

The CPP-ACP, CPP-ACP with 900 ppm fluoride and saliva controls resulted in 46.24%, 64.25% and 2.98% increase in post-erosion microhardness values, respectively. One-way ANOVA revealed statistically significant differences in the mean microhardness values between pastes containing CPP-ACP and CPP-ACP with 900 ppm fluoride.

CONCLUSIONS

Both CPP-ACP and CPP-ACP with 900 ppm fluoride substantially remineralized the softened enamel, with the CPP-ACP and fluoride combination showing higher remineralization potential than CPP-ACP. This study confirmed the synergistic effect of fluoride with CPP-ACP on remineralization of eroded enamel.

Anti-cariogenic effect of a cetylpyridinium chloride-containing nanoemulsion

OBJECTIVES

The aim of this pilot study was to investigate the anticaries activity of a nanoemulsion composed of soybean oil, water, Triton X-100 and cetylpyridinium chloride.

METHODS

Tooth blocks (3 mm length x 3 mm width x 2 mm thickness) were cut from smooth surfaces of selected molar teeth using a water-cooled diamond wire saw. The blocks were randomly assigned to three experimental groups: (A) nanoemulsion, (B) 0.12% chlorhexidine gluconate, and (C) no treatment. The formation of dental caries in human tooth enamel was tested using a continuous flow dual-organism (Streptococcus mutans and Lactobacillus casei), biofilm model, which acts as an artificial mouth and simulates the biological and physiological activities observed within the oral environment. Experimental groups A and B were treated with their respective solutions once daily for 30 s on each occasion, while group C received no treatment. 10% sucrose was supplied every 6 h for 6 min to simulate meals and pH cycling. The experiment lasted for 5 days, and the tooth blocks were harvested and processed for demineralization assessment using transverse microradiography (TMR).

RESULTS

For both lesion depth and mineral loss, statistical analysis indicated that Emulsion was significantly lower than Control and Chlorhexidine, and Chlorhexidine was significantly lower than Control.

CONCLUSIONS

We conclude that cetylpyridinium-containing nanoemulsions appear to present a feasible means of preventing the occurrence of early caries.

Regression of post-orthodontic lesions by a remineralizing cream

Orthodontic patients have an increased risk of white-spot lesion formation. A clinical trial was conducted to test whether, in a post-orthodontic population using fluoride toothpastes and receiving supervised fluoride mouthrinses, more lesions would regress in participants using a remineralizing cream containing casein phosphopeptide- amorphous calcium phosphate compared with a placebo. Forty-five participants (aged 12-18 yrs) with 408 white-spot lesions were recruited, with 23 participants randomized to the remineralizing cream and 22 to the placebo. Product was applied twice daily after fluoride toothpaste use for 12 weeks. Clinical assessments were performed according to ICDAS II criteria. Transitions between examinations were coded as progressing, regressing, or stable. Ninety-two percent of lesions were assessed as code 2 or 3. For these lesions, 31% more had regressed with the remineralizing cream than with the placebo (OR = 2.3, P = 0.04) at 12 weeks. Significantly more post-orthodontic white-spot lesions regressed with the remineralizing cream compared with a placebo over 12 weeks.

Combining casein phosphopeptide-amorphous calcium phosphate with fluoride: synergistic remineralization potential of artificially demineralized enamel or not?

Recaldent is a product of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). The remineralizing potential of CPP-ACP per se, or when combined with 0.22% Fl gel on artificially demineralized enamel using laser florescence, is investigated. Mesial surfaces of 15 sound human molars are tested using a He-Cd laser beam at 441.5 nm with 18-mW power as an excitation source on a suitable setup based on a Spex 750-M monochromator provided with a photomultiplier tube (PMT) for detection of collected autofluorescence from sound enamel. Mesial surfaces are subjected to demineralization for ten days. The spectra from demineralized enamel are measured. Teeth are divided into three groups according to the remineralizing regimen: group 1 Recaldent per se, group 2 Recaldent combined with fluoride gel and ACP, and group 3 artificial saliva as a positive control. After following these protocols for three weeks, the spectra from the remineralized enamel are measured. The spectra of enamel autofluorescence are recorded and normalized to peak intensity at about 540 nm to compare spectra from sound, demineralized, and remineralized enamel surfaces. A slight red shift occurred in spectra from demineralized enamel, while a blue shift may occur in remineralized enamel. Group 2 shows the highest remineralizing potential. Combining fluoride and ACP with CPP-ACP can give a synergistic effect on enamel remineralization.

In vitro evaluation of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) effect on stripped enamel surfaces. A SEM investigation

OBJECTIVES

Interproximal enamel reduction (orthodontic stripping) leaves surface-roughness that encourages plaque adherence. Sealants and fluoride products have been recommended to avoid possible detrimental effects. The objective of this study was to qualitatively evaluate, by means of scanning electron microscopy (SEM), the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on stripped enamel morphology after exposure to an acid solution.

METHODS

15 extracted lower incisors underwent stripping with metal strips (Horico, 80 microm) by 1 operator. Mesial and distal surfaces were sectioned into 30 samples (22 stripped; 8 unstripped) and assigned to 2 groups: Group A (2 stripped; 2 unstripped) served as control; in Group B (20 stripped; 6 unstripped) tooth mousse containing CPP-ACP was tested. For 8 days, teeth were placed in acid lactic solution for 2h three times a day (from 9a.m. to 9p.m.) with 2h water preservation in between. After each demineralizing bath, samples of group B were coated with CPP-ACP for 5 min before immersion into water.

RESULTS

In Group A, stripped samples exhibited greater demineralization compared to unstripped. In Group B, CPP-ACP reduced enamel dissolution on both intact and abraded samples compared to Group A.

CONCLUSIONS

Injuries to enamel morphology caused by stripping might predispose to greater demineralization in the event of exposure to acid environment. Topical applications of CPP-ACP could be effective in promoting enamel remineralization after interdental stripping.