Remineralization of enamel subsurface lesions by sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate

Clinical and Radiographic Progression of Proximal Enamel Caries of Primary Molars Following the Application of Resin Infiltrant vs Tooth Mousse

Background

Resin infiltration is a technique in which a low-viscosity resin penetrates the proximal carious lesions and stops caries progression.

Aim

This study aimed to compare the progression of proximal enamel caries of primary molars following the application of resin infiltrant clinically and radiographically vs Tooth Mousse.

Materials and methods

This case-control split-mouth study evaluated 64 proximal surfaces of primary molars in 32 patients. Each patient had one pair of noncavitated proximal caries in two primary molars from different quadrants with radiographic evidence of enamel involvement. The carious lesions in each patient were randomly treated with resin infiltrant and Tooth Mousse. Progression of carious lesions was evaluated clinically and radiographically after 12 months. The two groups were compared by Fisher's exact test.

Results

No caries progression was noted in the resin infiltrant group at 12 months, and all 32 surfaces (100%) showed cessation of caries. Four surfaces (12.5%) in the Tooth Mousse group showed caries progression. The two groups were not significantly different in this regard (p = 0.242).

Conclusion

Resin infiltrant and Tooth Mousse were both effective in stopping the progression of proximal enamel caries of primary molars.

How to cite this article

Baniebrahim G, Seraj B, Ghonche Z, et al. Clinical and Radiographic Progression of Proximal Enamel Caries of Primary Molars Following the Application of Resin Infiltrant vs Tooth Mousse. Int J Clin Pediatr Dent 2024;17(4):385-389.

Evaluation of Iontophoresis as a Tool in Comparison to Topical Remineralization Systems by Transverse Microradiography and Polarized Light Microscopy: An In Vitro Study

Aim

To compare the efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (GC Tooth Mousse) and tricalcium phosphate formulation (Clinpro) by topical application and iontophoresis.

Background

Noninvasive treatment of dental caries is a major advance in the clinical management of the disease.

Materials and methods

A total of 20 primary anterior and 20 primary molars were included in the study to be analyzed by transverse microradiography (TMR) and polarized light microscopy (PLM). The samples were coated with acid-resistant varnish, leaving a window on the buccal/lingual surface of enamel and immersed in demineralizing solution for 96 hours. Each sample was coated with varnish on the left half (control), and the right half served as a test. All the samples were divided into four groups. The test windows of specimens in groups I (GC Tooth Mousse) and II (Clinpro) were subjected to remineralization treatments for 10 days. Similarly, groups III and IV were subjected to iontophoresis using GC Tooth Mousse and Clinpro for 7 minutes. The samples were analyzed by TMR and PLM.

Results

There was no significant difference in the mean difference of mineral loss among the four groups. There was a significant difference in the mean difference of lesion depth among the four groups.

Conclusion

Both iontophoresis and topical application were equally efficient, but one remineralization by iontophoresis equals 10 topical applications.

How to cite this article

VC R, Muppa R, Nallanchakrava S, et al. Evaluation of Iontophoresis as a Tool in Comparison to Topical Remineralization Systems by Transverse Microradiography and Polarized Light Microscopy: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(S-1):S85-S90.

Shear bond strength of metallic brackets bonded to enamel pretreated with CPP-ACP: a systematic review and meta-analysis of in vitro studies

BACKGROUND

Development of white spot lesions (WSLs) is common among orthodontic patients. Several measures have been introduced to prevent and remineralize the lesions. Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is used for both prevention and remineralization. The effect of its application before bonding is controversial. This systematic review was conducted to investigate the most up to date available literature regarding the effect of CPP-ACP enamel pre-treatment on shear bond strength (SBS) of metallic orthodontic brackets.

METHODS

A search was conducted in electronic databases (MEDLINE (via PubMed), Scopus, Cochrane Library, Web of Science and Google scholar (grey literature)) up to March 29th, 2023. The inclusion criteria included in vitro studies comparing the SBS of metal orthodontic brackets following pre-treatment of enamel using CPP-ACP versus control. The exclusion criteria included study types other than in vitro studies, studies conducted on non-human enamel, or studies using CPP-ACP in combination with another intervention. The included studies were analysed by two reviewers, independently. The risk of bias assessment was done using a modified risk of bias tool. A Meta-analysis was performed. I2 values and Q-test were used for assessment of heterogeneity. Results were displayed in forest plots with a random-effects model. Standardized mean difference, standard error (SE) and 95% confidence intervals were calculated for all studies.

RESULTS

The search resulted in 76 articles. After duplicate removal and assessment for eligibility, 15 studies were included in the review. High statistical heterogeneity was found among the included studies using I2 values and Q-Test (I2 = 95.147%; Q = 288.456; df = 14; P < 0.001). The overall effect of CPP-ACP pre-treatment on the SBS of metal orthodontic brackets was not significant (Mean difference = 1.163 MPa, SE = 0.757, 95% CI = -0.321, 2.648, p value = 0.125). The use of CPP-ACP for prevention of WSLs did not significantly affect the SBS of brackets (Standardized mean difference = 1.009, SE = 0.884, 95% CI = -0.723, 2.740, p value = 0.254). No significant change was found when CPP-ACP was used for remineralization of WSLs (Standardized mean difference = 1.501, SE = 1.087, 95% CI = -0.630, 3.632, p value = 0.167).

CONCLUSIONS

Within the limitations of the study, the evidence suggests that the use of CPP-ACP for either prevention or remineralization of WSLs before bonding does not affect the SBS of metal orthodontic brackets.

Effectiveness of Clinpro Tooth Crème in comparison with MI Varnish with RECALDENT™ for treatment of white spot lesions: a randomized controlled trial

BACKGROUND

Unsightly opaque white impaired enamel may ruin a great aesthetic orthodontic outcome. This study aims to evaluate effectiveness of Clinpro Tooth Crème (0.21% w/w NaF anti-caries dentifrice with 950 ppm fluoride and f-TCP) and MI Varnish with RECALDENT™ (CPP-ACP) for treatment of white spot lesions (WSLs).

MATERIALS AND METHODS

This was a randomized (1:1:1), single-blind, 3-armed, active-controlled, parallel-group trial. The study comprised three groups of 35 patients randomly assigned in blocks of 3 or 6 to one of the three following arms of the study- Group I: Clinpro™ Tooth Crème 0.21% Sodium Fluoride Anti-Cavity Paste with functional-Tri Calcium Phosphate(f-TCP) group. Group II: Fluoride varnish group (MI Varnish with RECALDENT™). Group III: Home-care group (control). For the subjective assessment, a blinded panel of 4 dental experts rated the improvement in WSLs over the eight weeks using a visual analog scale (VAS).

RESULTS

In total, 240 WSLs were identified, with maxillary lateral incisors and canines showing the highest incidence. Group I achieved the highest success rate of 67.61 (%) followed by group II (60.59%). There were no significant differences between the success rates of treatment in groups I and II. A minimum decline in WSLs was found in the control group, with a success rate of only 32.43%, significantly less than the first two groups (P < .001).

CONCLUSION

Both the test agents in consideration were comparable in their remineralization potential. Clinpro Tooth Crème provides additional protection against decalcification of enamel compared to MI Varnish with RECALDENT™ (CPP-ACP). TRIAL/PROJECT REGISTRATION NO.

AND DATE

4857/2017 on 21 June 2017.

Advances in the stability challenges of bioactive peptides and improvement strategies

Bioactive peptides are widely used in functional foods due to their remarkable efficacy, selectivity, and low toxicity. However, commercially produced bioactive peptides lack quality stability between batches. Furthermore, the efficacies of bioactive peptides cannot be guaranteed in vivo due to gastrointestinal digestion and rapid plasma, liver, and kidney metabolism. The problem of poor stability has restricted the development of peptides. Bioactive peptide stability assessments use different stability assays, so the results of different studies are not always comparable. This review summarizes the quality stability challenges in the enzymatic hydrolysis production of bioactive peptides and the metabolism stability challenges after oral administration. Future directions on the strategies for improving their stability are provided. It was proposed that we use fingerprinting as a quality control measure using qualitative and quantitative characteristic functional peptide sequences. The chemical modification and encapsulation of bioactive peptides in microcapsules and liposomes are widely used to improve the digestive and metabolic stability of bioactive peptides. Additionally, the establishment of a universal stability test and a unified index would greatly improve uniformity and comparability in research into bioactive peptides. In summary, the reliable evaluation of stability is an essential component of peptide characterization, and these ideas may facilitate further development and utilization of bioactive peptides.

•

Stability challenges encountered by bioactive peptides were summarized.

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Strategies to improve the stability of bioactive peptides were provided.

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A universal stability test and unified index would improve uniformity and comparability in research into bioactive peptides.

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It was proposed that we use a method of traditional Chinese medicine fingerprinting as a quality control measure.

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.

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.

Effect of Temperature on Electrochemically Assisted Deposition and Bioactivity of CaP Coatings on CpTi Grade 4

Calcium phosphate (CaP) coatings are able to improve the osseointegration process due to their chemical composition similar to that of bone tissues. Among the methods of producing CaP coatings, the electrochemically assisted deposition (ECAD) is particularly important due to high repeatability and the possibility of deposition at room temperature and neutral pH, which allows for the co-deposition of inorganic and organic components. In this work, the ECAD of CaP coatings from an acetate bath with a Ca:P ratio of 1.67, was developed. The effect of the ECAD conditions on CaP coatings deposited on commercially pure titanium grade 4 (CpTi G4) subjected to sandblasting and autoclaving was presented. The physicochemical characteristics of the ECAD-derived coatings was carried out using SEM, EDS, FTIR, 2D roughness profiles, and amplitude sensitive eddy current method. It was showed that amorphous calcium phosphate (ACP) coatings can be obtained at a potential −1.5 to −10 V for 10 to 60 min at 20 to 70 °C. The thickness and surface roughness of the ACP coatings were an increasing function of potential, time, and temperature. The obtained ACP coatings are a precursor in the process of apatite formation in a simulated body fluid. The optimal ACP coating for use in dentistry was deposited at a potential of −3 V for 30 min at 20 °C.

The Top 100 Most-Cited Papers in Cariology: A Bibliometric Analysis

A highly cited paper is seen as a landmark in any field and can influence both research and clinical practice. This study aimed to quali-quantitatively analyze the 100 most-cited papers in Cariology. A search strategy was first determined using specific keywords related to the field. A comprehensive search was then conducted in the Thompson Reuters Web of Science citation indexing database up to April 2019. Papers focused on any aspect of Cariology were included. A panel of 4 researchers conducted the selection of papers and extracted data on the number of citations, title, authors, country, year, journals, study design, and topic of interest. Scopus and Google Scholar were also searched to compare the number of citations. The VOSviewer software was used to generate bibliometric networks. The number of citations among the top 100 most-cited papers ranged from 168 to 1,961 with a mean of 292,66. Three papers had more than 1,000 citations. The Journal of Dental Research (20%) and Caries Research (17%) had more top papers. The oldest and the most recent papers were published in 1960 and 2015. Literature reviews (35%) and laboratorial studies (31%) were the most common study designs. The countries with the highest number of most-cited papers were the USA (40%), Sweden (10%), and Japan (9%). The most studied fields of interest were etiology/pathogenesis (41%) and prevention (20%). VOSviewer maps revealed collaborative networks between countries and organizations. The top 100 most-cited papers in Cariology were published mainly by European and Anglo-Saxon American authors and were composed mainly of literature reviews with etiology/pathogenesis as the most frequent topic of interest.

Combined effect of Er,Cr:YSGG laser and casein phosphopeptide amorphous calcium phosphate on the prevention of enamel demineralization

OBJECTIVES

To compare the effect of use of laser, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and their combination on prevention of enamel demineralization using polarized light microscopy to assess lesion depth.

MATERIALS AND METHODS

Eighty premolars were randomly allocated to four equal groups (n = 20): Group I: Control group, no preventive measures. Group II: CPP-ACP. Group III: Er,Cr:YSGG laser. Group IV: Er,Cr:YSGG laser followed by CPP-ACP. Specimens were subjected to thermocycling and brushing protocols equivalent to 1 year intraorally. Then, all teeth were subjected to acid challenge. Teeth were then sectioned longitudinally and examined under a polarized light microscope and lesion depth was measured.

RESULTS

Group IV resulted in the least lesion depth with a significant difference between it and all other groups. CPP-ACP alone and laser alone also showed a significant difference in white spot lesion (WSL) depth compared to the control group; however, no significant difference was found between them.

CONCLUSIONS

The combined use of laser and CPP-ACP showed the best prevention against WSL development. The use of CPP-ACP or laser alone also resulted in a significant reduction in lesion depth but was significantly less than their combined use, with no significant difference between them.

Effect of Resin Infiltration Technique on Improving Surface Hardness of Enamel Lesions: A Systematic Review and Meta-analysis

OBJECTIVE

White spot lesion (WSL) is recognized as the first clinical sign of enamel caries; it is a very critical phase because it can be prevented from progression to frank caries by changing the surrounding destructive environment. The present study was undertaken to systematically review the effect of resin infiltration (RI) technique on surface hardness (SH) of WSL.

METHODS

Five electronic databases were searched with proper key words. Related titles and abstracts, up to October 2018, were screened, selected, and subjected to quality assessments. After collecting data, meta-analyses were carried out to compare the effect of RI with untreated WSL and sound enamel by using the STATA software.

RESULTS

A total of 4567 articles were included in the study after initial search. Finally, 10 studies were reliable enough in methodology to be included in the study. Metadata analyses, carried out on 7 studies that compared SH of RI group with untreated samples, showed a significant increase in SH with 3.66 mean difference (95% confidence interval = 2.56‒4.77, Q value = 36.07, I² = 83.4%). However, meta-analysis on 4 studies that compared SH of RI with sound enamel showed a significant decrease in SH with -2.35 overall mean difference (95% confidence interval = -3.91-0.98, P = .00, Q value = 31.75, I² = 90.6%).

CONCLUSION

The RI technique can enhance SH of WSL; however, regaining the SH of RI-treated WSLs similar to sound enamel is doubtful. Application of RI is more effective than other methods, including application of fluoride, enamel pro-varnish, adhesive, and colloidal silica infiltration for enhancing SH of WSLs.

Comparative Evaluation of Microhardness and Enamel Solubility of Treated Surface Enamel with Resin Infiltrant, Fluoride Varnish, and Casein Phosphopeptide-amorphous Calcium Phosphate: An In Vitro Study

Aim and objective

The aim and objective of this study was to do a comparative evaluation of microhardness and enamel solubility (ES) of the treated surface enamel with resin infiltrant, fluoride varnish, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP).

Materials and methods

An in vitro study was conducted on freshly extracted 85 sound permanent teeth of which 5 teeth were subjected to check for microhardness by the Vickers microhardness tester and the remaining teeth were exposed to demineralizing solution to create initial enamel lesions. These 80 teeth were assigned to four groups: group I—negative control (n = 20), group II—resin infiltrant (n = 20), group III—fluoride varnish (n = 20), and group IV—CPP-ACP (n = 20), and microhardness was checked after application. These teeth were exposed to caries attack three times a day for three consecutive days. The ES of these four groups was checked by calcium ion loss in the artificial cariogenic solution and whole saliva by an atomic absorption spectrophotometer.

Results

It was found that none of the experimental groups reached the microhardness values of sound intact teeth. At 3rd day, the values of microhardness were: group II = group III > group IV > group I. Maximum ES was found for group I (control) followed with group IV.

Conclusion

All agents used in study remineralized initial carious lesion. Fluoride varnish has the highest microhardness and showed least ES compared to other remineralizing agents.

Clinical significance

Fluoride varnish can be regarded as the choice of material to be used for the treatment of incipient carious lesions because of the low application frequency (once every 3–6 months), requires minimal patient compliance as it is a noninvasive procedure and less time consuming.

How to cite this article

Dhillon SN, Deshpande AN, Macwan C, et al. Comparative Evaluation of Microhardness and Enamel Solubility of Treated Surface Enamel with Resin Infiltrant, Fluoride Varnish, and Casein Phosphopeptide-amorphous Calcium Phosphate: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(S-1):S14–S25.

Hemicellulose from Plant Biomass in Medical and Pharmaceutical Application: A Critical Review

BACKGROUND

Due to the non-toxicity, abundance and biodegradability, recently more and more attention has been focused on the exploration of hemicellulose as the potential substrate for the production of liquid fuels and other value-added chemicals and materials in different fields. This review aims to summarize the current knowledge on the promising application of nature hemicellulose and its derivative products including its degradation products, its new derivatives and hemicellulosebased medical biodegradable materials in the medical and pharmaceutical field, especially for inmmune regulation, bacteria inhibition, drug release, anti-caries, scaffold materials and anti-tumor.

METHODS

We searched the related papers about the medical and pharmaceutical application of hemicellulose and its derivative products, and summarized their preparation methods, properties and use effects.

RESULTS

Two hundred and twenty-seven papers were included in this review. Forty-seven papers introduced the extraction and application in immune regulation of nature hemicellulose, such as xylan, mannan, xyloglucan (XG) and β-glucan. Seventy-seven papers mentioned the preparation and application of degradation products of hemicellulose for adjusting intestinal function, maintaining blood glucose levels, enhancing the immunity and alleviating human fatigue fields such as xylooligosaccharides, xylitol, xylose, arabinose, etc. The preparation of hemicellulose derivatives were described in thirty-two papers such as hemicellulose esters, hemicellulose ethers and their effects on anticoagulants, adsorption of creatinine, the addition of immune cells and the inhibition of harmful bacteria. Finally, the preparations of hemicellulose-based materials such as hydrogels and membrane for the field of drug release, cell immobilization, cancer therapy and wound dressings were presented using fifty-five papers.

CONCLUSION

The structure of hemicellulose-based products has the significant impact on properties and the use effect for the immunity, and treating various diseases of human. However, some efforts should be made to explore and improve the properties of hemicellulose-based products and design the new materials to broaden hemicellulose applications.

Effects of Fluoride and Calcium Phosphate Materials on Remineralization of Mild and Severe White Spot Lesions

Fixed orthodontic treatments often lead to enamel demineralization and cause white spot lesions (WSLs). The aim of this study was to evaluate the mineralization degree of 2 types of WSLs based on ICDAS index and compare the remineralizing efficacy of 3 oral hygiene practices after 1 month and 3 months. 80 mild demineralized and 80 severe demineralized enamel specimens were randomized into three treatments: fluoride toothpaste (FT), fluoride varnish plus fluoride toothpaste (FV+FT), and CPP-ACP plus fluoride toothpaste (CPP-ACP+FT). Microhardness tester, DIAGNODent Pen 2190, and scanning electron microscope were used to evaluate the changes of mineralization degree. Both qualitative and quantitative indicators suggested that the mild and severe white spot lesions were different in the degree of mineralization. Severe WSLs demineralized much more seriously than mild lesions even after 3 months of treatment. Despite the variation in severity, both lesions had the same variation trend after each measure was applied: FT had weak therapeutic effect, FV + FT and CPP-ACP + FT were effective for remineralization. Their remineralizing efficacy was similar after 1 month, and combined use of CPP-ACP plus F toothpaste was more effective after 3 months. In order to fight WSLs, early diagnosis was of great importance, and examination of the tooth surface after air-dry for 5 seconds was recommended. Also, when WSLs were found, added remineralizing treatments were required.

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

Objective:

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

Methodology:

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

Results:

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

Conclusions:

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

Remineralization potential of fluoride, amorphous calcium phosphate-casein phosphopeptide, and combination of hydroxylapatite and fluoride on enamel lesions: An in vitro comparative evaluation

Aim:

The purpose of this study was to evaluate and compare remineralization potential of fluoride, amorphous calcium phosphate-casein phosphopeptide (ACP-CPP), and combination of hydroxyapatite (HAP) and fluoride on enamel lesions.

Materials and Methodology:

Ten intact caries-free human premolars were selected. The coronal portion of each tooth was sectioned into four parts to make four enamel blocks. The baseline surface microhardness (SMH) was measured for all the enamel specimens using Vickers microhardness testing machine. The artificial carious lesion was created by immersing the specimens in demineralizing solution for 3 consecutive days at 35° The SMH of each specimen was evaluated. All the four enamel sections of each tooth were subjected to various surface treatments, i.e., Group A – Fluoride varnish, Group B – ACP-CPP, Group C – Combination of HAP and fluoride (Clinpro), and Group D – Control group; no surface treatment. A carious progress test (pH cycle) was carried out which consisted of alternative demineralization (3 h) and remineralization using artificial saliva (21 h.) for 5 consecutive days. After pH cycling, SMH readings of each specimen were again assessed to evaluate remineralization potential of each surface treatment agent.

Results:

Data obtained were statistically analyzed using one-way ANOVA followed by Tukey–Kramer multiple comparison test which was applied to detect significant differences between different surface treatments at different phases of studies.

Conclusion:

Fluoride varnish shows higher remineralization potential of early carious lesion compare to ACP-CPP and Clinpro.

CPP-ACP and Fluoride: A Synergism to Combat Caries

Aims

The aim of this study is to evaluate and compare the demineralization inhibitory effect, fluoride release at varying time intervals, and antibacterial property of MI varnish and fluor protector varnish.

Materials and methods

Twenty-four extracted human premolars were sectioned mesiodistally. The buccal and the lingual halves of the teeth were utilized to evaluate the demineralization inhibitory effect and fluoride release of MI varnish and fluor protector varnish, respectively. To evaluate the demineralization inhibitory effect, 150-μm axial longitudinal section was obtained that was photographed and evaluated under a polarized light microscope. To evaluate the fluoride release, a fluoride-specific ion electrode was used. To evaluate the antibacterial susceptibility, the disk diffusion test (Kirby–Bauer method) was done.

Results

Statistical analysis was done using the Students unpaired t test for intergroup comparison and the p value <0.01 was obtained for all the three parameters, i.e., demineralization inhibitory effect, antimicrobial property, and fluoride releasing property at different time intervals.

Conclusion

A combination of casein phosphopeptide (CPP)–amorphous calcium phosphate (ACP) in fluoride varnish seems to enhance the caries preventive potential of fluoride varnish and antibacterial activity against Streptococcus mutans.

Clinical significance

MI varnish, a combination of CPP–ACP and fluoride varnish could be the future of minimally invasive dentistry as it is minimally invasive yet an effective modality for caries prevention.

How to cite this article

Attiguppe P, Malik N, et al. CPP–ACP and Fluoride: A Synergism to Combat Caries. Int J Clin Pediatr Dent 2019;12(2):120–125.

Efficacy of fluorides and CPP-ACP vs fluorides monotherapy on early caries lesions: A systematic review and meta-analysis

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.

The Effect of MIpaste Plus and Reminpro on Incipient Caries Using DIAGNOdent and SEM: An Invitro Study

BACKGROUND

The remineralization of early caries lesion has an effective role on decreasing caries. For initial remineralization of caries lesion, using Compounds of Casein phosphopeptides (CPP) in different studies has been proposed. REMINPRO including Fluoride, Xylitol and Calcium phosphate has just been offered in the market. This study aims to investigate the efficacy of Reminpro and MI paste plus in terms of remineralization of early enamel lesions.

MATERIALS AND METHODS

In 15 samples of healthy enamels of the maxillary first premolar teeth and 15 samples of Primary Mandibular First Molar under the effect of demineralized gel, artificial caries has been created. The samples have been divided in 3 groups of 20. After performing the cycles of demineralization and remineralization during 5 weeks, the samples were investigated by DIAGNOdent and two samples from each group were compared with SEM. To investigate the remineralization of enamel, two-way ANOVA and to compare the groups in pair, the post hoc tests were used.

RESULTS

The mean of mineralization of teeth in the group using reminpro was 25.2 ± 6.16 and in the group using MI paste plus was 23 ± 5.60, which was significantly high.

CONCLUSIONS

MI paste plus in mineralization of initial enamel caries were more efficient that reminpro pate.

Comparison of the newer preventive therapies on remineralisation of enamel in vitro

OBJECTIVES

To investigate in vitro the effect of MI Paste, MI Paste Plus and 2800ppm fluoride (F) toothpaste (TP) on the remineralisation of enamel subsurface lesions and to compare these to the effect of 1450ppm and 0ppm F toothpastes.

METHODS

Enamel subsurface lesions were created in bovine enamel slabs (n=120) which were assigned randomly to five groups; (1) 0ppm F TP, (2) 1450ppm F TP, (3) 2800ppm F TP, (4) 1450ppm F TP+MI Paste (Tooth Mousse-TM,10% w/v CPP-ACP) and (5) 1450ppm F TP+MI Paste Plus (Tooth Mousse Plus,10% w/v CPP-ACP, 900ppm F as 0.2% w/w sodium fluoride). The enamel slabs were subjected to a pH cycling regimen for 21days. Quantitative Light-induced Fluorescence (QLF) images were taken and analysed. Data analysis was carried out using one way ANOVA.

RESULTS

In all groups, both ΔF (percentage fluorescence loss) and ΔQ (ΔF times the area) values improved significantly within the same group after the treatment. In addition, the mean difference in ΔF of the non-fluoride control group was significantly lower than all other groups but not for the 2800ppm F^- group. Whereas the mean difference in ΔQ of the non-fluoride control of group was significantly lower when compared with all other groups (p<0.05).

CONCLUSIONS

Both MI Paste and MI Paste Plus when used in conjunction with 1450ppm F did not show a significant increase in efficacy for the remineralisation of bovine enamel subsurface lesions in the model used in this study.

CLINICAL SIGNIFICANCE

Newer preventive agents such as MI paste and MI paste plus are advocated as promoting remineralisation when used in addition to routine oral care. This in vitro study shows that they may have a limited value in promoting remineralisation over and above that of 1450ppm F toothpaste used twice a day.

Polyols and remineralisation of enamel subsurface lesions

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.

Micro-CT and FE-SEM enamel analyses of calcium-based agent application after bleaching

OBJECTIVES

The objective of the present study is to evaluate the effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on bleached enamel.

MATERIALS AND METHODS

A bleaching agent (35% hydrogen peroxide) was applied, 4 × 8 min on premolar teeth (n = 8). A CPP-ACP paste was applied for 7 days. Prior and post-treatment, microtomography images were obtained and 3D regions of interest (ROIs) were selected, from outer enamel, extending to 110.2-μm depth. CT parameters of structure: thickness (St.Th), separation (St.Sp), and fragmentation index (Fr.I.) were calculated for each (ROI). Data was submitted to paired t tests at a 95% confidence level. The samples were evaluated at 3000 to 100,000 magnification. Quantitative analysis of enamel mineral content was also determined by SEM EDX.

RESULTS

There was a significant increase in structure thickness and calcium content. The phosphorus content increased after bleaching. There was also a decreased separation and fragmentation index on the outer enamel to a depth of 56.2 μm (p < 0.05). There were no changes at 110.2-μm depth for the bleaching CPP-ACP association. A covering layer and decreased spaces between the hydroxyapatite crystals appeared around the enamel prisms, 7 days after the CPP-ACP application.

CONCLUSIONS

The application of a CPP-ACP provides a compact structure on the enamel's outer surface, for 7 days, due to calcium deposition. CT parameters seem to be a useful tool for mineralizing and remineralizing future studies.

CLINICAL RELEVANCE

CPP-ACP neutralizes any adverse effects on enamel surface when applied during a week after bleaching and minimizes any side effects of the bleaching treatment due to a more compact structure.

Microcomputed tomography evaluation of white spot lesion remineralization with various procedures

INTRODUCTION

The aim of this study was to use microcomputed tomography to evaluate the effects on white spot lesions of 3 remineralizing agents compared with artificial saliva (Inonu University, Malatya, Turkey). The agents were GC Tooth Mousse (GC International, Itabashi-ku, Tokyo, Japan), 50-ppm sodium fluoride solution (Inonu University, Malatya, Turkey), and Clinpro 5000 (3M ESPE Dental Products (St Paul, Minn). The experimental and control teeth were stored in artificial saliva.

METHODS

Forty-four extracted premolars were divided into 4 groups of 11 teeth each (3 experimental groups and 1 control group). After white spot lesions were created on the teeth, a remineralizing agent was applied. Microcomputed tomography scanning was performed at the following times: T0 (sound enamel), T1 (day 0, when the white spot lesion was formed), T2 (day 15), and T3 (day 30). Volume, depth, surface area, and mineral density changes of the white spot lesions were evaluated at different time points using CTAn software (SkyScan; Bruker, Kontich, Belgium).

RESULTS

GC Tooth Mousse and Clinpro 5000 improved all measurements after 30 days. However, Clinpro 5000 was not as effective in reducing lesion depth as it was in the other parameters. The artificial saliva group and the 50-ppm sodium fluoride solution did not show significant effects in the regression of the white spot lesions at the end of the 30-day experiment.

CONCLUSIONS

GC Tooth Mousse and Clinpro 5000 were more effective in remineralization of white spot lesions than sodium fluoride solution and artificial saliva. They can be preferred for use clinically. Microcomputed tomography is a novel and effective method that shows promise in accurately evaluating white spot lesions and remineralization.

Comparison of CPP-ACP, Tri-Calcium Phosphate and Hydroxyapatite on Remineralization of Artificial Caries Like Lesions on Primary Enamel -An in vitro Study

OBJECTIVES

To compare CPP-ACP, Tri-calcium phosphate and Hydroxyapatite on remineralization of artificial caries like lesions on primary enamel.

STUDY DESIGN

Ten extracted Primary molars coated with nail varnish, leaving a window of 2×4 mm on buccal and lingual surface were immersed in demineralizing solution for 96 hours and sectioned longitudinally to obtain 40 sections (4 sections per tooth) and were randomly divided into 4 groups (A to D) n=10; Group A: negative control, Group B: CPP-ACP, Group C: Tri-calcium phosphate, Group D: Hydroxyapatite. Sections were subjected to pH cycling for 10 days and were evaluated by polarized light microscope before and after treatment.

RESULTS

Intra group comparison of demineralization and remineralization was done by paired t-test. One way ANOVA was used for multiple group comparisons followed by post HOC TUKEY'S Test for group wise comparisons. Remineralization was found more with Group D followed by Group B, C and A.

CONCLUSION

Hydroxyapatite showed better remineralization when compared to CPP-ACP and Tri-calcium phosphate.

Prevention and Treatment of White Spot Lesions in Orthodontic Patients

Decalcification of enamel, appearing as white spot lesions (WSLs), around fixed orthodontic appliances is a major challenge during and after fixed orthodontic treatment by considering the fact that the goal of orthodontic treatment is to enhance facial and dental esthetic appearance. Banded or bonded teeth exhibit a significantly higher rate of WSLs compared to the controls with no braces as fixed appliances and the bonding materials promote retention of biofilms. These lesions are managed in the first step by establishing good oral hygiene habits and prophylaxis with topical fluorides, including high-fluoride toothpastes, fluoride mouthwashes, gels, varnishes, fluoride-containing bonding materials, and elastic ligatures. Recently, other materials and methods have been recommended, including the application of casein phosphopeptides-amorphous calcium phosphate, antiseptics, probiotics, polyols, sealants, laser, tooth bleaching agents, resin infiltration, and microabrasion. This article reviews the currently used methods to manage enamel demineralization during and after orthodontic treatment and the risk factors and preventive measures based on the latest evidence.

The Importance of Intrafibrillar Mineralization of Collagen on the Mechanical Properties of Dentin

It is widely held that the hardness and modulus of dentin increase in proportion to the mineral concentration. To test this belief, we measured hardness and modulus of normal dentin and an altered form of dentin without gap-zone mineralization in wet and dry conditions by AFM nanoindentation to determine if the modulus and hardness scale linearly with mineral concentration. Mineral concentrations in the mid-coronal location of the normal and altered dentins were 44.4 vol% and 30.9 vol%, respectively. Surrounding the pulp of the altered dentin was a region of higher mineralization, 40.5 vol%. The indentation modulus of normal dentin was 23.9 (SD = 1.1) GPa dry and 20.0 (SD = 1.0) GPa wet. In mid-coronal regions of the altered dentin, the indentation modulus was 13.8 (SD = 2.0) GPa dry and 5.7 (SD = 1.4) GPa wet. In the more mineralized regions of the altered dentin, the modulus was 20.4 (SD = 1.8) GPa dry and 5.3 (SD = 0.8) GPa wet; the properties of the altered wet dentin did not correlate with mineral concentration. The results of this study raise doubt as to whether mineral concentration alone is a sufficient endpoint for assessing the success or failure of remineralization approaches in restorative dentistry.

Casein Phosphopeptide-Amorphous Calcium Phosphate Reduces Streptococcus mutans Biofilm Development on Glass Ionomer Cement and Disrupts Established Biofilms

Glass ionomer cements (GIC) are dental restorative materials that are suitable for modification to help prevent dental plaque (biofilm) formation. The aim of this study was to determine the effects of incorporating casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) into a GIC on the colonisation and establishment of Streptococcus mutans biofilms and the effects of aqueous CPP-ACP on established S mutans biofilms. S. mutans biofilms were either established in flow cells before a single ten min exposure to 1% w/v CPP-ACP treatment or cultured in static wells or flow cells with either GIC or GIC containing 3% w/w CPP-ACP as the substratum. The biofilms were then visualised using confocal laser scanning microscopy after BacLight LIVE/DEAD staining. A significant decrease in biovolume and average thickness of S. mutans biofilms was observed in both static and flow cell assays when 3% CPP-ACP was incorporated into the GIC substratum. A single ten min treatment with aqueous 1% CPP-ACP resulted in a 58% decrease in biofilm biomass and thickness of established S. mutans biofilms grown in a flow cell. The treatment also significantly altered the structure of these biofilms compared with controls. The incorporation of 3% CPP-ACP into GIC significantly reduced S. mutans biofilm development indicating another potential anticariogenic mechanism of this material. Additionally aqueous CPP-ACP disrupted established S. mutans biofilms. The use of CPP-ACP containing GIC combined with regular CPP-ACP treatment may lower S. mutans challenge.

In Vivo Release Kinetics and Antibacterial Activity of Novel Polyphenols-Enriched Chewing Gums

Chewing gums may be particularly effective means for delivering and maintaining bioactive molecules, included in the gum formulation, able to have an anti-cariogenic effect. The purposes of this study were: to develop novel chewing gums containing quercetin (Qt); to evaluate their release using in vivo trial; finally, to test their in vivo antibacterial effect against oral Streptococcus mutans strains. A preliminary study was performed to produce new gums, enriched with the polyphenol quercetin. Then, a first in vivo experimental study was assessed to test the percentages of Qt released in the saliva of young volunteers. Moreover, a second clinical trial was performed to analyze the antibacterial capability of these enriched chewing gums against S. mutans strains after 14 days of daily consumption. The release analysis showed that a more effective release of Qt occurs in the first minutes of chewing, and it does not change saliva pH values. Moreover, Qt included in gums demonstrates an effective antibacterial activity, showing a reduction of the concentration of S. mutans strains in saliva samples, especially after 7 days. Qt included in experimental chewing gums could be efficiently released into the oral cavity and could promote an effective anti-caries concentration in volunteer's saliva, without changing salivary pH values.

Casein Phosphopeptide-Amorphous Calcium Phosphate Nanocomplexes: A Structural Model

Tryptic digestion of the calcium-sensitive caseins yields casein phosphopeptides (CPP) that contain clusters of phosphorylated seryl residues. The CPP stabilize calcium and phosphate ions through the formation of complexes. The calcium phosphate in these complexes is biologically available for intestinal absorption and remineralization of subsurface lesions in tooth enamel. We have studied the structure of the complexes formed by the CPP with calcium phosphate using a variety of nuclear magnetic resonance (NMR) techniques. Translational diffusion measurements indicated that the β-CN(1-25)-ACP nanocomplex has a hydrodynamic radius of 1.526 ± 0.044 nm at pH 6.0, which increases to 1.923 ± 0.082 nm at pH 9.0. (1)H NMR spectra were well resolved, and (3)JH(N)-H(α) measurements ranged from a low of 5.5 Hz to a high of 8.1 Hz. Total correlation spectroscopy and nuclear Overhauser effect spectroscopy spectra were acquired and sequentially assigned. Experiments described in this paper have allowed the development of a structural model of the β-CN(1-25)-amorphous calcium phosphate nanocomplex.

Remineralizing potential of CPP-ACP applied for 1 min in vitro

AIM

To evaluate (1) the remineralizing potential of Tooth Mousse(®) (TM) on artificial carious lesions, when applied for 1 min, and (2) the benefit of a fluoridated dentifrice prior to TM application.

METHODS

Demineralisation caries-like lesions 120-200 μm deep were produced by placing molars in demineralizing solution for 96 h, sections 100-150 μm thick were then randomly assigned to four groups. Specimens were treated thrice daily with a non-fluoridated (Group A), or fluoridated dentifrice (1000 ppm) (Group B), or TM (Group C), or a fluoridated dentifrice followed by TM (Group D) then subjected to a 10-day pH cycling model. Lesion evaluation involved polarizing light microscopy and microradiography.

RESULTS

Application of TM in isolation (Group C) for 1 min resulted in significant increase in lesion depth (LD), however, an increase in mineral content deposition (V max) was not significant. Post treatment LD increases were greatest in Group A, then Group C and Group B respectively. A decrease in LD (by 19.9 %) was noted only after fluoridated dentifrice and TM (Group D) were applied consecutively for 1 min each (p < 0.05). Mineral content deposition was also greatest in this group (Group D) and both V max and LD changes were statistically significant when compared to other groups.

CONCLUSIONS

TM alone failed to remineralize carious lesions when applied for 1 min. However, remineralization occurred after a prior application of a fluoridated dentifrice.

Effective in situ repair and bacteriostatic material of tooth enamel based on salivary acquired pellicle inspired oligomeric procyanidins

Remineralization and reduction of cariogenic bacteria at the tooth surface are effective ways to treat dental caries.

Children's Oral Health Assessment, Prevention, and Treatment

This article provides a brief introduction to various aspects of oral health care in children, with emphasis on the epidemiology, risk assessment, prevention, and treatment modalities for dental caries. In addition, barriers to dental care and the involvement of pediatricians in advocating for and providing preventive dental care for children are reviewed. Oral health care is one of the most prevalent unmet needs among infants, toddlers, and adolescents in the United States. Routine or preventive dental visits are important for early diagnosis, prevention, and treatment of oral diseases, and for establishing and maintaining good oral health and overall well-being.

Microshear Bond Strength of Adhesives to Enamel Remineralized Using Casein Phosphopeptide Agents

Objective

This study was carried out to evaluate the difference between bonding to demineralized enamel and remineralized enamel using casein phosphopeptide–amorphous calcium phosphate with fluoride (CPP-ACFP) or without fluoride (CPP-ACP) compared to normal enamel. Another aim was to test if the newly introduced Single Bond Universal adhesive system would show better bonding to any enamel condition in comparison to the other tested adhesive systems.

Methods

The lingual enamel surfaces of 40 non carious human third molars were divided into four main groups according to the enamel condition (ground normal enamel [negative control]; demineralized enamel [positive control]; and remineralized enamel with CPP-ACP or with CPP-ACFP, respectively). Within each main group, the lingual enamel surface of each tooth was sectioned into three slabs, resulting in 30 slabs that were distributed into three subgroups according to the adhesive system utilized (Clearfil S3 Bond Plus, Single Bond Universal, or G-aenial Bond). Two resin composite microcylinder buildups were made on each enamel slab using Filtek Z350 XT. The μSBS was evaluated at a crosshead speed of 0.5 mm/min. Modes of failure were detected using an environmental scanning electron microscope at 300× magnification.

Results

The two-way analysis of variance with repeated measures revealed a significant effect for the enamel condition. However, there was no significant effect for the type of adhesive system. The interaction between the enamel condition and the type of adhesive system was also not significant. Modes of failure were mainly adhesive except for the demineralized enamel. It showed a mixed type of failure, in which cohesive failure in enamel was recorded.

Conclusions

All single-step self-etch adhesives revealed comparable μSBS values to ground enamel and enamel remineralized with CPP-ACP or CPP-ACFP. Bonding to demineralized enamel was ineffective. With any enamel condition, no tested single-step self-etch adhesive was superior in its bonding.

Effects of different pre-treatment methods on the shear bond strength of orthodontic brackets to demineralized enamel

OBJECTIVE

To compare the effects of different treatment methods used for the enamel damage, on the shear bond strength (SBS) and fracture mode of orthodontic brackets.

MATERIALS AND METHODS

Freshly-extracted 140 premolars were randomly allocated to seven groups: Group I was considered as the control of other groups. The remaining groups were exposed to demineralization. In group II, brackets were directly bonded to the demineralized enamel surface. CPP-ACP paste (GC Tooth Mousse), fluoride varnish (Bifluorid 12), microabrasion with a mixture prepared with 18% hydrochloric acid and fine pumice powder, microabrasion with an agent (Opalustre) and resin infiltrant (Icon®) were applied in Groups III, IV, V, VI and VII, respectively. The specimens were tested for SBS and bond failures were scored according to the Adhesive Remnant Index (ARI). Analysis of variance and Tukey tests were used to compare the SBS of the groups. ARI scores were compared with G-test. The statistical significance was set at p < 0.05 level.

RESULTS

Statistically significant differences were found among seven groups (F = 191.697; p < 0.001). The SBSs of groups I (mean = 18.8 ± 2.0 MPa) and VII (mean = 19.1 ± 1.4 MPa) were significantly higher than the other groups. No statistically significant difference was found between groups IV (mean = 11.5 ± 1.2 MPa) and V (mean = 12.6 ± 1.5 MPa). The differences in ARI scores of the groups were statistically significant (p < 0.01).

CONCLUSIONS

All demineralization treatment methods improve bonding to demineralized enamel. Resin infiltrant application after demineralization showed similar bond strength values as intact enamel.

Bioactive peptides from egg: a review

Purpose

– The aim of the article was to focus on various peptides identified in the egg and their probable application as novel ingredients in the development of functional food products. Bioactive peptides of egg origin have attracted increasing interest as one of the prominent candidates for development of various health-promoting functional and designer foods.

Design/methodology/approach

– Traditionally known as a source of highly valuable proteins in human nutrition, eggs are nowadays also considered as an important source of many bioactive peptides which may find wide application in medicine and food production. These specific protein fragments from egg proteins which, above and beyond their nutritional capabilities, have a positive impact on the body’s function or condition by affecting the digestive, endocrine, cardiovascular, immune and nervous systems, and may ultimately influence health.

Findings

– Several peptides that are released in vitro or in vivo from egg proteins have been attributed to different health effects, including antihypertensive effects, antimicrobial properties, antioxidant activities, anticancer activity, immunomodulating activity, antiadhesive properties and enhancement of nutrient absorption and/or bioavailability. Extensive research has been undertaken to identify and characterize these biologically active peptides of egg origin which has changed the image of egg as a new source of biologically active ingredients for the development of functional foods with specific benefits for human health and treatment and prevention of diseases.

Originality/value

– The paper mainly describes the above-stated properties of bioactive peptides derived from egg proteins.

Interproximal enamel reduction: an in vivo study

The study aimed to investigate the morphology and composition of the interproximal reduced enamel after exposition to saliva and casein phosphopeptide amorphous calcium phosphate with sodium fluoride (CPP-ACPF). Fourteen patients undergoing an orthodontic treatment with 4 premolars extractions participated to the study. Interproximal enamel reduction (IER) was performed on mesial surfaces of 3 extractive premolars for each patient while 1 served as untreated control. Premolars were assigned to 4 groups: No-S group, sound enamel as control; S-Ex group, stripped and immediately extracted enamel; S-Sal group, stripped and exposed to saliva enamel; S-CPP group, stripped enamel treated with CPP-ACPF. Teeth were extracted at different times, depending on the group they were assigned to and sliced into mesial and distal halves. Mesial surfaces were subjected to environmental scanning electron microscopy with energy dispersive X-ray spectrometry (ESEM/EDX) and to scanning electron microscopy (SEM) analysis. ESEM/EDX investigations showed no statistically significant differences in the content of calcium and phosphate between the 4 groups. SEM observations showed no difference in the morphological appearance of stripped enamel after 30 days of exposure to saliva and CPP-ACPF. Saliva and CPP-ACPF effects on stripped enamel in vivo showed no difference after 30 days.

Remineralizing efficacy of a CPP-ACP cream on enamel caries lesions in situ

The aim of this double-blind, randomized, cross-over in situ study was to compare the remineralizing effects induced by the application of casein phosphopeptide-stabilized amorphous calcium phosphate complexes (CPP-ACP)-containing cream (without fluoride) after the use of fluoride toothpaste with the prolonged use of fluoride toothpaste on enamel caries lesions in situ. During each of three experimental legs of 4 weeks, 13 participants wore intra-oral mandibular appliances with 8 pre-demineralized bovine enamel specimens in the vestibular flanges mimicking either 'easily cleanable' or 'proximal' surfaces (n = 312). The three randomly allocated treatments were as follows: (1) application of CPP-ACP-containing cream (GC Tooth Mouse, non-fluoride) after the use of fluoride toothpaste (1,400 ppm NaF; TM), (2) prolonged application of fluoride toothpaste (1,400 ppm NaF; positive control, PC) and (3) prolonged application of fluoride-free toothpaste (negative control, NC). Additionally, one of each of the two flanges was brushed twice daily with the respective toothpaste. The differences in integrated mineral loss as assessed by transversal microradiography were calculated between values before and after the in situ period. Changes in mineral loss were analysed for those pairs of subgroups differing in only one of the three factors (intervention, brushing and position). The PC treatment induced a significantly higher mineral gain compared with the TM and NC treatments. No significant differences between TM and NC for both positions were observed. In conclusion, the additional use of a CPP-ACP-containing cream seems to be less efficacious in remineralizing caries lesions than the prolonged application of fluoride toothpaste.

Effect of erbium, chromium: yttrium, scandium, gallium, garnet laser and casein phosphopeptide-amorphous calcium phosphate on surface micro-hardness of primary tooth enamel

Objective:

The aim was to evaluate the effect of Er, Cr: YSGG laser and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on surface micro-hardness of primary tooth enamel.

Materials and Methods:

A total of 30 freshly extracted caries free primary anterior teeth were cleaned and stored in 1% thymol. Teeth were embedded in acrylic resin such that only their buccal surfaces were exposed and were divided into four groups. Group I: Five intact teeth (negative control). The remaining 25 teeth were immersed for 30 min in 1% citric acid for demineralization. Group II: Five demineralized teeth (positive control), Group III: CPP-ACP (GC tooth mousse-GC International, Itabashi-Ku, Tokyo, Japan) application and Group IV: Etching using Er, Cr: YSGG laser + CPP-ACP application. Groups III and IV were subjected to pH cycling for 5 days. Surface micro-hardness of all the teeth was measured using Brinell hardness tester (Fuel Instruments and Engineers Pvt. Ltd.). Data were analyzed using ANOVA.

Results:

Mean surface micro-hardness of Groups I and II were 177.43 kgf/mm² and 164.86 kgf/mm², respectively. Group IV showed a higher mean surface micro-hardness (230.68 kgf/mm²) compared with that of Group III (190.28 kgf/mm²). In comparison to all other groups, laser etching prior to CPP-ACP application increased surface micro-hardness significantly (P < 0.001).

Conclusion:

Laser irradiation of primary teeth followed by CPP-ACP application increased surface micro-hardness of enamel.

In situ effect of a commercial CPP-ACP chewing gum on the human enamel initial erosion

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.