Physicochemical Characterization of Casein Phosphopeptide-Amorphous Calcium Phosphate Nanocomplexes

A comparative evaluation of human enamel remineralization ability of biomimetic nacre against casein phosphopeptide-amorphous calcium phosphate: An in vitro study

Introduction

This study aimed to assess and compare the efficacy of Nacre and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on the remineralization of enamel using surface microhardness analysis, scanning electron microscopy (SEM), and energy dispersive X-ray (EDX) spectroscopy.

Materials and Methods

Twenty human maxillary premolars extracted for orthodontic reasons were collected. Under cool water spray, the crowns were sectioned mesiodistally into buccal and palatal halves using a diamond disc. The samples were subsequently mounted in self-cure acrylic resin. The samples were then subjected to Vickers hardness testing and SEM-EDX for baseline. To simulate carious lesions, all of the samples were acid-etched with 37% phosphoric acid for 30 s in a specific area on the enamel samples and subjected to surface microhardness testing and SEM-EDX. The enamel samples were randomly assigned to Group 1: Nacre water-soluble matrix (WSM), Group 2: Nacre varnish, and Group 3: CPP-ACP for remineralization. After 21 days, remineralization assessment of the test samples was done using SMH analysis and SEM-EDX analysis. Data obtained were statistically analyzed using the one-way analysis of variance to reveal the significant differences between the groups. Tukey's test was used for post hoc comparisons.

Results

All three groups showed a significant increase in surface microhardness. All three groups showed a significant calcium and phosphorous ratio increase after remineralization. Among the three groups, the highest Ca:P ratio was seen in the Nacre WSM group (0.58) followed by the Nacre Varnish (0.57) and CPP-ACP group (0.57). SEM images of the Nacre surface revealed the presence of extensive interlocking. A layer of packed hydroxyapatite particles was formed on the surface of the nacre through surface reactions.

Conclusion

All the groups in the present study showed some extent of remineralizing ability irrespective of the different materials and mechanisms of action. Nacre WSM showed a remarkable hardness spike close to natural enamel after demineralization.

Calcium Orthophosphate (CaPO4) Containing Composites for Biomedical Applications: Formulations, Properties, and Applications

The goal of this review is to present a wide range of hybrid formulations and composites containing calcium orthophosphates (abbreviated as CaPO4) that are suitable for use in biomedical applications and currently on the market. The bioactive, biocompatible, and osteoconductive properties of various CaPO4-based formulations make them valuable in the rapidly developing field of biomedical research, both in vitro and in vivo. Due to the brittleness of CaPO4, it is essential to combine the desired osteologic properties of ceramic CaPO4 with those of other compounds to create novel, multifunctional bone graft biomaterials. Consequently, this analysis offers a thorough overview of the hybrid formulations and CaPO4-based composites that are currently known. To do this, a comprehensive search of the literature on the subject was carried out in all significant databases to extract pertinent papers. There have been many formulations found with different material compositions, production methods, structural and bioactive features, and in vitro and in vivo properties. When these formulations contain additional biofunctional ingredients, such as drugs, proteins, enzymes, or antibacterial agents, they offer improved biomedical applications. Moreover, a lot of these formulations allow cell loading and promote the development of smart formulations based on CaPO4. This evaluation also discusses basic problems and scientific difficulties that call for more investigation and advancements. It also indicates perspectives for the future.

Comparing the effect of animal and plant-based yogurt extracts on enamel demineralization: an in vitro study

BACKGROUND

Yogurt, due to its rich casein phosphopeptide (CPP) content could promote remineralization of enamel. Contrary to the age-old usage of animal milk based yogurt, vegan dairy products are gaining momentum due to multiple reasons. Considering this change, the aim of the present study was to assess the in vitro effect of animal and plant-based yogurt extracts on demineralization of enamel.

METHODS

Enamel windows were prepared on the crowns of sixty premolar teeth using nail paint. Teeth were divided into four groups of fifteen each and were treated with distilled water, demineralizing agent, solution with a mixture of demineralizing agent and yogurt supernatants, respectively for 96 hrs. Quantitative analysis was done using EDXRF (baseline and postexperimental calcium and phosphorus content). Additionally, confocal microscopic analysis was performed to assess the extent of demineralization.

RESULTS

The animal-based yogurt (Group III) had the highest post experimental calcium value (mean±SD=81.15±5.02) and positive percentage of change in calcium level (15%; P=0.007) among the groups. This was followed by plant-based yogurt (Group IV) (mean calcium= 76.18±5.12; positive percentage change =8.11%; P=0.003).

CONCLUSIONS

Animal based yogurt could provide higher protection against enamel demineralization when compared to plant-based yogurt.

Caseinophosphopeptides Overcome Calcium Phytate Inhibition on Zinc Bioavailability by Retaining Zinc from Coprecipitation as Zinc/Calcium Phytate Nanocomplexes

Caseinophosphopeptides have shown great potential to increase zinc bioavailability from phytate-rich diets, but the mechanism of action remains unclear. Here, caseinophosphopeptides from a sodium caseinate hydrolysate dose-dependently retained zinc in solution against calcium phytate coprecipitation under physiologically relevant conditions. The 3 kDa ultrafiltration separation unveiled no added low-molecular-weight chelates of zinc and calcium by caseinophosphopeptides. Tyndall effect, dynamic light scattering measurements, transmission electron microscopy observation, electron diffraction pattern, X-ray diffraction spectrum, and energy-dispersive X-ray analysis demonstrated the caseinophosphopeptides-mediated formation of single-crystal zinc/calcium phytate nanocomplexes (Zn/CaPA-NCs) with a size and ζ-potential of 10-30 nm and -25 mV, respectively. Caseinophosphopeptides-stabilized Zn/CaPA-NCs were found to deliver bioavailable nanoparticulate zinc in mouse jejunal loop ex vivo model and polarized Caco-2 cells, and the treatments with specific inhibitors revealed that intestinal zinc absorption from Zn/CaPA-NCs invoked macropinocytosis, lysosomal release into the cytosol, and transcytosis. Overall, our study proposes a new paradigm for the benefit of caseinophosphopeptides for zinc bioaccessibility and bioavailability in phytate-rich diets.

Application of small angle scattering (SAS) in structural characterisation of casein and casein-based products during digestion

In recent years, small and ultra-small angle scattering techniques, collectively known as small angle scattering (SAS) have been used to study various food structures during the digestion process. These techniques play an important role in structural characterisation due to the non-destructive nature (especially when using neutrons), various in situ capabilities and a large length scale (of 1 nm to ∼20 μm) they cover. The application of these techniques in the structural characterisation of dairy products has expanded significantly in recent years. Casein, a major dairy protein, forms the basis of a wide range of gel structures at different length scales. These gel structures have been extensively researched utilising scattering techniques to obtain structural information at the nano and micron scale that complements electron and confocal microscopy. Especially, neutrons have provided opportunity to study these gels in their natural environment by using various in situ options. One such example is understanding changes in casein gel structures during digestion in the gastrointestinal tract, which is essential for designing personalised food structures for a wide range of food-related diseases and improve health outcomes. In this review, we present an overview of casein gels investigated using small angle and ultra-small angle scattering techniques. We also reviewed their digestion using newly built setups recently employed in various research. To gain a greater understanding of micro and nano-scale structural changes during digestion, such as the effect of digestive juices and mechanical breakdown on structure, new setups for semi-solid food materials are needed to be optimised.

Impact of Dairy Products and Plant-Based Alternatives on Dental Health: Food Matrix Effects

The impact of dairy products on dental health has been researched widely and shows an important role of various constituents, as well as the specific product matrix, in maintaining and improving dental health. These include, for instance, the position of lactose as the least cariogenic fermentable sugar, the high levels of calcium and phosphate, the presence of phosphopeptides as well as the antibacterial peptides lactoferrin and lysozyme and high buffering capacity. With plant-based alternatives for dairy products being developed and marketed these days, the specific benefits of dairy products in relation to dental health are often overlooked and most products contain more cariogenic carbohydrates, lack phosphopeptides, and have fewer minerals and less buffering capacity. Comparative studies performed to date indeed suggest that plant-based products do not match dairy counterparts when it comes to maintaining and improving dental health. Careful consideration of these aspects is required in relation to future developments of products and human diets. In this paper, we review the impact of dairy products and plant-based dairy alternatives on dental health.

Reply to the 'Comment on "Deciphering calcium-binding behaviors of casein phosphopeptides by experimental approaches and molecular simulation"' by D. Horne, Food Funct., 2022, , https://doi.org/D2FO00808D

The comment regarding a method we used to calculate the binding capacity of casein phosphopeptides (CPPs) with calcium. Dr. Horne stated that we overestimated the concentration of Ca²⁺. Indeed, peptides would bind with more calcium ions with the help of phosphate ions. However, in our statement, the binding capacity of CPPs with calcium we used included the binding with calcium in the presence of phosphate. In our solution, peptides sequester calcium phosphate to form soluble core-shell nanoclusters, preventing calcium phosphate precipitating. Even if the binding capacity of CPPs with calcium are overestimated as stated by Dr. Horne, these could not be a problem in deciphering calcium-binding behaviors. Phosphate was applied only in the optimizing and screening process presented in Fig. 1 and Table 1, other experiments (Fig. 2-5 in the commented article) did not include phosphate in the reaction system. Phosphate could not be a factor of these experiments.

Evaluation of Resin Infiltration, Fluoride and the Biomimetic Mineralization of CPP-ACP in Protecting Enamel after Orthodontic Inter-Proximal Enamel Reduction

BACKGROUND

This study investigated the effect of using different agents for protecting enamel proximal surfaces against acidic attack after interproximal reduction (IPR) using the trans micro radiography technique.

METHODS

Seventy-five sound-proximal surfaces were obtained from extracted premolars for orthodontic reasons. All teeth were measured miso-distally and mounted before being stripped. The proximal surfaces of all teeth were hand stripped with single-sided diamond strips (OrthoTechnology, West Columbia, SC, USA) followed by polishing via Sof-Lex polishing strips (3M, Maplewood, MN, USA). Three-hundred micrometers of enamel thickness was reduced from each proximal surface. The teeth were randomly divided into 5 groups: group 1 (control un-demineralized) received no treatment, group 2 (control demineralized) had their surfaces demineralized after the IPR procedure, group 3 (fluoride) specimens were treated with fluoride gel (NUPRO, DENTSPLY, Charlotte, NC, USA) after the IPR, group 4 (Icon) resin infiltration material (Icon Proximal Mini Kit, DMG, Bielefeld, Germany) was applied after IPR, group 5 (MI varnish) specimens were treated with Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) containing varnish (MI Varnish, G.C, USA, St. Alsip, IL, USA) after the IPR. The specimens in (groups 2-5) were stored in a 4.5 pH demineralization solution for 4 days. The trans-micro-radiography (TMR) technique was conducted to evaluate the mineral loss (∆Z) and lesion depth of all specimens after the acid challenge. The obtained results were analyzed statistically using a one-way ANOVA at a significance level of α = 0.05.

RESULTS

The MI varnish recorded significant ∆Z and lesion depth values compared to the other groups p > 0.05. There was no significant difference in ∆Z and lesion depth between the control demineralized, Icon, and fluoride groups p < 0.05.

CONCLUSION

The MI varnish increased the enamel resistance to acidic attack, and thus can be considered an agent capable of protecting the proximal enamel surface after IPR.

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.

Synthesis and characterization of nano bioactive glass for improving enamel remineralization ability of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)

OBJECTIVE

Nanomaterials with superior properties such as high surface area over volume ratio are widely used in dentistry and medicine. This in vitro study was performed to synthesize and characterize nano bioactive glass (nBG) and to evaluate the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) containing nBG (CPP-ACP@nBG) on enamel remineralization by its application to pH-cycled, synthetically demineralized enamel surfaces.

MATERIALS AND METHODS

nBG particles were prepared by sol-gel method. X-ray diffraction pattern (XRD), Fourier-transform infrared spectroscopy (FTIR) and transmittance electron microscopy (TEM) were used for nBG characterization. Synthetic CPP-ACP paste was prepared and nBG particles were added to it. To evaluate the degree of remineralization, 32 healthy human premolars were selected. The samples were randomly divided into 4 groups as: Group 1: Commercial CPP-ACFP (MI paste plus), Group 2: Synthetic casein phosphopeptide-amorphous calcium phosphate containing fluoride (CPP-ACP@F), Group 3: Synthetic CPP/ACP containing nBG (CPP-ACP@nBG), and Group 4: Control (received no treatment). The pastes were then applied on the tooth surfaces for 28 days. The Vickers microhardness of enamel surfaces was evaluated, and enamel surface morphology was assessed using scanning electron microscopy (SEM).

RESULTS

X-Ray diffraction pattern (XRD) of the synthesized nBG show its crystalline nature with the Larnite crystalline mode. Transmittance electron microscope (TEM) microimage of the synthesized nBG shows its formation as less that 100 nm spherical nanoparticle with partial agglomeration. Fourier transform infrared spectroscopy (FTIR) confirm the success formation of nBG with high purity. The results of this study showed that microhardness of the experimental groups was significantly higher than the control group (p ≥ 0.05). SEM images showed a layer of hydroxyapatite in the CPP-ACP@nBG, synthetic and commercial CPP-ACP@F remineralized groups.

CONCLUSION

The results of this study demonstrated that CPP-ACP@F and CPP-ACP@nBG remineralize the surface of the demineralized enamel. Microhardness of the remineralized enamel in the CPP-ACP@nBG group was higher than synthetic and commercial CPP-ACP@F groups.

A comprehensive review on preparation, structure-activities relationship, and calcium bioavailability of casein phosphopeptides

Calcium is one of the important elements for human health. Calcium deficiencies can lead to numerous diseases. Calcium chelating peptides have shown potential application in the management of calcium deficiencies. Casein phosphopeptides (CPP) are phosphoseryl-containing fragments of casein by enzymatic hydrolysis or fermentation during manufacture of milk products as well as during intestinal digestion. An increasing number of CPP with the ability to facilitate and enhance the bioavailability of calcium are being discovered and identified. In this review, 249 reported CPP derived from four types of bovine casein (αs1, αs2, β and κ) were collected, and the amino acid sequence and phosphoserine group information were sorted out. This review outlines the current enzyme hydrolysis, detection methods, purification, structure-activity relationship and mechanism of intestinal calcium absorption in vitro and in vivo as well as application of CPP.

Bio-inspired special wettability in oral antibacterial applications

Most oral diseases originate from biofilms whose formation is originated from the adhesion of salivary proteins and pioneer bacteria. Therefore, antimicrobial materials are mainly based on bactericidal methods, most of which have drug resistance and toxicity. Natural antifouling surfaces inspire new antibacterial strategies. The super wettable surfaces of lotus leaves and fish scales prompt design of biomimetic oral materials covered or mixed with super wettable materials to prevent adhesion. Bioinspired slippery surfaces come from pitcher plants, whose porous surfaces are infiltrated with lubricating liquid to form superhydrophobic surfaces to reduce the contact with liquids. It is believed that these new methods could provide promising directions for oral antimicrobial practice, improving antimicrobial efficacy.

Application of Amorphous Calcium Phosphate Agents in the Prevention and Treatment of Enamel Demineralization

Enamel demineralization, as a type of frequently-occurring dental problem that affects both the health and aesthetics of patients, is a concern for both dental professionals and patients. The main chemical composition of the enamel, hydroxyapatite, is easy to be dissolved under acid attack, resulting in the occurrence of enamel demineralization. Among agents for the preventing or treatment of enamel demineralization, amorphous calcium phosphate (ACP) has gradually become a focus of research. Based on the nonclassical crystallization theory, ACP can induce the formation of enamel-like hydroxyapatite and thereby achieve enamel remineralization. However, ACP has poor stability and tends to turn into hydroxyapatite in an aqueous solution resulting in the loss of remineralization ability. Therefore, ACP needs to be stabilized in an amorphous state before application. Herein, ACP stabilizers, including amelogenin and its analogs, casein phosphopeptides, polymers like chitosan derivatives, carboxymethylated PAMAM and polyelectrolytes, together with their mechanisms for stabilizing ACP are briefly reviewed. Scientific evidence supporting the remineralization ability of these ACP agents are introduced. Limitations of existing research and further prospects of ACP agents for clinical translation are also discussed.

Effect of Fluoride-based Varnishes with Added Calcium and Phosphate on Microhardness of Esthetic Restorative Materials: An In Vitro Study

Background and objectives

Fluoride varnishes are being used to prevent caries in children. The high concentration of fluoride in varnishes apart from caries prevention may cause changes in surface properties of esthetic restorations. The study aims to evaluate and compare the effect of four commercially available fluoride varnishes with added calcium and phosphate on microhardness of three esthetic materials namely conventional GIC (Fuji II), high viscosity GIC (Fuji IX), and nanocomposite (Filtek Z350).

Materials and methods

A total of 28 pellets were made of each material and stored in distilled water at 37 °C for 48 hours. The microhardness of the pellets was tested which served as a baseline. These were then randomly divided into four subgroups. In one subgroup Profluorid varnish was applied, second subgroup MI varnish was applied, third subgroup Embrace varnish was applied, and in the fourth subgroup Enamel Pro varnish was applied as per protocol. Thereafter, all the pellets were subjected to microhardness testing (load = 100 g for 15 seconds).

Results

The fluoride varnishes increased the microhardness of conventional GIC (Fuji II) whereas in case of high viscosity GIC (Fuji IX) the application of varnishes reduced the microhardness. In case of nanocomposite restorative material (Filtek Z350) only Profluorid varnish increased its microhardness.

Conclusion

Fluoride varnish and calcium-phosphate containing fluoride varnish effect on the microhardness of restorative material is material dependent. So, the choice of fluoride varnish with or without proprietary additives depends on the nature and composition of the restorative material.

How to cite this article

Shetty RS, Bhat SS, HK Sundeep, et al. Effect of Fluoride-based Varnishes with Added Calcium and Phosphate on Microhardness of Esthetic Restorative Materials: An In Vitro Study. Int J Clin Pediatr Dent 2022;15(2):187-193.

Cross-Linking of Apatite-Gelatin Nanocomposites as the Basis for Dentine Replacement Materials

A novel approach for the production of a bioinspired dentine replacement material is introduced. An apatite-gelatin nanocomposite material was cross-linked with various cross-linkers. These nanocomposites have a high resemblance to mammalian dentine regarding its composition and properties. A precipitation reaction was used to produce apatite-gelatin nanocomposites as starting materials. Cross-linking of the gelatin has to be performed to produce dentine-like and thus tough and robust apatite-gelatin nanocomposites. Therefore, the efficacy of various protein cross-linkers was tested, and the resulting materials were characterized by scanning electron microscopy, transmission electron microscopy, powder X-ray diffraction, and EXAFS as well as CHNS analysis and tested for their mechanical performance using Vickers hardness measurements as well as for their dissolution stability in EDTA. Especially glutaraldehyde, proanthocyanidins, and transglutaminase gave promising results with hardness values of up to 63 HV0.2. To further improve the material properties, we combined the effective cross-linker transglutaminase with casein, which led to an improved interconnection between the single nanocomposite platelets. By doing so, a cross-linked composite was obtained, which shows even higher hardness values than does human dentine, at 76 HV_0.2. The combination of apatite-gelatin nanocomposites with an effective cross-linker resulted in a bioinspired material with composition and properties close to those of human dentine.

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.

Synthetic amorphous calcium phosphates (ACPs): preparation, structure, properties, and biomedical applications

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 PO₄^3- 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.

Surface Analysis and Spectrophotometric Evaluation of Different Esthetic Restorative Materials Frequently Exposed to a Desensitizing Agent

Background

Patients with tooth sensitivity are frequently exposed to desensitizing agents on a regular basis. These agents might have an impact on the surface properties and color of existing oral restorations. Accordingly, this study aimed to investigate the color stability, surface microhardness, and surface roughness of resin-modified glass ionomer (RMGIC), amalgomer CR, nanohybrid, and bulk-fill resin composites restorative materials after frequent exposure to a desensitizing agent. Materials and Methods. One hundred and twenty specimens were prepared; 10 specimens for each restorative material were equally subdivided into control and desensitizing-agent-exposed groups in each test. Surface microhardness and surface roughness were evaluated using the Vickers microhardness tester and surface profilometer, respectively. The color change was measured by using a spectrophotometer using the CIE L^∗a^∗b^∗ formula. Surface topography was analyzed using a scanning electron microscope (SEM). The collected data were analyzed with Student's t-test, one-way ANOVA, and Tukey post hoc tests for pairwise comparison at a level of significance of 0.05.

Result

The frequent use of a desensitizing agent significantly decreased surface hardness of RMGIC, amalgomer, and bulk-fill composite materials. However, nanohybrid composite exhibited a significant surface hardness increase. The surface roughness of RMGIC, amalgomer, and nanohybrid composite increased significantly. Meanwhile, the bulk-fill resin composite showed a nonsignificant decrease. Both RMGIC and amalgomer exhibited significantly higher values of color change in comparison to those of nanohybrid and bulk-fill composites.

Conclusion

The bulk-fill composite seems to be more resistant to discoloration and surface topographical changes than other tested materials on frequent exposure to the desensitizing agent. However, this exposure may pose a negative impact on its surface hardness. Bulk-fill resin composite may be the most suitable esthetic restorative in patients who frequently use desensitizing agents.

The potential nutrition-, physical- and health-related benefits of cow's milk for primary-school-aged children

Cow's milk is a naturally nutrient-dense foodstuff. A significant source of many essential nutrients, its inclusion as a component of a healthy balanced diet has been long recommended. Beyond milk's nutritional value, an increasing body of evidence illustrates cow's milk may confer numerous benefits related to health. Evidence from adult populations suggests that cow's milk may have a role in overall dietary quality, appetite control, hydration and cognitive function. Although evidence is limited compared with the adult literature, these benefits may be echoed in recent paediatric studies. This article, therefore, reviews the scientific literature to provide an evidence-based evaluation of the associated health benefits of cow's milk consumption in primary-school-aged children (4-11 years). We focus on seven key areas related to nutrition and health comprising nutritional status, hydration, dental and bone health, physical stature, cognitive function, and appetite control. The evidence consistently demonstrates cow's milk (plain and flavoured) improves nutritional status in primary-school-aged children. With some confidence, cow's milk also appears beneficial for hydration, dental and bone health and beneficial to neutral concerning physical stature and appetite. Due to conflicting studies, reaching a conclusion has proven difficult concerning cow's milk and cognitive function; therefore, a level of caution should be exercised when interpreting these results. All areas, however, would benefit from further robust investigation, especially in free-living school settings, to verify conclusions. Nonetheless, when the nutritional-, physical- and health-related impact of cow's milk avoidance is considered, the evidence highlights the importance of increasing cow's milk consumption.

Activity of Phosvitin in Hydroxyapatite Acid-Damage Immersion and Antimicrobial Assays

Phosvitin, the most highly phosphorylated metal-binding protein found in nature, binds more than 100 calcium ions, and has been identified as an agent that could be used to generate biomineralization scaffolds. Because of published reports describing phosvitin's affinity for calcium and potential antibiotic activity, this study was undertaken in order to evaluate phosvitin for both antibiotic activity against common microorganisms and the ability to protect hydroxyapatite surfaces from acid damage. To more clearly define its antibiotic action, the effects of phosvitin on Micrococcus luteus, P. mirabilis, B. cereus, E. coli, and S. epidermidis were evaluated. In both Kirby–Bauer tests and liquid culture growth inhibition assays, phosvitin inhibited M. luteus, a microorganism that thrives in the human mouth, but not the other bacteria tested. The MIC of phosvitin was determined to be 31.3 μg/mL when delivered in 1 mM CaCl₂ but was 0.5 mg/mL in the absence of added calcium. Expanding on the potential impacts of phosvitin on the mouth, its action was evaluated in a model of tooth decay represented by acid-damaged hydroxyapatite discs. SEM, AFM, and FAAS analyses revealed that pretreatment of discs with phosvitin modulated the damage-induced morphology and topography changes associated with acid-damaged discs.

Addition of CPP-ACP to yogurt inhibits enamel subsurface demineralization

OBJECTIVES

The aim of this study was to investigate the capacity of an approved food additive with anticariogenic properties, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), when added to a processed, sugar-containing yogurt with added lactic-acid bacteria (probiotics), to prevent demineralization of enamel subsurface lesions in vitro.

METHODS

Enamel subsurface demineralised lesions were created in thirty extracted human third molars. These were then exposed to artificial saliva (AS) with: 1) Danone yogurt alone; 2) Danone yogurt with 0.2 % w/w CPP-ACP; or 3) Danone yogurt with 0.5 % w/w CPP-ACP at 37 °C for two weeks. The yogurt/AS was replaced with fresh preparations each day. At the completion of each treatment the enamel slabs were embedded, sectioned and analyzed using transverse microradiography to measure changes in enamel lesion depths and subsurface mineral content. Yogurt samples were analysed for soluble calcium (Ca) and inorganic phosphate (Pi) levels and pH.

RESULTS

Yogurt alone demineralized enamel subsurface lesions to produce significantly larger lesions. However, the addition of 0.2 % CPP-ACP to the yogurt resulted in significant reduction in demineralization compared with yogurt alone (p < 0.0001). The addition of 0.5 % CPP-ACP to the yogurt produced a net remineralization effect with a significant increase in lesion mineral content (p < 0.0001). The addition of CPP-ACP resulted in a significant (p < 0.0001) dose-related increase in Ca, Pi and pH.

CONCLUSIONS

The addition of CPP-ACP to a commercial yogurt exhibited a dose related protective effect with 0.5 % CPP-ACP producing remineralization of existing enamel subsurface lesions under the in vitro experimental conditions. CLINICAL SIGNIfiCANCE: The results of this study suggest that some processed yogurts with added sugar could result in enamel demineralization when frequently consumed by individuals with poor oral hygiene. The addition of CPP-ACP to these yogurts may help prevent demineralization and promote enamel subsurface lesion remineralization, and therefore, make them safer for teeth.

Integrated Continuous Bioprocess Development for ACE-Inhibitory Peptide Production by Lactobacillus helveticus Strains in Membrane Bioreactor

Production of bioactive peptides (BAPs) by Lactobacillus species is a cost-effective approach compared to the use of purified enzymes. In this study, proteolytic Lactobacillus helveticus strains were used for milk fermentation to produce BAPs capable of inhibiting angiotensin converting enzyme (ACE). Fermented milks were produced in bioreactors using batch mode, and the resulting products showed significant ACE-inhibitory activities. However, the benefits of fermentation in terms of peptide composition and ACE-inhibitory activity were noticeably reduced when the samples (fermented milks and non-fermented controls) were subject to simulated gastrointestinal digestion (GID). Introducing an ultrafiltration step after fermentation allowed to prevent this effect of GID and restored the effect of fermentation. Furthermore, an integrated continuous process for peptide production was developed which led to a 3 fold increased peptide productivity compared to batch production. Using a membrane bioreactor allowed to generate and purify in a single step, an active ingredient for ACE inhibition.

Structural Biology of Calcium Phosphate Nanoclusters Sequestered by Phosphoproteins

Biofluids that contain stable calcium phosphate nanoclusters sequestered by phosphopeptides make it possible for soft and hard tissues to co-exist in the same organism with relative ease. The stability diagram of a solution of nanocluster complexes shows how the minimum concentration of phosphopeptide needed for stability increases with pH. In the stable region, amorphous calcium phosphate cannot precipitate. Nevertheless, if the solution is brought into contact with hydroxyapatite, the crystalline phase will grow at the expense of the nanocluster complexes. The physico-chemical principles governing the formation, composition, size, structure, and stability of the complexes are described. Examples are given of complexes formed by casein, osteopontin, and recombinant phosphopeptides. Application of these principles and properties to blood serum, milk, urine, and resting saliva is described to show that under physiological conditions they are in the stable region of their stability diagram and so cannot cause soft tissue calcification. Stimulated saliva, however, is in the metastable region, consistent with its role in tooth remineralization. Destabilization of biofluids, with consequential ill-effects, can occur when there is a failure of homeostasis, such as an increase in pH without a balancing increase in the concentration of sequestering phosphopeptides.

Antioxidant Properties of Casein Phosphopeptides (CPP) and Maillard-Type Conjugated Products

A casein phosphopeptide (CPP) fraction derived from tryptic hydrolysis of bovine casein was evaluated for antioxidant activity. Conjugations or mixtures of CPP with polysaccharide, galactomannan (Gal), or xyloglucan (Xyl) were prepared to evaluate potential enhancement of CPP antioxidant activity. The effect of calcium was also investigated. The CPP preparation alone was effective at scavenging hydroxyl radicals and sequestering Fe2+ to protect against Fenton reaction-induced deoxyribose oxidation in non-site-specific (up 63.3% inhibition) and site-specific (up 32.1% inhibition) binding assays, respectively. CPP also effectively quenched 2,2'-azinobis-3-ethylbenzothiazoline-6-sulfonic acid radicals (ABTS•+) to an extent of 67.6% scavenging in an aqueous system. In a soybean lecithin liposome system, CPP exhibited effective protection against peroxyl radical-induced liposomal peroxidation (38.3% of control in terms of rate of propagation). Conjugating CPP with Gal or Xyl polysaccharides using Maillard reaction conditions significantly reduced activity in the Fenton reaction-deoxyribose assays, while exhibiting no effect on the antioxidant activity of native CPP in both the ABTS and liposome assays, respectively. These results represent comparative antioxidant capacity of the native CPP and associated conjugates in phases that varied in relative hydrophilic and hydrophobic character. We conclude that CPP has the potential to act as both a primary and secondary antioxidant by displaying transition metal ion sequestering activity and free radical quenching activity. Improvements in antioxidant activity of CPP by Maillard-type conjugation with Xyl or Gal were relatively small and model-specific.

Casein phosphopeptide combined with fluoride enhances the inhibitory effect on initial adhesion of Streptococcus mutans to the saliva-coated hydroxyapatite disc

Background

Recent preventive strategies for dental caries focus on targeting the mechanisms underlying biofilm formation, including the inhibition of bacterial adhesion. A promising approach to prevent bacterial adhesion is to modify the composition of acquired salivary pellicle. This in vitro study investigated the effect and possible underlying mechanism of pellicle modification by casein phosphopeptide (CPP) on Streptococcus mutans (S. mutans) initial adhesion, and the impact of fluoride on the efficacy of CPP.

Methods

The salivary pellicle-coated hydroxyapatite (s-HA) discs were treated with phosphate buffered saline (negative control), heat-inactivated 2.5% CPP (heat-inactivated CPP), 2.5% CPP (CPP) or 2.5% CPP supplemented with 900 ppm fluoride (CPP + F). After cultivation of S. mutans for 30 min and 2 h, the adherent bacteria were visualized by scanning electron microscopy (SEM) and quantitatively evaluated using the plate count method. Confocal laser scanning microscopy (CLSM) was used to evaluate the proportions of total and dead S. mutans. The concentrations of total, free, and bound calcium and fluoride in the CPP and fluoride-doped CPP solutions were determined. The water contact angle and zeta potential of s-HA with and without modification were measured. The data were statistically analyzed using one-way ANOVA followed by a Turkey post hoc multiple comparison test.

Results

Compared to the negative control group, the amount of adherent S. mutans significantly reduced in the CPP and CPP + F groups, and was lowest in the CPP + F group. CLSM analysis showed that there was no statistically significant difference in the proportion of dead S. mutans between the four groups. Water contact angle and zeta potential of s-HA surface significantly decreased in the CPP and CPP + F groups as compared to the negative control group, and both were lowest in the CPP + F group.

Conclusions

Pellicle modification by CPP inhibited S. mutans initial adhesion to s-HA, possibly by reducing hydrophobicity and negative charge of the s-HA surface, and incorporating fluoride into CPP further enhanced the anti-adhesion effect.

Remineralization of dentin slices using casein phosphopeptide-amorphous calcium phosphate combined with sodium tripolyphosphate

Background

The remineralization approach mechanically occludes the exposed dentinal tubules mechanically, reduces the permeability of dentinal tubules and eliminates the symptoms of dentin hypersensitivity. The aim of the present study was to investigate the remineralization of demineralized dentin slices using CPP–ACP combined with TPP, and the research hypothesis was that CPP–ACP combined with TPP could result in extrafibrillar and intrafibrillar remineralization of dentin.

Methods

Demineralized dentin slices were prepared and randomly divided into the following groups: A (the CPP–ACP group), B (the CPP–ACP + TPP combination group), C (the artificial saliva group), D (the negative control group), and E (the positive control group). Dentin slice samples from groups A, B and C were remineralized and the remineralization effect was evaluated using scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy (EDX), attenuated total reflection–Fourier transform infrared spectroscopy (ATR–FTIR) and X-ray diffraction (XRD).

Results

Treatment with CPP–ACP combined with TPP occluded the dentinal tubules and resulted in remineralization of collagen fibrils. The hydroxyapatite crystals formed via remineralization were found to closely resemble the natural dentin components.

Conclusion

CPP–ACP combined with TPP has a good remineralization effect on demineralized dentin slices.

Prevention and caries risk management in teenage and orthodontic patients

As patients progress from childhood through to teenage years, they progress through periods of high caries risk as they undergo changes in lifestyle and oral microflora. Removable or fixed orthodontic treatment also alters the oral microflora and can dramatically increase caries risk. This paper outlines ways to identify the transition to higher caries risk, and practical ways to lower the risk of hard tissue loss from dental caries during orthodontic treatment across the teenage years, including tooth surface protection, optimised use of mechanical and chemical plaque control, and appropriate delivery of remineralising agents over time.

Functionalized calcium orthophosphates (CaPO4) and their biomedical applications

Due to the chemical similarity to natural calcified tissues (bones and teeth) of mammals, calcium orthophosphates (abbreviated as CaPO₄) appear to be good biomaterials for creation of artificial bone grafts. However, CaPO₄ alone have some restrictions, which limit their biomedical applications. Various ways have been developed to improve the properties of CaPO₄ and their functionalization is one of them. Namely, since surfaces always form the interfaces between implanted grafts and surrounding tissues, the state of CaPO₄ surfaces plays a crucial role in the survival of bone grafts. Although the biomedically relevant CaPO₄ possess the required biocompatible properties, some of their properties could be better. For example, functionalization of CaPO₄ to enhance cell attachment and cell material interactions has been developed. In addition, to prepare stable formulations from nanodimensional CaPO₄ particles and prevent them from agglomerating, the surfaces of CaPO₄ particles are often functionalized by sorption of special chemicals. Furthermore, there are functionalizations in which CaPO₄ are exposed to various types of physical treatments. This review summarizes the available knowledge on CaPO₄ functionalizations and their biomedical applications.

The importance of being amorphous: calcium and magnesium phosphates in the human body

This article focuses on the relevance of amorphous calcium (and magnesium) phosphates in living organisms. Although crystalline calcium phosphate (CaP)-based materials are known to constitute the major inorganic constituents of human hard tissues, amorphous CaP-based structures, often in combination with magnesium, are frequently employed by Nature to build up components of our body and guarantee their proper functioning. After a brief description of amorphous calcium phosphate (ACP) formation mechanism and structure, this paper is focused on the stabilization strategies that can be used to enhance the lifetime of the poorly stable amorphous phase. The various locations of our body in which ACP (pure or in combination with Mg²⁺) can be found (i.e. bone, enamel, small intestine, calciprotein particles and casein micelles) are highlighted, showing how the amorphous nature of ACP is often of paramount importance for the achievement of a specific physiological function. The last section is devoted to ACP-based biomaterials, focusing on how these materials differ from their crystalline counterparts in terms of biological response.

Profiling of Multiphosphorylated Peptides in Kefir and Their Release During Simulated Gastrointestinal Digestion

Casein phosphopeptides are multiphosphorylated milk peptides, which can have anticariogenic activity and improve mineral absorption by binding bivalent metal ions. The present study investigated phosphopeptides in kefir because fermentation may lead to their enhanced release from milk proteins. After selective enrichment by hydroxyapatite extraction, phosphopeptides and their phosphorylation degree were identified by matrix-assisted desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) before and after enzymatic dephosphorylation. Peptide structures were determined by ultrahigh-performance liquid chromatography coupled to electrospray ionization tandem mass spectrometry (UHPLC-ESI-MS/MS) revealing 27 phosphopeptides in kefir, including nine peptides containing the motif pSpSpSEE, which binds minerals most efficiently. The majority (18) of phosphopeptides were derived from β-casein, but only three were derived from the most abundant milk protein α_s1-casein. After simulated gastrointestinal digestion, MALDI-TOF-MS analysis detected eight putative phosphopeptides in kefir, four of which were assigned by UHPLC-ESI-MS/MS to α_s2-casein_124-133, α_s2-casein_137-146, β-casein_30-40, and κ-casein_147-161. These results indicate that kefir is a good dietary source of multiphosphorylated peptides.

Repair of dentine-related lesions without a drill or injection

For covering the shortages of traditional treatments, a novel and non-invasive system was developed with the simple adaption of nature's own repair process, while an extrinsic electric field was introduced to improve its remineralization kinetics. In an in vivo study, acid-etched rabbit dentine was used to evaluate the remineralization efficacy and safety of the system. The exposed dentine tubules were fully occluded after 5 hours/1.0 mA and 8 hours/0.5 mA of remineralization. After 5 hours of remineralization (1.0 mA), the micro-hardness of the demineralized dentine was fully recovered, equal to native rabbit dentine. Haematoxylin-eosin staining demonstrated no obvious inflammatory reaction. This study provides a feasible solution to realize rapid repair of dentine.

Evaluation of novel nanoscaled metal fluorides on their ability to remineralize enamel caries lesions

The aim of this in vitro study was to evaluate the ability of two nanoscaled metal fluorides (NMF) to remineralize shallow (SL) and deep (DL) artificial enamel caries lesions. NMF are synthesized via a non-aqueous fluorolytic sol-gel-synthesis and dissolve low fluoride concentration in aqueous solutions (n-CaF₂: 7 ppm, n-MgF₂: 70 ppm), whilst containing a nominal fluoride concentration of 3,400 ppm. For comparison, an aqueous sodium fluoride solution (NaF: 3,400 ppm), a sodium fluoride containing varnish (Duraphat: 22,600 ppm) and a fluoride-free negative control were investigated. Bovine enamel specimens with SL (n = 86, 4649–4795 vol%xμm) or DL (n = 145, 9091–9304 vol%xμm) were prepared and allocated to five groups each. In each group the respective agent was applied and pH-cycling was performed for 14 days (SL) and 90 days (DL), respectively. Mineral loss and lesion depth were assessed by transversal microradiography. For SL, all fluoride agents significantly remineralized the specimens compared to baseline (p > 0.05; Mann-Whitney test) to a similar extent. For DL, both NMF showed significantly higher mineral gain compared to the other fluoride agents (p < 0.05). In conclusion, the novel NMF- showing relatively low free fluoride concentrations- bear at least the similar potential for remineralization of early caries lesions as highly fluoridated agents being commonly used.

Self-assembly of dental surface nanofilaments and remineralisation by SnF2 and CPP-ACP nanocomplexes

Dental caries, erosion and hypersensitivity are major public health problems. SnF₂ is used widely in oral care products to help prevent/treat these conditions. Casein phosphopeptide-stabilised amorphous calcium phosphate nanocomplexes (CPP-ACP) are a biomimetic nanotechnology of salivary phosphopeptide-ACP complexes that deliver bioavailable calcium and phosphate ions to promote dental remineralisation (repair). We show here using in vitro studies and a double-blind, randomised controlled, cross-over design in situ clinical trial that SnF₂ and CPP-ACP interact to form a nanofilament coating on the tooth surface and that together they are superior in their ability to promote dental remineralisation. Sn(II) by cross-linking the CPP-ACP helps to stabilise the complexes which improves delivery to the tooth surface and enhances binding and ion incorporation into tooth mineral. The combination of SnF₂ and CPP-ACP in oral care products may significantly improve their efficacy in prevention/treatment of dental caries/erosion and hypersensitivity.

Effect of casein phosphopeptide-amorphous calcium phosphate on fluoride release and micro-shear bond strength of resin-modified glass ionomer cement in caries-affected dentin

Objectives

This study was conducted to evaluate fluoride release and the micro-shear bond strength of resin-modified glass ionomer cement (RMGIC) in casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-remineralized caries-affected dentin (CAD).

Materials and Methods

Exposed dentin surfaces of 30 human third molar teeth were divided into 2 equal groups for evaluating fluoride release and the micro-shear bond strength of RMGIC to CAD. Each group was subdivided into 3 equal subgroups: 1) control (sound dentin); 2) artificially demineralized dentin (CAD); 3) CPP-ACP remineralized dentin (remineralized CAD). To measure fluoride release, 15 disc-shaped specimens of RMGIC (4 mm in diameter and 2 mm in thickness) were bonded on one flat surface of the dentin discs of each group. Fluoride release was tested using ion chromatography at different intervals; 24 hours, 3, 5, 7 days. RMGIC micro-cylinders were built on the flat dentin surface of the 15 discs, which were prepared according to the assigned group. Micro-shear bond strength was measured after 24 hours water storage. Data were analyzed using 1- and 2-way analysis of variance and the post hoc least significant difference test (α = 0.05).

Results

Fluoride detected in solutions (at all intervals) and the micro-shear bond strength of RMGIC bonded to CPP-ACP-remineralized dentin were significantly higher than those bonded to artificial CAD (p < 0.05).

Conclusions

Demineralized CAD consumes more fluoride released from RMGIC into the solution for remineralization than CPP-ACP mineralized dentin does. CPP-ACP increases the micro-shear bond strength of RMGIC to CAD.

Technical note: Fourier transform infrared spectral analysis in tandem with 31P nuclear magnetic resonance spectroscopy elaborates detailed insights into phosphate partitioning during skimmed milk microfiltration and diafiltration

Our previous study identified peaks in the ³¹P nuclear magnetic resonance (³¹P NMR) spectra of skim milk, denoting the interaction of different phosphate species such as inorganic and casein-associated phosphate during the separation of colloidal and serum phases of skim milk by microfiltration (MF) and diafiltration (DF). In the current study, we investigated the same samples generated by the aforementioned separation using attenuated total reflectance (ATR) Fourier transform infrared (FTIR) spectroscopy analysis. The results confirmed that the technique was not only capable of differentiating between the mineral equilibrium of the casein phosphate nanocluster (CPN) and milk serum, but also complemented the application of ³¹P NMR. An ATR-FTIR broad band in the region of 1,055 to 1,036 cm^-1 and a specific band at 1,076 cm^-1 were identified as sensitive to the repartitioning of different phosphate species in milk in accordance with the ³¹P NMR signals representing casein-associated phosphate and inorganic phosphate in the serum. A third ATR-FTIR signal at 1,034 cm^-1 in milk, representing precipitated inorganic calcium phosphate, had not previously been detected by ³¹P NMR. Thus, the results indicate that a combination of ATR-FTIR and ³¹P NMR spectroscopies may be optimally used to follow mineral and protein phase changes in milk during membrane processing.