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Rahmath Meeral P, Doraikannan S, Indiran MA. Efficiency of casein phosphopeptide amorphous calcium phosphate versus topical fluorides on remineralizing early enamel carious lesions - A systematic review and meta analysis. Saudi Dent J 2024; 36:521-527. [PMID: 38690375 PMCID: PMC11056415 DOI: 10.1016/j.sdentj.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 05/02/2024] Open
Abstract
Objective To assess the remineralizing efficiency of caesin phosphopepdide amorphous calcium phosphate (CPP-ACP) versus topical fluorides on early enamel lesions in vivo. Data sources PubMed, Web of Science, Scopus, EBSCO were searched based on the PICOS criteria up to December 2022 with English language restriction. All relevant studies were subjected to two separate reviews before being included at the title, abstract, and full text levels. Study selection 41 studies were reviewed and 11 selected for inclusion in the final sample for the review. All were randomized clinical trials with the follow-up period of the studies ranging from 3 to 12 months. Out of the 11 studies, only two are with low risk of bias on assessment with Cochrane risk of bias assessment tool, while the other nine articles were with the moderate and high risk of bias. Conclusions Conflicting evidence exists on the clinical efficacy of CPP-ACP compared to the various fluoride forms tested, and no adverse effect associated with CPP-ACP use was discovered in comparison to fluorides that had certain detrimental health impacts. Although, the review results in favor of both fluorides and CPP-ACP with similar clinical efficiency, when ill effects are considered the CPP-ACP can be a choice of remineralizing early enamel lesions. However, before concrete suggestions can be given, high-quality, well-designed clinical research in this area are still necessary. Clinical significance A considerable remineralizing impact has been shown in both in vitro and in vivo experiments, making CPP-ACP/CPP-ACPF a more promising remineralizing agent than fluorides. Therefore, this can be applied clinically to early enamel carious lesion.
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Affiliation(s)
- P. Rahmath Meeral
- Department of Public Health Dentistry, Saveetha Dental College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, No. 162, Poonamallee High Road, Chennai 600077, India
| | - Srisakthi Doraikannan
- Department of Public Health Dentistry, Saveetha Dental College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, No. 162, Poonamallee High Road, Chennai 600077, India
| | - Meignana Arumugham Indiran
- Department of Public Health Dentistry, Saveetha Dental College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, No. 162, Poonamallee High Road, Chennai 600077, India
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Chatzidimitriou K, Seremidi K, Kloukos D, Gizani S, Papaioannou W. The role of calcium in the prevention of erosive tooth wear: a systematic review and meta-analysis. Evid Based Dent 2024; 25:55. [PMID: 38200328 DOI: 10.1038/s41432-023-00966-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The loss of hard dental tissue due to recurrent acid challenges and mechanical stresses without bacterial involvement is known as erosive tooth wear (ETW). Many studies in the literature have concentrated on variables that may affect the ETW process and prevent its occurrence or reduce its advancement. However, to date, no previous systematic review has evaluated the role of calcium in preventing ETW. Therefore, the purpose of the present systematic review was to review and critically appraise the scientific evidence regarding the role of calcium formulations in the prevention of ETW. METHODS The review protocol was registered in the PROSPERO international prospective register of systematic reviews (Ref: CRD42021229819). A literature search was conducted in electronic databases to identify in situ randomized controlled trials evaluating the prevention of ETW following the application of calcium formulations. The outcomes studied included mean enamel loss, surface microhardness, surface roughness, mean erosion/softening depth, mineral loss/precipitation and remineralization. Study characteristics and outcomes of included studies were summarized. Cochrane's risk-of-bias tool 2.0 was used to assess the quality of eligible studies, and meta-analysis using a random effects model was performed. RESULTS The search retrieved 869 studies of which 21 were considered eligible. Regarding the results of the quality assessment for potential risk of bias in all included studies, overall, 5 studies were considered as being at low risk, another 12 at unclear risk and 4 at high risk of bias. The findings of the studies showed that the addition of calcium in juice drinks led to reduced enamel loss, with blackcurrant juice presenting 2.6 times statistically significant less enamel loss compared to orange juice (p = 0.0001, I2 = 89%). No statistically significant difference in mean surface microhardness of eroded enamel was recorded between chewing gum with or without casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (p = 0.31, I2 = 71%). Contradictory were the results regarding the effect of milk and CPP-ACP pastes on prevention of ETW. CONCLUSIONS Calcium formulations play an important role in ETW prevention, mainly through their addition to acidic drinks.
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Affiliation(s)
- Konstantina Chatzidimitriou
- Department of Preventive & Community Dentistry, National and Kapodistrian University of Athens, School of Dentistry, 2 Thivon Str, 115 27, Goudi, Athens, Greece.
| | - Kyriaki Seremidi
- Department of Paediatric Dentistry, National and Kapodistrian University of Athens, School of Dentistry, 2 Thivon Str, 115 27, Goudi, Athens, Greece
| | - Dimitrios Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, CH-3012, Hochschulstrasse 4, Bern, Switzerland
| | - Sotiria Gizani
- Department of Paediatric Dentistry, National and Kapodistrian University of Athens, School of Dentistry, 2 Thivon Str, 115 27, Goudi, Athens, Greece
| | - William Papaioannou
- Department of Preventive & Community Dentistry, National and Kapodistrian University of Athens, School of Dentistry, 2 Thivon Str, 115 27, Goudi, Athens, Greece
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Pithon MM, Santos AFSD, Santos AMD, Fidalgo TKDS, França AKAD, Coqueiro RS, Andrade ACDVD, Oliveira DD, Maia LC. Effectiveness of Chewing Gum Containing CPP-ACP for Remineralisation of Demineralised Enamel around Orthodontic Brackets: An in Situ Study. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2022. [DOI: 10.1590/pboci.2022.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Matheus Melo Pithon
- Southwest Bahia State University, Brazil; Federal University of Rio de Janeiro, Brazil
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Dorozhkin SV. Synthetic amorphous calcium phosphates (ACPs): preparation, structure, properties, and biomedical applications. Biomater Sci 2021; 9:7748-7798. [PMID: 34755730 DOI: 10.1039/d1bm01239h] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Amorphous calcium phosphates (ACPs) represent a metastable amorphous state of other calcium orthophosphates (abbreviated as CaPO4) possessing variable compositional but rather identical glass-like physical properties, in which there are neither translational nor orientational long-range orders of the atomic positions. In nature, ACPs of a biological origin are found in the calcified tissues of mammals, some parts of primitive organisms, as well as in the mammalian milk. Manmade ACPs can be synthesized in a laboratory by various methods including wet-chemical precipitation, in which they are the first solid phases, precipitated after a rapid mixing of aqueous solutions containing dissolved ions of Ca2+ and PO43- in sufficient amounts. Due to the amorphous nature, all types of synthetic ACPs appear to be thermodynamically unstable and, unless stored in dry conditions or doped by stabilizers, they tend to transform spontaneously to crystalline CaPO4, mainly to ones with an apatitic structure. This intrinsic metastability of the ACPs is of a great biological relevance. In particular, the initiating role that metastable ACPs play in matrix vesicle biomineralization raises their importance from a mere laboratory curiosity to that of a reasonable key intermediate in skeletal calcifications. In addition, synthetic ACPs appear to be very promising biomaterials both for manufacturing artificial bone grafts and for dental applications. In this review, the current knowledge on the occurrence, structural design, chemical composition, preparation, properties, and biomedical applications of the synthetic ACPs have been summarized.
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de Oliveira PRA, Schubach da Costa Barreto L, Tostes MA. Effectiveness of CPP-ACP and Fluoride Products in Tooth Remineralization. Int J Dent Hyg 2021; 20:635-642. [PMID: 34392591 DOI: 10.1111/idh.12542] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/15/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the effectiveness of the casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP) in the in situ remineralization of enamel exposed to two different degrees of preformed enamel lesions. METHODS One hundred and sixty 3x3x2 mm human enamel slabs were demineralized and divided into two subgroups according to baseline surface hardness (SH=B1≤150 and B2 >150). During each of four 10-day experimental periods, 10 participants wore intraoral removable acrylic palatal expanders with four human enamel slabs with preformed lesions (B1 and B2): CO1 and CO2 - Control: silica dentifrice without fluoride; MP1 and MP2: MI Paste; MPP1 and MPP2: MI Paste Plus; and FD1 and FD2: Fluoride dentifrice. The Knoop hardness test (50/15s Micromet 2001, Buehler, IL, USA) was performed after demineralization (B1 and B2) and after treatment (T1 and T2). RESULTS SH was higher in all treatment groups when compared with the controls, except for CO2 (Mann Whitney Wilcoxon Test; p <0.05). %SH was similar between MPP2 and FD2 and between MPP2 and MP2; however, FD2 and MPP2 products were more effective in microhardness recovery. In B1, all treatment groups were similar. CONCLUSION MPP and FD are more effective in preventing demineralization in enamel subsurface lesions.
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Tao S, Yang X, Liao L, Yang J, Liang K, Zeng S, Zhou J, Zhang M, Li J. A novel anticaries agent, honokiol-loaded poly(amido amine) dendrimer, for simultaneous long-term antibacterial treatment and remineralization of demineralized enamel. Dent Mater 2021; 37:1337-1349. [PMID: 34175131 DOI: 10.1016/j.dental.2021.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/12/2021] [Accepted: 06/02/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Existing agents to induce enamel self-repair and inhibit the progression of dental caries in the early stage have been proven to be inadequate and far from satisfactory. In this study, a honokiol-loaded poly(amido amine) (PAMAM) dendrimer (PAMH) was constructed to combat early caries lesions in enamel. METHODS PAMH was prepared via a codissolution method. Computational simulation analysis was used to explore the mechanism of honokiol release. The cytotoxicity of PAMH was tested. The antibacterial effects of PAMH were tested by planktonic growth assays and biofilm formation inhibition assays. The remineralization effect of PAMH was examined via transverse microradiography and scanning electron microscopy after a pH cycling model. The in vivo anti-caries effect of PAMH was carried out in a rat model. RESULTS Honokiol released from PAMH was slower but more durable in a cariogenic pH environment than in a neutral pH environment, which could be explained through the computational simulation analysis results. Under electrostatic action, P3 beads with the same charge repelled each other and extended outwards, resulting in the rapid expansion of the PAMAM dendrimer and accelerating the release of the drug. At a low pH of 5.5, the protonated P3 beads were not charged and the protonated P1 beads were positively charged. However, the electrostatic repulsive interaction between protonated P1 beads was restricted by the P3 beads in the outermost layer of the PAMAM dendrimer, so the swelling rate was relatively slow, resulting in the slow release of drug molecules in the acidic environment. The cytotoxicity demonstration and the biocompatibility experiment in animal study showed that PAMH is biologically safe. PAMH showed excellent enamel remineralizing ability after pH cycling and showed a long-term antibacterial effect in vitro. Meanwhile, PAMH showed long-term anticaries efficacy in vivo. SIGNIFICANCE Our findings indicated that PAMH had great potential to combat early caries lesions in enamel for future clinical application.
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Affiliation(s)
- Siying Tao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xi Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Lin Liao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jiaojiao Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Kunneng Liang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Sijun Zeng
- Guangdong Provincial Key Lab for Green Chemical Product Technology, School Chemistry and Chemical Engineering, South China University of Technology, Guangzhou 510640, China
| | - Jian Zhou
- Guangdong Provincial Key Lab for Green Chemical Product Technology, School Chemistry and Chemical Engineering, South China University of Technology, Guangzhou 510640, China
| | - Min Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Jiyao Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
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Wang Y, Hua F, Jiang H. CPP-ACP May be effective, but not Significantly Greater than using Fluorides Alone, in Preventing and Treating white Spot Lesions Around Orthodontic Brackets. J Evid Based Dent Pract 2020; 20:101416. [PMID: 32381413 DOI: 10.1016/j.jebdp.2020.101416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Effectiveness of casein phosphopeptide-amorphous calcium phosphate-containing products in the prevention and treatment of white spot lesions in orthodontic patients: A systematic review. Pithon MM, Baião FS, Sant'Anna LID, Tanaka OM, Cople-Maia L. J Invest Clin Dent 2019;e12391. SOURCE OF FUNDING No financial support was reported. TYPE OF STUDY/DESIGN Systematic review.
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Jordão MC, Ionta FQ, Bergantin BTP, Mendonça FL, Santos NMD, Honório HM, Oliveira TMD, Rios D. Influence of mandibular and palatal intraoral appliances on erosion in situ study outcome. J Appl Oral Sci 2019; 27:e20180153. [PMID: 30673029 PMCID: PMC6438665 DOI: 10.1590/1678-7757-2018-0153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/11/2018] [Indexed: 11/22/2022] Open
Abstract
The standardization of in situ protocols for dental erosion is important to enable comparison between studies.
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Affiliation(s)
- Maisa Camillo Jordão
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, São Paulo, Brasil
| | - Franciny Querobim Ionta
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, São Paulo, Brasil
| | - Bianca Tozi Portaluppe Bergantin
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, São Paulo, Brasil
| | - Fernanda Lyrio Mendonça
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, São Paulo, Brasil
| | - Natália Mello Dos Santos
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, São Paulo, Brasil
| | - Heitor Marques Honório
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, São Paulo, Brasil
| | - Thais Marchini de Oliveira
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, São Paulo, Brasil
| | - Daniela Rios
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, São Paulo, Brasil
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Arifa MK, Ephraim R, Rajamani T. Recent Advances in Dental Hard Tissue Remineralization: A Review of Literature. Int J Clin Pediatr Dent 2019; 12:139-144. [PMID: 31571787 PMCID: PMC6749882 DOI: 10.5005/jp-journals-10005-1603] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The dental caries is not simply a continuous and unidirectional process of the demineralization of the mineral phase, but a cyclic event with periods of demineralizations and remineralisation. The remineralization process is a natural repair mechanism to restore the minerals again, in ionic forms, to the hydroxyapatite (HAP) crystal lattice. It occurs under near-neutral physiological pH conditions whereby calcium and phosphate mineral ions are redeposited within the caries lesion from saliva and plaque fluid resulting in the formation of newer HAP crystals, which are larger and more resistant to acid dissolution. Numerous types of remineralizing agents and remineralizing techniques have been researched and many of them are being used clinically, with significantly predictable positive results. The recent researches on remineralization are based on biomimetic remineralization materials, having the capability to create apatite crystals within the completely demineralized collagen fibers. How to cite this article Arifa MK, Ephraim R, et al. Recent Advances in Dental Hard Tissue Remineralization: A Review of Literature. Int J Clin Pediatr Dent 2019;12(2):139-144.
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Affiliation(s)
- Mando K Arifa
- Department of Pediatric and Preventive Dentistry, Mahe Institute of Dental Sciences and Hospital, Mahe, Puducherry, India
| | - Rena Ephraim
- Department of Pediatric and Preventive Dentistry, Mahe Institute of Dental Sciences and Hospital, Mahe, Puducherry, India
| | - Thiruman Rajamani
- Department of Pediatric and Preventive Dentistry, Mahe Institute of Dental Sciences and Hospital, Mahe, Puducherry, India
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Yu H, Jiang NW, Ye XY, Zheng HY, Attin T, Cheng H. In situ effect of Tooth Mousse containing CPP-ACP on human enamel subjected to in vivo acid attacks. J Dent 2018; 76:40-45. [PMID: 29857075 DOI: 10.1016/j.jdent.2018.05.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/27/2018] [Accepted: 05/28/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This in situ study aimed to evaluate the protective effect of Tooth Mousse (GC) containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on human enamel erosion and to compare the difference in erosion between the anteriorly and posteriorly positioned human enamel. METHODS This study used a 2-treatment (7 days each) crossover design with 12 healthy volunteers wearing intraoral appliances. Each appliance contained 4 human enamel specimens positioned on the buccal surfaces of the volunteers' maxillary central incisors and first molars. The specimens were intraorally treated withTooth Mousse (CPP-ACP group) or deionized water (control group) for 3 min and then exposed to in vivo acid attacks by rinsing with 150 ml of a cola drink (4 × 5 min/day). The surface microhardness (SMH) of the specimens was measured and used to calculate the percentage of SMH loss (%SMHl). Erosion effect on enamel was also investigated by scanning electron microscopy (n = 4) at the end of study. The data were statistically analysed using two-way analysis of variance (ANOVA) and Tukey's test at a level of P < 0.05. RESULTS A significant decrease in %SMHl was observed for the specimens of CPP-ACP group compared to that for the controls (P = 0.007). The specimens positioned posteriorly exhibited a significantly lower %SMHl than those positioned anteriorly (P = 0.033). Samples of CPP-ACP group showed fewer etching patterns than those of the control group. CONCLUSIONS In this in situ model, application of Tooth Mousse containing CPP-ACP before erosion reduced the %SMHl of human enamel. Enamel located in different positions showed different patterns of erosion. CLINICAL SIGNIFICANCE Application of Tooth Mousse containing CPP-ACP could be considered as a suitable preventive strategy against enamel erosion. ClinicalTrials.gov Identifier: NCT03426150.
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Affiliation(s)
- Hao Yu
- Department of Prosthodontics, School and Hospital of Stomatology, Fujian Medical University, Fujian, China; Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
| | - Neng-Wu Jiang
- Department of Prosthodontics, School and Hospital of Stomatology, Fujian Medical University, Fujian, China
| | - Xin-Yi Ye
- Department of Prosthodontics, School and Hospital of Stomatology, Fujian Medical University, Fujian, China
| | - Hai-Yan Zheng
- Department of Prosthodontics, School and Hospital of Stomatology, Zhejiang University, Zhejiang, China
| | - Thomas Attin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University Zurich, Zurich, Switzerland
| | - Hui Cheng
- Department of Prosthodontics, School and Hospital of Stomatology, Fujian Medical University, Fujian, China.
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Tao S, Zhu Y, Yuan H, Tao S, Cheng Y, Li J, He L. Efficacy of fluorides and CPP-ACP vs fluorides monotherapy on early caries lesions: A systematic review and meta-analysis. PLoS One 2018; 13:e0196660. [PMID: 29709015 PMCID: PMC5927405 DOI: 10.1371/journal.pone.0196660] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/17/2018] [Indexed: 02/05/2023] Open
Abstract
The study aimed to evaluate the efficacy of the combination of CPP-ACP and fluorides compared with fluorides monotherapy on patients with early caries lesions. The Medline, Embase and Cochrane databases up to August 2017 were scanned, with no restrictions. Studies satisfied the guideline of randomised controlled trials (RCTs), the patients with early caries lesions and data considering the efficacy of fluorides and CPP-ACP versus fluorides alone were selected. There was no language restriction during the literature search process, however, only papers in English or Chinese were included during the selection process. Outcome variables include laser fluorescence, quantitative light-induced fluorescence, lesion area and visual inspection scores. Mean differences were calculated during the data extraction process. Ten studies including 559 patients were selected in the meta-analysis. Fluorides combined with CPP-ACP achieved the same efficacy for early caries lesions on smooth surfaces compared with fluorides monotherapy (mean difference: -13.90, 95% confidence interval: [-39.25, 11.46], P = 0.28), and the combination treatment showed significantly better efficacy than fluorides monotherapy for occlusal early caries lesions (mean difference: -21.02, 95% confidence interval: [-27.94, -14.10], P<0.01). However, further well-designed studies are still needed.
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Affiliation(s)
- Siying Tao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yan Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - He Yuan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Sibei Tao
- Renal Division, Department of Internal Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yiming Cheng
- Renal Division, Department of Internal Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jiyao Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- * E-mail: (JL); (LH)
| | - Libang He
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- * E-mail: (JL); (LH)
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Shen P, Walker GD, Yuan Y, Reynolds C, Reynolds EC. Polyols and remineralisation of enamel subsurface lesions. J Dent 2017; 66:71-75. [PMID: 28838679 DOI: 10.1016/j.jdent.2017.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/10/2017] [Accepted: 08/16/2017] [Indexed: 11/16/2022] Open
Abstract
Sugar-free chewing gum containing polyols has been demonstrated to reduce caries experience in randomised controlled clinical trials. A range of polyols (mannitol, sorbitol, xylitol and maltitol) can be found in sugar-free gums and it has been claimed that they can facilitate calcium uptake into enamel subsurface lesions promoting remineralisation. OBJECTIVES The aim of this study was to compare the effect of polyols on remineralisation of enamel subsurface lesions in vitro by artificial saliva (AS) and by AS containing the salivary biomimetic casein phosphopeptide amorphous calcium phosphate (CPP-ACP). METHODS The polyols (12.6% w/v) and CPP-ACP (0.376% w/v) were used at physiologically relevant concentrations approximating those released into saliva during chewing a CPP-ACP/polyol chewing gum. Enamel subsurface lesions were exposed to one of the polyols (xylitol, sorbitol, maltitol, mannitol) in AS or AS containing CPP-ACP for 7days at 37°C with a change of solution each day. Remineralisation of the enamel subsurface lesions was measured by transverse microradiography. RESULTS A statistical test for equivalence showed there was no difference in remineralisation between the AS solutions with or without any of the polyols. The AS+CPP-ACP solution substantially promoted remineralisation over AS alone independently of any polyol added. CONCLUSION This controlled in vitro study showed that polyols at physiologically relevant concentrations did not promote remineralisation of enamel subsurface lesions by facilitating calcium uptake into the lesion.
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Affiliation(s)
- Peiyan Shen
- Oral Health Cooperative Research Centre, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Glenn D Walker
- Oral Health Cooperative Research Centre, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yi Yuan
- Oral Health Cooperative Research Centre, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Coralie Reynolds
- Oral Health Cooperative Research Centre, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Eric C Reynolds
- Oral Health Cooperative Research Centre, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Victoria, Australia.
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Alencar CRBD, Oliveira GCD, Magalhães AC, Buzalaf MAR, Machado MADAM, Honório HM, Rios D. In situ effect of CPP-ACP chewing gum upon erosive enamel loss. J Appl Oral Sci 2017; 25:258-264. [PMID: 28678944 PMCID: PMC5482248 DOI: 10.1590/1678-7757-2016-0304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/15/2016] [Indexed: 11/22/2022] Open
Abstract
Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is able to increase salivary calcium and phosphate levels at an acidic pH. Previous studies demonstrated that a CPP-ACP chewing gum was able to enhance the re-hardening of erosion lesions, but could not diminish enamel hardness loss. Therefore, there is no consensus regarding the effectiveness of CPP-ACP on dental erosion.
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Affiliation(s)
| | - Gabriela Cristina de Oliveira
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, SP, Brasil
| | - Ana Carolina Magalhães
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ciências Biológicas, Bauru, SP, Brasil
| | - Marília Afonso Rabelo Buzalaf
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ciências Biológicas, Bauru, SP, Brasil
| | | | - Heitor Marques Honório
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, SP, Brasil
| | - Daniela Rios
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Bauru, SP, Brasil
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Wessel SW, van der Mei HC, Maitra A, Dodds MWJ, Busscher HJ. Potential benefits of chewing gum for the delivery of oral therapeutics and its possible role in oral healthcare. Expert Opin Drug Deliv 2016; 13:1421-31. [DOI: 10.1080/17425247.2016.1193154] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Stefan W. Wessel
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Henny C. van der Mei
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Henk J. Busscher
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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Jordão M, Alencar C, Mesquita I, Buzalaf M, Magalhães A, Machado M, Honório H, Rios D. In situ Effect of Chewing Gum with and without CPP-ACP on Enamel Surface Hardness Subsequent to ex vivo Acid Challenge. Caries Res 2016; 50:325-30. [DOI: 10.1159/000444718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 02/14/2016] [Indexed: 11/19/2022] Open
Abstract
The erosion-protective effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is controversial. This study aimed to investigate the ability of CPP-ACP chewing gum to prevent a single event of erosive demineralization in situ. Bovine enamel blocks (n = 120) were randomly assigned to 3 phases according to the baseline surface hardness: phase I (PI) - chewing gum with CPP-ACP, phase II (PII) - chewing gum without CPP-ACP, and control phase (PIII) - salivary effect without stimulation (no gum). Nineteen volunteers participated in this study during 3 crossover phases of 2 h. In PI and PII, the volunteers wore intraoral palatal appliances for 120 min and chewed a unit of the corresponding chewing gum for the final 30 min. In the control phase the volunteers wore the appliance for 2 h, without chewing gum. Immediately after intraoral use, the appliances were extraorally immersed in a cola drink for 5 min to promote erosive demineralization. The percentage of surface hardness loss was calculated. The data were analyzed by ANOVA models and Tukey's test. Lower enamel hardness loss was found after the use of chewing gum with CPP-ACP (PI: 32.7%) and without CPP-ACP (PII: 33.5%) compared to the salivary effect without stimulation (PIII: 39.8%) (p < 0.05). There was no difference between PI and PII (p > 0.05). The results suggest that the use of chewing gum immediately before an erosive demineralization can diminish enamel hardness loss. However, the presence of CPP-ACP in the chewing gum cannot enhance this protective effect.
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In situ effect of a CPP-ACP chewing gum on enamel erosion associated or not with abrasion. Clin Oral Investig 2016; 21:339-346. [DOI: 10.1007/s00784-016-1796-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
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Lussi A, Carvalho TS. The Future of Fluorides and Other Protective Agents in Erosion Prevention. Caries Res 2015; 49 Suppl 1:18-29. [DOI: 10.1159/000380886] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The effectiveness of fluoride in caries prevention has been convincingly proven. In recent years, researchers have investigated the preventive effects of different fluoride formulations on erosive tooth wear with positive results, but their action on caries and erosion prevention must be based on different requirements, because there is no sheltered area in the erosive process as there is in the subsurface carious lesions. Thus, any protective mechanism from fluoride concerning erosion is limited to the surface or the near surface layer of enamel. However, reports on other protective agents show superior preventive results. The mechanism of action of tin-containing products is related to tin deposition onto the tooth surface, as well as the incorporation of tin into the near-surface layer of enamel. These tin-rich deposits are less susceptible to dissolution and may result in enhanced protection of the underlying tooth. Titanium tetrafluoride forms a protective layer on the tooth surface. It is believed that this layer is made up of hydrated hydrogen titanium phosphate. Products containing phosphates and/or proteins may adsorb either to the pellicle, rendering it more protective against demineralization, or directly to the dental hard tissue, probably competing with H+ at specific sites on the tooth surface. Other substances may further enhance precipitation of calcium phosphates on the enamel surface, protecting it from additional acid impacts. Hence, the future of fluoride alone in erosion prevention looks grim, but the combination of fluoride with protective agents, such as polyvalent metal ions and some polymers, has much brighter prospects.
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Matthews F. The use of sugar free chewing gum as a supplement in the prevention of dental caries. Narrative Review. JOURNAL OF ORAL RESEARCH 2015. [DOI: 10.17126/joralres.2015.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Asl-Aminabadi N, Najafpour E, Samiei M, Erfanparast L, Anoush S, Jamali Z, Pournaghi-Azar F, Ghertasi-Oskouei S. Laser-Casein phosphopeptide effect on remineralization of early enamel lesions in primary teeth. J Clin Exp Dent 2015; 7:e261-7. [PMID: 26155343 PMCID: PMC4483334 DOI: 10.4317/jced.52165] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/05/2015] [Indexed: 11/26/2022] Open
Abstract
Background The aim of this study was to assess the effect of Nd:YAG laser irradiation following casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) application on calcium and phosphate concentration and surface microhardness (SMH) of enamel surface in artificial white spot lesions of primary teeth. Material and Methods Eighty teeth with artificial white spot lesions were randomly divided into four groups: (A) distilled and deionized water, (B) Nd:YAG laser, (C) CPP-ACP crème, & (D) CPP-ACP plus laser. SMH was measured using Vickers diamond indenter in Vickers Hardness Number (VHN). Two samples of each group were analyzed using scanning electron microscope (SEM). The results were analyzed with the SPSS 17/win. Results The subjects of group D demonstrated a significant increase in the calcium and phosphate contents of enamel surface compared to those of groups A (P < 0.001, P < 0.001), B (P < 0.001, P < 0.001) and C (P = 0.024, P = 0.04), respectively. A statistically significant difference was seen for mean VHN between groups A and B (P = 0.002). SEM evaluations confirmed the results. Conclusions The combination of Nd:YAG laser and CPP-ACP crème could be recommended as an effective preventive modality for remineralizing of white spot lesions in primary teeth. Key words:CPP-ACP, enamel remineralization, microhardness, Nd:YAG, primary teeth, SEM.
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Affiliation(s)
- Naser Asl-Aminabadi
- Professor, Department of Paediatric Dentistry, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, East Azerbaijan, Iran
| | - Ebrahim Najafpour
- Assistant Professor, Department of Paediatric Dentistry, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, East Azerbaijan, Iran
| | - Mohammad Samiei
- Assistant Professor, Department of Endodontic, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, East Azerbaijan, Iran
| | - Leila Erfanparast
- Assistant Professor, Department of Paediatric Dentistry, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, East Azerbaijan, Iran
| | - Somayeh Anoush
- Post graduate Student, Department of Paediatric Dentistry, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, East Azerbaijan, Iran
| | - Zahra Jamali
- Assistant Professor, Department of Oral Medicine, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, East Azerbaijan, Iran
| | - Fatemeh Pournaghi-Azar
- Assistant Professor, Department of Operative Dentistry, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, East Azerbaijan, Iran
| | - Sina Ghertasi-Oskouei
- Research Assistant, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, East Azerbaijan, Iran
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de Alencar CRB, Magalhães AC, de Andrade Moreira Machado MA, de Oliveira TM, Honório HM, Rios D. In situ effect of a commercial CPP-ACP chewing gum on the human enamel initial erosion. J Dent 2014; 42:1502-7. [PMID: 25174948 DOI: 10.1016/j.jdent.2014.08.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/13/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE This study evaluated the in situ rehardening effect of a commercial chewing gum containing casein phosphopeptide - amorphous calcium phosphate (CPP-ACP) on initial erosion lesions. METHODS Seventy-two human enamel blocks, after selection (initial surface hardness - SHi) and in vitro short-term acidic exposure (cola drink for 3 min - SHd) were randomly assigned to three groups. The factors under study were treatment (3 levels: GI chewing gum with CPP-ACP, GII chewing gum without CPP-ACP and GIII control group without gum) and intraoral period (2 levels: 2 and 24h). Twelve volunteers wore intraoral palatal devices for 24h in 3 crossover phases. On each phase, after 2h the surface hardness was assessed (SHf1) and the blocks were reinserted and the devices were used for additional 22 h (SHf2). In phases of GI and GII volunteers chewed the respective gum during 30 min, for 4 times with an interval of 4h. Percentage of surface hardness recovery (%SHR) was calculated after 2 and 24 h. The data were analysed by repeated measures ANOVA and Tukey's test. RESULTS Chewing gum with CPP-ACP (2h=50.0%<24h=95.9%) showed higher hardness recovery than chewing gum without CPP-ACP (2h=30.0%<24 h=71.1%) and control (2 h=15.7%<24 h=40.9%) (p<0.05). CONCLUSIONS The results suggest that saliva increased hardness of softened enamel after the use of conventional chewing gum (GII) and this effect was enhanced by the prolonged intraoral period (24 h) and by the use of CPP-ACP chewing gum (GI). CLINICAL SIGNIFICANCE Since chewing gum is an alternative to enhance salivary defenses after erosive challenges, CPP-ACP chewing gum might be a supplementary strategy to potentiate the mineral precipitation of initial erosion lesions.
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Affiliation(s)
- Catarina Ribeiro Barros de Alencar
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru/SP - PO Box 73, 17012-101, Brazil.
| | - Ana Carolina Magalhães
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru/SP - PO Box 73, 17012-101, Brazil.
| | - Maria Aparecida de Andrade Moreira Machado
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru/SP - PO Box 73, 17012-101, Brazil.
| | - Thais Marchini de Oliveira
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru/SP - PO Box 73, 17012-101, Brazil.
| | - Heitor Marques Honório
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru/SP - PO Box 73, 17012-101, Brazil.
| | - Daniela Rios
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru/SP - PO Box 73, 17012-101, Brazil.
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Long-term remineralizing effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on early caries lesions in vivo: A systematic review. J Dent 2014; 42:769-77. [DOI: 10.1016/j.jdent.2014.03.015] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 03/26/2014] [Accepted: 03/28/2014] [Indexed: 11/18/2022] Open
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Inhibition of tooth erosion by milk containing different fluoride concentrations: An in vitro study. J Dent 2014; 42:498-502. [DOI: 10.1016/j.jdent.2013.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 12/12/2013] [Accepted: 12/17/2013] [Indexed: 11/17/2022] Open
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Ionta FQ, Mendonça FL, de Oliveira GC, de Alencar CRB, Honório HM, Magalhães AC, Rios D. In vitro assessment of artificial saliva formulations on initial enamel erosion remineralization. J Dent 2014; 42:175-9. [DOI: 10.1016/j.jdent.2013.11.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/11/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022] Open
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Zhou C, Zhang D, Bai Y, Li S. Casein phosphopeptide–amorphous calcium phosphate remineralization of primary teeth early enamel lesions. J Dent 2014; 42:21-9. [DOI: 10.1016/j.jdent.2013.11.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 11/07/2013] [Accepted: 11/11/2013] [Indexed: 11/16/2022] Open
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