Effect of various remineralising agents on human eroded enamel of primary teeth

Long term remineralizing effect of casein phosphopeptide amorphous calcium phosphate in white spot lesions: A systematic review and meta-analysis

BACKGROUND

White spot lesions (WSLs) appear as white, opaque areas on the teeth and are caused by a demineralization of the enamel.

OBJECTIVE

The purpose of this systematic review and meta-analysis was to determine whether casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has beneficial effects on WSLs and provides remineralizing benefits that are superior to those of placebo or no treatment.

METHODS

Following a thorough analysis of the literature across major online sources, 103 papers - 54 of which underwent in-depth evaluation - were found. We used inclusion and exclusion criteria to choose research articles that were appropriate for our review.

RESULTS

10 papers met this review's requirements and were subsequently included. As compared to the controls, CPP-ACP demonstrated increased efficacy in treatment of WSLs in terms of remineralisation and other parameters which included microhardness tests and enamel surface roughness. The forest plots present the results of meta-analyses comparing the effect of CPP-ACP versus control/other agents on white spot lesions (WSLs). In terms of odds ratios (OR), CPP-ACP showed a small increase in the odds of WSLs compared to control/other agents. In-vitro studies showed no significant difference in relative risk (RR) between CPP-ACP and control/other agents. Randomized control trials indicated a small increase in the risk of WSLs with CPP-ACP treatment, but the overall effect was not statistically significant.

CONCLUSION

There was evidence to support the use of CPP-ACP over other agents for WSL prevention or treatment, but further research is needed to confirm these findings.

Effect of three different remineralising agents on prevention against acidic erosion of primary teeth: an in vitro study

PURPOSE

This study aimed to evaluate and compare the protective effect of fluoride varnish (Enamelast™, Ultradent Inc., Cologne, Germany), casein phosphopeptide-amorphous calcium phosphate fluoride/CPP-ACPF (MI Paste Plus, GC Corp., Tokyo, Japan) and self-assembling P11-4 peptide (Curodont™ Protect, Credentis AG, Windisch, Switzerland), against acidic erosion of primary teeth.

METHODS

Forty primary anterior teeth were randomly assigned to four groups (n = 10): group 1: control, group 2: fluoride varnish, group 3: CPP-ACPF and group 4: self-assembling P11-4 peptide. After applying remineralising agents, except for the control group, all specimens underwent an erosive challenge of carbonated soft drink and artificial saliva for 15 cycles of 6 s each at 6-h intervals for a day. Groups were compared in terms of surface microhardness, roughness readings, and surface scanning with an extra-oral scanner (D800; 3Shape A/S) before and after the erosive process.

RESULTS

All experimental groups showed superior results than the control group regarding microhardness, surface roughness, and substance loss. The fluoride varnish group showed significantly favourable results in microhardness change. There was no significant difference between the experimental groups regarding surface roughness and enamel loss measurements.

CONCLUSION

5% NaF fluoride varnish, CPP-ACPF and self-assembling P11-4 peptide protect the enamel of primary teeth against erosion compared to artificial saliva alone.

Effect of silver diamine fluoride/potassium iodide treatment on the prevention of dental erosion in primary teeth: an in vitro study

INTRODUCTION

Dental erosion has a great effect on oral health, when diagnosed it is irreversible, this sets the importance of different preventive measures being investigated against dental erosion.

AIM

This in vitro study aims to evaluate the effectiveness of silver diamine fluoride and Potassium iodide (SDF-KI) in comparison to casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) varnish, sodium fluoride (NaF) varnish, silver diamine fluoride (SDF) alone and deionized water as a control group in the prevention of dental erosion in primary teeth and assessing its staining effect.

MATERIALS AND METHODS

Forty deciduous teeth enamel specimens were randomly allocated into the five study groups. Tested materials were applied. An erosive challenge was done by immersing the specimens in a citric acid-containing soft drink with pH 2.85, for 5 min, 4 times/day, for 5 days. Changes in surface microhardness, mineral loss, and color change were evaluated besides recording of the surface topography and surface roughness for selected specimens.

RESULTS

The highest decrease in surface microhardness was recorded in the control group (-85.21 ± 10.60%), with a statistically significant difference (p = 0.002). SDF-KI group (-61.49 ± 21.08%) showed no statistically significant difference when compared to CPP-ACPF, NaF, and SDF groups. For calcium and phosphorous loss, control group was statistically significantly higher compared to the treatment groups (p = 0.003) and (p < 0.001) respectively, while there was no statistically significant difference between the tested treatment groups. The highest mean value for color change was recorded in SDF group (26.26 ± 10.31), followed by SDF-KI group (21.22 ± 12.87) with no statistically significant difference between groups.

CONCLUSIONS

SDF-KI is as effective as CPP-ACPF, NaF varnishes and SDF in the prevention of dental erosion in primary teeth, there was no statistically significant difference regarding its staining potential.

Treatment for dental erosion: a systematic review of in vitro studies

Background

Dental erosion is a chemical loss of the mineralized dental tissue caused by exposure to nonbacterial acids. Different treatment protocols have been adopted with the use of fluoride compounds to promote the formation of a layer of mineral precipitation in eroded lesions.

Aim

This systematic review aimed to evaluate the main treatments for dental erosion.

Methodology

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recorded in the Open Science Framework database (OSF) under DOI 10.17605/OSF.IO/XMFNZ. The searches were conducted in six electronic databases (Pubmed, Embase, Web of Science, Cochrane, Scopus, Lilacs) and two grey literature sources (Google Scholar and OpenGrey). The eligibility criteria included in vitro studies that evaluated eroded teeth under treatment with some topical agent. Risk of bias assessment and qualitative synthesis were performed using the Cochrane collaboration's tool for assessing risk of bias modified for in vitro studies.

Results

A total of 522 studies were identified, and only four studies that fulfilled our eligibility criteria were included in this review. Among these studies, three were considered to have a low risk of bias, and one to have a high risk of bias. Two studies evaluated the anti-erosion effect of fluoride toothpaste, and the other two assessed the action of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on the surface of human teeth. Among the products analyzed, CPP-ACP was the only one that promoted a significant increase in enamel microhardness and reduced tooth wear.

Conclusion

Based on the in vitro studies included in this review, there was no anti-erosion effect after using different fluoride toothpaste. However, it should be considered that one of these studies presented a high risk of bias. On the other hand, studies with CPP-ACP showed anti-erosion efficacy when applied before or after erosive wear.

Evaluation of the effects of different remineralisation agents on initial enamel lesions by scanning electron microscope and energy-distributed X-ray analysis

BACKGROUND

This study compared the ability of four remineralization agents to restore demineralised enamel lesions in permanent human incisors.

METHODS

In total, 40 teeth were included in the study. Two samples were obtained from each tooth. The 80 samples were divided into 10 groups (n = 8 per group). The right halves of the teeth were controls solely subjected to demineralisation and stored in artificial saliva for the duration of the experiment. The left halves of the teeth were remineralised using a 5% NaF-containing fluoride varnish (GC MI varnish; GC Corp.), a toothpaste containing casein phosphopeptide and amorphous calcium (GC tooth mousse; GC Corp.), a water-soluble remineralisation paste containing fluoride, hydroxyapatite, xylitol (Remin Pro; Voco), and ROCS remineralising gel containing Ca, magnesium(Mg) and phosphate (P). After 21 days of remineralisation, scanning electron microscopy and energy-dispersive X-ray (EDX) assessments were performed, and the results were analysed using one-way analysis of variance.

RESULTS

EDX analysis showed that the ROCS medical remineralising gel had the lowest Ca/P ratio among the groups (P = .04). Compared with the control groups, the Remin Pro and ROCS medical remineralising gel treatments produced significantly higher Ca/P ratios (P = .014 and P = .025). These results were statistically significant, and P-value <.05 was accepted for statistical significance.

CONCLUSIONS

The group treated with a fluoride-free, xylitol-containing ROCS medical remineralising gel had the lowest Ca/P ratio. Compared with the control groups, Remin Pro and ROCS remineralising gel appeared effective for repairing initial enamel lesions.

Effect of the usage of Er,Cr:YSGG laser with and without different remineralization agents on the enamel erosion of primary teeth

The aim of the present study was to evaluate the effects of different remineralization agents associated with erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) (0.5 W power, 20 Hz frequency, 60% water, 40% air, 25 mJ pulse energy, 8.84 J/cm² fluence, 60 μs pulse duration, 600 μm tip diameter, and an approximate 1-1.5 mm distance to the target) laser irradiation on erosion induced by the consumption of carbonated drinks in human primary enamel. There were 8 groups and 10 primary teeth in each g0roup. The distribution was as follows: group 1, casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF); group 2, Er,Cr:YSGG laser+CPP-ACPF; group 3, fluor varnish; group 4, Er,Cr:YSGG Laser+fluoride varnish; group 5, ROCS® medical mineral gel; group 6, Er,Cr:YSGG laser + ROCS® medical mineral gel; group 7, Er,Cr:YSGG laser; and group 8, artificial saliva. The samples in the groups were submerged in artificial saliva and acid twice a day for 6 s at 6-h intervals and were then exposed to an erosion cycle 15 times. In the groups in which the Er,Cr:YSGG laser was applied in combination with the remineralization agents, the laser application was made first, and then the remineralization agents were applied for 4 min in each group. The Friedman and Wilcoxon signed-rank tests and the Bonferroni correction were used in statistical analyses, and the significance level was taken as p < 0.05. According to the results, all agents had a statistically significant difference (groups 1, 2, 3, 4, and 6: p = 0.005, p < 0.017; groups 5 and 7: p = 0.007, p < 0.017) between BL-RM periods. However, all agents had a statistically significant remineralization effect on primary teeth enamel (groups 1, 2, 3, 6, and 7: p = 0.005, p < 0.017; group 4: p = 0.011, p < 0.017) except that group 5 (p = 0.074, p < 0.017) between DM-RM periods. The coadministration of an agent with the laser did not make any difference at a statistical level (p = 0.804, p > 0.05). The results were supported by scanning electron microscopy (SEM) and X-ray diffraction (XRD) analysis. As a result of this study, CPP-ACPF had a notable impact in terms of the remineralization effect on eroded enamel, and the Er,Cr:YSGG laser alone may be an alternative method, which may be related to the modified hydroxyapatite structure, 38.5% H_0.56Ca_4.56O₁₃P₃Y_0.44, that was determined in XRD analysis.

Evaluation of the efficacy of casein phosphopeptide-amorphous calcium phosphate on remineralization of white spot lesions in vitro and clinical research: a systematic review and meta-analysis

BACKGROUND

This systematic review with meta-analyses sought to answer whether casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) provided a remineralizing benefit superior to that of nonintervention or placebo.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, Cochrane databases, PubMed, EmBase, and Ovid up to May 20th, 2019, were scanned, only published in English. Study information extraction and methodological quality assessments were accomplished independently by two reviewers. The "Criteria for judging risk of bias in the 'Risk of bias' assessment tool" was used for methodological quality assessment. The continuous data was analyzed by mean difference (MD) or standardized mean difference (SMD) with a 95% confidence interval (CI). Review Manager 5.3 was used for statistical analysis. Outcome variables include quantitative light-induced fluorescence in clinical research, average surface roughness and surface microhardness in vitro.

RESULTS

There were significant differences in the quantitative light-induced fluorescence (SMD = - 0.43, 95% CI: [- 0.79, - 0.07], P = 0.02), average surface roughness (SMD = - 8.21, 95% CI: [- 10.37, - 6.04], P < 0.01), Vickers microhardness (SMD = 1.19, 95% CI: [0.72, 1.66], P < 0.01), and Knoop microhardness (SMD = 3.52, 95% CI: [2.68, 4.36], P < 0.01) between the CPP-ACP and control groups or baseline.

CONCLUSION

Within the limitations of this meta-analysis, CPP-ACP exhibited excellent remineralization effects evaluated in clinical research and in vitro, indicating outstanding restoration of form, aesthetics, and function in treating white spot lesions.

Effect of Er,Cr:YSGG on Remineralization Using CPP - ACPF (MI - Paste Plus) after Enamel Erosion Caused by Carbonated Soft Drink in Primary Teeth: In-Vitro Study

BACKGROUND:

Erosion is a widespread phenomenon with higher predilection in primary dentition.

AIM:

The aim of the present study is to assess the remineralising effect of Er,Cr:YSGG laser application combined with CPP-ACPF after erosive demineralisation by Coca-Cola in primary teeth.

METHODS:

Fifty teeth (n = 10) were divided into; Group I: Artificial saliva, (Saliva natural, Medac, UK), Group II: CPP-ACPF (MI Paste Plus, GC Corp, USA), Group III: Er,Cr:YSGG (Waterlase iPlus, USA), Group IV: CPP-ACPF + Er,Cr:YSGG, Group V: Er,Cr:YSGG + CPP-ACPF. Teeth were immersed in Coca-Cola for 10 min, 5 times/day for 5 days. DIAGNOdent (DD) measurements were taken before and after the experiment.

RESULTS:

There was a significant increase in DD readings after erosive-treatment cycles in all test groups. The highest reading was in samples immersed in artificial saliva, and the lowest was in those subjected to combined CPP-ACPF and Er,Cr:YSGG laser application, regardless of the sequence used. There was no significant difference between samples immersed in artificial saliva, and after CPP-ACPF application. Similarly, there was no significant difference between samples treated by combined treatment of CPP-ACPF and Er,Cr:YSGG application. However, there was a significant difference between samples immersed in artificial saliva or treated with CPP-ACPF application and those subjected to combined treatment CPP-ACPF along with Er,Cr:YSGG.

CONCLUSION:

Combining Er,Cr:YSGG laser and CPP-ACPF paste significantly increased enamel remineralisation, regardless of the sequence implemented. Saliva naturally and CPP-ACPF application had a comparable effect on remineralisation.

Fluoride Varnishes against Dental Erosion Caused by Soft Drink Combined with Pediatric Liquid Medicine

Abstract The present study evaluated the effect of NaF and CPP-ACP/NaF varnishes to reduce erosion produced by soft drink (SD) combined or not with pediatric liquid medicine. Enamel specimens were pre-treated with fluoride varnish, according to the following groups: NaF varnish (Duraphat®) or CPP-ACP/NaF varnish (MI varnishTM). Two types of erosive cycles were made: by soft drink erosion (SDE) or by pediatric liquid medicine plus soft drink erosion (PLM/SDE). Bovine enamel specimens were randomly assigned in six groups (n=10): G1=NaF + SDE; G2=CPP-ACP/NaF + SDE; G3=Distilled and deionized (DD) water + SDE; G4=NaF + PLM/SDE; G5=CPP-ACP/NaF + PLM/SDE and G6=DD water + PLM/SDE. Before treatments, the sample surface was divided in two areas (unexposed area-UA and exposed area-EA). The specimens were evaluated by 3D non-contact profilometry technique to determinate tooth structure loss (TSL) and surface roughness (Sa). Scanning electron microscopy (SEM) analysis was also performed. After SDE, G2 presented the lowest TSL values compared to G3 (p=0.008). G1 and G2 did not differ between them (p=0.203) and no groups differed among them despite Sa. Regarding TSL and Sa, G4 and G5 differed from G6 (p=0.0001), but not between them (p=1.00). Examining 3D and SEM images, the greatest differences between UA and EA were observed for G3 and G6. CPP-ACP/NaF varnish seems to be a promising treatment to reduce enamel loss from the erosion produced by a soft drink. Both varnishes also showed capacity to reduce TSL and Sa after erosion by soft drink combined to pediatric liquid medicine.