Analysis of the effect of CPP-ACP tooth mousse on enamel remineralization by circularly polarized images

Effects of Two Remineralizing Agents in Combination with Er:YAG and CO2 Laser Irradiation on Microhardness of Demineralized Enamel: A Preliminary In Vitro Study

Objectives: This study assessed the effects of two remineralizing agents namely MI Paste Plus containing casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACFP) and Remin Pro containing hydroxyapatite, fluoride and xylitol (HFX) with/without erbium-doped yttrium aluminium garnet (Er:YAG) and CO2 laser irradiation on demineralized enamel microhardness. Materials and Methods: In this in vitro study, 70 sound human premolars were mesiodistally sectioned, demineralized at a pH of 4.6 for 8 hours, and randomly divided into 7 remineralization groups (n=10): of (I) MI Paste Plus (CPP-ACFP), (II) Remin Pro (HFX), (III) MI Paste Plus+CO2 laser (0.7 W power, 50 Hz), (IV) Remin Pro+CO2 laser, (V) MI Paste Plus+Er:YAG laser (1 W power, 10 Hz), (VI) Remin Pro+Er:YAG laser, and (VII) negative control. The Vickers hardness number of specimens was then measured. The groups were compared by one-way ANOVA and Tukey's test (α=0.05). Results: The mean microhardness was 319.8±49.9, 325.3±44.6, 359.4±35.7, 296.4±33.7, 319.9±58.1, 358.9±28.4, and 240.0±41.6 kg/mm2 in groups 1 to 7, respectively. The difference in microhardness was significant among the groups (P<0.0001). Pairwise comparisons revealed significant differences in microhardness between all groups (P≤0.03) except between groups 1 and 2, 1 and 5, 2 and 5, and 3 and 6 (P>0.05). Conclusion: Both Remin Pro (containing HFX) and MI Paste Plus (containing CPP-ACFP) can cause enamel remineralization. MI Paste Plus+CO2 laser irradiation and Remin Pro+Er:YAG laser irradiation were significantly more effective than the application of each remineralizing agent alone.

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.

Effect of sodium fluoride plus tricalcium phosphate with and without CO2 laser on remineralization of white spot lesions

Objectives

The aim of this in vitro study was to evaluate the effect of NaF plus TCP with and without CO₂ laser irradiation on management of demineralized enamel using microhardness test and digital microscopy.

Methods

Eighty intact extracted human premolar teeth were randomly divided into 4 groups (20/each). Each group was subjected to a demineralizing solution to create white spot lesion. Group 1 was treated with 3M Vanish™. Group 2 was irradiated with CO₂ laser. Group 3 was subjected to CO₂ laser followed by 3M Vanish™. Group 4 was treated by 3M Vanish™ then CO₂ laser. The teeth were immersed in artificial saliva. Surface microhardness was measured for each tooth before demineralization at base line (M1 as a control), after demineralization (M2) and after management (M3). Comparison of microhardness values between groups was performed using one way ANOVA test with significant level (0.05) followed by multiple comparisons post-hoc Tukey test between groups. Enamel surface was photographed by digital microscope.

Results

All intervention methods used in the current study significantly increased microhardness values of demineralized enamel (P < 0.001). Little improvement of enamel appearance was observed in all groups meanwhile using CO₂ laser on demineralized enamel directly led to signs of white and black dots affecting the appearance of enamel surface.

Significance

The most effective intervention regarding microhardness was group 2 followed by group 3, group 4 and group 1. Coating the enamel surface with 3M Vanish™ before CO₂ laser irradiation acted as a protective layer from the undesirable effects of laser on the teeth with increasing enamel microhardness values more than using Vanish alone. So the promising intervention method regarding both microhardness and appearance was group 4.

Effect of CPP-ACPF, resin infiltration, and colloidal silica infiltration on surface microhardness of artificial white spot lesions in primary teeth: An in vitro study

Background

Remineralizing agents such as fluoride and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) are popular treatment choices for incipient enamel lesions. Recently introduced resin infiltration enhances the esthetics of teeth affected by these enamel lesions. Furthermore, few studies reported the utilization of colloidal silica infiltration for the white spot lesions. However, the potency of these materials for treatment in primary teeth necessitates investigation.Thus, this study evaluated and compared the effectiveness of CPP-ACP fluoride (CPP-ACPF), resin infiltration, and colloidal silica infiltration on surface microhardness in artificial white spot lesions in primary incisors using the Vickers microhardness testing machine.

Materials and Methods

In this in vitro study, on the labial surface of 45 primary incisors, artificial white spot lesions were created by immersing them in a demineralizing solution. According to the evaluation method, random distribution of specimens into three groups: Group 1: CPP-ACPF, Group 2: resin infiltration, and Group 3: colloidal silica infiltration. Specimens after treatment were stored in artificial saliva, followed by microhardness evaluation using Vickers microhardness. Microhardness readings at baseline, post demineralization, and after treating them with different materials were taken. The level of significance was 0.01.

Results

Enamel specimens treated with resin infiltration showed a high microhardness mean value compared to CPP-ACPF and colloidal silica infiltration.

Conclusion

Resin infiltration is a promising and effective treatment option for incipient enamel lesions followed by CPP-ACPF compared to colloidal silica infiltration in primary teeth.

Effect of Diode Laser and Remineralizing Agents on Microstructure and Surface Microhardness of Therapeutic Gamma-Irradiated Primary Teeth Enamel

BACKGROUND: Radiation caries is a serious complication to head and neck cancer (HNC) radiotherapy, for which the primary teeth are more susceptible to be affected. Preventive protocols are recommended to enhance dental structure resistance against the direct effects of radiotherapy. AIM: The aim of the study is to evaluate the effect of diode laser and two types of remineralizing agents on the microhardness of the primary teeth enamel and examine microstructural alterations. METHODS: Twenty primary molars were sectioned into two halves in a mesiodistal direction, to obtain 40 specimens, which were then randomly allocated into five groups. Group 1 (Control Negative) n = 5 was not subjected to any treatment or radiation. Group 2 (Control positive) n = 5 was gamma irradiated with a dose of 60 Gray. For Groups 3, 4, and 5, specimens were divided into two subgroups: A and B (n = 5/subgroup). Subgroups A were gamma irradiated, then exposed to different surface treatments: 3A:10% nano-hydroxyapatite (nHA) paste, 4A: 5% sodium fluoride varnish (FV), and 5A: diode laser 980 nm. Subgroups B were exposed to surface treatments (3B: 10% nHA, 4 B: 5% FV, and 5B: diode laser 980 nm), then gamma irradiated. Surface micromorphology and microhardness were examined using environmental scanning electron microscope (ESEM), and Vickers microhardness tester, respectively. RESULTS: Group 2 (G) specimens possessed the lowest mean microhardness, while nHA-G (3B), G-Fl (4A), and L-G (5B) had significantly higher values. ESEM analysis showed an alteration in Group G and the obliteration of enamel micropores with remineralizing agents. The melting and fusion of enamel in laser subgroups were also observed. CONCLUSIONS: The findings indicated that using FV, nHA, or diode laser increased microhardness and maintained the integrity of the enamel microstructure. Therefore, applying preventive strategies should be considered in HNC radiotherapy.

Bionic effects of nano hydroxyapatite dentifrice on demineralised surface of enamel post orthodontic debonding: in-vivo split mouth study

BACKGROUND

Orthodontic debonding procedure produces inevitable enamel surface alterations, sequelae to which are enamel demineralization, sensitivity and retention of pigments. Several agents have been employed to counterbalance the same. The purpose of this study was (1) To evaluate the hypothesis that no significant difference exists in the remineralising potential of nano hydroxyapatite (NanoHAP) dentifrice and fluoridated dentifrice after orthodontic debonding, (2) To estimate the enamel topographic parameters following use of nano HAP dentifrice, post orthodontic debonding.

METHODS

Sixty upper first bi-cuspids (30 subjects) planned for therapeutic extraction for the orthodontic treatment were bonded with a light cured adhesive. Envelope method of randomisation was followed in this prospective in-vivo study. In each subject, one of the first premolar brackets was debonded using a debonding plier and polished following standard protocols. Envelope method of randomisation was used to determine the side of the premolar to be debonded first. Patient was advised to use fluoridated (Group I) dentifrice for the first 15 days, then the first premolar was covered with a heavy-bodied putty cap, extracted and subjected to atomic force microscopy (AFM). Contralateral first premolar was then debonded and polished using similar protocol, and patient was advised to use nano hydroxyapatite dentifrice (Group II) for next 15 days. The premolar was then extracted and analyzed for surface roughness using AFM. The remineralizing potential of dentifrices was assessed by evaluating surface roughness parameters of the two groups and were compared using a two-sample t test.

RESULTS

A significant difference was found amongst Group I (Fluoridated dentifrice) and Group II (NanoHAP dentifrice) (p > 0.001***) for enamel surface roughness variables which reflect remineralising potential of dentifrices. Group II showed significantly lesser value of surface roughness characteristics.

CONCLUSIONS

NanoHAP dentifrice was shown, after 15 days, to be superior to fluoridated dentifrice in remineralising enamel post orthodontic debonding.

Effect of Bioactive Glass-Containing Light-Curing Varnish on Enamel Remineralization

This study aimed to evaluate the effect of novel experimental light-curing bioactive glass (BAG)-containing varnish on enamel remineralization. An experimental light-curing, BAG-containing varnish and two commercial varnishes (Nupro White Varnish; Dentsply International, York, PA, USA and Tooth Mousse; GC Corporation, Tokyo, Japan) were used. Microhardness tests (n = 3), field emission scanning electron microscopy (FE-SEM) coupled with energy dispersive X-ray spectroscopy (EDS) (n = 5), and X-ray diffraction (XRD) analysis (n = 5) were performed to compare the remineralization effect of three varnishes with and without ultrasonication. The data of microhardness test were analyzed using one-way ANOVA and Tukey's post hoc comparison (P < 0.05). Microhardness of demineralized enamel increased after the application of three varnishes (P < 0.05). The experimental BAG-containing varnish showed the highest microhardness among the three varnishes (P < 0.05). Ultrasonication decreased microhardness of Tooth Mousse and BAG-containing varnish groups (P < 0.05). FE-SEM and XRD revealed precipitates of hydroxyapatite (HAP) or fluorapatite (FAP) crystals of three varnishes. The novel experimental BAG-containing varnish may be a promising clinical strategy for the remineralization of early carious lesions or demineralized enamel surfaces.

Breaking the vicious circle of diet, malnutrition and oral health for the independent elderly

Aging impairs senses, mastication, oral status and function, causing nutritional needs and diet insufficiencies. The present needs of independent older adults suggest that health research and oral health care should shift from reductionist disease management to integral and personal treatment plans, including lifestyle, psychological, nutritional and oral health coaching approaches. Dentists and other medical professionals that work in the field of gerodontology should be educated on the macro and micronutrient needs of the elderly and incorporate certain nutritional plans early in the life of their patients with their approval and cooperation, in order to postpone tooth loss and masticatory impairment. Old recipes such as the Mediterranean diet should be kept as a base for all the elderly and be enriched in a customized interpersonal way from the dentist as well as the medical professional according to the specific needs of one's oral and general health status. In this nonsystematic review paper, the basic aspects of the vicious cycle of nutrition and oral health status are discussed and suggestions of major nutrients' influence and needs for independent elders are reported. Based on the scientific data collected, suggestions are made for the food industry for better quality and dosage of foods for this category of individuals. Such strategies can be a whole new area of interest for the food industry in order to obtain better quality of food packaging for the independent OA with accepted texture, odor, colors, macronutrients and micronutrients' consistency and in specific portions.

The Efficacy of Resin Infiltrant and Casein Phosphopeptide-amorphous Calcium Fluoride Phosphate in Treatment of White Spot Lesions (Comparative Study)

Background:

White spot lesions (WSLs) are considered as the first sign of the progression of dental caries that can be reversed. Casein phosphopeptide–amorphous calcium fluoride phosphate (CPP-ACFP) varnish can promote remineralization process of the demineralized tooth structure. Also, WSLs can be managed by using caries infiltrant (ICON), which infiltrates etched enamel surface of the WSLs.

Objectives:

The main aim was to evaluate and compare the efficacy of ICON versus CPP-ACFP varnish to treat WSLs in the same oral environments.

Materials and Methods:

A total of 30 participants aged 20–40 years with at least two WSLs have participated in this trial. Split-mouth technique has been used in this trial where WSLs on the left side have been treated with ICON, whereas WSLs on the right side have been treated with CPP-ACFP varnish. Clinical evaluation using DIAGNOdent was carried out at baseline, 1 week, 1, 3, 6, and 12 months after application to determine the effectiveness of these materials in treating WSLs.

Results:

Significant differences were observed between all follow-up DIAGNOdent scores compared to baseline readings of both ICON and CPP-ACFP (P = 0.000 for all comparisons). Statistically significant differences were observed between DIAGNOdent scores of ICON compared to CPP-ACFP at all follow-up intervals (P = 0.006, 0.008, 0.045, 0.036, and 0.000).

Conclusion:

Both ICON and CPP-ACFP were effective in the treatment of WSLs of smooth surfaces but the efficacy of CPP-ACFP was better than ICON.

Oral manifestations of magnesium and vitamin D inadequacy

Adequate nutrition is essential for maintaining good oral health. Minerals such as magnesium, calcium, and phosphorus found in the diet constitute the main structural components of the tooth. Their inadequacy leads to absorption impairment, increased bleeding tendency, bone resorption, looseness, and premature tooth loss. Inadequacy of those essential minerals is associated with delayed tooth eruption and with enamel or dentin hypoplasia. Taking calcium without magnesium results in soft dental enamel, which cannot resist the acids causing tooth decay. In addition to magnesium, calcium, and phosphorus, adequate vitamin D is needed to maintain optimal oral health. Vitamin D exerts anti-inflammatory effects and helps in calcium absorption and bone remodeling. Moreover, adequate vitamin D status could reduce formation of dental caries by delaying its onset and progression. Here we summarize the oral manifestations of vitamin D and magnesium inadequacy.

Comparative evaluation of remineralization potential of nanohydroxyapatite crystals, bioactive glass, casein phosphopeptide-amorphous calcium phosphate, and fluoride on initial enamel lesion (scanning electron microscope analysis) - An in vitro study

Aim:

The aim of this in vitro study was to evaluate and compare the remineralization potential of four different remineralizing agents, i.e., nanohydroxyapatite crystals, bioactive glass, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and fluoride on initial enamel lesion.

Materials and Methods:

Sixty human maxillary central incisors were used in the present study. Samples were randomly divided into four groups (n = 15). Group 1: nanohydroxyapatite-containing dentifrice (Acclaim); Group 2: bioactive glass containing-dentifrice (SHY-NM); Group 3: CPP-ACP-containing dentifrice; and Group 4: fluoride-containing dentifrice. Baseline microhardness was checked, followed by immersion of teeth samples in demineralizing and remineralizing solution. This was followed by a pH cycle of 10 days. Data were analyzed using ANOVA and Bonferroni method. After this, scanning electron microscopic analysis was done to evaluate remineralization.

Results:

Statistical analysis of data was conducted using ANOVA, and multiple comparisons within groups were done using the Bonferroni method (post hoc tests). The decision criterion was to reject the null hypothesis if P < 0.05. If there was a significant difference between the groups, multiple comparisons (post hoc test) using the Bonferroni test were carried out.

Conclusion:

There is a significant difference in mean microhardness between the groups after remineralization. The mean value was found to be highest for nanohydroxyapatite, bioactive glass, CPP-ACP, and fluoride in descending order.

Effect of Two Methods of Remineralization and Resin Infiltration on Surface Hardness of Artificially Induced Enamel Lesions

Statement of the Problem:

The progression of incipient carious lesions may be simply prevented by non-invasive remineralization of lesions, eliminating the need for invasive and high-cost restorative procedures.

Purpose:

This study aimed to assess the effect of two commonly used remineralizing agents and resin infiltration on surface micro hardness of incipient enamel lesions at different time points.

Materials and Method:

In this in vitro study, 45 intact human maxillary central incisors were selected. After disinfection, enamel samples measuring 5x5x2.5 mm were cut out of the labial surface of the teeth. The surface of samples was polished and they were mounted in auto-polymerizing acrylic resin. According to Amaechi’s method, samples were immersed in acidified hydroxyethylcellulose system (pH= 4.5) for 96 hours to induce white spot lesions (WSLs). The baseline value of surface micro hardness of samples was measured using a Vickers hardness tester, then the samples were randomly divided into three groups (n=15) based on different remineralization methods: MI-Paste Plus, Remin Pro and ICON-Infiltrant according to the manufacturer’s instructions. All samples were stored in anti-dry mouth treatment agent during the experiment and their surface hardness was measured at 15 days (T1) and 20 weeks (T2).

Results:

The hardness of samples in MI-Paste Plus and Remin Pro groups significantly increased at both T1 and T2 (p< 0.001) but this increase was not significant in ICON group (p> 0.05).

Conclusion:

MI-Paste Plus and Remin Pro can efficiently increase the hardness of incipient enamel lesions.

Efficacy of erbium-doped yttrium aluminum garnet laser with casein phosphopeptide amorphous calcium phosphate with and without fluoride for remineralization of white spot lesions around orthodontic brackets

Objective

This study aimed to assess the efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser, pastes containing casein phosphopeptide amorphous calcium phosphate (CPP-ACP) with and without fluoride and their combination for prevention of white spot lesions in the enamel.

Materials and Methods

This in vitro experimental study was conducted on 90 extracted sound premolars. The teeth were then randomly divided into six groups of 15: (1) Control, (2) laser, (3) CPP-ACP with fluoride (GC MI Paste, Recaldent™ 900 ppm as NaF), (4) CPP-ACP without fluoride (GC Tooth Mousse Recaldent™), (5) laser + CPP-ACP with fluoride, and (6) laser + CPP-ACP without fluoride. In each group, enamel surface was exposed to the remineralizing agent. The teeth were then subjected to pH cycling for 14 days. The teeth were then sectioned, polished, and underwent cross-sectional microhardness testing at 20-160 μ depth quantitatively. Using the Simpson's rule, the amount of mineral loss was calculated in each group. Statistical Analysis Used: ANOVA was used for the comparisons, and Tukey's test was applied for pairwise comparisons.

Results

The highest mean volume percentage of microhardness at 20-60 μ depth belonged to the group laser + CPP-ACP with fluoride and the lowest belonged to the control group (P = 0.001). The differences were not significant at 80-120 μ depth (P > 0.05). These finding are confirmed according to △Z (mineral loss).

Conclusion

Based on these results, Er: YAG laser was able to decrease demineralization and was a potential alternative to preventive dentistry and was more effective when combined with CPP-ACP products.

Increasing the efficiency of CPP-ACP to remineralize enamel white spot lesions

OBJECTIVES

To compare the remineralization efficacy of using the MI paste plus according to manufacturer's instructions to MI varnish and to using a modified method of MI-paste plus application.

MATERIALS AND METHODS

100 enamel specimens were obtained from the buccal and lingual surfaces of 50 extracted human non-caries third molars. All specimens were challenged by a buffered demineralization solution for 4 days, and were divided in 4 groups with 25 specimens in each group. 25 demineralized specimens had MI paste plus applied for 4 min and then wiped out (MI), 25 specimens had MI paste applied followed by application of SE-bonding agent (MI + Bond), 25 specimens had MI Varnish applied according to manufacturer instructions (MI Varnish) the rest of specimens served as controls (C). All specimens were stored for 7 days in artificial saliva. All specimens had their surface hardness (SH) measured by micro-hardness tester before/after the acidic challenge and after the treatment procedures. After the SH test all specimens were crosssectioned to obtain 100-150 micron thickness specimens to observe the lesion depth before/after treatment by the TMR (Transverse Micro Radiography) technique.

RESULTS

TMR experiment showed that (MI + Bond) and (MI varnish) groups recorded significant decrease in lesion depth and mineral loss of the tested subsurface lesion p < 0.05. (MI + Bond) group scored the highest significant regain of surface micro hardness results p < 0.05.

CONCLUSION

(MI varnish) and the modified application of MI paste are methods that can increase the efficacy of CPP-ACP in remineralizing the enamel surface lesions.

Effectiveness of MI Paste Plus and Remin Pro on remineralization and color improvement of postorthodontic white spot lesions

BACKGROUND

This clinical trial investigated the effectiveness of two remineralizing creams on regression of white spot lesions (WSLs) after orthodontic therapy.

MATERIALS AND METHODS

The study included patients with WSLs on their upper anterior teeth who recently completed orthodontic treatment at the Department of Orthodontics of Mashhad Dental School and two private offices. The participants were randomly assigned into three groups by treatment: (1) a 12-week regimen of a cream containing casein phosphopeptide-amorphous calcium phosphate and fluoride (MI Paste Plus); (2) a 12-week regimen of a cream containing hydroxyapatite and fluoride (Remin Pro); and (3) usual home care (control). Thirty-nine patients participated and three withdrew. The main outcomes including area, mineral content, and color of WSLs were measured at enrolment and 4, 8, and 12 weeks later, respectively. Blinding was applied for outcome assessment only. The data were analyzed by analysis of variance and repeated measures analysis at the statistical significance of P < 0.05.

RESULTS

Over a 3-month period, the application of both MI Paste Plus and Remin Pro caused significantly greater reduction in area and significantly higher increase in mineral content of WSLs compared to the control group (P < 0.05). The appearance of WSLs improved significantly in both experimental groups (P < 0.05), but not in the control group. No side effect was observed throughout the experiment.

CONCLUSION

The application of either MI Paste Plus or Remin Pro was effective in reducing the area, increasing the mineral content and improving the appearance of demineralized enamel, indicating that these products could be recommended for managing postorthodontic WSLs.

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.

Evaluation of the remineralization capacity of CPP-ACP containing fluoride varnish by different quantitative methods

Objective

The aim of this study was to evaluate the efficacy of CPP-ACP containing fluoride varnish for remineralizing white spot lesions (WSLs) with four different quantitative methods.

Material and Methods

Four windows (3x3 mm) were created on the enamel surfaces of bovine incisor teeth. A control window was covered with nail varnish, and WSLs were created on the other windows (after demineralization, first week and fourth week) in acidified gel system. The test material (MI Varnish) was applied on the demineralized areas, and the treated enamel samples were stored in artificial saliva. At the fourth week, the enamel surfaces were tested by surface microhardness (SMH), quantitative light-induced fluorescence-digital (QLF-D), energy-dispersive spectroscopy (EDS) and laser fluorescence (LF pen). The data were statistically analyzed (α=0.05).

Results

While the LF pen measurements showed significant differences at baseline, after demineralization, and after the one-week remineralization period (p<0.05), the difference between the 1- and 4-week was not significant (p>0.05). With regards to the SMH and QLF-D analyses, statistically significant differences were found among all the phases (p<0.05). After the 1- and 4-week treatment periods, the calcium (Ca) and phosphate (P) concentrations and Ca/P ratio were higher compared to those of the demineralization surfaces (p<0.05).

Conclusion

CPP-ACP containing fluoride varnish provides remineralization of WSLs after a single application and seems suitable for clinical use.

THE ROLE OF COMPLEX OF PROPHYLACTIC ARRANGEMENTS WITH THE USE OF REMINERALIZING PREPARATION AS TO ENAMEL RESISTANCE IN CHILDREN WITH DISORDERS OF TEETH FORMATION

Aim of research: To increase the resistance of teeth enamel in children with disorders of their formation by introduction of the complex of prophylactic arrangements using remineralizing preparation. Materials and methods. The object of research is the zones of injured enamel (on the background of hypoplasia) of permanent teeth. The subject is the level of general calcium and orthophosphates in acid biopsy materials of injured teeth enamel. Methods of research: the vital coloration of enamel, transillumination, acid biopsy of enamel, photometric, statistic. There was carried out the determination of level of calcium and orthophosphates in acid biopsy materials of injured enamel in 45 children, 6–12 years old with enamel hypoplasia. The group № 1 (21 persons) – children who underwent the complex of prophylactic arrangements that included recommendations as to the choice of means and subjects for oral cavity care and teaching the standard method of teeth brushing. The group № 2 (24 persons) – children, who additionally used remineralyzing cream on the water base with casein phosphopeptide – amorphous calcium phosphate (СРР-АСР) (Certificate on the state registration №10014/2010 of 03.12.2010). Results. In children with chronologic enamel hypoplasia was established the low level of calcium and orthophosphates in acid biopsy materials of injured enamel. Calcium/phosphorus (Са/Р) coefficient in examined groups № 1 and № 2 was 1,26±1,14 and 1,19±0,56, respectively. The high effectiveness of the offered complex of prophylactic arrangements (teaching the hygienic habits – group №1, additional use of remineralizing cream – group № 2) is proved by the growth of macroelements content in acid biopsy materials of injured enamel in examined children. The holding of prophylactic arrangements in children of the group № 2 using remineralizing cream, favored the more essential growth of level of calcium and orthophosphates in biopsy materials comparing with group of children № 1 (р=0,002 and р=0,03, respectively), and also reliably increased Са/Р coefficient (р=0,0005). Conclusions. Introduction of complex of prophylactic arrangements using remineralizing preparation in children with disorders of teeth formation favored the rise of enamel resistance as a result of growth of the level of calcium and orthophosphates in its mineral component.

OPTIMIZATION OF PROPHYLACTIC ARRANGEMENTS IN CHILDREN WITH HYPOPLASIA OF DENTAL ENAMEL

Aim of research. To raise the effectiveness of anticarious properties of oral cavity in children with enamel hypoplasia by introduction of the complex of arrangements, directed on optimization of the oral cavity hygiene, level of secretory immunoglobulin А (sIgA) and the content of mineral components of oral liquid (calcium and orthophosphates). Materials and methods. Object of research – enamel hypoplasia of the permanent teeth. Subject of research – hygienic status of the oral cavity, level of general calcium, orthophosphates, sIgA in the oral liquid. Methods of research: vital coloration of enamel, transillumination, photometric, immune-enzyme method, indices of hygienic status of the oral cavity (Green–Vermillion (1964) index, Silness–Loe (1964, 1967) index). There was carried out an assessment of hygienic status of the oral cavity, determination of the level of calcium, orthophosphates and sIgA in the oral liquid of 45 children, 6–14 years old (group № 1 – 21 persons, group № 2 – 24 persons). Group №1 – children, who underwent the complex of prophylactic arrangements that included recommendations as to the choice of means and subjects for the oral cavity care and teaching the standard method of teeth brushing. Group № 2 – children, who additionally used remineralizing cream on the water base with casein phosphopeptide – amorphous calcium phosphate (СРР-АСР) (Certificate on the state registration №10014/2010 of 03.12.2010). Results. Hygienic status of the oral cavity of children from the both groups was assessed as “unsatisfactory” one according to Green–Vermillion index and as “bad” one according to Silness–Loe index. After prophylactic arrangements the oral cavity status was improved in children of the group № 1: Green–Vermillion (p=0,0013) and Silness–Loe (p=0,0002) indices essentially decreased. In children of the group №2 after prophylactic arrangements hygienic status of the oral cavity was improved more essentially: Green–Vermillion (p=0,0002) and Silness–Loe (p=0,0002) indices reliably decreased. Prescription of remineralizing cream to the children of group № 2 reliably raised the content of calcium (р=0,0051) and sIgA in the oral liquid (р=0,001). Orthophosphates level did not essentially change in both groups. Conclusions. Introduction of the complex of prophylactic arrangements with additional use of remineralizing preparation favored the more essential improvement of the oral cavity hygiene, raise of calcium and sIgA in the oral liquid.

Casein phosphopeptide-amorphous calcium phosphate products in caries prevention

Data sourcesMedline, Embase, PreMedline and Cochrane Central Register of Controlled Trials.Study selectionClinical trials, investigating only clinical caries outcomes on participants of any age comparing the use of Tooth Mousse(®) or Tooth Mousse Plus(®) to a routine oral care regimen for the prevention of dental caries with or without comparison to additional preventive products. Studies that used other formulations of CCP-ACP were excluded. Trials using split-mouth design were also excluded. Only English language papers were considered.Data extraction and synthesisPapers were assessed independently by both authors using the Cochrane Collaboration tool for assessing risk of bias in randomised trials.1 Meta-analysis was not possible due to study heterogeneity.ResultsTwelve studies were available for the final review; three studies on caries prevention were assessed as having low risk of bias. The remaining nine studies, with high risk of bias, reported on treatment or regression of early carious lesions. Two RCTs reported no significant benefits in the use of Tooth Mousse(®) over brushing with a fluoride toothpaste, a third study demonstrated a statistically significant increase in enamel microhardness for the Tooth Mousse(®) group compared to control group but no difference to the group who had fluoride gel treatment. Overall the authors concluded that Tooth Mousse(®) performs no better than fluoride in the prevention of carious lesions.Seven of nine studies evaluated caries lesion severity in orthodontic patients, with four demonstrating statistically significant white spot regression. Two trials in non-orthodontic patients showed statistically significant remineralising potential of Tooth Mousse(®) over fluoride mouthrinse or the regular use of fluoride toothpaste in 14-30 days.ConclusionsThe authors found no evidence to support the use of Tooth Mousse(®) over brushing with a fluoride toothpaste for the prevention of early caries. ToothMousse(®) appeared to benefit regression of white spot lesions associated with orthodontic treatment but the evidence is limited. Effectiveness of Tooth Mousse(®) was not significantly increased by the addition of fluoride in Tooth Mousse Plus(®) and evidence is still lacking to support the use of one over another. High quality randomised clinical trials are needed before these products can be recommended for the prevention and treatment of early carious lesions in the general population.Source of fundingThe publication was funded by Colgate Palmolive, Australia.

Combined effects of Er: YAG laser and casein phosphopeptide-amorphous calcium phosphate on the inhibition of enamel demineralization: An in vitro study

BACKGROUND

Development of white spot lesions on enamel is a significant and common problem during the fixed orthodontic treatment. Various preventive methods have been suggested. The purpose of this study was to evaluate the preventive potential of MI Paste Plus, Er: YAG Laser and combined under similar in vitro conditions against demineralization.

MATERIALS AND METHODS

In this experimental in vitro study, 60 extracted premolars were randomly allocated to four groups (n = 15) of control, MI Paste Plus, Laser and MI + Laser (MIL). Enamel surface of each group was treated with one of above materials before and during the pH cycling for 12 days through a daily procedure of demineralization and remineralization for 3 h and 20 h, respectively. Teeth were sectioned and evaluated quantitatively by cross-sectional microhardness testing at 20 μm intervals from the outer enamel surface toward dentinoenamel junction up to 160 μm and data were analyzed using the one-way analysis of variance and Tukey test. P < 0.05 was considered as significant.

RESULTS

MIL group had the least amount of demineralization (P < 0.001). Control group (C group) had the greatest relative mineral loss and the laser group (L group) had 45% less mineral loss than the C group and there was no significant difference between the MI Paste Plus and L group (P = 0.154).

CONCLUSION

BASED ON THESE RESULTS, ER: YAG laser was able to decrease demineralization and was a potential alternative to preventive dentistry and was more effective when combined with casein phosphopeptide-amorphous calcium phosphate products.

Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: a randomized controlled trial

INTRODUCTION

White spot lesions are a common sequela of orthodontic therapy. In this parallel-group randomized trial, we assessed the effectiveness of 2 agents commonly used to ameliorate white spot lesions compared with a normal home-care regimen.

METHODS

Patients aged 12 to 20 years were recruited from the offices of orthodontists and dentists who belonged to the Practice-based Research Collaborative in Evidence-based Dentistry network. The patients had their orthodontic appliances removed within the past 2 months and had at least 1 white spot lesion affecting their maxillary incisors. The subjects were randomized to 1 of 3 arms: (1) an 8-week regimen of MI Paste Plus (GC America, Alsip, Ill), (2) a single application of PreviDent fluoride varnish (Colgate Oral Pharmaceuticals, New York, NY), and (3) usual home care (control). Photographs were taken at enrollment and 8 weeks later. Two panels consisting of 5 dental professionals and 5 laypersons assessed the before-and-after pairs of photographs in a blinded fashion. Objective assessments and self-assessments were also performed.

RESULTS

One hundred fifteen subjects completed the study; 34 were assigned to the MI Paste Plus group, 40 to the fluoride varnish group, and 41 to the control group. The mean improvements assessed by the professional panel were 21%, 29%, and 27% in the MI Paste Plus, fluoride varnish, and control groups, respectively.The results from the lay panel were 29%, 31%, and 25%, respectively. Objective improvements in the surface affected were 16%, 25%, and 17%, respectively; self-assessments of improvement were 37% in all 3 groups. No assessments indicated significant differences between subjects in the active arms compared with the control arm.

CONCLUSIONS

MI Paste Plus and PreviDent fluoride varnish do not appear to be more effective than normal home care for improving the appearance of white spot lesions over an 8-week period.

Treatment of white spot lesions with ACP paste and microabrasion

OBJECTIVE

To examine the effects of application of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) paste and microabrasion treatment on the regression of white spot lesions (WSLs).

MATERIALS AND METHODS

Artificially-induced WSLs in bovine enamel were randomly assigned to one of four treatment groups: CPP-ACP paste only, microabrasion only, microabrasion and CPP-ACP, and a control. Samples were treated with each regimen twice daily for 2 weeks and stored in remineralizing solution between the treatments. Quantitative light-induced fluorescence was used to measure changes in fluorescence, which indicate changes in mineral content of WSLs immediately before (T1) and 2 weeks after treatment (T2). A two-within-subject factor analysis of variance was used to analyze the significance of any changes in mineral content of the lesions from T1 to T2.

RESULTS

There was a statistically significant (P < .05) gain in fluorescence associated with the microabrasion only, as well as the microabrasion and CPP-ACP treatments. The changes in fluorescence for the CPP-ACP treatment alone were not statistically significant (P  =  .40).

CONCLUSIONS

CPP-ACP paste alone does not significantly improve the fluorescence value (ie, the mineral content) of WSLs. Within the limitations of this in vitro study, microabrasion treatment with or without CPP-ACP improved the fluorescence and thus reduced WSLs.

Biofunctional properties of caseinophosphopeptides in the oral cavity

Caseinophosphopeptides (CPPs), bioactive peptides released from caseins, have the ability to enhance bivalent mineral solubility. This is relevant to numerous biological functions in the oral cavity (promotion of tooth enamel remineralisation, prevention of demineralisation and buffering of plaque pH). Therefore, CPPs may play a positive role as prophylactic agents for caries, enamel erosion and regression of white spot lesions. Most in vitro and in situ studies demonstrate strong evidence for the bioactivity of CPPs in the oral cavity. Nevertheless, relatively little is known concerning their use as adjuvants for oral health and more particularly regarding their long-term effects on oral health.