In-vitro study of the effect of casein phosphopeptide amorphous calcium fluoride phosphate on iatrogenic damage to enamel during orthodontic adhesive removal

White Spot Lesions (WSLs)-Post-Orthodontic Occurrence, Management and Treatment Alternatives: A Narrative Review

Although treatment with fixed or mobile appliances has become an important part of modern orthodontics, side effects such as white spot lesions (WSLs) have a negative impact on the aesthetic outcome of orthodontic treatment. The purpose of this article was to review current evidence on the diagnosis, risk assessment, prevention, management and post-orthodontic treatment of these lesions. Data collection was performed electronically, and the initial search using the keywords "white spot lesions", "orthodontics", "WSL", "enamel" and "demineralization" in different combinations resulted in 1032 articles for the two electronic databases used. Ultimately, a total of 47 manuscripts were considered relevant to the aim of this research and included in this review. The results of the review indicate that WSLs remain a significant problem during orthodontic treatment. According to studies in the literature, the severity of WSLs correlates to the duration of treatment. Using toothpaste with more than 1000 ppm fluoride at home reduces the frequency of WSL separation and regular application of varnishes in the office reduces the frequency of the occurrence of WSLs only in the context of maintaining a strict hygiene regime. The old hypothesis that elastomeric ligatures retain more dental plaque than metal ones has been refuted. There are no differences in the appearance of WSLs between conventional brackets and self-ligating brackets. Clear aligner mobile devices develop fewer WSLs but are more extensive as opposed to conventional fixed devices, while lingual orthodontic appliances have a lower incidence of WSLs, and the most effective device for preventing these lesions is WIN, followed by Incognito.

Comparative Efficacy of Novel Biomimetic Remineralising Technologies

Biomimetic technologies for the remineralisation of enamel subsurface lesions (ESLs) have been developed and include: fluorocalcium phosphosilicate bioglass (BG/F); casein phosphopeptide-amorphous calcium phosphate (CPP−ACP) and with fluoride (CPP−ACFP); and self-assembling oligopeptide P11-4 (SAP). The aim of this study was to compare the remineralisation of ESLs in vitro using these technologies. Human enamel slabs with ESLs were cut into two half-slabs; one half-slab was untreated (control), and the other half was treated by exposure to one of the four technologies with artificial saliva (AS) or AS alone for 14 days at 37 °C. The technologies were applied to the ESL surface according to the manufacturer’s instructions. At the completion of each treatment, the treated half-slabs and their paired control half-slabs were embedded, sectioned and the mineral content was determined using transverse microradiography. The change in mineral content (remineralisation) between treatments was statistically analysed using one-way ANOVA. The order from highest to lowest remineralisation was CPP−ACFP (52.6 ± 2.6%) > CPP−ACP (43.0 ± 4.9%) > BG/F (13.2 ± 2.5%) > SAP (5.8 ± 1.6%) > AS (2.1 ± 0.5%). Only CPP−ACFP and CPP−ACP produced remineralisation throughout the body of the lesions. All four biomimetic technologies had some effect on the remineralisation of ESLs; however, CPP−ACFP with calcium, phosphate and fluoride ions stabilised by CPP was superior in the level and pattern of remineralisation obtained.

Efficacy of Fluoride Varnish with Casein Phosphopeptide and Amorphous Calcium Phosphate vs Fluoride Varnish in Prevention of White Spots Lesion in fixed Orthodontic Patients: In Vivo Study

AIM

The aim of the study is to compare the in vivo efficiency of Michigan (MI) varnish containing casein phosphopeptide (CPP) and amorphous calcium phosphate (ACP) and Fluoritop containing sodium fluoride (5% NaF) in the prevention and remineralization of white spot lesions (WSLs) around orthodontic brackets at days 28 and 56 after bonding.

MATERIALS AND METHODS

A total of 30 patients were selected and divided into two groups I (MI varnish) II (Fluoritop varnish) of 15 patients in each group. All the patients were bonded and then varnish was applied around the brackets. Right-side upper and lower first premolar teeth were taken as the control group and left-side upper and lower first premolar teeth as the experimental group. Also, 14, 24 teeth were extracted on day 28 after bonding and 34, 44 teeth after day 56 of bonding. Samples were collected and sent to laboratory for evaluation of surface microhardness (SMH).

RESULTS

Based on the statistics results, there was a significant decrease in demineralization and an increase in remineralization of WSLs after the application of varnish. No statistical significance was found between the effectiveness of MI varnish and Fluoritop except in the cervical region.

CONCLUSION

Through our study, we concluded that no statistical significance was found between the effectiveness of MI varnish and Fluoritop except in the cervical region where MI varnish was found to be more effective than Fluoritop in preventing WSLs.

CLINICAL SIGNIFICANCE

The results from the above study concluded that CPP-ACP varnish can be an effective method in preventing WSLs in patients undergoing fixed orthodontic treatment.

Evaluation of white spot lesions around orthodontic brackets using different bonding agents – An in vivo study

Objectives:

The objectives of the study were to assess the white spot lesions around orthodontic bracket macroscopically using two different bonding agents – one with amorphous calcium phosphate (ACP) (Aegis Ortho) and one without ACP (Transbond XT).

Materials and Methods:

The study comprises 10 patients from 14 to 23 years of age. Patients were divided into control and study groups. Forty premolar teeth were then observed (20 teeth in each group). Bonding procedure was done and brackets were positioned on all four 1st pre-molars teeth and pre-treatment photographs were taken. The experimental material used was Aegis Ortho composite (study group) and Transbond XT (control group). Debonding procedure (by Wing deformation technique) was performed after 16 weeks which led to adhesive fracture at composite resin adhesive bracket interface leaving essentially all adhesive on the enamel. Then, follow-up photographs were taken to evaluate each.

Results:

Aegis Ortho containing ACP used for bonding purpose, provided lesser enamel demineralization than Transbond XT.

Conclusion:

Aegis Ortho for orthodontic bonding is significantly more beneficial and reliable, however, further investigations are also required to understand its clinical performance better.

Novel avenues to approach non-CPAP therapy and implement comprehensive OSA care

Recent advances in obstructive sleep apnoea (OSA) pathophysiology and translational research have opened new lines of investigation for OSA treatment and management. Key goals of such investigations are to provide efficacious, alternative treatment and management pathways that are better tailored to individual risk profiles to move beyond the traditional, continuous positive airway pressure (CPAP)-focused, "one size fits all", trial and error approach which is too frequently inadequate for many patients. Identification of different clinical manifestations of OSA (clinical phenotypes) and underlying pathophysiological phenotypes (endotypes), that contribute to OSA have provided novel insights into underlying mechanisms and have underpinned these efforts. Indeed, this new knowledge has provided the framework for precision medicine for OSA to improve treatment success rates with existing non-CPAP therapies such as mandibular advancement devices and upper airway surgery, and newly developed therapies such as hypoglossal nerve stimulation and emerging therapies such as pharmacotherapies and combination therapy. These concepts have also provided insight into potential physiological barriers to CPAP adherence for certain patients. This review summarises the recent advances in OSA pathogenesis, non-CPAP treatment, clinical management approaches and highlights knowledge gaps for future research. OSA endotyping and clinical phenotyping, risk stratification and personalised treatment allocation approaches are rapidly evolving and will further benefit from the support of recent advances in e-health and artificial intelligence.

Advanced non-fluoride approaches to dental enamel remineralization: The next level in enamel repair management

In modern dentistry, a minimally invasive management of early caries lesions or early-stage erosive tooth wear (ETW) with synthetic remineralization systems has become indispensable. In addition to fluoride, which is still the non-plus-ultra in these early caries/ETW treatments, a number of new developments are in the test phase or have already been commercialized. Some of these systems claim that they are comparable or even superior to fluoride in terms of their ability to remineralize enamel. Besides, their use can help avoid some of the risks associated with fluoride and support treatments of patients with a high risk of caries. Two individual non-fluoride systems can be distinguished; intrinsic and extrinsic remineralization approaches. Intrinsic (protein/peptide) systems adsorb to hydroxyapatite crystals/organics located within enamel prisms and accumulate endogenous calcium and phosphate ions from saliva, which ultimately leads to the re-growth of enamel crystals. Extrinsic remineralization systems function on the basis of the external (non-saliva) supply of calcium and phosphate to the crystals to be re-grown. This article, following an introduction into enamel (re)mineralization and fluoride-assisted remineralization, discusses the requirements for non-fluoride remineralization systems, particularly their mechanisms and challenges, and summarizes the findings that underpin the most promising advances in enamel remineralization therapy.

Accuracy and reliability of tooth widths and Bolton ratios measured by ClinCheck Pro

INTRODUCTION

This study aimed to assess the accuracy and reliability of tooth widths and Bolton ratios measured in ClinCheck Pro.

METHODS

Five sets of typodonts were scanned using an iTero scanner, and the digital models were electronically transmitted to Align Technology for treatment planning. The typodont teeth were then segmented and measured using 3-dimensional optical profilometry (3D OP) and a calibrated digital caliper. Tooth widths estimated by ClinCheck Pro were compared with those measurements obtained using 3D OP and digital calipers. To determine the reliability of ClinCheck Pro measured tooth widths and Bolton ratios, the records of 30 consecutive patients treated with the Invisalign appliance without interproximal reduction were obtained. Values at the initial ClinCheck Pro treatment plan were compared with those from additional aligner scans. Accuracy, the agreement between methods, and reliability were investigated using the Bland Altman method.

RESULTS

A systematic under measurement was observed in the tooth widths measured by ClinCheck Pro (mean, 0.36 mm) compared with those obtained using 3D OP and digital caliper (individually segmented teeth). Although the overall reliability of ClinCheck Pro measured tooth widths was good (intraclass correlation coefficient, 0.96), the reliability of Bolton ratios was only moderate with wide confidence intervals.

CONCLUSIONS

ClinCheck Pro systematically underestimates tooth widths compared with 3D OP and digital caliper (individually segmented teeth). In addition, clinicians need to be cautious while relying solely on ClinCheck's Bolton ratios estimation for the treatment plan. These findings may be due to "shape assumptions" in the interproximal areas and could have clinical implications.

Effect of fluoride-releasing 4-META/MMA-TBB resin on enamel demineralization around orthodontic brackets: An in vitro µCT analysis

This study aimed to evaluate the impact of fluoride-releasing 4-META/MMA-TBB resin on the degree of enamel demineralization typically detected around orthodontic brackets using μCT. Enamel-dentin blocks were prepared from bovine teeth. Brackets were attached with either 4-META/MMA-TBB resin (SBC), fluoride-releasing 4-META/MMA-TBB resin (SBF), or fluoride-releasing RMGIC (FLC). The specimens were subjected to demineralization (pH 4.5, 21 days) and scanned by μCT (0, 7, and 21 days). Fluoride ion release under the experimental conditions was measured. The degree of demineralization detected in SBF and FLC was significantly lower than that in SBC; there were no significant differences in the degree of demineralization detected in SBF and FLC. The level of fluoride ion detected in FLC was significantly higher than that detected in SBC. Fluoride-releasing 4-META/MMA-TBB resin protected against enamel demineralization around orthodontic brackets when compared to the results from the fluoride-free resin.

Acceleration of Enamel Subsurface Lesion Remineralisation by Intralesion pH Modulation

Remineralisation of demineralised enamel subsurface lesions can be enhanced by pretreatment of the lesions with base (NaOH). The aim of this study was to test the effect of intralesion pH modulation on remineralisation of demineralised enamel subsurface lesions by casein phosphopeptide-stabilised amorphous calcium fluoride phosphate (CPP-ACFP) in vitro. Two remineralisation models were utilised, the first involving 60-min cyclic pH modulation for 105 h and the second involved short-term cyclic pH modulation (12-min cycle, 240 min total duration) compared with the equivalent time of continuous treatment (200 min total duration). The intralesion pH modulation was achieved by cyclic exposure to a pH 12.9 NaOH solution and a CPP-ACFP remineralisation solution at pH 5.5. Percent remineralisation was assessed using transverse microradiography with data statistically analysed using a 2-sample Student t test. For the first model, the intralesion pH modulation group had significantly (p < 0.001) higher remineralisation (43.8 ± 6.9%) than the control group (28.2 ± 5.8%) cycled with water. For the second model, the intralesion pH modulation group had significantly (p < 0.001) higher remineralisation (23.1 ± 3.4%) than the group with continuous equivalent CPP-ACFP treatment time (1.9 ± 1.3%). In both models, intralesion pH modulation significantly accelerated remineralisation, and this was attributed to the effect pH modulation had on the diffusion gradients of ions/ion pairs and the degree of saturation with respect to apatite phases within the lesion fluid.

Post-gel shrinkage, elastic modulus, and stress generated by orthodontic adhesives

OBJECTIVES

To measure post-gel shrinkage, elastic modulus, and flexural strength of orthodontic adhesives and to predict shrinkage stress using finite element analysis (FEA).

MATERIALS AND METHODS

The following 6 orthodontic adhesives were tested: Transbond XT (3M Unitek, Monrovia, Calif), Transbond Plus Color Change (3M Unitek), Greengloo (Ormco, Brea, Calif), Ortho Connect (GC America, Alsip, Ill), Trulock (RMO, Denver, Colo), GoTo (Reliance, Itasca, Ill). Post-gel shrinkage was measured using a biaxial strain gauge during light curing. Elastic modulus and flexural strength were measured with a 4-point bending test. Analysis of variance and Student-Newman-Keuls post hoc tests were used to compare the shrinkage, elastic modulus, and flexural strengths among the materials (α = .05). Shrinkage stresses caused by the post-gel shrinkage and elastic modulus values were calculated using a cross-sectional FEA of a metallic bracket bonded to an incisor.

RESULTS

Properties were highly different among the adhesives (P ≤ .0001). Transbond XT (0.38 ± 0.09 percent volumetric contraction) and GoTo (0.42 ± 0.05 percent volumetric contraction) had the lowest post-gel shrinkage; Transbond Plus Color Change had the highest (0.84 ± 0.08 percent volumetric contraction). OrthoConnect (6.8 ± 0.6 gigapascals) had the lowest elastic modulus; GoTo (28.3 ± 3.1 gigapascals) had the highest. Trulock (64.1 ± 8.2 megapascals) had the lowest flexural strength; Greengloo (139.1 ± 20.7 megapascals) had the highest. FEA showed that the highest shrinkage stresses were generated with Transbond Plus Color Change and the lowest with OrthoConnect.

CONCLUSIONS

Post-gel shrinkage of orthodontic adhesives was comparable with restorative composites, which are known to create shrinkage stresses in restored teeth. FEA indicated that this shrinkage creates stresses in the adhesive and in the enamel around the brackets.

The in vitro remineralizing effect of CPP-ACP and CPP-ACPF after 6 and 12 weeks on initial caries lesion

Objective:

The aim of this in vitro study was to determine the effects of remineralization promoting agents containing casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP), or CPP-ACP in combination with fluoride (CPP-ACPF) on artificial white spot lesions (WSLs) after 6 and 12 weeks.

Methodology:

White spot lesions were created on 123 sectioned premolars (246 specimens) with a demineralization solution during a 96 hours pH-cycling regime. Two experimental groups were created: a CPP-ACP group (Tooth Mousse™), and a CPP-ACPF group (Mi Paste Plus™). Additionally, two control groups were created, one using only a conventional toothpaste (1450 ppm fluoride) and another one without any working agents. All teeth were also daily brushed with the conventional toothpaste except the second control group. Tooth Mousse™ and Mi Paste Plus™ were applied for 180 seconds every day. The volume of demineralization was measured with transverse microradiography. Six lesion characteristics regarding the lesion depth and mineral content of WSLs were also determined.

Results:

The application of CPP-ACP and CPP-ACPF had a significant regenerative effect on the WSLs. Compared to Control group 1 and 2 the volume of demineralization after 6 weeks decreased significantly for CPP-ACP (respectively p<0.001 and p<0.001) and CPP-ACPF (respectively p=0.001 and p=0.003). The same trend was observed after 12 weeks. For the CPP-ACPF group, WSL dimensions decreased significantly between 6 and 12 weeks follow-up (p=0.012). The lesion depth reduced significantly after application of CPP-ACP and CPP-ACPF but increased significantly in the Control groups. Mineral content increased for CPP-ACP and CPP-ACPF after an application period of 12 weeks, but this was only significant for CPP-ACP.

Conclusions:

Long-term use of CPP-ACP and CPP-ACPF in combination with a conventional tooth paste shows beneficial effects in the recovery of in vitro subsurface caries lesions.

Comparison of intraoral biofilm reduction on silver-coated and silver ion-implanted stainless steel bracket material : Biofilm reduction on silver ion-implanted bracket material

PURPOSE

The objective of this in situ study was to quantify the intraoral biofilm reduction on bracket material as a result of different surface modifications using silver ions. In addition to galvanic silver coating and physical vapor deposition (PVD), the plasma immersion ion implantation and deposition (PIIID) procedure was investigated for the first time within an orthodontic application.

MATERIALS AND METHODS

An occlusal splint equipped with differently silver-modified test specimens based on stainless steel bracket material was prepared for a total of 12 periodontally healthy patients and was worn in the mouth for 48 h. The initially formed biofilm was fluorescently stained and a quantitative comparative analysis of biofilm volume, biofilm surface coverage and live/dead distribution of bacteria was performed by confocal laser scanning microscopy (CLSM).

RESULTS

Compared to untreated stainless steel bracket material, the antibacterial effect of the PIIID silver-modified surface was just as significant with regard to reducing the biofilm volume and the surface coverage as the galvanically applied silver layer and the PVD silver coating. Regarding the live/dead distribution, however, the PIIID modification was the only surface that showed a significant increase in the proportion of dead cells compared to untreated bracket material and the galvanic coating.

CONCLUSIONS

Orthodontic stainless steel with a silver-modified surface by PIIID procedure showed an effective reduction in the intraoral biofilm formation compared to untreated bracket material, in a similar manner to PVD and galvanic silver coatings applied to the surface. Additionally, the PIIID silver-modified surface has an increased bactericidal effect.

State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management

The principles of minimally invasive dentistry clearly dictate the need for clinically effective measures to remineralize early enamel caries lesions. While fluoride-mediated remineralization is the cornerstone of current caries management philosophies, a number of new remineralization strategies have been commercialized or are under development that claim to promote deeper remineralization of lesions, reduce the potential risks associated with high-fluoride oral care products, and facilitate caries control over a lifetime. These non-fluoride remineralizing systems can be broadly categorized into biomimetic enamel regenerative technologies and the approaches that repair caries lesions by enhancing fluoride efficacy. This paper discusses the rationale for non-fluoride remineralization and the mechanism of action, challenges, and evidence behind some of the most promising advances in enamel remineralization therapies.

Detection of residual resin-based orthodontic adhesive based on light-induced fluorescence

INTRODUCTION

This study evaluated the fluorescence of orthodontic adhesives using quantitative light-induced fluorescence-digital (QLF-D) images, and compared differences in the color characteristics of the fluorescence between adhesive and the adjacent tooth with that under white-light illumination in specimens containing residual adhesive of various thicknesses.

METHODS

Disc-shaped adhesive samples and samples comprising adhesive attached to extracted human teeth were prepared using Transbond XT, Blugloo, and Enlight, and they were ground to thicknesses ranging from 800 to 20 μm. Fluorescence and white-light images of the two types of specimens were taken with a QLF-D system. The color parameters for the fluorescence from the discs and the color difference (ΔE) between residual adhesive and the adjacent tooth were quantified in images using the CIE L*a*b* system.

RESULTS

The fluorescence color values of the discs differed significantly among the three adhesive products (P <  0.05). The ΔE values in fluorescence (ΔE_F) and white-light (ΔE_W) images for all three adhesives were lower for thinner residual adhesive specimens. The thickness of the adhesive could be perceived over a range of 50-100 μm for fluorescence images and 400-800 μm for white-light images (ΔE > 3.3). ΔE_F was significantly larger than ΔE_W for all of the residual adhesives, Blugloo specimens thicker than 100 μm, and Transbond XT and Enlight specimens thicker than 50 μm (P <  0.05).

CONCLUSIONS

Detecting and analyzing fluorescence signals can improve the ability to detect residual adhesive on a tooth and also provide thickness information.

Enamel Remineralization with Novel Bioactive Glass Air Abrasion

Enamel demineralization or white spot lesions (WSLs) are a frequent complication associated with fixed appliance–based orthodontic treatment. The remineralization potential of a novel fluoride-containing bioactive glass (QMAT3) propelled via an air abrasion system was compared with Sylc glass and artificial saliva on artificially induced WSLs. Thirty extracted human premolars were randomly assigned into 3 groups ( n = 10) per method of treatment and scanned with optical coherence tomography and noncontact profilometer in the 4 enamel states: sound, demineralized, after glass propulsion, and after immersion in artificial saliva. Knoop hardness testing was also performed. Twenty additional prepared teeth samples were also randomly selected for examination by scanning electron microscopy and energy-dispersive X-ray spectroscopy (2 teeth per technique) under each of the 4 enamel conditions. 19F MAS-NMR (magic angle spinning–nuclear magnetic resonance) was also used to detect the type of apatite formed on the enamel surface. Significant enamel remineralization with surface roughness and intensity of light backscattering similar to that of sound enamel was observed following treatment with QMAT3. In addition, mineral deposits were detected on the remineralized enamel surfaces, forming a protective layer and improving its hardness. This layer was rich in calcium, phosphate, and fluoride; 19F MAS-NMR confirmed the formation of fluorapatite. This finding is particularly beneficial since fluorapatite is more chemically stable than hydroxyapatite and has greater resistance to acid attack. Hence, a promising fluoride-containing bioactive glass for enamel remineralization has been developed, although further clinical evaluation and refinement is required.

Casein phosphopeptide- amorphous calcium phosphate effects on brackets shear bond strength and enamel damage

Background

The aim of study was to evaluate the application of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride regarding their effect on the shear bond strength (SBS), bond failure pattern of brackets using the adhesive remnant index (ARI) and assessing the quality of enamel surface using the enamel damage index (EDI).

Material and Methods

Sixty extracted premolar teeth were randomly divided into four groups regarding pretreatment application of CPP-ACP and fluoride. Brackets were bonded using the conventional method. Specimens were thermocycled for 1000 cycles and were subsequently tested for the SBS in a universal testing machine. After debonding, the teeth were examined under a stereomicroscope to evaluate the ARI. Then, The EDI was assessed using a scanning electron microscope (SEM). Data were analyzed using ANOVA and the Chi-square test.

Results

Evaluation of SBS, ARI and EDI scores showed no significant difference among the study groups. However, a correlation was found between the ARI and EDI scores, indicating that with more adhesive remnants on enamel surface, enamel damage was lower.

Conclusions

The use of CPP-ACP and fluoride can be considered a prophylactic application since these agents did not compromise bracket bond strength although they did not reduce iatrogenic damage to the enamel.

Key words:CPP-ACP, Enamel damage, SEM, Shear bond strength, ARI.

Prevention and Treatment of White Spot Lesions During and After Treatment with Fixed Orthodontic Appliances: a Systematic Literature Review

Objectives

The aim of the systematic literature review is to update the evidence for the prevention of white spot lesions, using materials containing fluoride and/or casein phosphopeptide-amorphous calcium phosphate during and after treatment with fixed orthodontic appliances.

Material and Methods

Information search for controlled studies on humans published between January 2008 and February 2016 was performed in PubMed, ScienceDirect, Embase, The Cochrane Library. Inclusion criteria were: the English language, study on humans, patients undergoing orthodontic treatment with fixed appliances, randomized or quasi-randomized controlled clinical studies fluoride-containing product or casein derivates used throughout the appliance therapy or straightaway after debonding.

Results

326 articles were reviewed (Embase 141, PubMed 129, ScienceDirect 41, Cochrane 15). Twelve clinical studies fulfilled all inclusion criteria. Use of fluoridated toothpaste had a remineralizing effect on white spot lesions (WSLs) (P < 0.05); fluoride varnish and casein supplements were effective in prevention and early treatment of WSLs (P < 0.05).

Conclusions

Early detection of white spot lesions during orthodontic treatment would allow implementing preventive measures to control the demineralization process before lesions progress. The systemic review has showed that the usage of fluoride and casein supplements in ameliorating white spot lesions during and after fixed orthodontic treatment is significantly effective. However the use of casein phosphopeptide-amorphous calcium phosphate can be more beneficial than fluoride rinse in the reduction of demineralization spots.

The effect of casein phosphopeptide amorphous calcium phosphate fluoride paste (CPP-ACPF) on oral and salivary conditions of patients undergoing chemotherapy: A randomized controlled clinical trial

Background

Oral and saliva conditions of patients undergoing chemotherapy is often affected by the medication they receive. Up to now, no appropriate medication that possesses the positive effects of chemotherapy without presenting oral complications has been introduced.

Objective

The aim of this study was to assess the clinical effects of CPP-ACPF paste on the oral and salivary status of patients undergoing chemotherapy.

Methods

From October 2013 to April 2014, 20 patients in chemotherapy treatment plans and who met the inclusion criteria enrolled in this randomized parallel single-blind controlled clinical trial in Shohada-e-Tajrish Hospital in Tehran, Iran. Patients were divided into two groups: 1) patients received their daily medication of cancer therapy center (group 1, control); 2) patients applied CPP-ACPF Crème (MI paste plus, GC USA) twice a day as instructed (group 2). The baseline status of oral conditions of patients (mucositis, dry mouth, infection, diminished tasting sense, difficulty in food intake, burning sensation of mucosa, saliva and dental plaque pH, rest and stimulated saliva, buffering capacity of saliva) were recorded and reevaluated after 21 and 42 days. The data were analyzed with a Mann-Whitney U-test.

Results

A total of 20 patients were allocated randomly to groups 1 and 2. The Mann-Whitney U-test showed that application of CPP-ACPF paste twice daily did not cause any significant difference in oral complication of the subject group compared with the control group (p>0.05). Among salivary signs, resting and stimulated saliva rates and saliva buffering capacity had significantly altered in the CPP-ACPF group in day 21 and 42 in comparison with those of the control group (p<0.05).

Conclusion

Application of CPP-ACPF paste before and during chemotherapy can improve the salivary status of patients undergoing this treatment.

Casein phosphopeptide-amorphous calcium phosphate and glass ionomer show distinct effects in the remineralization of proximal artificial caries lesion in situ

This study aimed to compare the ability of casein-phosphopeptide amorphous-calcium-phosphate (CPP-ACP) and glass-ionomer (GI) in remineralizing proximal artificial caries lesions (ACLs). Molar enamel-slabs were divided into: original-lesion control, intra-oral controls, and experimental (CPP-ACP or GI) groups. Specimens received ACLs and were bonded on subject maxillary first molars. After 4-weeks, mineral density (MD) was analyzed by μCT. Compared to control, CPP-ACP increased MD at 0-38/68-84 microns and the GI group had an increase at 0-68 microns, with a greater increase in MD compared to the CPP-ACP group from 0-53 microns. The mean percent remineralization (%R) showed differences between the GI, CPP-ACP groups and their paired controls. GI tended to increase remineralization more than CPP-ACP. In conclusion, CPP-ACP and GI demonstrated distinct remineralizing ability. GI induced greater remineralization in the superficial lesion, while CPP-ACP remineralized the lesion body. Their effects on percent remineralization and reducing lesion depth of proximal ACLs were similar.

Effect of different preventive agents on bracket shear bond strength: in vitro study

Background

The effects of fluoride and CPP-ACP before bracket bonding on the shear bond strength of orthodontic brackets have been reported with contradicting results. The objective of this in vitro study was to evaluate the effect of different preventive agents namely; casein phosphopeptide-amorphous-calcium-phosphate (CPP-ACP), fluoride-containing-CPP-ACP (CPP-ACPF) and 5% sodium fluoride (5% NaF), on the enamel-bracket shear bond strength (SBS) and to compare their effects when applied before or after acid-etching.

Methods

Human premolar teeth were randomly divided into seven groups (16 teeth per group) as follows: the control group, where no preventive agent was applied on the enamel and 6 experimental groups. Teeth in groups 1a, 2a, and 3a were treated with CPP-ACP paste, CPP-ACPF paste, and 5% NaF, respectively before acid-etching. Teeth in groups 1b, 2b and 3b were treated using the same preventive agents after acid-etching. The brackets were then bonded and the teeth were thermocycled. The brackets' SBS was measured and the adhesive remnant was assessed using adhesive remnant index (ARI). Analysis of variance (ANOVA) and Tukey test were performed to compare the SBS among different groups. Chi-square test was used to evaluate differences in ARI scores between the groups.

Results

Enamel surface treatment with CPP-ACPF after acid-etching significantly increased SBS compared to the control and to its application before acid-etching (P < 0.05). Higher ARI index was recorded when the preventive agents were applied after acid-etching.

Conclusion

Brackets' SBS significantly increased when fluoride-containing-CPP-ACP was applied after acid-etching.

A SEM and non-contact surface white light profilometry in vivo study of the effect of a crème containing CPP-ACP and fluoride on young etched enamel

The aim of this in vivo study was to evaluate the short and a longer term effect on enamel of the application of a crème containing 10% CPP-ACP and 900 ppm fluoride, in orthodontically planned, high caries-risk patients. Epoxy resin replicas of upper lateral incisors were obtained from polyvinyl siloxane (PVS) impressions, before and after etching. The right incisors were left untreated in order to control saliva remineralizing potential. The upper left surfaces were coated with a pea-size amount of the crème. Replicas were obtained at 3 weeks and 6 months and analyzed by SEM and non-contact surface white light profilometry. In the treated sample the profilometric roughness parameters at 3 weeks were statistically significantly lower than the control group values (p < 0.05). At 3 weeks SEM images of the enamel surface showed fewer irregularities. After 6 months, differences between test and control groups were not present on SEM images and profilometric values. CPP-ACP and fluoride crème had positive in vivo effects on enamel surfaces. Significant differences in surface roughness existed after a 3-week period of crème use.

Calcium orthophosphates in dentistry

Dental caries, also known as tooth decay or a cavity, remains a major public health problem in the most communities even though the prevalence of disease has decreased since the introduction of fluorides for dental care. Therefore, biomaterials to fill dental defects appear to be necessary to fulfill customers' needs regarding the properties and the processing of the products. Bioceramics and glass-ceramics are widely used for these purposes, as dental inlays, onlays, veneers, crowns or bridges. Calcium orthophosphates belong to bioceramics but they have some specific advantages over other types of bioceramics due to a chemical similarity to the inorganic part of both human and mammalian bones and teeth. Therefore, calcium orthophosphates (both alone and as components of various formulations) are used in dentistry as both dental fillers and implantable scaffolds. This review provides brief information on calcium orthophosphates and describes in details current state-of-the-art on their applications in dentistry and dentistry-related fields. Among the recognized dental specialties, calcium orthophosphates are most frequently used in periodontics; however, the majority of the publications on calcium orthophosphates in dentistry are devoted to unspecified "dental" fields.

Calcium phosphopeptides -- mechanisms of action and evidence for clinical efficacy

Phosphoproteins/phosphopeptides with clusters of acidic residues are found throughout nature, where they aid in the prevention of unwanted precipitation of solid calcium phosphates. The acidic residues, particularly phosphoserine, interact with calcium and stabilize clusters of calcium and phosphate. Saliva and milk are two examples of biological fluids that contain such phosphoprotein/phosphopeptide-stabilized calcium phosphates, and both share a similar evolutionary pathway. Saliva has been shown to have remineralization potential and is of critical importance in maintaining the mineral content of teeth in the oral environment. Milk can be enzymatically modified to release casein phosphopeptides that contain the clusters of residues that allow milk to stabilize high concentrations of calcium and phosphate. These casein phosphopeptide-stabilized amorphous calcium phosphate nanocomplexes (CPP-ACP) can stabilize even higher concentrations of calcium and phosphate than milk and can be considered a salivary biomimetic, since they share many similarities to statherin. The mechanisms of action and the growing body of scientific evidence that supports the use of CPP-ACP to augment fluoride in inhibiting demineralization and enhancing the remineralization of white-spot lesions are reviewed.

A novel biomimetic orthodontic bonding agent helps prevent white spot lesions adjacent to brackets

OBJECTIVE

To compare changes in enamel microhardness adjacent to orthodontic brackets after using bonding agents containing various compositions of bioactive glass compared to a traditional resin adhesive following a simulated caries challenge.

MATERIALS AND METHODS

Extracted human third molars (n  =  10 per group) had orthodontic brackets bonded using one of four novel bioactive glass (BAG)-containing orthodontic bonding agents (BAG-Bonds) or commercially available Transbond-XT. The four new adhesives contained BAG in varying percentages incorporated into a traditional resin monomer mixture. Teeth were cycled through low-pH demineralizing and physiologic-pH remineralizing solutions once each day over 14 days. Microhardness was measured on longitudinal sections of the teeth 100, 200, and 300 µm from the bracket edge and beneath the brackets, at depths of 25 to 200 µm from the enamel surface. Normalized hardness values were compared using three-way analysis of variance.

RESULTS

Significantly less reduction in enamel microhardness was found with the experimental adhesives at depths of 25 and 50 µm at all distances from the bracket edge. In all groups, there were no significant changes in enamel microhardness past 125-µm depth. Results varied with the different BAG-Bonds, with 81BAG-Bond showing the smallest decrease in enamel microhardness.

CONCLUSIONS

The BAG-Bonds tested in this study showed a reduction in the amount of superficial enamel softening surrounding orthodontic brackets compared to a traditional bonding agent. The results indicate that clinically, BAG-Bonds may aid in maintaining enamel surface hardness, therefore helping prevent white spot lesions adjacent to orthodontic brackets.